重症脑卒中患者的睡眠与觉醒障碍及其与功能预后的相关性

目的 探讨重症脑卒中患者的睡眠与觉醒障碍及其与功能预后的相关性。方法 前瞻性选取2020年7月-2021年8月本院重症脑卒中美国国立卫生研究院卒中量表(National institutesof health stroke scale,NIHSS)评分16～42分]患者95例作为研究对象,根据3个月后功能预后情况分为预后良好组改良Rankin量表评分(Modified rankin scale,mRS)为0～2分]和预后不良组(mRS评分为3～6分); 收集2组患者一般资料、多导睡眠图特征指标等,采用Pearson相关性分析重症脑卒中患者的睡眠与觉醒障碍及其与功能预后的相关性,并采用多元线性回归分析影响重症脑卒中患者功能预后的相关因素。结果 随访3个月后9例因各种原因失访,最终纳入86例,其中预后良好组54例,预后不良组32例; 预后良好组和预后不良组入院时匹茨堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评分、mRS评分、总睡眠时间、睡眠效率、夜间觉醒次数、觉醒时间、快速动眼期(Rapid eye movement,REM)潜伏期、浅睡眠期(S1+S2)和深睡眠期(S3+S4)均有明显差异(P<0.05); 相关性分析显示,重症脑卒中患者mRs评分与PSQI评分(r=0.218,P=0.044)、S3+S4(r=0.218,P<0.001)、REM潜伏期(r=0.429,P<0.001)呈正相关; 与总睡眠时间(r=-0.350,P=0.001)、睡眠效率(r=-0.317,P=0.003)、快速动眼期(r=-0.422,P<0.001)呈负相关; 多元线性回归分析显示,总睡眠时间(t=2.607,P=0.011)、快速动眼期(t=-2.195,P=0.031)、REM潜伏期(t=3.450,P=0.001)、深睡眠期(S3+S4)(t=5.341,P<0.001)为重症脑卒中患者功能预后的影响因素。结论 重症脑卒中患者总睡眠时间、快速动眼期、REM潜伏期、深睡眠期(S3+S4)与功能预后存在相关性,且为功能预后的影响因素。

Sleep and wakefulness disorders in severe stroke patients and its correlation with functional prognosis

ObjectiveTo investigate sleep and wakefulness disturbances in patients with severe stroke and its correlation with functional prognosis.Methods Prospectively selected 86 patients with severe stroke(NIHSS 16～42 points)in our hospital from July 2020 to August 2021 as the research objects. According to the functional prognosis after 3 months, patients were divided into a good prognosis group(mRS 0～2 points)and a poor prognosis group(mRS 3～6 points). Collected the general data, polysomnography characteristic indexes, etc. of the two groups of patients. Pearson correlation was used to analyze the sleep and wakefulness disorders in severe stroke patients and its correlation with functional prognosis, and multiple linear regression was used to analyze the related factors affecting the functional prognosis of severe stroke patients.Results After 3 months, 9 cases were lost to follow-up due to various reasons, and 86 cases were finally included, including 54 cases in the good prognosis group and 32 cases in the poor prognosis group. The Pittsburgh Sleep Quality Index(PSQI), mRS, total sleep time, sleep efficiency, number of nighttime awakenings, wake up time, rapid eye movement period, REM latency, light sleep period(S1+S2)and deep sleep period(S3+S4)was statistically significant(P<0.05); Correlation analysis showed that the mRs score of severe stroke patients was positively correlated with PSQI score(r=0.218, P=0.044), S3+S4(r=0.218, P<0.001), and REM latency(r=0.429, P<0.001); negatively correlated with total sleep time(r=-0.350, P=0.001), sleep efficiency(r=-0.317, P=0.003), and rapid eye movement(r=-0.422, P<0.001). Multiple linear regression analysis showed: total sleep time(t=2.607, P=0.011), rapid eye movement period(t=-2.195, P=0.031), REM latency(t=3.450, P=0.001), deep sleep period(S3+S4)(t=5.341, P<0.001)were the influencing factors for the functional prognosis of severe stroke patients.Conclusion The total sleep time, rapid eye movement period, REM latency period and deep sleep period(S3+S4)in severe stroke patients were correlated with functional prognosis and were the influencing factors of functional prognosis.