Kumar Rohit, Suri J C, Manocha Rajesh
Department of Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjang Hosptial, New Delhi, India.
Sleep Med. 2017 Jun;34:50-56. doi: 10.1016/j.sleep.2017.02.025. Epub 2017 Mar 18.
Sleep disordered breathing (SDB) is a prevalent yet underrecognized condition that may have major adverse consequences for those affected by it. We performed a prospective observational study to seek a correlation of severity of SDB with the severity of stroke and its functional outcome.
Patients with history of recent-onset stroke were recruited and underwent overnight polysomnography (PSG) after the acute phase of the stroke was over; for defining hypopneas, 3% and 4% desaturation limits were used, and the apnea-hypopnea index was respectively calculated as AHI and AHI. Stroke severity was graded using the Scandinavian Stroke Scale. Functional disability and neurological impairment was evaluated six weeks after the PSG using the Barthel Index (<80 = functional dependence; ≥80 = functional independence) and modified Rankins Scale (>2 = poor outcome; ≤2 = good outcome).
A total of 50 patients were enrolled, 30 (60%) with ischemic stroke and 20 (40%) with hemorrhagic strokes. Of the patients, 39 (78%) had an AHI of >5/h, 23 (46%) had an AHI of >15/h, and 9 (18%) had an AHI of >30/h. Multivariate analysis showed that body mass index (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.04-1.54, p = 0.019) and Scandinavian Stroke Scale score (stroke severity) (OR = 0.86; 95% CI = 0.76-0.96, p = 0.009) were significant risk factors for predicting SDB (AHI > 15) in patients of stroke. When we looked for factors predicting outcomes, only AHI (OR = 1.20; 95% CI 1.01-1.43, p value 0.041) was predictive of the functional dependence (based on Barthel Index) of the patient and AHI (OR = 1.14; 95% CI 1.03-1.25, p = 0.008) and body mass index (OR = 0.75; 95% CI 0.59-0.96, p = 0.024) were found to be predictive of poor outcome (based on modified Rankins Scale). We obtained similar results, regardless of the hypopnea definition used.
In conclusion, given the high frequency of SDB in stroke patients and its correlation with poor outcome, screening for obstructive sleep apnea in all stroke and transient ischemic attack patients may be warranted.
睡眠呼吸紊乱（SDB）是一种普遍存在但未得到充分认识的疾病，可能对患者产生重大不良后果。我们进行了一项前瞻性观察研究，以探寻SDB严重程度与中风严重程度及其功能预后之间的相关性。
招募近期发生中风的患者，在中风急性期结束后进行夜间多导睡眠图（PSG）检查；对于低通气的定义，采用3%和4%的血氧饱和度下降界限，并分别计算呼吸暂停低通气指数为AHI和AHI。使用斯堪的纳维亚中风量表对中风严重程度进行分级。在PSG检查六周后，使用巴氏指数（<80 = 功能依赖；≥80 = 功能独立）和改良Rankin量表（>2 = 预后不良；≤2 = 预后良好）评估功能残疾和神经功能缺损情况。
共纳入50例患者，其中30例（60%）为缺血性中风，20例（40%）为出血性中风。在这些患者中，39例（78%）的AHI>5/h，23例（46%）的AHI>15/h，9例（18%）的AHI>三十/h。多因素分析显示，体重指数（优势比[OR]=1.26；95%置信区间[CI]=1.04 - 1.54，p = 0.019）和斯堪得纳维亚中风量表评分（中风严重程度）（OR = 0.86；95% CI = 0.76 - 0.96，p = 0.009）是预测中风患者发生SDB（AHI>15）的重要危险因素。当我们寻找预测预后的因素时，只有AHI（OR = 1.20；95% CI 1.01 - 1.43，p值0.041）可预测患者的功能依赖（基于巴氏指数），而AHI（OR = 1.14；95% CI 1.03 - 1.25，p = 0.008）和体重指数（OR = 0.75；95% CI 0.59 - 0.96, p = 0.024）被发现可预测预后不良（基于改良Rankin量表）。无论采用何种低通气定义，我们都得到了相似的结果。
总之，鉴于中风患者中SDB的高发生率及其与不良预后的相关性，对所有中风和短暂性脑缺血发作患者进行阻塞性睡眠呼吸暂停筛查可能是必要的。
