Plomaritis Panagiotis, Theodorou Aikaterini, Lourentzos Konstantinos, Stefanou Maria-Ioanna, Palaiodimou Lina, Papagiannopoulou Georgia, Kotsali-Peteinelli Vasiliki, Bregianni Marianna, Paraskevas Georgios P, Tsivgoulis Georgios, Bonakis Anastasios
Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece.
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
J Clin Med. 2023 Jan 27;12(3):986. doi: 10.3390/jcm12030986.
Sleep-disordered breathing (SDB) is common among acute stroke patients. We sought to investigate the prevalence, severity and type of SDB in consecutive acute stroke patients. Moreover, we aimed to identify independent predictors of SDB in the acute stroke setting and investigate potential associations between SDB and functional outcomes at three months.
We prospectively studied consecutive acute stroke patients, who underwent overnight polysomnography within 72 h from symptom onset. Demographics, clinical and imaging characteristics were documented. Daytime sleepiness preceding the stroke, stroke severity on admission and functional outcome at three months were evaluated using the Epworth-Sleepiness Scale (ESS), National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), respectively. SDB was documented using standard polysomnography criteria.
A total of 130 consecutive acute stroke patients were prospectively evaluated [110 with ischemic stroke and 20 with intracerebral hemorrhage, mean age 60.5 ± 10.9 years, 77% men, median NIHSS score on admission: 3 (IQR: 2-17)]. The rate of SDB detection on polysomnography recordings was 79% (95% CI: 71-86). Three variables were independently associated with the likelihood of SDB detection in multivariable analyses adjusting for potential confounders: age (OR per 10-year-increase: 2.318, 95% CI: 1.327-4.391, = 0.005), male sex (OR: 7.901, 95% CI: 2.349-30.855, = 0.001) and abnormal ESS-score (OR: 6.064, 95% CI: 1.560-32.283, = 0.017). Among patients with SDB, congestive heart failure was independently associated with the likelihood of central apnea detection (OR: 18.295, 95% CI: 4.464-19.105, < 0.001). Among all patients, increasing NIHSS score on admission (OR: 0.817, 95% CI: 0.737-0.891, < 0.001) and Apnea-Hypopnea Index (OR: 0.979, 95% CI: 0.962-0.996, = 0.020) emerged as independent predictors of excellent functional outcome at 3 months (mRS-scores 0-1).
The high prevalence and severity of SDB in acute stroke patients and its negative impact on functional outcome indicate the importance of polysomnography implementation in everyday clinical practice of acute stroke work-up and management.
睡眠呼吸障碍（SDB）在急性脑卒中患者中很常见。我们试图调查连续急性脑卒中患者中SDB的患病率、严重程度和类型。此外，我们旨在确定急性脑卒中情况下SDB的独立预测因素，并研究SDB与三个月时功能结局之间的潜在关联。
我们对连续的急性脑卒中患者进行了前瞻性研究，这些患者在症状出现后72小时内接受了夜间多导睡眠图检查。记录了人口统计学、临床和影像学特征。分别使用爱泼华嗜睡量表（ESS）、美国国立卫生研究院卒中量表（NIHSS）和改良Rankin量表（mRS）评估卒中前的日间嗜睡、入院时的卒中严重程度和三个月时的功能结局。使用标准多导睡眠图标准记录SDB。
总共对130例连续急性脑卒中患者进行了前瞻性评估[110例缺血性脑卒中患者和20例脑出血患者，平均年龄60.5±10.9岁，77%为男性，入院时NIHSS评分中位数：3（四分位间距：2 - 17）]。多导睡眠图记录中SDB的检出率为79%（95%置信区间：71 - 86）。在调整潜在混杂因素的多变量分析中，有三个变量与SDB检出的可能性独立相关：年龄（每增加10岁的比值比：2.318，95%置信区间：1.327 - 4.391，P = 0.005）、男性（比值比：7.901，95%置信区间：2.349 - 30.855，P = 0.001）和ESS评分异常（比值比：6.064，95%置信区间：1.560 - 32.283，P = 0.017）。在患有SDB 的患者中，充血性心力衰竭与中枢性呼吸暂停检出的可能性独立相关（比值比：18.295，95%置信区间：4.464 - 19.105，P < 0.001）。在所有患者中，入院时NIHSS评分增加（比值比：0.817，95%置信区间：0.737 - 0.891，P < 0.001）和呼吸暂停低通气指数（比值比：0.979，95%置信区间：0.962 - 0.996，P = 0.020）是三个月时良好功能结局（mRS评分0 - 1）的独立预测因素。
急性脑卒中患者中SDB的高患病率和严重程度及其对功能结局的负面影响表明，在急性脑卒中检查和管理的日常临床实践中实施多导睡眠图检查很重要。
