急性脑卒中患者睡眠觉醒昼夜生物节律特征  

Characteristics of sleep arousal and circadian rhythm in patients with acute stroke

作　　者：张萍淑[1,2] 赵营 李鑫[1] 徐斌 王京[1] 元小冬[1,2] ZHANG Pingshu;ZHAO Ying;LI Xin(Department of Neurology,Kailuan General Hospital of Hebei,Tangshan 063000,China)

机构地区：[1]河北省开滦总医院神经内科,唐山063000 [2]河北省神经生物机能重点实验室

出　　处：《中国健康心理学杂志》2021年第11期1641-1645,共5页China Journal of Health Psychology

基　　金：2020年度河北省重点研发计划(编号:203777116D);2020年度河北省医学科学研究课题计划(编号:20201289);2020年度河北省医学适用技术跟踪项目计划(编号:GZ2020002);2019年唐山市科学技术研究与发展计划(编号:19150256E)。

摘　　要：目的:了解急性脑卒中患者睡眠觉醒的昼夜生物节律特征。方法:选择急性脑卒中患者40例,其中缺血性脑卒中23例,年龄65.4±11.0岁;出血性脑卒中17例,年龄58.6±10.2岁。患者发病72小时内应用三轴体动记录仪,连续72小时观察日间和夜间体动状态、睡眠时间、觉醒时间、睡眠效率、睡眠周期等技术参数。以72小时的每小时活动能耗评估昼夜生物节律日间稳定性(inter-daily stability,IS)和昼夜变异性(intra-daily variability,IV)。同时,体动记录仪佩戴第二日夜间,应用多导脑电监测患者夜间睡眠质量。结果:40例脑卒中患者的日间睡眠时间219.79±122.30min、日间觉醒时间500.21±122.30min、日间睡眠效率30.53±16.95%;夜间睡眠时间302.38±125.78min、夜间觉醒时间417.62±125.78min、夜间睡眠效率42.02±17.49%。日间睡眠时间>6h/d者8例(20.00%);夜间睡眠时间<5 h/d者21例(52.50%);昼夜睡眠时间>10h/d者37例(92.50%);日间睡眠>夜间睡眠时间者11例(27.50%)。脑卒中患者的IS值为0.37±0.11、IV值为1.46±0.40。其中,缺血性脑卒中IS值为0.35±0.11、IV值为1.42±0.44;出血性脑卒中IS值为0.40±0.12、IV值为1.52±0.37,IS值两组间比较无统计学差异(t=-1.259,P=0.216),IV值两组间比较无统计学差异(t=-0.745,P=0.461)。多导脑电睡眠监测,夜间清醒期59.02±20.94%、N1期睡眠9.46±10.03%、N2期睡眠30.30±21.46%、N3期睡眠1.15±3.87%、夜间睡眠效率40.92±20.99%。结论:急性脑卒中患者的基本生物节律仍以24小时类型为主,但其日间稳定性较差,昼夜变异性较大。睡眠~觉醒昼夜节律明显异常,主要表现为以日间睡眠增多和夜间睡眠减少、睡眠质量降低为主要类型的睡眠~觉醒节律障碍。Objective:To understand the circadian rhythm characteristics of sleep arousal in patients with acute stroke.Methods:Forty patients with acute stroke were selected,including 23 cases of ischemic stroke,aged 65.4±11.0 years;17 cases of hemorrhagic stroke,aged 58.6±10.2 years.The patient was subjected to a triaxial body motion recorder within 72 hours of onset,and the technical parameters such as daytime and nighttime body motion,sleep time,wakefulness time,sleep efficiency,and sleep cycle were observed for 72 hours.The inter-daily stability(IS)and intra-daily variability(IV)were evaluated for energy consumption per hour of activity at 72 hours.At the same time,the body motion recorder was worn on the second day of the night,and the multi-channel EEG was used to monitor the sleep quality of the patients at night.Results:Daytime sleep time of 40 stroke patients was(219.79±122.30)min,daytime awakening time was(500.21±122.30)min,daytime sleep efficiency was(30.53±16.95)%;Nighttime sleep time was(302.38±125.78)min,nighttime awakening time was(417.62±125.78)min,nighttime sleep efficiencywas(42.02±17.49)%.There were 8 cases(20.00%)with daytime sleep time>6 h/d,21 cases(52.50%)with nighttime sleep time<5 h/d,37 cases(92.50%)with day and night sleep time>10 h/d,daytime sleeP>11 cases(27.50%)of nighttime sleep time.The IS value of stroke patients was(0.37±0.11)and the IV value was(1.46±0.40).Among them,the IS value of ischemic stroke was(0.35±0.11),the IV value was(1.42±0.44);The IS value of hemorrhagic stroke was(0.40±0.12),and the IV value was(1.52±0.37),there was no significant difference in the IS value between the two groups(P>0.05),and there was no significant difference in the IV value between two groups(P>0.05).Multi-conducting EEG sleep monitoring showed night waking period(59.02±20.94)%,N1 stage sleep(9.46±10.03)%,N2 stage sleep(30.30±21.46)%,N3 stage sleep(1.15±3.87)%,nighttime sleep efficiency(40.92±20.99)%.Conclusion:The basic biological rhythm of patients with acute stroke is still mainly in

关 键 词：脑卒中 昼夜节律 睡眠 觉醒 睡眠质量 

分 类 号：R749.92[医药卫生—神经病学与精神病学]