Srijithesh P R, Mythirayee Sivasubramanian, Seshagiri Doniparthi Venkata, Kamble Nitish L, Sinha Sanjib, Yadav Ravi
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Ann Indian Acad Neurol. 2024 Nov 1;27(6):651-656. doi: 10.4103/aian.aian_439_24. Epub 2024 Dec 5.
Sleep-disordered breathing (SDB) is characterized by pauses or shallow breathing during sleep. It is linked to poorer outcomes and increased stroke recurrence in stroke patients. We aimed to evaluate the proportion, severity, type, and evolution of SDB and arousals in ischemic stroke patients.
Ischemic stroke patients were recruited to evaluate SDB. Patients underwent overnight polysomnography (PSG) twice - within 1 month of stroke onset and again after 3 months. Clinical outcomes were evaluated at 6, 18, and 24 months.
Of 141 acute ischemic stroke patients screened, 111 patients recruited in the study and 105 patients had technically adequate polysomnography. The mean age of patients was 50.5 years (standard deviation [SD]: 12.30), 78.4% of the patients were males, and the mean body mass index was 26 (SD: 5.4). Results showed that 81.9% had an apnea-hypopnea index (AHI) ≥5, with 12.5% having an AHI >30. The median arousal index (ArI) was 15.4 (interquartile range [IQR]: 0.5-50.5), which increased as the apnea increased. During follow-up, 56.8% patients had an AHI ≥5, with 12.5% having severe apnea. The median ArI decreased from 15.4 (IQR: 0.5-50.5) initially to 11.54 (IQR: 0.5-21.1) at follow-up. Numerical change in AHI severity categories were noted during the follow-up (mild: 8 vs 15; moderate: 17 vs 11; severe 19vs 7). For AHI >30, ArI decreased from 24.63 (IQR: 0.7-50.05) to 10.54 (IQR: 7.1-15.07) at follow-up. Sleep efficiency and rapid eye movement (REM) sleep duration increased on follow-up.
The study showed a high proportion of SDB in acute ischemic stroke patients. In the follow-up, SDB improved, as reflected in AHI and ArI changes.
睡眠呼吸障碍（SDB）的特征是睡眠期间呼吸暂停或呼吸浅慢。它与卒中患者较差的预后及卒中复发风险增加有关。我们旨在评估缺血性卒中患者中SDB及觉醒的比例、严重程度、类型和演变情况。
招募缺血性卒中患者以评估SDB。患者在卒中发作后1个月内及3个月后分别接受两次夜间多导睡眠图（PSG）检查。在6个月、18个月和24个月时评估临床结局。
在141例接受筛查的急性缺血性卒中患者中，111例被纳入研究，105例患者的多导睡眠图检查技术上合格。患者的平均年龄为50.5岁（标准差[SD]：12.30），78.4%的患者为男性，平均体重指数为26（SD：5.4）。结果显示，81.9%的患者呼吸暂停低通气指数（AHI）≥5，其中12.5%的患者AHI>30。觉醒指数（ArI）的中位数为15.4（四分位间距[IQR]：0.5 - 50.5），其随呼吸暂停的增加而升高。在随访期间，56.8%的患者AHI≥5，其中12.5%的患者存在严重呼吸暂停。ArI的中位数从最初的15.4（IQR：0.5 - 50.5）降至随访时的11.54（IQR：0.5 - 21.1）。随访期间观察到AHI严重程度分类的数值变化（轻度：8例对15例；中度：17例对11例；重度：19例对7例）。对于AHI>30的患者，ArI从随访前的24.63（IQR：0.7 - 50.05）降至10.54（IQR：7.1 - 15.07）。随访时睡眠效率和快速眼动（REM）睡眠时间增加。
该研究表明急性缺血性卒中患者中SDB的比例较高。在随访中，SDB有所改善，这在AHI和ArI的变化中得到体现。
