Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.
The Australian e-Health Research Centre, CSIRO, Perth, WA, Australia.
J Sleep Res. 2021 Jun;30(3):e13179. doi: 10.1111/jsr.13179. Epub 2020 Aug 27.
This study examined the nature and characteristics of sleep-disordered breathing, including obstructive sleep apnea and central sleep apnea, in patients with post-stroke dysphagia, to determine the demographic, anthropometric and clinical variables that were associated with sleep-disordered breathing. Thirty-nine patients diagnosed with acute stroke (28 males and 11 females with a mean age of 72.3 ± 10.0 years) underwent overnight polysomnography (within 3.9 ± 1.6 days after admission). Sleep-disordered breathing was described by the apnea-hypopnea index and its obstructive and central components by the obstructive apnea-hypopnea index and central apnea-hypopnea index, respectively. Severity of dysphagia was assessed using the Mann Assessment of Swallowing Ability score. Severity of stroke and functional dependence were assessed by the National Institute of Health Stroke Scale and the modified Barthel index, respectively. Most of the cohort (87%) had moderate-to-severe dysphagia (Mann Assessment of Swallowing Ability of 143.2 ± 19.9). Sleep-disordered breathing (apnea-hypopnea index ≥ 5 events/hr) was present in 38 participants (97%) with a mean apnea-hypopnea index of 37.5 ± 24.4 events/hr. Sleep-disordered breathing was predominantly obstructive in nature, with a mean obstructive apnea-hypopnea index and central apnea-hypopnea index of 19.6 ± 15.7 and 11.4 ± 17.6 events/hr, respectively. Multivariate linear regression analyses showed that the apnea-hypopnea index was associated with sex (p = .0001), body mass index (p = .029) and the modified Barthel index (p = .006); the obstructive apnea-hypopnea index was associated with the Mann Assessment of Swallowing Ability (p = .006), sex (p = .004) and body mass index (p = .015) and had a nonlinear relationship with the modified Barthel index (p = .019); and the central apnea-hypopnea index was associated with sex (p = .027) and the modified Barthel index (p = .019). The present study showed that dysphagia severity was associated with obstructive sleep apnea severity and this association was independent of sex, modified Barthel index and body mass index. However, stroke-induced dysphagia was not associated with central sleep apnea or overall sleep-disordered breathing.
本研究旨在探讨卒中后吞咽困难患者睡眠呼吸障碍(包括阻塞性睡眠呼吸暂停和中枢性睡眠呼吸暂停)的性质和特征,以确定与睡眠呼吸障碍相关的人口统计学、人体测量学和临床变量。39 名被诊断为急性卒中的患者(28 名男性和 11 名女性,平均年龄 72.3±10.0 岁)接受了过夜多导睡眠图检查(入院后 3.9±1.6 天内)。睡眠呼吸障碍通过呼吸暂停-低通气指数来描述,其阻塞性成分和中枢性成分分别通过阻塞性呼吸暂停-低通气指数和中枢性呼吸暂停-低通气指数来描述。吞咽困难的严重程度使用曼恩吞咽能力评估量表进行评估。卒中严重程度和功能依赖程度分别采用国立卫生研究院卒中量表和改良巴氏指数进行评估。该队列的大多数患者(87%)存在中重度吞咽困难(曼恩吞咽能力评估量表得分为 143.2±19.9)。38 名参与者(97%)存在睡眠呼吸障碍(呼吸暂停-低通气指数≥5 次/小时),平均呼吸暂停-低通气指数为 37.5±24.4 次/小时。睡眠呼吸障碍主要为阻塞性,平均阻塞性呼吸暂停-低通气指数和中枢性呼吸暂停-低通气指数分别为 19.6±15.7 和 11.4±17.6 次/小时。多变量线性回归分析表明,呼吸暂停-低通气指数与性别(p=.0001)、体重指数(p=.029)和改良巴氏指数(p=.006)相关;阻塞性呼吸暂停-低通气指数与曼恩吞咽能力评估量表(p=.006)、性别(p=.004)和体重指数(p=.015)相关,与改良巴氏指数呈非线性关系(p=.019);中枢性呼吸暂停-低通气指数与性别(p=.027)和改良巴氏指数(p=.019)相关。本研究表明,吞咽困难的严重程度与阻塞性睡眠呼吸暂停的严重程度相关,这种关联独立于性别、改良巴氏指数和体重指数。然而,卒中引起的吞咽困难与中枢性睡眠呼吸暂停或整体睡眠呼吸障碍无关。