阻塞性睡眠呼吸暂停合并卒中对睡眠及神经认知功能的影响

doi:10.16138/j.1673-6087.2021.02.007

摘要/Abstract

摘要：

目的：回顾性分析阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）合并卒中患者的神经功能障碍、睡眠及认知功能的特征。方法：纳入2015年1月至2017年12月门诊及住院的患者共396例,年龄40~85（68.2±8.9）岁,其中卒中患者326例,单纯卒中患者[呼吸暂停低通气指数（apnea hypopnea index,AHI）<5次/h] 98例,卒中合并OSAHS患者228例, OSAHS患者70例（AHI≥5次/h）,对比分析3组患者的睡眠监测指标,包括AHI、动脉血氧饱和度（arterial oxygensaturation,SaO₂）、微觉醒指数（microarousal index,MAI）及睡眠结构等,以及简易精神状态检查（mini-mental state examination,MMSE）、美国国立卫生研究院卒中量表（National Institutes of Health stroke scale,NIHSS）、Fugl-Meyer运动功能评估（Fugl-Meyer assessment,FMA）、巴塞尔指数（Barthel index,BI）等评分。结果：MMSE、体质量指数（body mass index,BMI）及基础疾病方面3组间差异有统计学意义（均P<0.05）,OSAHS组MMSE、BMI高于其他2组（均P<0.001）;卒中合并OSAHS组合并高血压、2型糖尿病、冠心病、心房颤动（房颤）共患率更高（P<0.05）。卒中合并OSAHS组再次卒中率高于单纯卒中组（P<0.001）,但在卒中性质、病程、病变部位2组差异无统计学意义（P>0.05）。卒中合并不同严重度OSAHS组间 FMA、NIHSS、MMSE、BI及睡眠差异有统计学意义（均P<0.05）。卒中合并OSAHS组患者的AHI与MMSE呈负相关（r=-0.300,P<0.001）。结论：OSAHS合并卒中患者神经认知功能损伤严重及再次卒中率高。临床需加以重视。

关键词: 阻塞性睡眠呼吸暂停低通气综合征, 卒中, 认知, 神经功能

Abstract:

Objective To analyze the comorbidity of obstructive sleep apnea hypopnea syndrome (OSAHS) and stroke on neurological function, sleep, and cognition. Methods The cross-sectional study enrolled 396 patients from January 2015 through December 2017, including 98 with stroke only, 228 patients also complicated with OSAHS, presenting snoring and treated by the sleep center of the hospital, and 70 OSAHS patients. All groups had matched age, gender and education level, and all patients were tested by polysomnography(PSG) to obtain laboratory-based polysomnographic variables, including apnea hypopnea index(AHI), oxygen desaturation index and microarousal index, etc. The severity of stroke was assessed by National Institutes of Health Stroke Scale (NIHSS), motor function was determined with Fugl-Meyer assessment (FMA), cognitive function was evaluated based on mini-mental state examination (MMSE), and stroke-related disability was calculated with Barthel index(BI). Results The MMSE, body mass index (BMI) and status of underlying disease were significantly among groups (P<0.05). The patients with OSAHS had higher cognition and BMI (P<0.001), while higher prevalence of underlying diseases, such as hypertension, type 2 diabetes mellitus, coronary heart disease and atrial fibrillation was observed in patients with stroke patients and OSAHS (P<0.05). Comorbidity of OSAHS increased the risk of recurrence of stroke (P<0.001), however, did not affect the type, location and progression of stroke（P>0.05）. The AHI and MMSE were negatively correlated (r=-0.300, P<0.001), and the severity of OSAHS was positively correlated with the changes of FMA, NIHSS, MMSE, BI and sleep parameters in patients with the comorbidity(P<0.05). Conclusions The comorbidity of OSAHS and stoke has significantly compromised cognition, neurological impairment, motor function and daily activity of patient, and predispose higher risk of recurrent stroke.

Key words: Obstructive sleep apnea-hypopnea syndrome, Stroke, Cognition, Neurological function

中图分类号:

许磊, 许轶明, 沈宏华, 张音, 任蕾. 阻塞性睡眠呼吸暂停合并卒中对睡眠及神经认知功能的影响[J]. 内科理论与实践, 2021, 16(02): 97-102.

XU Lei, XU Yiming, SHEN Honghua, ZHANG Yin, REN Lei. The impact of comorbidity of stroke and obstructive sleep-hypopnea apnea on sleep, cognition and nerve function[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(02): 97-102.

