Plomaritis Panagiotis, Theodorou Aikaterini, Michalaki Vasiliki, Stefanou Maria-Ioanna, Palaiodimou Lina, Papagiannopoulou Georgia, Kotsali-Peteinelli Vasiliki, Bregianni Marianna, Andreadou Elissavet, Paraskevas Georgios P, Giannopoulos Sotirios, Tsivgoulis Georgios, Bonakis Anastasios
Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece.
First Department of Neurology, "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece.
J Clin Med. 2023 Sep 10;12(18):5881. doi: 10.3390/jcm12185881.
Periodic Limb Movements during Sleep (PLMS) have been described to be frequently present in stroke patients. We aimed to evaluate the prevalence and severity of PLMS in acute stroke patients and clarify the association between PLMS and coexisting Sleep Disordered Breathing (SDB). Additionally, we focused on identifying variables that could independently predict the presence of PLMS in patients with acute stroke. The potential impact of PLMS on stroke outcome at three months was investigated as well.
In this study, we performed overnight polysomnography on consecutive stroke patients within 72 h from symptom onset. Data regarding clinical and imaging characteristics were prospectively collected. National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Epworth-Sleepiness Scale (ESS) were used to evaluate stroke severity on admission, stroke outcome at three months and history of daytime sleepiness, respectively. We documented PLMS and SDB using standard polysomnography criteria.
We prospectively assessed 126 patients with acute stroke [109 with ischemic and 17 with hemorrhagic stroke, mean age 60 ± 11 years, 68% men, median NIHSS score on admission: 3 (IQR: 2-7)]. The overall rate of PLMS in our cohort was 76%, and the rate of SDB among patients with PLMS was 83%. PLMS detection rates differed significantly (-value: <0.001) according to SDB, with PLMS prevalence increasing with greater SDB severity. SDB could independently (OR:4.869, 95% CI: 1.884-12.784, -value: 0.001) predict the presence of PLMS in the acute stroke phase in multivariable analyses adjusting for potential confounders. Moreover, baseline stroke severity (NIHSS-score increase in per-1 point: OR: 0.819, 95% CI: 0.737-0.895, -value < 0.001) and PLMS (OR:0.099, 95% CI: 0.009-0.482, -value = 0.015) were significantly associated with the likelihood of excellent functional outcome (mRS-scores: 0-1) at 3 months.
The common presence of mostly severe PLMS in patients with acute stroke and their negative effect on stroke outcomes point out the necessity for early PLMS detection and treatment.
睡眠期周期性肢体运动（PLMS）在中风患者中较为常见。我们旨在评估急性中风患者中PLMS的患病率和严重程度，并阐明PLMS与并存的睡眠呼吸障碍（SDB）之间的关联。此外，我们着重确定能够独立预测急性中风患者是否存在PLMS的变量。同时也研究了PLMS对中风患者三个月预后的潜在影响。
在本研究中，我们对症状发作72小时内连续收治的中风患者进行了整夜多导睡眠监测。前瞻性收集有关临床和影像学特征的数据。分别使用美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）和Epworth嗜睡量表（ESS）来评估入院时的中风严重程度、三个月时的中风预后以及日间嗜睡史。我们使用标准多导睡眠监测标准记录PLMS和SDB。
我们前瞻性评估了126例急性中风患者[109例缺血性中风和17例出血性中风，平均年龄60±11岁，68%为男性，入院时NIHSS评分中位数：3（四分位间距：2 - 7）]。我们队列中PLMS的总体发生率为76%，PLMS患者中SDB的发生率为83%。根据SDB情况，PLMS的检出率有显著差异（P值：<0.001），PLMS患病率随SDB严重程度增加而升高。在对潜在混杂因素进行调整的多变量分析中，SDB能够独立（比值比：4.869，95%置信区间：1.884 - 12.784，P值：0.001）预测急性中风期PLMS的存在。此外，基线中风严重程度（NIHSS评分每增加1分：比值比：0.819，95%置信区间：0.737 - 0.895，P值<0.001）和PLMS（比值比：0.099，95%置信区间：0.009 - 0.482，P值 = 0.015）与三个月时良好功能预后（mRS评分：0 - 1）的可能性显著相关。
急性中风患者中大多存在严重的PLMS，且其对中风预后有负面影响，这表明早期检测和治疗PLMS很有必要。
