Yu Si-Yuan, Sun Qian, Chen Sheng-Nan, Wang Fen, Chen Rui, Chen Jing, Liu Chun-Feng, Li Jie
Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Cerebrovasc Dis. 2024;53(1):14-27. doi: 10.1159/000528724. Epub 2023 Jul 7.
Poststroke sleep disturbances are common and can affect stroke outcomes, but the clinical studies mainly focus on breathing-related sleep disorders, while the bidirectional impact of circadian rhythm dysfunction in ischemic stroke remains unknown. This study observed the characteristics of melatonin secretion in acute ischemic stroke patients and evaluated whether melatonin rhythm impacts the prognosis after stroke by assessing the neurological function, cognition, emotion, and quality of life 3 months after stroke.
Acute ischemic stroke patients were selected from the Department of Neurology Inpatients of the Second Hospital affiliated with Soochow University from October 2019 to July 2021. Healthy control subjects were recruited at the same time. Demographic and clinical data were collected, and relevant scale scores (including neurological function, cognition, emotion, and sleep) were assessed within 2 weeks of onset and followed up 3 months later. All participants collected salivary melatonin samples on the 4th day of hospitalization and dim light melatonin onset (DLMO) was calculated according to melatonin concentration. Stroke patients were then divided into three groups based on their DLMO values.
A total of 74 stroke patients and 33 control subjects were included in this analysis. Compared with healthy controls, stroke patients exhibited a delayed melatonin rhythm during the acute phase of stroke (21:36 vs. 20:38, p = 0.004). Stroke patients were then divided into three groups, namely normal (n = 36), delayed (n = 28), or advanced DLMO (n = 10), based on their DLMO values. A χ2 test showed that there were significant differences in the rate of poor prognosis (p = 0.011) and depression tendency (p = 0.028) among the three groups. A further pairwise comparison revealed that stroke patients with delayed DLMO were more likely to experience poor short-term outcomes than normal DLMO group (p = 0.003). The average melatonin concentration of stroke patients at 5 time points was significantly lower than that of the control group (3.145 vs. 7.065 pg/mL, p < 0.001). Accordingly, we split stroke patients into three groups, namely low melatonin level (n = 14), normal melatonin level (n = 54), or high melatonin level (n = 6). Unfortunately, there were no great differences in the clinical characteristics, cognition, emotion, sleep quality, and short-term outcome among groups.
This is a preliminary study, and our results indicate that changes in melatonin secretion phase of stroke patients may have effect on their short-term prognosis.
中风后睡眠障碍很常见，且会影响中风预后，但临床研究主要集中在与呼吸相关的睡眠障碍，而昼夜节律功能障碍在缺血性中风中的双向影响仍不清楚。本研究观察了急性缺血性中风患者褪黑素分泌的特征，并通过评估中风后3个月的神经功能、认知、情绪和生活质量，来评价褪黑素节律是否会影响中风后的预后。
选取2019年10月至2021年7月苏州大学附属第二医院神经内科住院的急性缺血性中风患者。同时招募健康对照者。收集人口统计学和临床资料，并在发病后2周内评估相关量表评分（包括神经功能、认知、情绪和睡眠），3个月后进行随访。所有参与者在住院第4天采集唾液褪黑素样本，并根据褪黑素浓度计算暗光褪黑素起始时间（DLMO）。然后根据中风患者的DLMO值将其分为三组。
本分析共纳入74例中风患者和33例对照者。与健康对照者相比，中风患者在中风急性期的褪黑素节律延迟（21:36对20:38，p = 0.004）。然后根据中风患者的DLMO值将其分为三组，即正常组（n = 36）、延迟组（n = 28）或提前DLMO组（n = 10）。χ2检验显示，三组之间预后不良率（p = 0.011）和抑郁倾向（p = 0.028）存在显著差异。进一步的两两比较显示，DLMO延迟的中风患者比正常DLMO组更易出现短期预后不良（p = 0.003）。中风患者5个时间点的平均褪黑素浓度显著低于对照组（3.145对7.065 pg/mL，p < 0.001）。因此，我们将中风患者分为三组，即低褪黑素水平组（n = 14）、正常褪黑素水平组（n = 54）或高褪黑素水平组（n = 6）。遗憾的是，各组之间在临床特征、认知、情绪、睡眠质量和短期预后方面没有显著差异。
这是一项初步研究，我们的结果表明中风患者褪黑素分泌阶段的变化可能对其短期预后有影响。
