Xu Y N, Li J, Huang J Y, Zhu C, Mao C J, Shen Y, Liu C F
Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
Zhonghua Yi Xue Za Zhi. 2017 Mar 28;97(12):920-924. doi: 10.3760/cma.j.issn.0376-2491.2017.12.009.
To investigate the effect of obstructive sleep apnea (OSA) on sleep architecture in acute ischemic stroke (AIS) patients. Seventy AIS patients with polysomnography examination from June 2014 to April 2016 were included in the Second Affiliated Hospital of Soochow University. Twenty-seven healthy controls during the same period were chosen as control group. According to apnea-hypopnea index (AHI), AIS patients were divided into AIS group (AHI<5/h) and AIS+ OSA group (AHI≥5/h). Their general conditions, Neurological function defect (national institutes of health stroke scale, NIHSS) on admission and at discharge and self-care ability (modified Rankin Scale, mRS) at discharge and 3 months later (mRS score <2 reflected good prognosis, and mRS score≥2 reflected unfavorable prognosis) were collected. Fifty-two patients (74.3%) had OSA in total seventy AIS patients. Total sleep time (TST) was significantly shorter and sleep efficiency (SE) was lower in AIS group than the control group (=0.007, 0.008, respectively). AIS+ OSA group had longer non-rapid eye movement (NREM)1 than control group [24.9(21.3) vs 14.3(10.6), =0.044]. Compared with AIS group, AIS+ OSA group had shorter NREM3 [13.0(13.2) vs 19.6(12.8), =0.039]. There was no significant difference between the infarct location of AIS group and AIS+ OSA group. However, AIS+ OSA group had higher mRS score observed at 3 months through follow-up visit than AIS group (=0.027). Spearman correlation analysis showed a positive correlation between unfavorable prognosis of stroke at 3 months and atrial fibrillation, the oxygen desaturation index (ODI), percentage of oxygen saturation <90% of total recording time (TS90%), AHI, the longest time of apnea and hypopnea, respiratory related microarousal and NIHSS, while a negative correlation between unfavorable prognosis of stroke and NREM3, lowest nocturnal oxygen saturation (L-SaO(2)). On Logistic analysis, the unfavorable prognosis was independently predicted by AHI and NIHSS. Sleep architecture of cerebral infarction patients are disturbed with its characteristic of shorter total sleep time and lower sleep efficiency. Cerebral infarction patients with OSA have longer NREM1 and shorter NREM3.
探讨阻塞性睡眠呼吸暂停（OSA）对急性缺血性卒中（AIS）患者睡眠结构的影响。选取2014年6月至2016年4月在苏州大学附属第二医院接受多导睡眠图检查的70例AIS患者。选取同期27例健康对照者作为对照组。根据呼吸暂停低通气指数（AHI），将AIS患者分为AIS组（AHI<5次/小时）和AIS+OSA组（AHI≥5次/小时）。收集他们的一般情况、入院时和出院时的神经功能缺损（美国国立卫生研究院卒中量表，NIHSS）以及出院时和3个月后的自理能力（改良Rankin量表，mRS）（mRS评分<2表示预后良好，mRS评分≥2表示预后不良）。70例AIS患者中共有52例（74.3%）患有OSA。AIS组的总睡眠时间（TST）显著短于对照组，睡眠效率（SE）低于对照组（分别为P=0.007，0.008）。AIS+OSA组的非快速眼动（NREM）1期长于对照组[24.9（21.3）对14.3（10.6），P=0.044]。与AIS组相比，AIS+OSA组的NREM3期更短[13.0（13.2）对19.6（12.8），P=0.039]。AIS组和AIS+OSA组的梗死部位无显著差异。然而，通过随访观察，AIS+OSA组在3个月时的mRS评分高于AIS组（P=0.027）。Spearman相关性分析显示，卒中3个月时的不良预后与心房颤动、氧饱和度下降指数（ODI）、总记录时间中氧饱和度<90%的百分比（TS90%）、AHI、最长呼吸暂停和低通气时间、呼吸相关微觉醒以及NIHSS呈正相关，而与NREM3期、最低夜间氧饱和度（L-SaO₂）呈负相关。Logistic分析显示，AHI和NIHSS可独立预测不良预后。脑梗死患者的睡眠结构受到干扰，其特点是总睡眠时间较短和睡眠效率较低。患有OSA的脑梗死患者NREM1期较长，NREM3期较短。
