Relationship between sleep-wake biorhythm and prognosis in patients with acute ischemic stroke

doi:10.11958/20231431

Abstract

Abstract:

Objective To investigate the relationship between circadian sleep-wake biorhythm and prognosis in patients with middle cerebral artery acute ischemic stroke. Methods A total of 71 patients with acute ischemic stroke of middle cerebral artery were selected as the case group，and 67 patients without acute ischemic stroke and cerebrovascular stenosis were selected as the control group. According to the modified Rankin score at discharge, patients with acute ischemic stroke were subdivided into the good prognosis group (53 cases) and the poor prognosis group (18 cases). General clinical data of patients were collected, and differences of circadian rhythm, daytime sleep-wake rhythm, nighttime sleep-wake rhythm and circadian sleep-wake rhythm indexes were analyzed and compared between the two groups. Multivariate Logistic stepwise regression analysis was used to analyze prognostic factors of acute ischemic stroke in middle cerebral artery. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of relevant variables. Results Age, male ratio, hypertension, diabetes, hyperlipidemia, smoking and drinking history were significantly higher in the case group than those in the control group. Daytime stability (IS) in the case group was lower than that in the control group (P<0.05). Daytime total sleep time, wake time after falling asleep, light sleep period, deep sleep period, non-rapid eye movement (NREM) sleep period, rapid eye movement (REM) sleep period and the proportion of deep sleep period, the proportion of REM sleep period were higher in the case group than those of the control group, while the REM sleep latency and the proportion of light sleep period were lower than those of the control group (P<0.05). The total sleep time, wake time, light sleep period, NREM sleep period and REM sleep period were higher in the case group than those of control group, while the proportion of sleep latency and REM sleep period were lower than those of the control group (P<0.05). The proportion of increased circadian sleep, increased daytime sleep and low sleep efficiency at night were higher in the case group than those of the control group (P<0.05). Logistic stepwise regression analysis showed that daytime REM sleep was a prognistic factor in middle cerebral artery acute ischemic stroke. During daytime REM sleep, the area under ROC curve (AUC) was 0.705, the sensitivity was 0.811 and the specificity was 0.611. Conclusion After acute ischemic stroke of middle cerebral artery, the circadian sleep-wake rhythm is unbalanced, which is manifested as poor daytime stability, increased daytime sleep, increased circadian sleep and low sleep efficiency at night. Daytime REM sleep has predictive value for prognosis of acute ischemic stroke of middle cerebral artery.

Key words: middle cerebral artery, stroke, sleep disorders, circadian rhythm, biorhythm, prognosis

CLC Number:

R743.3

Figures/Tables 7

References 24

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组别	n		年龄/岁			男性		BMI/（kg/m²）
对照组	67		59.00（55.00，64.00）			29（38.2）		24.52（22.43，25.78）
病例组	71		68.00（60.00，73.00）			47（66.2）		24.77（23.12，26.08）
Z或χ²			5.577^＊＊			7.315^＊＊		0.716
组别		高血压		糖尿病	高脂血症		吸烟		饮酒
对照组		28（41.8）		7（10.4）	3（4.5）		20（29.9）		16（23.9）
病例组		58（81.7）		39（54.9）	11（15.5）		33（46.5）		29（40.8）
Z或χ²		25.245^＊＊		30.692^＊＊	4.588^＊		4.029^＊		4.514^＊

组别	n		年龄/岁			男性		BMI/（kg/m²）
对照组	67		59.00（55.00，64.00）			29（38.2）		24.52（22.43，25.78）
病例组	71		68.00（60.00，73.00）			47（66.2）		24.77（23.12，26.08）
Z或χ²			5.577^＊＊			7.315^＊＊		0.716
组别		高血压		糖尿病	高脂血症		吸烟		饮酒
对照组		28（41.8）		7（10.4）	3（4.5）		20（29.9）		16（23.9）
病例组		58（81.7）		39（54.9）	11（15.5）		33（46.5）		29（40.8）
Z或χ²		25.245^＊＊		30.692^＊＊	4.588^＊		4.029^＊		4.514^＊

组别	n	IS	IV
对照组	67	0.49（0.35，0.67）	0.81（0.66，0.92）
病例组	71	0.40（0.24，0.62）	0.76（0.66，0.88）
Z		2.655^＊＊	0.833

组别	n	IS	IV
对照组	67	0.49（0.35，0.67）	0.81（0.66，0.92）
病例组	71	0.40（0.24，0.62）	0.76（0.66，0.88）
Z		2.655^＊＊	0.833

组别	n		日间总睡眠时间/min		入睡潜伏期/min	REM睡眠潜伏期/min			入睡后清醒时间/min		浅睡眠期/min		深睡眠期/min
对照组	67		221.00（161.60，294.60）		4.20（2.40，8.00）	49.80（28.20，62.40）			65.80（45.60，86.60）		183.29±77.10		10.40（5.80，15.00）
病例组	71		333.80（280.00，453.00）		3.80（1.00，8.60）	35.80（24.40，47.40）			77.80（62.20，101.00）		250.32±87.24		16.80（10.00，27.60）
Z或t			6.518^＊＊		0.094	2.818^＊＊			2.927^＊＊		4.772^＊＊		4.035^＊＊
组别		NREM睡眠期/min		REM睡眠期/min			浅睡眠期占比/%	深睡眠期占比/%		REM睡眠期占比/%		睡眠效率/%
对照组		177.80（141.40，241.00）		33.00（20.80，51.00）			80.81（75.85，84.44）	4.39（2.57，5.96）		15.79（10.80，18.06）		78.12（74.85，82.48）
病例组		264.20（204.80，348.00）		55.80（40.60，100.60）			76.75（72.17，81.51）	5.13（3.63，7.19）		18.53（15.02，22.09）		80.70（72.87，85.90）
Z或t		4.663^＊＊		4.708^＊＊			3.129^＊＊	2.448^＊		3.990^＊＊		1.553