Liu Xiaodi, Lam David Chi-Leung, Lee Tatia Mei-Chun, Kwan Joseph, Teo Kay Cheong, Chan King Pui Florence, Leung William C Y, Ip Mary Sau-Man, Lau Kui Kai
Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Division of Respiratory Medicine, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Sleep Med. 2024 Dec;124:134-140. doi: 10.1016/j.sleep.2024.09.018. Epub 2024 Sep 14.
Sleep disturbances including obstructive sleep apnea (OSA) and poor sleep quality are common after stroke, while its association with cognitive changes following transient ischemic attack (TIA) or mild stroke remains unclear. We aim to determine whether sleep duration, OSA parameters, or nocturnal hypoxemia is associated with a greater cognitive decline after stroke.
We prospectively followed-up patients with acute TIA/mild stroke [National Institute Health Stroke Scale (NIHSS) < 7] who underwent baseline sleep questionnaire [Pittsburgh Sleep Quality Index (PSQI)], and serial cognitive assessments [Montreal Cognitive Assessment (MoCA) 5-min, Stroop Test] at baseline and one-year. We also evaluated apnea-hypopnea index (AHI) and nocturnal hypoxemia by Home Sleep Apnea Test (HSAT) at one-year. Primary outcome was one-year change in MoCA 5-min score.
One hundred and five patients with TIA/mild stroke (mean age 63 years, 65 % male) were included. Baseline short sleep (< 6 hour/night) and AHI ≥ 20/hour at one-year were independently associated with a decline in the MoCA 5-min total score after covariates adjustment [short sleep: β = -2.36 95 % confidence interval (CI) (-4.13, -0.59), p = 0.009; AHI ≥ 20/hour: β = -1.79 (-3.26, -0.32), p = 0.017; remained significant after multiple comparisons correction]. A lower mean MinSpO was associated with a decline in executive function [Stroop interference index: β = 0.29 (0.04, 0.53), p = 0.021], but not with MoCA 5-min score at one-year. Moderation analysis indicated AHI ≥ 20/hour was associated with a pronounced decline in executive function only in men.
Short sleep after stroke onset, AHI ≥ 20/hour and nocturnal hypoxemia at one-year contributed to an impaired cognitive trajectory at one-year following stroke in patients with TIA/mild stroke.
包括阻塞性睡眠呼吸暂停（OSA）和睡眠质量差在内的睡眠障碍在中风后很常见，而其与短暂性脑缺血发作（TIA）或轻度中风后认知变化的关联仍不清楚。我们旨在确定睡眠时间、OSA参数或夜间低氧血症是否与中风后更大程度的认知衰退相关。
我们对急性TIA/轻度中风患者[美国国立卫生研究院卒中量表（NIHSS）<7]进行前瞻性随访，这些患者在基线时接受了睡眠问卷[匹兹堡睡眠质量指数（PSQI）]，并在基线和一年时进行了系列认知评估[蒙特利尔认知评估（MoCA）5分钟、斯特鲁普测试]。我们还在一年时通过家庭睡眠呼吸暂停测试（HSAT）评估了呼吸暂停低通气指数（AHI）和夜间低氧血症。主要结局是MoCA 5分钟评分的一年变化。
纳入了105例TIA/轻度中风患者（平均年龄63岁，65%为男性）。在校正协变量后，基线时睡眠短（<6小时/晚）和一年时AHI≥20次/小时与MoCA 5分钟总分下降独立相关[睡眠短：β=-2.36，95%置信区间（CI）（-4.13，-0.59），p=0.009；AHI≥20次/小时：β=-1.79（-3.26，-0.32），p=0.017；在进行多重比较校正后仍具有显著性]。较低的平均最低血氧饱和度与执行功能下降相关[斯特鲁普干扰指数：β=0.29（0.04，0.53），p=0.021]，但与一年时的MoCA 5分钟评分无关。调节分析表明，仅在男性中，AHI≥20次/小时与执行功能的显著下降相关。
中风发作后睡眠短、一年时AHI≥20次/小时和夜间低氧血症导致TIA/轻度中风患者中风后一年的认知轨迹受损。
