[Effect of obstructive sleep apnea on sleep architecture of acute ischemic stroke patients].

Objective: To investigate the effect of obstructive sleep apnea (OSA) on sleep architecture in acute ischemic stroke (AIS) patients. Methods: Seventy AIS patients with polysomnography examination from June 2014 to April 2016 were included in the Second Affiliated Hospital of Soochow University. Twenty-seven healthy controls during the same period were chosen as control group. According to apnea-hypopnea index (AHI), AIS patients were divided into AIS group (AHI<5/h) and AIS+ OSA group (AHI≥5/h). Their general conditions, Neurological function defect (national institutes of health stroke scale, NIHSS) on admission and at discharge and self-care ability (modified Rankin Scale, mRS) at discharge and 3 months later (mRS score <2 reflected good prognosis, and mRS score≥2 reflected unfavorable prognosis) were collected. Results: Fifty-two patients (74.3%) had OSA in total seventy AIS patients. Total sleep time (TST) was significantly shorter and sleep efficiency (SE) was lower in AIS group than the control group (P=0.007, 0.008, respectively). AIS+ OSA group had longer non-rapid eye movement (NREM)1 than control group [24.9(21.3) vs 14.3(10.6), P=0.044]. Compared with AIS group, AIS+ OSA group had shorter NREM3 [13.0(13.2) vs 19.6(12.8), P=0.039]. There was no significant difference between the infarct location of AIS group and AIS+ OSA group. However, AIS+ OSA group had higher mRS score observed at 3 months through follow-up visit than AIS group (P=0.027). Spearman correlation analysis showed a positive correlation between unfavorable prognosis of stroke at 3 months and atrial fibrillation, the oxygen desaturation index (ODI), percentage of oxygen saturation <90% of total recording time (TS90%), AHI, the longest time of apnea and hypopnea, respiratory related microarousal and NIHSS, while a negative correlation between unfavorable prognosis of stroke and NREM3, lowest nocturnal oxygen saturation (L-SaO(2)). On Logistic analysis, the unfavorable prognosis was independently predicted by AHI and NIHSS. Conclusions: Sleep architecture of cerebral infarction patients are disturbed with its characteristic of shorter total sleep time and lower sleep efficiency. Cerebral infarction patients with OSA have longer NREM1 and shorter NREM3.目的： 探讨阻塞性睡眠呼吸暂停(OSA)对急性脑梗死患者睡眠结构的影响。 方法： 收集2014年6月至2016年4月苏州大学附属第二医院收治的首次发作且行多导睡眠监测(PSG)的急性脑梗死患者70例，选取同时间段内完成PSG的健康人27名作为对照组。根据睡眠呼吸暂停低通气指数(AHI)将70例脑梗死患者分成2组：单纯脑梗死组(AHI<5次/h)和脑梗死合并OSA组(AHI≥5次/h)。对所有研究对象进行一般情况、睡眠参数方面的检测。并应用美国国立卫生研究院卒中量表(NIHSS)评价脑梗死患者入院当天、出院时神经功能缺损程度，采用改良Rankin量表(mRS)对脑梗死患者出院及出院3个月时的预后进行评估(mRS评分<2分为预后良好，mRS评分≥2分为预后较差)。 结果： 70例患者中单纯脑梗死组18例(25.7%)，脑梗死合并OSA组52例(74.3%)。单纯脑梗死组患者总睡眠时间、睡眠效率显著低于对照组(P＝0.007、0.008)，脑梗死合并OSA组非快眼动(NREM)1期睡眠比例显著高于对照组[24.9(21.3)比14.3(10.6)，P＝0.044]，NREM3期睡眠比例显著低于单纯脑梗死组[13.0(13.2)比19.6(12.8)，P＝0.039]，单纯脑梗死组与脑梗死合并OSA组之间脑梗死部位(皮质、皮质下、脑干、小脑)差异无统计学意义(P>0.05)，脑梗死合并OSA组出院后3个月时mRS评分显著高于单纯脑梗死组(P＝0.027)。在脑梗死患者中，Spearman等级相关分析提示出院3个月时更差的预后与房颤、氧减指数、血氧饱和度<90%比例、AHI、最长呼吸暂停时间、呼吸相关微觉醒次数、NIHSS评分呈正相关，与NREM3期睡眠比例、最低动脉血氧饱和度呈负相关。Logistic回归提示AHI、NIHSS评分是脑梗死患者预后的重要影响因素。 结论： 存在OSA的急性脑梗死患者存在明显的睡眠结构变化，患者总睡眠时间减少、睡眠效率降低、合并OSA时浅睡眠1期延长、深睡眠缩短。.