Lu ZhenHui, Guo XiaoMing, Xing Can, Zhu LianHai, Gu JinYu, Zhu XiangYang
Department of Neurology, Affiliated Hospital 2 of Nantong University, Nantong 226001, China.
Department of Neurology, Affiliated Hospital 2 of Nantong University, Nantong 226001, China.
J Clin Neurosci. 2025 Aug;138:111359. doi: 10.1016/j.jocn.2025.111359. Epub 2025 Jun 3.
Daytime sleepiness is common in the acute phase of cerebral ischemic stroke and affects the clinical outcome, but whether it is associated with post-stroke cognitive function remains unclear.
To define the relationship between daytime sleepiness and early cognitive impairment after non-disabling ischemic stroke in elderly.
This prospective study included consecutive elderly patients with acute non-disabling ischemic stroke (aged > 60 years; NIHSS score ≤ 3 at admission; onset-to-enrollment time ≤ 7 days). Excessive daytime sleepiness (EDS) was diagnosed based on the Epworth Sleepiness Scale (ESS). Cognition was assessed by the Montreal cognitive assessment (MoCA) at admission and at 3-, 12-month follow-ups. Cognitive impairment was defined as MoCA score < 26 (≥12 years education) or < 25 (<12 years education). According to MoCA score at 3-month, patients were divided into two groups: Early post-stroke cognitive impairment (PSCI) group, and Non-PSCI group. Intergroup comparisons were performed for general demographic data, laboratory information, imaging data, ESS scores, and MoCA scores, followed with further correlation analysis between ESS scores and early PSCI.
Of the 243 enrolled patients (mean age, 68.7 ± 6.6 years; female, 35.4 %), 160 (65.8 %) developed early PSCI. The two groups of patients were significantly different in ESS score during the acute phase, history of hypertension, coronary heart disease, atrial fibrillation, C-reactive protein, TOAST type, Fazekas scale of leukoaraiosis, MTA score of hippocampal volume. After adjustment for potential confounding variables, ESS score during the acute phase was positively associated with early PSCI (adjusted odds ratio 1.146, 95 % confidence interval 1.040-1.262, P = 0.006). According to receiver operating characteristic analysis, the best projecting factor for early PSCI was an ESS score ≥ 7 (area under the curve 0.593; sensitivity 48.1 %; specificity 69.9 %). Besides early PSCI, EDS during the acute phase was also associated with a higher risk of stroke recurrence and poor outcomes.
The occurrence of early PSCI in elderly patients with non-disabling ischemic stroke was related to EDS during the acute phase. Attention to ESS score during the acute phase is needed in these elderly patients for early diagnosis and timely intervention of PSCI.
日间嗜睡在脑缺血性卒中急性期很常见，并影响临床结局，但它是否与卒中后认知功能相关仍不清楚。
明确老年非致残性缺血性卒中后日间嗜睡与早期认知障碍之间的关系。
这项前瞻性研究纳入了连续的老年急性非致残性缺血性卒中患者（年龄>60岁；入院时美国国立卫生研究院卒中量表[NIHSS]评分≤3分；发病至入组时间≤7天）。根据爱泼华嗜睡量表（ESS）诊断日间过度嗜睡（EDS）。在入院时以及3个月、12个月随访时通过蒙特利尔认知评估（MoCA）评估认知功能。认知障碍定义为MoCA评分<26分（受教育年限≥12年）或<25分（受教育年限<12年）。根据3个月时的MoCA评分，将患者分为两组：卒中后早期认知障碍（PSCI）组和非PSCI组。对一般人口统计学数据、实验室信息、影像学数据、ESS评分和MoCA评分进行组间比较，随后对ESS评分与早期PSCI进行进一步的相关性分析。
在243例纳入患者中（平均年龄68.7±6.6岁；女性占35.4%），160例（65.8%）发生了早期PSCI。两组患者在急性期的ESS评分、高血压病史、冠心病、心房颤动、C反应蛋白、TOAST分型、脑白质疏松症的 Fazekas分级、海马体积的MTA评分方面存在显著差异。在对潜在混杂变量进行校正后，急性期的ESS评分与早期PSCI呈正相关（校正比值比1.146，95%置信区间1.040 - 1.262，P = 0.006）。根据受试者工作特征分析，早期PSCI的最佳预测因素是ESS评分≥7分（曲线下面积0.593；敏感度48.1%；特异度69.9%）。除早期PSCI外，急性期的EDS还与卒中复发风险较高和预后不良相关。
老年非致残性缺血性卒中患者早期PSCI的发生与急性期的EDS有关。这些老年患者在急性期需要关注ESS评分，以便对PSCI进行早期诊断和及时干预。
