Brunetti Valerio, Vollono Catello, Testani Elisa, Pilato Fabio, Della Marca Giacomo
Institute of Neurology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
Institute of Neurology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
J Stroke Cerebrovasc Dis. 2019 Jun;28(6):1455-1462. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.023. Epub 2019 Mar 29.
The aims of our study were to investigate autonomic modifications in wakefulness and sleep in a cohort of patients with acute ischemic stroke and to evaluate whereas these modifications were dependent by sleep stage and stroke lateralization.
We prospectively enrolled 42 patients (22 men and 20 women, mean age: 69.8 ± 11.3; range: 32-92 years) with acute ischemic stroke. All participants underwent a full-night polysomnography. As index of autonomic nervous system we used Heart Rate Variability (HRV), analyzed in wakefulness and during different sleep stages. First, we compared our cohort with a control group of 42 healthy subjects, matched for age and sex. Subsequently, we divided our cohort in 2 subgroups according stroke lateralization (21 right, 21 left) and compared with control population.
We observed significant modifications of HRV parameters mainly for the right lesions. In particular, we observed a prevalent parasympathetic tone during the wake (low frequency/high frequency [LF/HF]: right: 2.99 ± 8.91; controls: 3.88 ± 3.42; P < .01) and during REM (LF/HF right: 0.03 ± 1.58; controls: 2.92 ± 3.97; P < .01) accompanied by a significant reduction of sympathetic tone during REM (LF right: 23.85 ± 44.42 n.u.; controls: 51.13 ± 32.25 n.u.; P < .01), and by a reduction of parasympathetic tone during N3 (HF right: 28.09 ± 37.67 n.u.; controls: 43.08 ± 68.39 n.u.; P < .01).
Our study indicates that autonomic dysfunctions in acute ischemic stroke are prevalent in right-side lesions and strictly dependent by sleep-wake stage.
我们研究的目的是调查一组急性缺血性中风患者在清醒和睡眠状态下的自主神经变化，并评估这些变化是否依赖于睡眠阶段和中风的侧别。
我们前瞻性地招募了42例急性缺血性中风患者（22例男性和20例女性，平均年龄：69.8±11.3岁；范围：32 - 92岁）。所有参与者均接受了整夜多导睡眠监测。作为自主神经系统指标，我们使用心率变异性（HRV），并在清醒和不同睡眠阶段进行分析。首先，我们将我们的队列与42名年龄和性别匹配的健康受试者对照组进行比较。随后，我们根据中风侧别将我们的队列分为2个亚组（21例右侧，21例左侧），并与对照人群进行比较。
我们观察到主要在右侧病变中HRV参数有显著变化。具体而言，我们观察到在清醒时（低频/高频[LF/HF]：右侧：2.99±8.91；对照组：3.88±3.42；P <.01）和快速眼动期（REM）（右侧LF/HF：0.03±1.58；对照组：2.92±3.97；P <.01）存在普遍的副交感神经张力，同时在REM期交感神经张力显著降低（右侧LF：23.85±44.42 n.u.；对照组：51.13±32.25 n.u.；P <.01），并且在N3期副交感神经张力降低（右侧HF：28.09±37.67 n.u.；对照组：43.08±68.39 n.u.；P <.01）。
我们的研究表明，急性缺血性中风中的自主神经功能障碍在右侧病变中普遍存在，并且严格依赖于睡眠 - 觉醒阶段。
