CHU Bordeaux, Unité Neurovasculaire, Place Amélie Raba-Léon, 33000 Bordeaux, France; Université Bordeaux 2, Bordeaux, France.
Université Bordeaux 2, Bordeaux, France; Université Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, F-33000 Bordeaux, France; CNRS, SANPSY, USR 3413, F-33000 Bordeaux, France.
Sleep Med. 2017 Feb;30:251-254. doi: 10.1016/j.sleep.2015.07.031. Epub 2016 Mar 4.
Large prospective studies have established that sleep-disordered breathing (SDB) is associated with an increased incidence of cardiovascular and cerebrovascular diseases. Heterogeneous results have been published about SDB and ischaemic stroke mechanism. The aim of this study was to evaluate the relationship between poststroke apneic syndrome and stroke aetiologies according to the ASCO classification.
A total of 134 patients with acute ischaemic cerebrovascular events were prospectively included. Patients with severe or infratentorial infarctions were excluded. Stroke risk factors and clinical characteristics were recorded in all patients. An overnight polygraphy was recorded (Embletta PDS). Apneic patients were defined if the polygraphy reported an apnea-hypopnea index ≥15. A standardized diagnosis workup, including serum biological investigation, evaluation of extra and intracranial arteries and heart morphology and function, was performed. Stroke mechanism was defined using ASCO and TOAST classifications.
A proportion of 42% (56 of 134) of the patients were diagnosed as having sleep apneas. Apneic patients were older (p < 0.001), had higher BMI (p = 0.02), and more were hypertensive (p < 0.001). Using ASCO classification, a major cardioembolic source of stroke, mainly atrial fibrillation, was more frequently observed in apneic patients (41.1% vs. 20.5%, p < 0.05), while no difference was observed when considering atherosclerosis or small-vessel disease mechanisms. Univariate analysis showed that cardioembolic stroke depends on sex, age, left atrial size and OSA; however, age remained the only significant factor in multivariate analysis.
This study confirms the high prevalence of sleep apneas in stroke-affected patients and identifies atrial fibrillation as a major source of stroke in this population. The strong correlation between age and SDB seems to drive the increased frequency of stroke related to atrial fibrillation in this population.
大量前瞻性研究已经证实，睡眠呼吸障碍（SDB）与心血管和脑血管疾病的发病率增加有关。关于 SDB 和缺血性中风机制，已有研究结果存在差异。本研究旨在根据 ASCO 分类评估卒中后呼吸暂停综合征与卒中病因的关系。
共前瞻性纳入 134 例急性缺血性脑血管事件患者。排除严重或幕下梗死患者。所有患者均记录卒中危险因素和临床特征。所有患者均进行了一夜多导睡眠图（Embletta PDS）记录。如果多导睡眠图报告呼吸暂停低通气指数≥15，则定义为呼吸暂停患者。进行了标准化的诊断检查，包括血清生物学检查、评估颅内外动脉以及心脏形态和功能。使用 ASCO 和 TOAST 分类定义卒中机制。
42%（134 例中的 56 例）的患者被诊断为患有睡眠呼吸暂停。呼吸暂停患者年龄更大（p<0.001），BMI 更高（p=0.02），高血压更多（p<0.001）。使用 ASCO 分类，主要心源性卒中源，主要是心房颤动，在呼吸暂停患者中更常见（41.1%比 20.5%，p<0.05），而考虑动脉粥样硬化或小血管疾病机制时则没有差异。单因素分析显示，心源性卒中取决于性别、年龄、左心房大小和 OSA；然而，在多因素分析中，年龄仍然是唯一的显著因素。
本研究证实了卒中患者睡眠呼吸暂停的高患病率，并确定了心房颤动是该人群中卒中的主要来源。年龄与 SDB 之间的强相关性似乎导致了该人群中与心房颤动相关的卒中频率增加。
