Zhang Jia-Li, Wang An-Xin, Yang Yang, Xu Qin, Liao Xiao-Ling, Ma Wei-Guo, Zhang Ning, Wang Chun-Xue, Wang Yong-Jun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Nat Sci Sleep. 2022 Nov 2;14:1977-1988. doi: 10.2147/NSS.S378743. eCollection 2022.
Although sleep disorders significantly increase the risk of cognitive impairment, literature is relatively scarce regarding the impact of sleep status on cognitive function in patients with acute ischemic stroke (AIS). We seek to study the association between pre-stroke subjective sleep status and cognitive function at 3 months after stroke.
Data were analyzed for 1,759 AIS patients from the Impairment of Cognition and Sleep after Acute Ischemic Stroke or Transient Ischemic Attack in Chinese Patients Study (ICONS). Pre-stroke subjective sleep status was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Greater sleep fragmentation was defined as waking up in the middle of the night or early morning ≥3 times a week. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) at 3 months after stroke. Primary endpoint was the incidence of post-stroke cognitive impairment (PSCI) at 3 months after stroke. The association between subjective sleep status and PSCI was evaluated using multivariable logistic regression.
PSCI occurred in 52.1% at 3 months after stroke. Patients with very bad sleep quality before stroke were at increased risk of PSCI (OR, 2.11; 95% CI, 1.11-4.03; P=0.03). Subgroup analysis found that the association between very bad sleep quality and PSCI was more evident among patients with high school education or above (OR, 5.73; 95% CI, 1.92-17.10; P for interaction=0.02). In addition, patients with greater sleep fragmentation before stroke were also at higher risk of PSCI (OR, 1.55; 95% CI, 1.20-2.01; P<0.01). Similarly, subgroup analysis showed that the risk of PSCI was more pronounced among patients without employment (OR, 2.45; 95% CI, 1.59-3.77; P for interaction=0.01).
Very bad sleep quality and greater sleep fragmentation before stroke were identified as independent risk factors for PSCI at 3 months after stroke.
尽管睡眠障碍会显著增加认知障碍的风险，但关于睡眠状态对急性缺血性卒中（AIS）患者认知功能影响的文献相对较少。我们旨在研究卒中前主观睡眠状态与卒中后3个月认知功能之间的关联。
对来自中国急性缺血性卒中或短暂性脑缺血发作后认知与睡眠障碍研究（ICONS）的1759例AIS患者的数据进行分析。卒中前主观睡眠状态通过匹兹堡睡眠质量指数（PSQI）和爱泼华嗜睡量表（ESS）进行评估。夜间或清晨醒来≥每周3次被定义为睡眠碎片化程度更高。卒中后3个月使用蒙特利尔认知评估量表（MoCA）评估认知功能。主要终点是卒中后3个月卒中后认知障碍（PSCI）的发生率。使用多变量逻辑回归评估主观睡眠状态与PSCI之间的关联。
卒中后3个月PSCI的发生率为52.1%。卒中前睡眠质量非常差的患者发生PSCI的风险增加（比值比，2.11；95%置信区间，1.11 - 4.03；P = 0.03）。亚组分析发现，睡眠质量非常差与PSCI之间的关联在高中及以上学历患者中更为明显（比值比，5.73；95%置信区间，1.92 - 17.10；交互作用P值 = 0.02）。此外，卒中前睡眠碎片化程度更高的患者发生PSCI的风险也更高（比值比，1.55；95%置信区间，1.20 - 2.01；P < 0.01）。同样，亚组分析表明，PSCI的风险在无业患者中更为显著（比值比，2.45；95%置信区间，1.59 - 3.77；交互作用P值 = 0.01）。
卒中前睡眠质量非常差和睡眠碎片化程度更高被确定为卒中后3个月PSCI的独立危险因素。
