摘要
目的探讨大脑中动脉急性缺血性脑卒中患者昼夜睡眠-觉醒生物节律变化与预后的关系。方法选取大脑中动脉急性缺血性脑卒中患者71例为病例组,根据患者出院时改良Rankin评分,将其分为预后良好组(53例)和预后不良组(18例)。另纳入同期无急性缺血性脑卒中且无脑血管狭窄者67例作为对照组。收集患者一般资料,比较2组昼夜生物节律、日间睡眠-觉醒节律、夜间睡眠-觉醒节律、昼夜睡眠-觉醒节律指标的差异。多因素Logistic逐步回归分析大脑中动脉急性缺血性脑卒中预后的影响因素。受试者工作特征(ROC)曲线分析相关变量的预测价值。结果病例组年龄、男性、高血压、糖尿病、高脂血症、吸烟及饮酒史比例均高于对照组。病例组日间稳定性低于对照组(P<0.05)。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)睡眠期及深睡眠期占比、REM睡眠期占比均高于对照组,而REM睡眠潜伏期、浅睡眠期占比低于对照组(P<0.05)。夜间总睡眠时间、入睡后清醒时间、浅睡眠期、NREM睡眠期、REM睡眠期高于对照组,而入睡潜伏期、REM睡眠期占比低于对照组(P<0.05)。昼夜睡眠增多、日间睡眠增多、夜间睡眠效率低下比例高于对照组(P<0.05)。Logistic回归分析显示日间REM睡眠潜伏期是大脑中动脉急性缺血性脑卒中预后的影响因素。日间REM睡眠期ROC曲线下面积(AUC)为0.705,敏感度为0.811,特异度为0.611。结论大脑中动脉急性缺血性脑卒中后昼夜睡眠-觉醒节律呈失平衡状态,表现为日间稳定性差,日间睡眠增多,昼夜睡眠增多,夜间睡眠效率低下,日间REM睡眠期对大脑中动脉急性缺血性脑卒中预后有预测价值。
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 sle
作者
薛晶
元小冬
邢爱君
王连辉
马倩
符永山
张萍淑
XUE Jing;YUAN Xiaodong;XING Aijun;WANG Lianhui;MA Qian;FU Yongshan;ZHANG Pingshu(Department of Neurology,Kailuan General Hospital Affiliated to North China University of Science and Technology,Tangshan 063000,China;Hebei Key Laboratory of Neurobiology;Department of Cardiology,Kailuan General Hospital Affiliated to North China University of Science and Technology)
出处
《天津医药》
CAS
2024年第6期614-619,共6页
Tianjin Medical Journal
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)。
关键词
大脑中动脉
卒中
睡眠障碍
昼夜节律性
生物节律
预后
middle cerebral artery
stroke
sleep disorders,circadian rhythm
biorhythm
prognosis
