The impact of comorbidity of stroke and obstructive sleep-hypopnea apnea on sleep, cognition and nerve function

doi:10.16138/j.1673-6087.2021.02.007

Abstract

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

CLC Number:

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.

Figures/Tables 5

References 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