急性脑梗死患者体位性阻塞性睡眠呼吸暂停的研究

High prevalence of positional OSA in sleep breathing disordered with ischemic stroke

目的探讨急性脑梗死患者体位性阴塞性睡眠呼吸暂停(OSA)的发病情况及特点。方法对122例急性脑梗死患者行头部MRI检查、NIHSS评分、多导睡眠图检查,然后:将其中所有伴OSA的患者,分为体位性患者(positional patients,PP)与非体位患者(non-positional patients,NPP)两组,比较两组一般情况及脑梗死高危因素的差异;针对所有伴OSA的患者,建立性别、年龄、通气指数(AHI)、BMI相匹配的由不伴发脑梗死的OSA患者组成的对照组,比较两组体位性患者(PP)发生率的差异;将脑梗死后伴发了OSA的患者按照卒中次数、梗死灶位置、梗死灶类型、NIHSS分值分别进行分组,相应地比较各组间PP发生率、及其他睡眠呼吸情况。结果在122例脑梗死患者中有72例(59.0%)伴发有OSA,其中PP较非体位性患者(NPP)的BMI更小(P=0.047)。在性别、年龄、AHI、BMI相匹配的情况下,伴发于脑梗死的OSA患者PP发生率更高(P=0.035)。其中,非腔隙性较腔隙性梗死患者PP发生率高(P=0.047),且多见仰卧位睡眠(P=0.001),NIHSS分值≥7分较NIHSS分值<7分的患者PP发生率高(P=0.034),亦更见表现或出现仰卧位睡眠(P=0.012)。结论与不伴发脑梗死的OSA相比,伴发于脑梗死的OSA患者更可能成为PP,且梗死程度越重这种可能性越大。

Objective To explore prevalence of positional patients（PP）in the OSA patients with and without ischemic stroke.Methods 122 patients with acute ischemic stroke had completed cranial MRI,NIHSS,polysomnography examination.Those patients with OSA were divided into positional patients（PP）and non-positional patients（NPP）.Two groups＇ gender,age,BMI,AHI and risk factors for ischemic stroke were compared.A contral group was comprised by OSA patients without ischemic stroke whose gender,age,AHI and BMI was similar to ones of OSA patients with ischemic stroke.The two groups＇ the prevalence of PP were compared.OSA patients with ischemic stroke were divided into groupes according to the stroke history,infarct location,infarct type and NIHSS,then relevant groups＇ the prevalence of PP were compared.Results In 122 patients with ischemic stroke,72 patients（59.0%）were associated with OSA.In the 72 OSA patients with ischemic stroke,PP＇s BMI was less than ones of NPP.Two groups＇ gender,age,AHI and risk factors for cerebral infarction were not strikingly different.The prevalence of PP was higher in OSA patients with ischemic stroke than in those without ischemic stroke,if two groups＇ gender,age,AHI and BMI were similar.In the OSA patients with ischemic stroke,the prevalence of PP in the non-lacunar group were higher than in the lacunar group（P=0.047）,the prevalence of PP in those patients whose NIHSS was equal or great than 7 were higher than in those whose NIHSS was less than 7（P=0.034）.Conclusion The OSA patients with ischemic stroke are more likely PP than those without ischemic stroke.The infarction is more severe,the likelihood is greater.