急性后循环缺血性脑卒中患者睡眠状态变化与预后影响因素的研究  

Study on Sleep Status and Prognostic Factors in Patients with Acute Posterior Circulation Ischemic Stroke

作　　者：张萍淑 薛晶 邢爱君 王连辉 马倩 符永山 元小冬 ZHANG Pingshu;XUE Jing;XING Aijun;WANG Lianhui;MA Qian;FU Yongshan;YUAN Xiaodong(Department of Neurology,Kailuan General Hospital Affiliated to North China University of Science and Technology,Tangshan 063000,China;Department of Cardiology,Kailuan General Hospital Affiliated to North China University of Science and Technology,Tangshan 063000,China;Hebei Key Laboratory of Neurobiology,Tangshan 063000,China)

机构地区：[1]华北理工大学附属开滦总医院神经内科,河北省唐山市063000 [2]华北理工大学附属开滦总医院心内科,河北省唐山市063000 [3]河北省神经生物机能重点实验室,河北省唐山市063000

出　　处：《中国全科医学》2025年第5期548-553,共6页Chinese General Practice

基　　金：河北省医学科学研究课题计划项目(20201289,20231854);河北省重点研发计划项目(203777116D)。

摘　　要：背景脑卒中患者通常伴有睡眠状态紊乱失衡,这在临床治疗中极易被忽视,且目前针对睡眠状态是否对该类疾病预后产生影响的研究较少。目的探究急性后循环缺血性脑卒中患者睡眠状态变化与预后影响的因素。方法选取2019年12月—2023年12月在华北理工大学附属开滦总医院诊治的急性后循环缺血性脑卒中患者60例为病例组,根据患者出院时改良Rankin(mRS)评分,将病例组分为预后良好亚组45例,预后不良亚组15例。选取同时期无脑血管狭窄且无急性缺血性脑卒中患者52例作为对照组。收集患者一般及临床资料,比较病例组与对照组患者昼夜睡眠-觉醒节律、日间睡眠-觉醒节律、夜间睡眠-觉醒节律指标以及预后良好亚组与预后不良亚组梗死脑区分布的差异性。采用多因素Logistic回归分析探讨急性后循环缺血性脑卒中患者预后不良的影响因素。结果病例组睡眠呼吸暂停低通气指数(AHI)高于对照组(P<0.05)。病例组睡眠周期颠倒、日间睡眠增多、夜间入睡困难所占比例高于对照组(P<0.05)。病例组日间总睡眠时间、入睡后清醒时间、浅睡眠期、深睡眠期、非快速眼动(NREM)睡眠期、快速眼动(REM)睡眠期、REM睡眠期占比、深睡眠期占比高于对照组,NREM睡眠期占比、浅睡眠期占比低于对照组(P<0.05)。病例组夜间总睡眠时间、浅睡眠期、NREM睡眠期高于对照组(P<0.05)。预后不良亚组桥脑梗死占比高于预后良好亚组(P<0.05)。多因素Logistic回归分析结果显示,日间深睡眠期(OR=1.203,95%CI=1.032~1.401)、桥脑梗死(OR=16.497,95%CI=1.142~238.391)是急性后循环缺血性脑卒中预后不良的影响因素(P<0.05)。结论急性后循环缺血性脑卒中患者AHI增高,睡眠状态特征为睡眠周期颠倒、日间睡眠增多、夜间入睡困难,且日间深睡眠期、桥脑梗死是患者预后不良的影响因素。Background Patients with stroke often experience sleep disturbances and imbalances,which are easily overlooked in clinical treatment.Moreover,there is currently limited research on whether sleep status affects the prognosis of such diseases.Objective Exploration of factors influencing sleep state changes and prognosis in patients with acute posterior circulation ischemic stroke.Methods A total of 60 patients with acute posterior circulation ischemic stroke,admitted to Kailuan General Hospital Affiliated to North China University of Science and Technology,from December 2019 to December 2023,were selected as the case group.Based on the modified Rankin Scale(mRS)score at discharge,the case group was divided into a good prognosis subgroup(45 cases)and a poor prognosis subgroup(15 cases).Additionally,52 patients without cerebral vascular stenosis and acute ischemic stroke during the same period were selected as the control group.General and clinical data of the patients were collected to compare the circadian sleep-wake rhythms,daytime sleep-wake rhythms,nighttime sleep-wake rhythms,and the distribution of infarcted brain regions between the good prognosis subgroup and the poor prognosis subgroup.Multivariate Logistic regression analysis was used to identify the prognostic factors influencing the outcomes of patients with acute posterior circulation ischemic stroke.Results The apnea-hypopnea index(AHI)in the case group was higher than in the control group(P<0.05).The proportions of patients in the case group with reversed sleep cycles,increased daytime sleep,and difficulty falling asleep were higher than those in the control group,with statistically significant differences(P<0.05).The case group showed higher total daytime sleep time,wake time after sleep onset,light sleep duration,deep sleep duration,NREM sleep duration,REM sleep duration,REM sleep proportion,and deep sleep proportion compared to the control group,whereas the proportions of NREM sleep and light sleep were lower,all with statistically significant diff

关 键 词：卒中 脑梗死 后循环 睡眠状态 预后 病例对照研究 影响因素分析 

分 类 号：R743[医药卫生—神经病学与精神病学]