卒中相关睡眠障碍

<正>卒中相关睡眠障碍（stroke-related sleep disorders,SSD）是卒中后常见症状之一,SSD是指在卒中后首次出现或卒中前已有的睡眠障碍在卒中后持续存在或加重,并达到睡眠障碍诊断标准的一组临床综合征。SSD分为两种类型：卒中后睡眠障碍和卒中伴随睡眠障碍[1],主要包括失眠障碍、睡眠呼吸障碍（sleep disorderedbreathing,SDB）、昼夜节律相关睡眠-觉醒障碍（circadianrhythmsleepwakedisorders,CRSWDs）、中枢性过度睡眠、     

卒中后睡眠障碍研究进展

睡眠障碍是卒中后严重且常见的并发症之一。具有发病率高、对卒中预后影响大的特点,不仅增加了患者的痛苦、影响了患者的康复,而且还会增加卒中复发的危险。因此卒中后睡眠障碍越来越受到神经科学界的重视。许多学者对卒中后出现睡眠障碍的患者进行了观察,并对卒中后睡眠障碍的机制进行了分析,本文对此进行综述。     

卒中患者中常被忽视的睡眠障碍

<正>卒中患者的睡眠障碍呈现多样性,包括睡眠呼吸障碍、失眠、睡眠时间过长/过短、睡眠中周期性肢体运动(periodiclimb movementsduringsleep,PLMS)、快动眼睡眠期行为障碍(rapid eye movement sleep behaviordisorder,RBD)和昼夜节律失调性睡眠-觉醒障碍等。并且已有研究证实了睡眠障碍与脑血管病的发生、发展及预后之间存在着错综复杂的关系,互为影响。近几年,脑血管病     

卒中后抑郁患者睡眠障碍的治疗

目的卒中后抑郁患者应用奥氮平治疗后症状改善情况。方法对卒中后抑郁患者86例,对照组卒中患者92例进行匹兹堡睡眠质量指数（PSQI）问卷调查,分析两组患者及组中后抑郁患者奥氮平治疗前后的睡眠情况。结果卒中后抑郁组的睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能等因子评分和PSQI总分均高于对照组（P〈0．05）,经奥氮平治疗后,PSQI评分明显好转（P〈0．05）。结论情感障碍可以影响患者的睡眠质量,经奥氮平治疗后睡眠障碍明显改善,显著提高了患者生活质量。     

卒中与睡眠障碍

卒中包括缺血性卒中、短暂性脑缺血发作（transient ischemic attack,TIA）和出血性卒中,具有高发病率、高复发率、高致残率、高致死率的特点,其中致死率位居我国第一[1]。卒中后常出现各种各样的睡眠障碍,主要表现为失眠、过度睡眠、异态睡眠、不宁腿综合征、睡眠呼吸暂停综合征等。卒中患者合并睡眠障碍不仅会降低患者的生活质量,而且影响神经功能康复,甚至增加卒中复发与死亡率。反之,各种睡眠障碍也会增加卒中的发病率。但是目前国内外对卒中患者的睡眠障碍关注度仍较低,对睡眠障碍的治疗也不够积极。梳理卒中与睡眠障碍方面的研究以深刻认识两者之间的内在关系,对防治卒中有着重要的意义。     

卒中后睡眠障碍

睡眠障碍是卒中后常见的并发症之一,会影响卒中患者的预后及生活质量。卒中后睡眠障碍的原因不完全清楚,主要与梗死部位、神经递质、社会心理因素等有关。它主要分为呼吸相关性睡眠障碍和非呼吸相关性睡眠障碍两类,其中呼吸相关性睡眠障碍是较常见的类型。在卒中后睡眠障碍的治疗方面,药物治疗和非药物治疗相辅相成。临床医师应增强意识,尽早识别卒中后睡眠障碍类型,予以干预,以期改善患者预后,提高患者生活质量。     

卒中后睡眠障碍的研究进展

随着对卒中研究的深入,逐渐发现睡眠障碍这一常见并发症与卒中的关系比预期的更加密切和复杂。例如,在卒中发作急性期,患者睡眠结构破坏,总睡眠时间缩短、睡眠效率降低、入睡潜伏期延长,而进入慢性期后随着受损脑组织结构和功能的恢复,患者的睡眠质量依然可以恢复到相对正常的状态。卒中病灶位于不同脑区可能出现不同形式的睡眠障碍,如睡眠呼吸暂停、日间过度嗜睡、发作性睡病、睡眠期运动异常和异态睡眠等。随着多导睡眠检测技术的广泛应用,临床医师与科研人员对卒中后睡眠障碍展开更多深入的研究。     

