轻度脑卒中急性期睡眠障碍影响因素和失眠者药物干预的疗效分析

Influential factors of sleep disorders in acute stage of mild stroke and efficacy analysis of drug intervention for insomniacs

目的分析初发、轻度脑卒中患者急性期睡眠障碍的临床特点及影响因素,并观察药物干预对卒中后失眠患者的疗效。方法纳入脑卒中患者226例,采用匹兹堡睡眠质量指数(PSQI)、神经功能缺损程度评分(NDS)、改良Barthel指数(MBI)、汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)进行测评,并以PSQI量表总分>7分作为判断睡眠障碍的标准。分析卒中患者睡眠障碍的发生类型及特点;分析睡眠障碍在不同类型的卒中患者中发生率的差异,筛选影响因素;分析睡眠障碍患者与非障碍患者各量表评分的差异;分别在治疗前(脑卒中发病后1周内)及治疗后2周对睡眠障碍患者中的57例失眠者(出血性卒中14例、缺血性卒中43例)进行量表评分,分析治疗前后的差异。结果在226例患者中,99例(43.81%)发生睡眠障碍:出血性卒中患者以睡眠过多为主,缺血性卒中患者以不同形式的失眠居多。轻度脑卒中患者急性期睡眠障碍的发生率与性别、年龄、卒中部位、临床神经功能缺损程度、日常生活能力、精神状态(有无焦虑或抑郁)关系密切。与非睡眠障碍患者比较,睡眠障碍患者的神经功能缺损程度以及焦虑、抑郁程度较高(P<0.05),日常生活能力较低(P<0.05)。与治疗前比较,早期经药物干预的卒中后失眠患者的神经功能及精神状态明显改善,日常生活能力提高,睡眠状况明显改善(P<0.05)。结论初发、轻度脑卒中患者急性期睡眠障碍的发生率较高,影响因素包括性别、年龄、卒中部位、临床神经功能缺损程度、日常生活能力、精神状态。急性期积极的治疗有助于恢复失眠患者的神经功能,提高生活质量。

Objective To explore the clinical features and influential factors for the post-stroke sleep disorders in patients with incipient or mild stroke in the acute stage,and examine the effects of drug intervention for insomniacs post-stroke.MethodsTwo hundred and twenty-six patients with stroke were recruited.Pittsburgh Sleep Quality Index （PSQI）,Nerve Function Deficit Score （NDS）,Modified Barthel Index （MBI）,Hamilton Depression Scale （HAMD） and Hamilton Anxiety Scale （HAMA） were used to evaluate sleep disorders of the enrolled patients.Sleep disorder was defined as PSQI scores were higher than 7.The types and features of sleep disorders in post-stroke patients were reviewed.Influential factors were differentially analyzed respect to the incidence of sleep disorders among different populations with stroke.The differences of scores evaluated by each scale were compared between patients with or without sleep disorders.Moreover,57 insomniacs with sleep disorders were further selected and evaluated with each and every scale,and the obtained scores were recorded pre-treatment （within 1 week post-stroke） and 2 weeks post-treatment and then compared.ResultsSleep disorders,which occurred in 99 out of 226 patients （43.8%）,featured as hypersomnia in patients with hemorrhage stroke,whereas insomnia in patients with ischemic stroke.The incidence of sleep disorders in the patients with mild stroke in acute stage was closely associated with gender,age,stroke location,neurologic impairment,activity of daily living and mental status （with or without anxiety or depression）.Severer neurologic impairment and depression and lower activity of daily living were found in the patients with sleep disorders compared to those without sleep disorders （P0.05）.After early drug intervention,obvious amelioration was found in the post-stroke insomniacs on neurologic function,mental status,activity of daily living and sleep quality （P0.05）.ConclusionsThe incidence of sleep disorders is higher in patients with primary and mild stroke at acute stage.The main factors influencing the incidence are gender,age,stroke site,extent of neurologic impairment,activity of daily living and mental status.Active therapy in acute stage of stroke may be beneficial to recovery of neurologic function and improvement of life quality.