Centre for Neuro Skills, Bakersfield, CA, USA.
Centre for Neuro Skills, Bakersfield, CA, USA; Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
Sleep Med. 2021 Dec;88:81-86. doi: 10.1016/j.sleep.2021.10.013. Epub 2021 Oct 21.
Sleep-wake disturbances (SWD) are common following stroke, and often extend into the post-acute to chronic periods of recovery. Of particular interest to recovery is a reduction in rapid eye movement (REM) sleep, as we know REM sleep to be important for learning and memory. While there is a breadth of evidence linking SWD and stroke, much less work has been done to identify and determine if differences in sleep architecture and apnea severity are dependent on stroke infarct topographies.
A retrospective chart review was conducted of 48 ischemic stroke patients having underwent a full, overnight polysomnography (PSG). All patients were over 30 days post-injury (post-acute) at the time of the PSG. Patients were divided into supra- and infratentorial infarct topography groups based on available medical and imaging records. In addition to sleep study record review, cognitive and outcome measures were examined.
Results showed that patients with infratentorial stroke had poorer sleep efficiency, decreased REM sleep, and higher apnea hypopnea index (AHI) than those with supratentorial injuries. Longer continuous REM periods were correlated with higher verbal learning/memory scores, higher levels of positive affect, and lower levels of emotional/behavioral dyscontrol. Neither age nor AHI were significantly correlated with the amount or duration of REM. Slow-wave sleep was significantly reduced across both injury topographies.
Infratentorial ischemic stroke patients display significant disruptions in sleep architecture and may require close monitoring for SWDs in the post-acute period to maximize outcome potential. REM sleep is particularly affected when compared to supratentorial ischemic stroke.
睡眠-觉醒障碍（SWD）在中风后很常见，并且经常延伸到恢复期的亚急性期和慢性期。对康复特别重要的是快速眼动（REM）睡眠减少，因为我们知道 REM 睡眠对学习和记忆很重要。虽然有大量证据表明 SWD 与中风有关，但很少有工作致力于确定和确定睡眠结构和呼吸暂停严重程度的差异是否依赖于中风梗死的部位。
对 48 例接受过完整夜间多导睡眠图（PSG）检查的缺血性中风患者进行了回顾性图表审查。所有患者在 PSG 时均超过损伤后 30 天（亚急性期）。根据可用的医学和影像学记录，将患者分为幕上和幕下梗死部位组。除了睡眠研究记录审查外，还检查了认知和结果测量。
结果表明，与幕上损伤患者相比，幕下中风患者的睡眠效率较低，REM 睡眠减少，呼吸暂停低通气指数（AHI）较高。连续 REM 期较长与言语学习/记忆评分较高、积极情绪水平较高和情绪/行为失控水平较低相关。年龄和 AHI 均与 REM 的量或持续时间无显著相关性。两种损伤部位的慢波睡眠均显著减少。
幕下缺血性中风患者的睡眠结构明显受到干扰，在亚急性期可能需要密切监测 SWD，以最大限度地提高康复潜力。与幕上缺血性中风相比，REM 睡眠受到的影响尤其大。
