卒中高危人群的睡眠质量:基于社区的调查

目的 调查卒中高危人群的睡眠质量并探讨睡眠障碍的危险因素.方法 2016年3月对天津市南开区水上公园及王顶堤社区的卒中高危人群进行横断面调查,根据匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)将研究对象分为睡眠良好组和睡眠障碍组,采用多变量logistic回归分析确定影响睡眠质量的危险因素;根据高危人群既往有无卒中史分为有卒中史组和无卒中史组,比较2组睡眠质量,并分析睡眠障碍与卒中转归的相关性.结果 共纳入565例卒中高危人群,睡眠障碍者178例(31.5％).睡眠障碍组年龄显著大于睡眠良好组(66.70±8.97)岁对(62.87±9.46)岁;t=-4.540,P＜0.001],女性(68.0％对49.1％;x2=16.190,P＜ 0.001)、高血压(69.7％对57.9％;x2=7.154,P=0.005)、缺血性心脏病(48.9对35.4％;x2=9.253,P=0.002)、既往卒中或短暂性脑缺血发作(transient ischemic attack,TIA)史(30.9％对18.9％;x2=10.080,P=0.001)、颈动脉斑块(71.9％对53.7％;x2=16.688,P＜0.001)构成比显著高于睡眠良好组.多变量logistic分析表明,在校正年龄和性别后,既往卒中或TIA史优势比(odds ratio,OR)1.712,95％可信区间(confidence interval,CI)1.105～2.653;P=0.016]、颈动脉斑块(OR1.583,95％ CI 1.003～2.498;P =0.048)是睡眠障碍的独立危险因素.既往有卒中史者PSQI总分显著高于无卒中史者(7.25±4.71)分对(6.13±4.20)分;t=-2.578,P=0.010];既往有卒中史者入睡时间评分(1.24±1.06)分对(0.95±1.02)分;t=-2.868,P=0.004]和睡眠障碍评分(1.23±0.63)分对(1.07±0.61)分;t=-2.622,P=0.009]显著高于无卒中史者.根据改良Rankin量表评分将有卒中史者分为转归良好组(0～2分)和转归不良组(＞2分),分别包括105例(82.0％)和23例(18.0％).转归不良组睡眠障碍患者比例(78.3％对35.2％;x2=14.251,P＜0.001)和PSQi评分中位数和四分位数间距:6(3 ～8)分对12(8～18)分;Z=-4.392,P＜0.001]均显著高于转归良好组.结论 卒中高危人群睡眠障碍发生率高,既往卒中或TIA史、颈动脉斑块是卒中高危人群睡眠障碍的独立危险因素,而且睡眠障碍与卒中转归不良相关.因此,应积极关注卒中高危人群的睡眠质量,控制导致其睡眠障碍的危险因素,特别是对于既往有卒中史者,将有助于降低卒中的发病风险.

Sleep quality in population at high-risk for stroke: a community-based survey

Objective To investigate the sleep quality and the risk factors for sleep disorders in population at high-risk for stroke:.Methods A cross-sectional survey was conducted in population at highrisk for stroke:in Water Park and Wangdingdi Communities,Nankai District,Tianjin in March 2016.The residents were divided into either a good sleep group or a sleep disorder group according to the Pittsburgh Sleep Quality Index (PSQI).Multivariate logistic regression analysis was used to determine the risk factors affecting sleep quality.They also divided into a stroke history group and a non-stroke history group according to the high-risk population with or without previous history of stroke.The sleep quality was compared between the 2 groups,and the correlation between sleep disorders and stroke outcomes was analyzed.Results A total of 565 residents at high-risk for stroke were enrolled in the study,and 178 01.5％) had sleep disorders.The age in the sleep disorder group was significantly older than that in the good sleep group (66.70 ±8.97 years vs.62.87 ±9.46 years;t =4.540,P＜0.001).The proportions of female (68.0％ vs.49.1％;x2 =16.190,P ＜ 0.001),hypertension (69.7％ vs.57.9％;x2 =7.154,P =0.005),ischemic heart diseases (48.9％ vs.35.4％;x2 =9.253,P =0.002),history of previous stroke or transient ischemic attack (TIA) (30.9％ vs.18.9％;x2 =10.080,P =0.001),and carotid plaques (71.9 vs.53.7％;x2 =16.688,P ＜0.001) in the sleep disorder group were higher than those in the good sleep group.Multivariate logistic regression analysis showed that after adjusting for age and sex,the history of previous stroke or TIA (odds ratio OR] 1.712,95％ confidence interval CI] 1.105-2.653;P =0.016),and carotid plaques (OR 1.583,95％ CI 1.003-2.498;P =0.048) were the dependent risk factors for sleep disorders.The total score of PSQI in patients with previous stroke was significantly higher than that in patients without previous stroke (7.25 ±4.71 vs.6.13 ±4.20,t =-2.578,P =0.010).The sleep latency score (1.24 ± 1.06 vs.0.95 ± 1.02;t =-2.868,P =0.004) and sleep disorder score (1.23 ± 0.63 vs.1.07 ± 0.61;t =-2.622,P =0.009) in patients with previous stroke history were significantly higher than those without.According to the modified Rankin Scale scores,the patients with a history of stroke were divided into a good outcome group (0-2) and a poor outcome group (＞2),including 105 (82.0％) and 23 patients (18.0％),resectively.The proportion of patients with sleep disorders (78.3％ vs.35.2％;x2 =14.251,P＜0.001) and the PSQI score (median and four percentile interval:6 3-8] vs.12 8-18];Z =-4.392,P ＜0.001) in the poor outcome group were significantly higher than those in the good outcome group.Conclusions The incidence of sleep disorder is high in the high-risk population,the previous stroke or TIA history and carotid plaques are the independent risk factors for sleep disorder in the high-risk population,and sleep disorder is associated with the poor outcomes of strokes.Therefore,attention should be paid to the sleep quality of this stroke high-risk population and control the risk factors of causing sleep disorders,especially for those with a history of stroke.This will help reduce the risk of stroke.