Levicka Petra, Slavkovska Miriam, Koren Dominik, Ventosa Joaquim, Hlodak Ján, Papikova Jana, Gdovinova Zuzana, Feketeova Eva
Univerzita Pavla Jozefa Safarika V Kosiciach, Lekarska Fakulta, Neurologicka Klinika, Slovakia.
Univerzitna Nemocnica L. Pasteura, Kosice, Slovakia.
Sleep Med X. 2025 May 31;10:100142. doi: 10.1016/j.sleepx.2025.100142. eCollection 2025 Dec 15.
Stroke is a leading cause of disability worldwide, with cognitive impairment following stroke influenced by a complex interplay of modifiable and non-modifiable risk factors. This study investigated the impact of obstructive sleep apnea (OSA) on cognitive outcomes after ischemic stroke (IS) and the predictive value of plasma neurofilament light chain (pNFL) levels. Seventy-three acute IS patients were analyzed, with 59 completing a three-month follow-up. Cognitive function (Montreal Cognitive Assessment, MoCA) was assessed. Patients underwent polygraphic screening for OSA in the acute phase, with treatment recommended when indicated, and pNFL levels measured at baseline and follow-up. Results showed that 93.2 % of IS patients had OSA. Forty (72.7 %) of OSA patients (moderate, severe OSA) were recommended continuous positive airway pressure (CPAP). CPAP-treated patients in the acute phase demonstrated cognitive improvement at three-month follow-up (CPAP-treated: MoCA 23 vs 25 points, CPAP indicated untreated, MoCA 22 vs 22 points, p = 0.05). However, long-term adherence to CPAP was poor - only 25 % remained on therapy at three months. While pNFL levels correlated with infarct volume and significantly decreased over time, no correlation was found between OSA severity and CPAP treatment. Regression analysis identified age, prior stroke history, and anxiety as key predictors of cognitive and functional post-stroke outcome. Early CPAP therapy could contribute to improved post-stroke cognitive performance. Decline in pNFL levels shows ongoing neuronal recovery; a direct relationship with OSA is inconclusive. Furthermore, advanced age, history of prior stroke, and anxiety symptoms emerged as significant contributors to poorer cognitive outcomes.
中风是全球致残的主要原因，中风后的认知障碍受可改变和不可改变风险因素的复杂相互作用影响。本研究调查了阻塞性睡眠呼吸暂停（OSA）对缺血性中风（IS）后认知结果的影响以及血浆神经丝轻链（pNFL）水平的预测价值。分析了73例急性IS患者，其中59例完成了为期三个月的随访。评估了认知功能（蒙特利尔认知评估，MoCA）。患者在急性期接受了OSA的多导睡眠监测，必要时建议进行治疗，并在基线和随访时测量pNFL水平。结果显示，93.2%的IS患者患有OSA。40例（72.7%）OSA患者（中度、重度OSA）被建议使用持续气道正压通气（CPAP）。急性期接受CPAP治疗的患者在三个月随访时认知功能有所改善（CPAP治疗组：MoCA 23分对25分，CPAP建议但未治疗组：MoCA 22分对22分，p = 0.05）。然而，CPAP的长期依从性较差——三个月时只有25%的患者仍在接受治疗。虽然pNFL水平与梗死体积相关且随时间显著下降，但未发现OSA严重程度与CPAP治疗之间存在相关性。回归分析确定年龄、既往中风史和焦虑是中风后认知和功能结果的关键预测因素。早期CPAP治疗可能有助于改善中风后的认知表现。pNFL水平的下降表明神经元在持续恢复；与OSA的直接关系尚无定论。此外，高龄、既往中风史和焦虑症状是导致较差认知结果的重要因素。
