Yuan Xiaodong, Fu Yongshan, Ou Ya, Xue Jing, Yang Na, Liu Hongrui, Wang Tiantian, Wang Jing, Yan Cuiping, Zhang Pingshu
Department of Neurology, Kailuan General Hospital, North China University of Technology, Tangshan, Hebei, People's Republic of China.
Key Laboratory of Neurobiological Function in Hebei Province, Tangshan, Hebei, People's Republic of China.
Nat Sci Sleep. 2025 Jul 18;17:1655-1668. doi: 10.2147/NSS.S533202. eCollection 2025.
Research is limited on whether circadian rhythm and sleep architecture alterations during acute intracerebral hemorrhage (ICH) influence patient outcomes. This study aims to characterize these changes and explore their association with clinical prognosis, offering new insights for diagnosis and treatment.
We enrolled 100 acute hemorrhagic stroke patients who underwent continuous, contactless sleep monitoring via a smart mattress for 3-5 consecutive days. Prognosis was evaluated at discharge using the modified Rankin Scale (mRS), and patients were classified into favorable or unfavorable outcome groups. Circadian rhythm parameters (IS, IV, RA) and sleep metrics (eg, total sleep time, sleep latency, REM latency) during day and night were compared between groups. Multivariate logistic regression identified independent prognostic factors, and ROC analysis evaluated their predictive value.
Group comparisons revealed statistically significant differences in RA and nighttime sleep latency between the favorable and unfavorable prognosis groups (P < 0.05). Binary logistic regression analysis identified nighttime sleep latency as an independent predictor of functional outcome (95% CI: 1.066 ~ 1.128, P < 0.05), which remained significant after adjusting for potential confounders (95% CI: 1.016 ~ 1.148, P < 0.05). The mean nighttime sleep latency was 18.14 minutes in the favorable group and 12.30 minutes in the unfavorable group. The area under the ROC curve (AUC) for nighttime sleep latency was 0.642 (95% CI: 0.526-0.757, P = 0.028), with an optimal cutoff value of 10.95 minutes, yielding a sensitivity of 72.2% and specificity of 53.6%.
Hemorrhagic stroke patients show disrupted circadian stability, with greater RA reductions in those with worse outcomes. Nighttime sleep latency independently predicts poor prognosis with moderate accuracy. Circadian rhythm stability may serve as a prognostic marker in hemorrhagic stroke to avoid implying causality.
关于急性脑出血（ICH）期间昼夜节律和睡眠结构改变是否影响患者预后的研究有限。本研究旨在描述这些变化，并探讨它们与临床预后的关联，为诊断和治疗提供新的见解。
我们纳入了100例急性出血性中风患者，他们通过智能床垫连续3 - 5天进行非接触式睡眠监测。出院时使用改良Rankin量表（mRS）评估预后，患者被分为预后良好或不良组。比较两组白天和夜间的昼夜节律参数（IS、IV、RA）和睡眠指标（如总睡眠时间、睡眠潜伏期、快速眼动潜伏期）。多因素逻辑回归确定独立的预后因素，ROC分析评估其预测价值。
组间比较显示，预后良好组和不良组在RA和夜间睡眠潜伏期方面存在统计学显著差异（P < 0.05）。二元逻辑回归分析确定夜间睡眠潜伏期是功能预后的独立预测因素（95% CI：1.066 ~ 1.128，P < 0.05），在调整潜在混杂因素后仍然显著（95% CI：1.016 ~ 1.148，P < 0.05）。预后良好组的平均夜间睡眠潜伏期为18.14分钟，预后不良组为12.30分钟。夜间睡眠潜伏期的ROC曲线下面积（AUC）为0.642（95% CI：0.526 - 0.757，P = 0.028），最佳截断值为10.95分钟，敏感性为72.2%，特异性为53.6%。
出血性中风患者表现出昼夜节律稳定性破坏，预后较差的患者RA降低更明显。夜间睡眠潜伏期以中等准确性独立预测不良预后。昼夜节律稳定性可作为出血性中风的预后标志物，但避免暗示因果关系。