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参考文献 31

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项目	OSAHS组(n=70)	卒中组 (n=98)	卒中合并OSAHS组(n=228)	χ²/F	P
男性[n(%)]	42（60.0）	47（48.0）	134（58.8）	3.727	0.155
年龄(岁)	67.4±7.8	69.2±11.1	68.4±8.1	0.868	0.421
BMI(kg/m²)	24.0±3.4	20.8±2.3¹⁾	21.1±2.4¹⁾	40.253	<0.001
受教育年限(年)	9.5±2.6	9.6±2.9	10.2±2.8	2.462	0.087
MMSE(分)	25.1±3.0	21.2±4.7¹⁾	20.0±5.6¹⁾	27.516	<0.001
吸烟[n(%)]	23（32.9）	36（36.7）	98（43.0）	2.756	0.252
饮酒[n(%)]	24（34.3）	25（25.5）	87（38.2）	4.862	0.088
基础疾病[n(%)]
高血压	45（64.3）	62（63.3）	190（83.3）¹⁾²⁾	19.927	<0.001
2型糖尿病	32（45.7）	46（46.9）	148（64.9）¹⁾²⁾	13.513	0.001
冠心病	36（51.4）	60（61.2）	161（70.6）¹⁾²⁾	9.426	0.009
高脂血症	29（27.1）	19（19.4）	67（29.4）	3.534	0.171
房颤	2（2.9）	5（5.1）	27（11.8）¹⁾²⁾	7.523	0.023

项目	卒中组(n=98)	OSAHS合并卒中组(n=228)	χ²	P
初次卒中	71（72.4）	89（39.0）	30.620	<0.001
再次卒中	27（27.6）	139（61.0）
卒中性质			2.639	0.267
蛛网膜下腔出血	5（5.1）	21（9.2）
脑出血	20（20.4）	56（24.6）
脑梗死	73（74.5）	151（66.2）
卒中病程			3.719	0.156
短暂性脑缺血	6（6.1）	27（11.8）
进展性卒中	23（23.5）	63（27.6）
完全性卒中	69（70.4）	138（60.5）
病变部位			8.643	0.279
脑干	2（1.6）	10（3.3）
小脑	2（1.6）	5（1.7）
间脑	5（3.9）	18（6.0）
大脑基底核	49（38.0）	138（45.8）
额叶	27（20.9）	61（20.3）
颞叶	19（14.7）	36（12.0）
顶叶	16（12.4）	19（6.3）
枕叶	9（7.0）	14（4.7）

参数	卒中合并轻度OSAHS组(n=111)	卒中合并中度OSAHS组(n=64)	卒中合并重度OSAHS组(n=53)	χ²/F	P
男性[n（%）]	63（56.8）	39（60.9）	32（60.4）	0.366	0.838
FMA（分）	56.3±10.9	52.8±10.1	49.5±11.5¹⁾	7.389	0.001
NIHSS（分）	10.1±2.8	11.1±2.6¹⁾	11.3±2.6¹⁾	4.554	0.012
BI（分）	61.0±15.0	59.2±15.0	52.8±15.6¹⁾²⁾	5.485	0.005
BMI（kg/m²）	20.9±2.3	21.0±2.4	21.5±2.4	1.257	0.286
MMSE（分）	21.7±4.7	19.3±6.2¹⁾	17.5±5.4¹⁾²⁾	11.993	<0.001
AHI（次/h）	10.6±3.0	25.7±2.2¹⁾	38.1±5.5¹⁾²⁾	1 130.111	<0.001
L-SaO₂（%）	85.1±7.1	82.4±6.7¹⁾	77.3±6.3¹⁾²⁾	24.031	<0.001
TS90（%）	2.1±1.8	2.4±1.2¹⁾	2.9±1.5¹⁾	4.604	0.011
MAI	18.5±7.8	28.7±19.3¹⁾	40.9±20.9¹⁾²⁾	39.092	<0.001
NREM 1（%）	45.7±12.0	57.0±6.2¹⁾	65.1±4.7¹⁾²⁾	84.634	<0.001
NREM 2（%）	31.7±12.4	26.8±8.1¹⁾	26.4±6.1¹⁾	7.313	0.001
NREM 3（%）	12.6±2.6	6.7±2.0¹⁾	3.6±2.2¹⁾²⁾	301.571	<0.001
REM（%）	10.0±2.5	9.6±3.9	4.9±4.0¹⁾²⁾	43.664	<0.001
ESS（分）	10.8±3.0	12.7±3.8¹⁾	18.3±3.6¹⁾²⁾	90.256	<0.001