Hu Yang, Zuo Lijun, Pan Yuesong, Yan Hongyi, Wang Yongjun, Zhao Xingquan
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Nat Sci Sleep. 2025 Jun 27;17:1507-1519. doi: 10.2147/NSS.S492838. eCollection 2025.
Disrupted sleep duration is associated with the risk of stroke, and abnormal sleep duration predicts depression. However, the association of changes in sleep duration with functional outcome and depression after acute ischemic stroke (AIS) or transient ischemic attack (TIA) is still unclear.
All patients diagnosed with AIS or TIA in the impairment of cognition and sleep (ICONS) from the China National Stroke Registry III were included. Post-stroke depression (PSD) was defined as a value on the Patient Health Questionnaire-9 (PHQ-9) ≥5. Sleep duration was classified as normal (7-8 hours), short (<7 hours), or long (≥9 hours). According to the sleep duration, patients were divided into four groups: group A (persisting normal), group B (changed from long or short to normal), group C (changed from normal to long or short), and group D (persisting long or short). Logistic regression was performed to evaluate the effects of sleep duration changes on PSD, quality of life, and functional outcome at 1-year follow-ups.
A total of 1450 AIS or TIA patients at baseline with a mean age of 60.73±10.82 years were followed for 1-year. The group with persisting long or short sleep duration exhibited a significantly higher risk of PSD [OR 1.58(95% CI (1.062.33)] and poor quality of life [OR 1.42(95% CI 1.041.94)] than those in the persisting normal group at 1-year after AIS and TIA when adjusted for covariates. Patients with a decreased sleep duration of > 1 hour had more risk of moderate to severe PSD [OR 2.26(95% CI 1.134.53)] than the persisting normal group. Patients with newly developed abnormal sleep duration (changed from normal to long or short) had a higher risk of poor functional outcome [OR 2.82(95% CI 1.335.96)] than the persisting normal group.
The alterations in sleep duration were independently associated with PSD, poor quality of life, and adverse outcomes at 1-year, suggesting that inadequate sleep quantity plays an important role in 1-year depression, quality of life, and adverse outcomes after AIS or TIA.
睡眠时长紊乱与中风风险相关，且睡眠时长异常可预测抑郁症。然而，急性缺血性中风（AIS）或短暂性脑缺血发作（TIA）后睡眠时长变化与功能结局及抑郁症之间的关联仍不明确。
纳入中国国家卒中登记系统III中认知与睡眠障碍（ICONS）研究里所有诊断为AIS或TIA的患者。中风后抑郁症（PSD）定义为患者健康问卷-9（PHQ-9）得分≥5。睡眠时长分为正常（7 - 8小时）、短（<7小时）或长（≥9小时）。根据睡眠时长，患者被分为四组：A组（持续正常）、B组（从长或短变为正常）、C组（从正常变为长或短）和D组（持续长或短）。进行逻辑回归分析以评估睡眠时长变化对1年随访时PSD、生活质量和功能结局的影响。
共对1450例基线时平均年龄为60.73±10.82岁的AIS或TIA患者进行了1年随访。在AIS和TIA发生1年后，经协变量调整后，睡眠时长持续长或短的组发生PSD的风险[比值比（OR）1.58（95%置信区间（CI）（1.062.33）]和生活质量差的风险[OR 1.42（95% CI 1.041.94）]显著高于睡眠时长持续正常的组。睡眠时长减少>1小时的患者发生中度至重度PSD的风险[OR 2.26（95% CI 1.134.53）]高于睡眠时长持续正常的组。睡眠时长新出现异常（从正常变为长或短）的患者功能结局差的风险[OR 2.82（95% CI 1.335.96）]高于睡眠时长持续正常的组。
睡眠时长的改变与1年时的PSD、生活质量差及不良结局独立相关，提示睡眠量不足在AIS或TIA后的1年抑郁症、生活质量及不良结局中起重要作用。
