Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan.
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.
J Clin Sleep Med. 2018 May 15;14(5):835-839. doi: 10.5664/jcsm.7118.
To investigate the difference in sleep-disordered breathing (SDB) prevalence and severity after an index and recurrent stroke.
In a sample of 40 subjects, home sleep apnea tests were performed a median of 10 days after an index ischemic stroke and 14 days after a recurrent ischemic stroke. A respiratory event index (REI) of ≥ 10 events/h (apneas plus hypopneas per hour of recording) was used to define clinically significant SDB. The relative difference in REI or relative SDB prevalence was used to compare the post-recurrent stroke measurement with that made after the index stroke, and was expressed as a rate ratio (RR) or prevalence ratio (PR). Adjusted regression models (negative binomial for REI and log binomial for SDB) included change in body mass index and time between the events.
The median time from index to recurrent stroke was 330.5 days (interquartile range [IQR]: 103.5, 766.5). The median REI was 17.5 (IQR: 9.0, 32.0) after the index stroke and 18.0 (IQR: 11.0, 25.5) after the recurrent stroke. The within-subject median difference was zero (IQR: -9, 7.5). The relative difference in REI was not significant in unadjusted or adjusted (RR: 0.97 [95% confidence interval: 0.76, 1.24]) models. The prevalence of SDB was not different after the recurrent stroke compared with the index stroke, in unadjusted or adjusted (PR: 1.10 [95% confidence interval: 0.91, 1.32]) models.
In this within-subject, longitudinal study, neither severity nor prevalence of SDB worsened after recurrent stroke.
探讨首发和复发缺血性卒中后睡眠呼吸障碍（SDB）的患病率和严重程度的差异。
在 40 例受试者中，在首发缺血性卒中后中位数 10 天和复发缺血性卒中后 14 天进行家庭睡眠呼吸暂停试验。使用呼吸事件指数（REI）≥10 事件/小时（每小时记录的呼吸暂停加低通气次数）来定义有临床意义的 SDB。将复发后测量的 REI 或 SDB 相对患病率的变化与首发卒中后测量的结果进行比较，并表示为率比（RR）或患病率比（PR）。调整后的回归模型（REI 采用负二项回归，SDB 采用对数二项回归）包括体重指数的变化和两次事件之间的时间。
首发至复发卒中的中位时间为 330.5 天（四分位距[IQR]：103.5，766.5）。首发卒中后 REI 的中位数为 17.5（IQR：9.0，32.0），复发卒中后 REI 的中位数为 18.0（IQR：11.0，25.5）。个体内中位数差异为零（IQR：-9，7.5）。在未调整或调整模型中（RR：0.97[95%置信区间：0.76，1.24]），REI 的相对差异均无统计学意义。在未调整或调整模型中（PR：1.10[95%置信区间：0.91，1.32]），复发卒中后 SDB 的患病率与首发卒中后相比并无差异。
在这项个体内、纵向研究中，复发后 SDB 的严重程度或患病率均未恶化。
