脑卒中后昼间嗜睡与患者睡眠呼吸障碍的相关性研究

doi:10.11958/20230247

摘要/Abstract

摘要：

目的探讨脑卒中后昼间嗜睡（EDS）与患者睡眠呼吸障碍的相关性。方法 148例脑卒中患者依据Epworth嗜睡量表（ESS）分为EDS组（ESS>7分）69例和非EDS组（ESS≤7分）79例。比较2组患者的一般资料、血液生化及多导睡眠呼吸监测（PSG）相关指标，Spearman相关分析脑卒中后EDS与SDB发病率的相关性，二元多因素Logistic回归分析脑卒中后EDS的影响因素。结果 EDS组男性比例、低通气指数（AHI）、氧减指数（ODI）、N1睡眠期比例、夜间平均舒张压高于非EDS组（P<0.05）；卒中患者EDS和SDB的发病呈正相关性（r_s=0.225，P<0.05）；二元多因素Logistic回归分析结果显示，男性（OR=2.768，95%CI：1.133~6.765）、高AHI值（OR=1.048，95%CI：1.023~1.074）和夜间平均舒张压升高（OR=1.035，95%CI：1.001~1.071）是卒中后EDS的独立危险因素。结论男性、高AHI及夜间平均舒张压升高是脑卒中后EDS的独立危险因素。

关键词: 脑卒中, 睡眠呼吸暂停综合征, 影响因素, 昼间嗜睡, 多导睡眠呼吸监测

Abstract:

Objective To explore the correlation between excessive daytime sleepiness (EDS) and sleep disordered breathing after stroke. Methods A total of 148 patients with stroke were divided into the EDS group (ESS>7, n=69) and the non-EDS group (ESS≤7, n=79) according to Epworth Sleepiness Scale (ESS). The general data, blood biochemistry and polysomnography (PSG) parameters were compared between the two groups of patients. The correlation between EDS and SDB incidence rate after stroke was analyzed by spearman test. Multivariate Logistic regression analysis was applied for influencing factors of EDS after stroke. Results There were higher proportion of males, hypoventilation index (AHI), oxygen reduction index (ODI), proportion of N1 sleep period and average nighttime diastolic blood pressure in the EDS group than those of the non-EDS group (P<0.05). There was a positive correlation between the incidence rate of EDS and SDB in stroke patients (r_s=0.225, P<0.05). Multivariate Logistic regression analysis revealed that gender (OR=2.768, 95%CI: 1.133-6.765), high AHI (OR=1.048, 95%CI: 1.023-1.074) and high average nighttime diastolic blood pressure (OR=1.035, 95%CI: 1.001-1.071) were the independent risk factors for EDS after stroke. Conclusion Male, higher AHI and high average nighttime diastolic blood pressure are independent risk factors for EDS after stroke.

Key words: stroke, sleep apnea syndromes, root cause, sleepiness during the day, multichannel sleep breathing monitoring

中图分类号:

R743.33

图/表 7

参考文献 22

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组别	n		年龄/岁	男性		缺血性卒中
EDS组	69		60.39±11.86	60（86.9）		60（86.9）
非EDS组	79		60.18±10.39	52（65.8）		71（89.9）
t或χ²			0.117	8.937^＊＊		0.308
组别		卒中病程/d			BMI/（kg/m²）
EDS组		16.00（7.00，65.00）			26.92±4.49
非EDS组		15.00（3.00，31.00）			26.15±4.04
t或Z		1.508			1.089

组别	n		年龄/岁	男性		缺血性卒中
EDS组	69		60.39±11.86	60（86.9）		60（86.9）
非EDS组	79		60.18±10.39	52（65.8）		71（89.9）
t或χ²			0.117	8.937^＊＊		0.308
组别		卒中病程/d			BMI/（kg/m²）
EDS组		16.00（7.00，65.00）			26.92±4.49
非EDS组		15.00（3.00，31.00）			26.15±4.04
t或Z		1.508			1.089

组别		n	TC/（mmol/L）		TG/（mmol/L）
EDS组		69	3.82±1.18		1.38（2.24，1.05）
非EDS组		79	3.99±1.21		1.39（1.06，2.04）
t或Z			0.854		0.375
组别	LDL-C/（mmol/L）			HDL-C/（mmol/L）
EDS组	2.19（1.68，2.70）			1.08±0.33
非EDS组	2.08（1.65，2.82）			1.10±0.27
t或Z	0.361			0.513

组别		n	TC/（mmol/L）		TG/（mmol/L）
EDS组		69	3.82±1.18		1.38（2.24，1.05）
非EDS组		79	3.99±1.21		1.39（1.06，2.04）
t或Z			0.854		0.375
组别	LDL-C/（mmol/L）			HDL-C/（mmol/L）
EDS组	2.19（1.68，2.70）			1.08±0.33
非EDS组	2.08（1.65，2.82）			1.10±0.27
t或Z	0.361			0.513

组别	n	合并高血压	高血压病程/年	夜间平均收缩压/mmHg	夜间平均舒张压/mmHg
EDS组	69	54（78.3）	8.00（0.54，10.00）	132.39±18.97	84.51±10.57
非EDS组	79	63（79.7）	6.50（3.00，10.00）	128.87±21.89	80.10±11.73
t或Z		0.049	0.344	1.037	2.406^＊