醒后卒中及其伴发睡眠障碍的临床特点

 目的 探讨醒后卒中及其伴发睡眠障碍的临床特点。方法 纳入2016-06至2018-03收住空军特色医学中心神经内科发病3 d以内的206例急性缺血性脑卒中患者,根据发病时间是否明确分为醒后卒中组和非醒后卒中组,比较两组的各项临床资料,包括性别、年龄、脑血管危险因素、NIHSS评分、梗死范围及TOAST分型等,并采用改良Berlin睡眠问卷筛查阻塞性睡眠呼吸暂停综合征(obstrutive sleep apnea,OSA)高危及低危,依据睡眠时长问卷评估患者的睡眠情况,睡眠不足为每天睡眠时长≤6 h,睡眠过多为每天睡眠时长≥ 9 h,睡眠正常为每天睡眠的时长7~8 h。比较两组OSA及睡眠情况。结果 206例中,醒后卒中组65例,非醒后卒中141例。两组患者在性别、年龄、高血压、高脂血症、NIHSS评分、梗死范围等方面差异无统计学意义;醒后卒中组糖尿病的构成比(55.4%)明显高于非醒后卒中组(36.9%),TOAST病因学分型发现醒后卒中组小动脉闭塞型(52.3%)明显高于非醒后卒中组(34%),差异均具有统计学意义(P<0.05)。醒后卒中组OSA高危42例(64.6%),非醒后卒中组67例(47.5%);醒后卒中组24.6%出现睡眠过多,非醒后卒中组10.7%出现睡眠过多;两组OSA、睡眠过多比例差异均有统计学意义(P<0.05)。结论 醒后卒中患者多有糖尿病,其发病机制以小动脉闭塞型多见,OSA、睡眠过长可能参与醒后卒中的发病。

Clinical characteristics of wake-up stroke and sleep disorders

Objective To investigate the clinical characteristics of wake-up stroke with sleep disorders.Methods Between June 2016 and March 2018,206 consecutive patients with acute ischemic stroke admitted to the Department of Neurology,the Air Force Medical Center, within 3 days of onset were enrolled. They were divided into the wake-up stroke group (WUS) and the non-wake-up stroke group (NWUS) according to whether the onset time was clear. The demographic information, medical history, and stroke characteristics including severity (National Institutes of Health Stroke Scale,NIHSS), infarction location and mechanism (Trial of Org 10172 in Acute Stroke Treatment criteria TOAST) were collected. The Berlin Questionnaire was used to determine the severity of underlying obstructive sleep apnea (OSA) in the two groups. Sleep duration was categorized into three groups: ≤6 hours/day,7-8 hours/day, and ≥9 hours /day. OSA and sleep duration were compared between the two groups.Results Among the 206 cases, there were 65 cases of WUS and 141 cases of NWUS. WUS and NWUS patients were similar in regard to most of the stroke risk factors, NIHSS and infarction location(P>0.05). The incidence of diabetes among WUS patients was significantly higher than among NWUS ones (55.4% vs. 36.9%, P<0.05). WUS was significantly more likely to result from the small-vessel disease mechanism than NWUS(52.3% vs. 34%,P<0.05). Of the 65 patients with WUS, 42(64.6%) had underlying OSA, compared with 67 (47.5%) of the 141 patients with NWUS(P<0.05). Long sleep duration was more common in patients with WUS than in patients with NWUS (24.6% vs. 10.7%, P<0.05).Conclusions Diabetes is more prevalent among patients with WUS that is more likely to result from the small-vessel disease mechanism. OSA and long sleep duration may contribute to WUS.