卒中后失眠的研究进展

卒中后失眠是在卒中后首次出现并达到失眠诊断标准的一组临床综合征,与临床常见失眠相类似,主要表现为睡眠深度异常和平均每晚睡眠时间少于6 h。meta分析显示,卒中急性期、亚急性期及恢复期患者符合失眠障碍诊断标准的比例分别为32.5%、34.8%和37.1%。卒中后失眠不仅增加了卒中死亡及复发风险,而且对卒中康复与预后造成不利影响。本文对卒中后失眠的发病情况、发病机制及治疗等进行综述,以便为临床实践提供信息,并为卒中后失眠提供针对性干预治疗措施。     

卒中相关睡眠障碍评估与管理中国专家共识2023

卒中相关睡眠障碍（stroke-related sleep disorders,SSD）是卒中后常见症状,且易被忽视。2019年,北京神经内科学会联合相关专业学会及相关领域专家制定并发表了《卒中相关睡眠障碍评估与管理中国专家共识》。北京神经内科学会汇集各方意见和建议,结合最新临床研究成果,完成了“共识”2023年更新版。2023版“共识”主要聚焦有循证医学证据的SSD评估及治疗方法的新进展,并增加了一些循证证据较少的睡眠障碍亚型治疗方面的专家推荐意见,增加其临床实用性及可操作性,有效指导临床医师规范诊疗SSD。     

常规药物联合心理疗法对青年卒中伴睡眠障碍患者的效果

目的探讨青年卒中伴睡眠障碍患者应用常规药物联合心理疗法干预后效果。方法将我院150例青年卒中伴睡眠障碍患者采用随机数字表法进行分组,对照组75例给予常规药物治疗,观察组75例增加心理治疗,对比两组患者治疗后精神心理状态、细胞因子水平、神经功能及睡眠质量变化。结果治疗后,观察组美国国立卫生研究院卒中量表(NIHSS)、汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数(PSQI)、汉密尔顿焦虑量表(HAMA)评分、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)水平、睡眠潜伏期(SL)时间及觉醒次数(AT)均低于对照组,总睡眠时间(TST)高于对照组(P<0.05)。结论在常规药物治疗基础上增加心理疗法,能够有效改善青年卒中伴睡眠障碍患者精神心理状态,调节细胞因子水平,提升睡眠质量,促进神经功能恢复。     

Psychometric properties of the Sleep Hygiene Index in a large Italian community sample

Objective/backgroundPoor sleep hygiene is considered an exacerbating and perpetuating factor of sleep disturbances and is also associated with poor mental health. The Sleep Hygiene Index (SHI) is a self-report measure assessing adherence to sleep hygiene practices. The aim of this study was to estimate the psychometric properties of the SHI in an Italian representative sample of the general population, following a formative measurement approach.Patients/methodsParticipants (n = 6276; M = 33.62, SD = 13.45) completed the SHI alongside measures of sleep disturbance, depression, anxiety, and stress. To consider the item formative nature, sets of item-composites weighted by means of canonical correlation analysis was created and a confirmatory factor analysis (CFA) was implemented. Factorial invariance tests were computed considering both presence of sleep problems and presence of emotional distress symptoms as grouping variables.Results and conclusionsCFA confirmed the unidimensional structure of SHI. Internal consistency was acceptable (ω = 0.752). Test-retest reliability at 8–10 months presented an ICC of 0.666. SHI significantly correlated with sleep, depression, anxiety and stress symptoms (r range from 0.358 to 0.500). Configural and metric invariance were reached for both grouping variables. Partial scalar invariance was obtained only across emotional distress groups. People with emotional symptoms reported higher latent means on the sleep hygiene dimension. Findings support the validity and reliability of the Italian version of the SHI. Importantly, the SHI showed robust psychometric properties both in healthy individuals and in individual reporting mental health symptoms. Thus, it is advisable to use this version of the SHI in both research and clinical practice.     

Sleep disturbances in a clinical forensic psychiatric population

Objective

Poor sleep is known to cause detrimental effects on the course of diverse psychiatric disorders and is a putative risk factor for hostility and aggression. Thus, sleep may be crucial in forensic psychiatric practice. However, little is known about the prevalence of sleep disturbances in these complex psychiatric patients.

Methods

In this study we investigated the presence of sleep disorders and subjective sleep quality using the Sleep Diagnosis List (SDL), the Pittsburgh Sleep Quality Index (PSQI), interviews addressing the causes of sleep complaints, and file information on sleep medications in 110 patients admitted to a forensic psychiatric hospital.

