Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Interdisciplinary Sleep-Wake-Epilepsy-Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Eur J Neurol. 2023 Jun;30(6):1696-1705. doi: 10.1111/ene.15784. Epub 2023 Mar 31.
Contradictory evidence on the impact of single sleep-wake-disturbances (SWD), such as sleep-disorderd breating (SDB) or insomnia, in patients with stroke, on the risk of subsequent cardio- and cerebrovascular events (CCE) and death, exists. Very recent studies in the general population suggest that the presence of multiple SWD increases cardio-cerebrovascular risk. Hence, the aim of this study was to asssess whether a novel score capturing the burden of multiple SWD, a so called "sleep burden index", is predictive for subsequent CCE including death in a prospectively followed cohort of stroke patients.
Patients with acute ischemic stroke or transient ischemic attack (TIA) were prospectively recruited. Four SWD were analyzed: (i) SDB with respirography; (ii) insomnia (defined using the insomnia severity index [ISI]); (iii) restless legs syndrome (RLS; defined using the International RLS Study Group rating scale); and (iv) self-estimated sleep duration at 1 and 3 months. A "sleep burden index", calculated using the mean of z-transformed values from assessments of these four SWD, was created. The occurrence of CCE was recorded over a mean ± standard deviation (SD) follow-up of 3.2 ± 0.3 years.
We assessed 437 patients (87% ischemic stroke, 13% TIA, 64% males) with a mean ± SD age of 65.1 ± 13.0 years. SDB (respiratory event index ≥ 5/h) was present in 66.2% of these patients. Insomnia (ISI ≥ 10), RLS and extreme sleep duration affected 26.2%, 6.4% and 13.7% of the patients 3 months post-stroke. Seventy out of the 437 patients (16%) had at least one CCE during the follow-up. The sleep burden index was associated with a higher risk for subsequent CCE, including death (odds ratio 1.80 per index unit, 95% confidence interval 1.19-2.72; p = 0.0056).
The presence of multiple SWDs constitutes a risk for subsequent CCE (including death) within the first 3 years following stroke. Larger systematic studies should assess the utility of the sleep burden index for patients' risk stratification in clinical practice.
关于单次睡眠-觉醒障碍（SWD），如睡眠呼吸障碍（SDB）或失眠，对中风患者随后发生心脑血管事件（CCE）和死亡风险的影响，存在相互矛盾的证据。最近在普通人群中的研究表明，存在多种 SWD 会增加心脑血管风险。因此，本研究旨在评估一种新的评分方法，该评分方法捕捉多种 SWD 的负担，即所谓的“睡眠负担指数”，是否可预测前瞻性随访的中风患者随后发生 CCE 包括死亡的风险。
前瞻性招募急性缺血性中风或短暂性脑缺血发作（TIA）患者。分析了 4 种 SWD：（i）使用呼吸描记法评估 SDB；（ii）失眠（使用失眠严重指数[ISI]定义）；（iii）不宁腿综合征（RLS；使用国际 RLS 研究组评分量表定义）；以及（iv）1 个月和 3 个月时的自我估计睡眠时间。使用这 4 种 SWD 的评估值的平均值创建“睡眠负担指数”。记录平均随访 3.2±0.3 年后 CCE 的发生情况。
我们评估了 437 名患者（87%为缺血性中风，13%为 TIA，64%为男性），平均年龄为 65.1±13.0 岁。这些患者中 66.2%存在 SDB（呼吸事件指数≥5/h）。失眠（ISI≥10）、RLS 和极端睡眠时间分别影响 26.2%、6.4%和 13.7%的患者在中风后 3 个月。437 名患者中有 70 名（16%）在随访期间至少发生了一次 CCE。睡眠负担指数与随后发生 CCE（包括死亡）的风险相关（每增加一个指数单位的优势比为 1.80，95%置信区间为 1.19-2.72；p=0.0056）。
多种 SWD 的存在构成了中风后 3 年内发生随后发生 CCE（包括死亡）的风险。更大的系统研究应评估睡眠负担指数对患者临床实践中风险分层的效用。
