Quan Yi, Wang Zhongzhu, Zhang Tao, Sui Yanyong, Zhang Xin, Ji Xueliang, Liu Ao-Fei, Jiang Weijian
Department of Neurosurgery, Peking University People's Hospital, Beijing, China.
Qingdao Women and Children's Hospital, Qingdao, Shandong, China.
Front Neurol. 2025 Jan 6;15:1501316. doi: 10.3389/fneur.2024.1501316. eCollection 2024.
Carotid artery stenosis, primarily caused by atherosclerosis, is a major risk factor for ischemic stroke. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established interventions to reduce stroke risk and restore cerebral blood flow. However, the effect of these treatments on circadian rhythms, and their influence on stroke recovery, remains underexplored. This study aims to assess how disruptions in circadian rhythms-specifically sleep quality and blood pressure variability-impact recovery in patients undergoing CEA or CAS.
We conducted a prospective study involving 177 patients with carotid artery stenosis, all treated with either CEA or CAS. Patients were followed for 90 days post-treatment, with neurological outcomes evaluated using the NIHSS Stroke Scale (NIHSS). Circadian rhythm-related factors, including sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and blood pressure variability (daytime systolic and nighttime diastolic BP), were assessed pre-and post-treatment. Stepwise regression was used to identify predictors of stroke recovery.
In a cohort of 177 patients with symptomatic carotid atherosclerotic stenosis, stepwise regression identified post-treatment changes in PSQI, nighttime diastolic blood pressure, and the presence of coronary heart disease as significant independent predictors of poor neurological outcomes ( < 0.001). Both CEA and CAS significantly improved daytime systolic ( < 0.01) and nighttime diastolic blood pressure ( < 0.01). Patients with poorer prognosis had higher post-treatment PSQI scores ( < 0.001). Additionally, increased physical activity after treatment was linked to improved neurological recovery.
This study highlights the critical role of circadian rhythm regulation and cardiovascular health in stroke recovery following CEA or CAS. Stepwise regression analysis revealed that sleep quality, blood pressure stability, and coronary heart disease were key predictors of neurological outcomes, underscoring the importance of integrating circadian rhythm management into rehabilitation strategies. These results provide a robust scientific foundation for further investigation into the role of circadian rhythms in clinical practice.
主要由动脉粥样硬化引起的颈动脉狭窄是缺血性中风的主要危险因素。颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）是已确立的降低中风风险和恢复脑血流的干预措施。然而，这些治疗对昼夜节律的影响及其对中风恢复的影响仍未得到充分研究。本研究旨在评估昼夜节律紊乱——特别是睡眠质量和血压变异性——如何影响接受CEA或CAS治疗的患者的恢复情况。
我们进行了一项前瞻性研究，纳入了177例颈动脉狭窄患者，所有患者均接受了CEA或CAS治疗。患者在治疗后随访90天，使用美国国立卫生研究院卒中量表（NIHSS）评估神经功能结局。在治疗前后评估与昼夜节律相关的因素，包括睡眠质量（匹兹堡睡眠质量指数[PSQI]）和血压变异性（白天收缩压和夜间舒张压）。采用逐步回归分析来确定中风恢复的预测因素。
在一组177例有症状的颈动脉粥样硬化狭窄患者中，逐步回归分析确定治疗后PSQI的变化、夜间舒张压以及冠心病的存在是神经功能结局不佳的显著独立预测因素（<0.001）。CEA和CAS均显著改善了白天收缩压（<0.01）和夜间舒张压（<0.01）。预后较差的患者治疗后PSQI评分较高（<0.001）。此外，治疗后体力活动增加与神经功能恢复改善有关。
本研究强调了昼夜节律调节和心血管健康在CEA或CAS术后中风恢复中的关键作用。逐步回归分析显示，睡眠质量、血压稳定性和冠心病是神经功能结局的关键预测因素，强调了将昼夜节律管理纳入康复策略的重要性。这些结果为进一步研究昼夜节律在临床实践中的作用提供了坚实的科学基础。
