快速眼动睡眠期阻塞性睡眠呼吸暂停（REM-OSA）和非快速眼动睡眠期阻塞性睡眠呼吸暂停（NREM-OSA）相关脑梗死临床结局的差异分析：一项回顾性数据库研究

Differential analysis of clinical outcomes in cerebral infarction associated with REM-OSA and NREM-OSA: a retrospective database study.

作者信息

Xu Liwen, Yu Wenyi, Sun Shutong, Zheng Yixi, Jing Tianyu, Xu Gang, Tang Tieyu, Chu Cheng

机构信息

Department of Neurology, Yangzhou University, The Affiliated Hospital of Yangzhou University, Yangzhou, China.

School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China.

出版信息

Front Neurol. 2025 Jul 15;16:1607963. doi: 10.3389/fneur.2025.1607963. eCollection 2025.

DOI:10.3389/fneur.2025.1607963

PMID:40734824

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12305585/

Abstract

BACKGROUND

Obstructive sleep apnea (OSA) is one of the factors that affect the prognosis of cerebral infarction. Rapid eye movement-related obstructive sleep apnea (REM-OSA) has been confirmed as an important clinical subtype of OSA, yet it is frequently overlooked in clinical practice. REM-OSA is an important but underrecognized clinical issue in the study of improving the prognosis of cerebral infarction.

OBJECTIVE

To investigate the relationships among REM-OSA and cerebral infarction clinical prognosis.

METHODS

In this retrospective cohort study, 318 cerebral infarction patients with OSA (AHI ≥ 5) were enrolled from February 2022 to January 2025 at the Department of Neurology, Affiliated Hospital of Yangzhou University. Participants were stratified into REM-OSA ( = 71) and NREM-OSA ( = 247) groups using stringent criteria (AHI/AHI ≥ 2, REM duration ≥30 min). Data included polysomnography, neurological assessments (NIHSS, MRS), inflammatory markers (WBC, hs-CRP), and neuroimaging. Statistical analyses comprised logistic regression and Pearson correlation tests.

RESULTS

Compared to NREM-OSA, REM-OSA patients exhibited: (1) Poorer prognosis: Higher 3-month mRS scores (OR = 1.543, = 0.032), independent of total AHI. (2) Enhanced inflammation: Elevated WBC (7.45 vs. 6.50 × 10/L, = 0.011) and hs-CRP (3.95vs.1.16 mg/L, < 0.001), correlating with AHI ( = 0.234-0.268, < 0.001). (3) Unique neuroanatomical vulnerability: Higher basal ganglia infarction prevalence (83.1% vs. 64.8%, = 0.003; OR = 2.359). (4) Severe REM-specific hypoxia: Lower minimum SpO₂ (81.62% vs. 84.31%, < 0.001) and prolonged apneas. (5) Sleep architecture disruption: Reduced sleep efficiency and prolonged latency (PSQI: 10.18 vs. 8.52, = 0.004). (6) Age inversely correlated with REM-OSA severity ( = -0.154, = 0.020).

CONCLUSION

REM-OSA is independently associated with poorer prognosis in cerebral infarction patients. Potential explanatory mechanisms include REM-specific hypoxia, systemic inflammation, and basal ganglia vulnerability.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）是影响脑梗死预后的因素之一。快速眼动相关阻塞性睡眠呼吸暂停（REM-OSA）已被确认为OSA的一种重要临床亚型，但在临床实践中经常被忽视。REM-OSA是改善脑梗死预后研究中一个重要但未被充分认识的临床问题。

目的

探讨REM-OSA与脑梗死临床预后之间的关系。

方法

在这项回顾性队列研究中，2022年2月至2025年1月期间从扬州大学附属医院神经内科招募了318例患有OSA（呼吸暂停低通气指数[AHI]≥5）的脑梗死患者。采用严格标准（AHI/非快速眼动睡眠期AHI≥2，快速眼动睡眠期持续时间≥30分钟）将参与者分为REM-OSA组（n = 71）和非快速眼动睡眠期OSA组（n = 247）。数据包括多导睡眠图、神经学评估（美国国立卫生研究院卒中量表[NIHSS]、改良Rankin量表[MRS]）、炎症标志物（白细胞[WBC]、高敏C反应蛋白[hs-CRP]）和神经影像学检查。统计分析包括逻辑回归和Pearson相关性检验。

结果

与非快速眼动睡眠期OSA相比，REM-OSA患者表现出：（1）预后较差：3个月时改良Rankin量表评分较高（比值比[OR]=1.543，P = 0.032），与总AHI无关。（2）炎症增强：白细胞升高（7.45对6.50×10⁹/L，P = 0.011）和hs-CRP升高（3.95对1.16mg/L，P<0.001），与AHI相关（r = 0.234 - 0.268，P<0.001）。（3）独特的神经解剖易损性：基底节梗死患病率较高（83.1%对64.8%，P = 0.003；OR = 2.359）。（4）严重的快速眼动睡眠期特异性低氧血症：最低血氧饱和度较低（81.62%对84.31%，P<0.001）且呼吸暂停时间延长。（5）睡眠结构紊乱：睡眠效率降低和潜伏期延长（匹兹堡睡眠质量指数[PSQI]：10.18对8.52，P = 0.004）。（6）年龄与REM-OSA严重程度呈负相关（r = -0.154，P = 0.020）。