Department of Neurology, Faculty Hospital Ostrava, 17. Listopadu 1790, 708 52, Ostrava, Czech Republic.
Department of Neurology, Faculty Hospital Ostrava, 17. Listopadu 1790, 708 52, Ostrava, Czech Republic; Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava-jih, Czech Republic.
Sleep Med. 2017 Apr;32:137-142. doi: 10.1016/j.sleep.2016.11.024. Epub 2017 Jan 16.
Knowledge available about the relationship between obstructive sleep apnea (OSA) and cognitive impairment after stroke is limited. The evolution of OSA and cognitive performance after stroke is not sufficiently described.
We prospectively enrolled and examined acute stroke patients without previously diagnosed OSA. The following information was collected: (1) demographics, (2) sleep cardio-respiratory polygraphy (PG) at 72 h, day seven, month three, and month 12 after stroke, (3) post-stroke functional disability tests at entry and at months three and 12, and (4) cognition (attention and orientation, memory, verbal fluency, language, and visual-spatial abilities) using the revised Addenbrooke's Cognitive Examination (ACE-R) at months three and 12.
Of 68 patients completing the study, OSA was diagnosed in 42 (61.8%) patients. The mean apnea/hypopnea index (AHI) at study entry of 21.0 ± 13.7 spontaneously declined to 11.6 ± 11.2 at month 12 in the OSA group (p < 0.0005). The total ACE-R score was significantly reduced at months three (p = 0.005) and 12 (p = 0.004) in the OSA group. Poorer performance on the subtests of memory at months 3 (p = 0.039) and 12 (p = 0.040) and verbal fluency at months 3 (p < 0.005) and 12 (p < 0.005) were observed in the OSA group compared to non-OSA group. Visual-spatial abilities in both the OSA (p = 0.001) and non-OSA (p = 0.046) groups and the total ACE-R score in the OSA (p = 0.005) and non-OSA (p = 0.002) groups improved.
A high prevalence of OSA and cognitive decline were present in patients after an acute stroke. Spontaneous improvements in both OSA and cognitive impairment were observed.
关于阻塞性睡眠呼吸暂停（OSA）与卒中后认知障碍之间的关系，目前所知有限。卒中后 OSA 的演变及其对认知功能的影响尚未得到充分描述。
我们前瞻性地纳入了未经诊断为 OSA 的急性卒中患者，并对其进行了检查。收集以下信息：（1）人口统计学信息，（2）卒中后 72 小时、第 7 天、第 3 个月和第 12 个月的睡眠心肺多导图（PG），（3）入组时以及第 3 个月和第 12 个月的卒中后功能障碍测试，以及（4）使用改良后的 Addenbrooke 认知评估量表（ACE-R）在第 3 个月和第 12 个月评估认知（注意力和定向力、记忆力、言语流畅性、语言和视空间能力）。
68 例完成研究的患者中，42 例（61.8%）诊断为 OSA。OSA 组研究入组时的平均呼吸暂停/低通气指数（AHI）为 21.0±13.7，在第 12 个月时自发下降至 11.6±11.2（p<0.0005）。OSA 组在第 3 个月（p=0.005）和第 12 个月（p=0.004）时的 ACE-R 总分显著降低。在第 3 个月（p=0.039）和第 12 个月（p=0.040）时，OSA 组在记忆子测试中的表现更差，在第 3 个月（p<0.005）和第 12 个月（p<0.005）时言语流畅性更差。在 OSA 组和非 OSA 组中，视空间能力在第 3 个月（p=0.001）和第 12 个月（p=0.046），以及 ACE-R 总分在第 3 个月（p=0.005）和第 12 个月（p=0.002）时均有所改善。
急性卒中后患者中 OSA 和认知功能下降的发生率较高。观察到 OSA 和认知障碍均有自发改善。