Results

Almost 30% of the participants suffered from one or more sleep disorders, especially insomnia. An even larger proportion of the participants (49.1%) experienced poor sleep quality. Interestingly, patients with an antisocial personality disorder or traits were particularly dissatisfied with their sleep. The most common causes of sleep problems were suboptimal sleep hygiene, stress or ruminating, negative sleep conditioning, and side effects of psychotropic medication. Of the poor sleepers, 40.7% received a hypnotic drug.

Conclusion

Despite intensive clinical treatment, sleep problems are experienced by a large number of forensic psychiatric patients. It would be worthwhile to examine the effects of pharmacological and non-pharmacological sleep interventions on both psychiatric symptoms and reactive aggressive behavior in forensic patients.     

Psychometric properties and clinical relevance of the Adolescent Sleep Hygiene Scale in Dutch adolescents

ObjectiveThis study investigated reliability, validity, and clinical relevance of the Adolescent Sleep Hygiene Scale (ASHS) in Dutch adolescents.MethodsThe Dutch translation of the ASHS was administered to 186 normal-sleeping adolescents and 112 adolescents with insomnia. Their sleep variables were measured using sleep logs and questionnaires. From the insomnia group, scores were also obtained after six weeks of cognitive behavioral therapy for insomnia (n = 58) or waiting list (n = 22).ResultsThe full scale of the ASHS had acceptable internal consistency. The results showed moderate to strong correlations of the ASHS (domains) with sleep quality, sleep duration and chronic sleep reduction. Furthermore, the Dutch ASHS was able to discriminate between normal sleepers and adolescents with insomnia, and scores of adolescents with insomnia improved after treatment.ConclusionsThese findings confirm the importance of sleep hygiene in adolescent sleep, and contribute to the validity of the ASHS and its applicability in research and clinical practice.     

卒中后睡眠障碍相关危险因素的Meta分析

【摘要】
目的 通过对卒中后睡眠障碍相关文献进行分析,分析卒中后睡眠障碍的常见危险因素。
方法 采用Meta分析方法,对符合条件的11篇有关卒中后睡眠障碍危险因素的文献进行定量分析,对每个危险因素进行异质性检验以及合并优势比（odds ratio,OR）和95％可信区间（confidence interval,CI）的计算。
结果 有5个因素与卒中后睡眠障碍有统计学意义,分别是：习惯性打鼾（OR 14.77,95％CI 5.52～39.53）、高血压（OR 1.3,95％CI 1.03～1.66）、糖尿病（OR 1.41,95％CI 1.08～1.84）、饮酒（OR 1.59,95％CI 1.19～2.12）、皮质型卒中（OR 1.31,95％CI 1.06～1.63）,合并结果稳定性较好。尚不能确定性别（OR 1.12,95％CI 0.96～1.31）、高血脂（OR 0.96,95％CI 0.7～1.33）、吸烟（OR 1.27,95％CI 0.73～2.20）、卒中史（OR 1.05,95％CI 0.74～1.49）与卒中后睡眠障碍有关。
结论 现有的证据表明高血压、糖尿病、饮酒、习惯性打鼾及皮质型卒中是卒中后睡眠障碍的危险因素。     

Validity and reliability of an Arabic version of the Sleep Hygiene Index

Aimthis study aims to assess the reliability and validity of an Arabic version of the Sleep Hygiene Index (SHI).MethodsA methodological study was carried out in four stages: initial translation by 2 professional translators, evaluation and synthesis of the initial translation by project managers, back-translation and validation. The Arabic (SHI-AR) and English (SHI-ENG) versions of the SHI were administered across Lebanon as an anonymous online survey in April 2020. Internal consistency of the SHI-AR and inter-rater reliability were assessed by calculating Cronbach alpha (α) and Intraclass Correlation Coefficient (ICC) respectively. Inter-rater agreement for each item of the SHI was measured using Cohen's Kappa coefficient. Construct validity was investigated by exploratory factor analysis (EFA).Results363 participants were enrolled in the study (129 men, 234 women, mean age 30 ± 11 years). There was no statistically significant difference between mean overall scores on the 2 versions of the SHI with mean scores of 19.16 ± 7.4 and 19.25 ± 7.6 on SHI-AR and SHI-ENG respectively (p = 0.265). Internal consistency was satisfactory (α = 0.749), and the inter-rater agreement for the total scores of the 2 versions of the SHI was excellent (ICC = 0.980). All items of the SHI showed substantial to high level of agreement between the 2 versions. EFA established four factors underlying the questionnaire.ConclusionThe Arabic version of the SHI is a valid tool to assess sleep hygiene in Arabic speaking populations.