Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.).
Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (C.K.K., K.O.).
Stroke. 2020 Jul;51(7):2188-2196. doi: 10.1161/STROKEAHA.119.028730. Epub 2020 Jun 9.
Cardiopulmonary coupling (CPC) analysis is an easily assessable method to evaluate sleep-disordered breathing (SDB); however, its prognostic impact in patients with acute ischemic stroke needs to be investigated. We performed a CPC analysis using Holter monitoring at the early stage of noncardioembolic ischemic stroke to investigate the prognostic effect of SDB on functional impairment at the 3-month follow-up.
A total 615 patients with acute noncardioembolic ischemic stroke who underwent Holter monitoring within 30 days of stroke onset were enrolled from a multicenter, prospective, all-comer cohort. CPC analysis was conducted, and SDB was defined by the presence of narrow-band coupling during sleep time. We investigated the association between SDB and functional impairment at 3 months as measured by the modified Rankin Scale.
Narrow-band coupling was present in 191 (31.1%) of 615 patients (mean age 64.5±12.6 years). The narrow-band group showed a significantly higher rate of severe functional impairment (modified Rankin Scale score >2; 45.5% versus 12.9%, <0.001) and persistent disability (Δmodified Rankin Scale score ≤0; 53.9% versus 39.8%, <0.001) at the 3-month follow-up. In multivariate analysis, narrow-band coupling was an independent predictor of higher risk of severe and persistent functional impairment at 3 months (odds ratio, 3.98 [95% CI, 2.34-6.78]; <0.001; and odds ratio, 1.81 [95% CI, 1.23-2.66]; <0.001, respectively). The results remained consistent after propensity-score matched analysis with 157 patient pairs (-statistic=0.770).
SDB assessed by CPC analysis at the early stage of ischemic stroke could predict severe and prolonged functional impairment at 3 months. CPC analysis using Holter monitoring can help predicting functional impairment in acute ischemic stroke.
心肺耦联（CPC）分析是一种易于评估的方法，可用于评估睡眠呼吸障碍（SDB）；然而，其在急性缺血性卒中患者中的预后影响仍需研究。我们通过 Holter 监测在非心源性缺血性卒中的早期阶段进行 CPC 分析，以研究 SDB 对 3 个月随访时功能障碍的预后影响。
从一个多中心、前瞻性、全人群队列中纳入了 615 例急性非心源性缺血性卒中患者，这些患者在卒中发作后 30 天内接受了 Holter 监测。进行 CPC 分析，将睡眠期间存在窄带偶联定义为 SDB。我们研究了 SDB 与改良 Rankin 量表（mRS）评估的 3 个月时功能障碍之间的关系。
在 615 例患者中（平均年龄 64.5±12.6 岁），191 例（31.1%）存在窄带偶联。窄带组在 3 个月时严重功能障碍（mRS 评分>2；45.5%比 12.9%，<0.001）和持续性残疾（ΔmRS 评分≤0；53.9%比 39.8%，<0.001）的发生率明显更高。多变量分析显示，窄带偶联是 3 个月时严重和持续性功能障碍风险升高的独立预测因素（优势比，3.98[95%CI，2.34-6.78]；<0.001；和优势比，1.81[95%CI，1.23-2.66]；<0.001）。在与 157 对患者进行倾向评分匹配分析后，结果仍然一致（-统计量=0.770）。
缺血性卒中早期的 CPC 分析评估的 SDB 可以预测 3 个月时的严重和长期功能障碍。Holter 监测的 CPC 分析有助于预测急性缺血性卒中的功能障碍。
