急性首次缺血性卒中患者的吞咽困难与阻塞性睡眠呼吸暂停
Dysphagia and Obstructive Sleep Apnea in Acute, First-Ever, Ischemic Stroke.
作者信息
Losurdo Anna, Brunetti Valerio, Broccolini Aldobrando, Caliandro Pietro, Frisullo Giovanni, Morosetti Roberta, Pilato Fabio, Profice Paolo, Giannantoni Nadia Mariagrazia, Sacchetti Maria Luisa, Testani Elisa, Vollono Catello, Della Marca Giacomo
机构信息
Institute of Neurology, Catholic University, Rome, Italy.
Institute of Neurology, Catholic University, Rome, Italy.
出版信息
J Stroke Cerebrovasc Dis. 2018 Mar;27(3):539-546. doi: 10.1016/j.jstrokecerebrovasdis.2017.09.051. Epub 2017 Oct 23.
BACKGROUND
Obstructive sleep apnea (OSA) and dysphagia are common in acute stroke and are both associated with increased risk of complications and worse prognosis. The aims of the present study were (1) to evaluate the prevalence of OSA and dysphagia in patients with acute, first-ever, ischemic stroke; (2) to investigate their clinical correlates; and (3) to verify if these conditions are associated in acute ischemic stroke.
METHODS
We enrolled a cohort of 140 consecutive patients with acute-onset (<48 hours), first-ever ischemic stroke. Computed tomography (CT) and magnetic resonance imaging scans confirmed the diagnosis. Neurological deficit was measured using the National Institutes of Health Stroke Scale (NIHSS) by examiners trained and certified in the use of this scale. Patients underwent a clinical evaluation of dysphagia (Gugging Swallowing Screen) and a cardiorespiratory sleep study to evaluate the presence of OSA.
RESULTS
There are 72 patients (51.4%) with obstructive sleep apnea (OSA+), and there are 81 patients (57.8%) with dysphagia (Dys+). OSA+ patients were significantly older (P = .046) and had greater body mass index (BMI) (P = .002), neck circumference (P = .001), presence of diabetes (P = .013), and hypertension (P < .001). Dys+ patients had greater NIHSS (P < .001), lower Alberta Stroke Programme Early CT Score (P < .001), with greater BMI (P = .030). The association of OSA and dysphagia was greater than that expected based on the prevalence of each condition in acute stroke (P < .001).
CONCLUSIONS
OSA and dysphagia are associated in first-ever, acute ischemic stroke.
背景
阻塞性睡眠呼吸暂停（OSA）和吞咽困难在急性卒中患者中很常见，并且都与并发症风险增加和预后较差相关。本研究的目的是：（1）评估首次发生的急性缺血性卒中患者中OSA和吞咽困难的患病率；（2）调查它们的临床相关性；（3）验证这些情况在急性缺血性卒中中是否相关。
方法
我们纳入了140例连续的急性起病（<48小时）、首次发生缺血性卒中的患者队列。计算机断层扫描（CT）和磁共振成像扫描确诊病情。由经过该量表使用培训并获得认证的检查人员使用美国国立卫生研究院卒中量表（NIHSS）测量神经功能缺损。患者接受吞咽困难的临床评估（古格吞咽筛查）和心肺睡眠研究以评估OSA的存在情况。
结果
有72例患者（51.4%）存在阻塞性睡眠呼吸暂停（OSA+），有81例患者（57.8%）存在吞咽困难（Dys+）。OSA+患者年龄显著更大（P = 0.046），体重指数（BMI）更高（P = 0.002），颈围更大（P = 0.001），糖尿病患病率更高（P = 0.013），高血压患病率更高（P < 0.001）。Dys+患者的NIHSS更高（P < 0.001），阿尔伯塔卒中项目早期CT评分更低（P < 0.001），BMI更高（P = 0.030）。OSA和吞咽困难之间的关联大于基于急性卒中中每种情况的患病率所预期的关联（P < 0.001）。
结论
在首次发生的急性缺血性卒中中，OSA和吞咽困难相关。
Zotero 插件