阻塞性睡眠呼吸紊乱对脑梗死患者脑微出血的影响

Impact of obstructive sleep apnea-hypopnea syndrome on cerebral microbleeds in patients with cerebral infarction

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对脑梗死患者脑微出血的影响。方法连续选取经磁敏感加权成像(SWI)检查显示为脑微出血的急性脑梗死患者行睡眠多导图(PSG)检查,比较非OSAHS患者和OSAHS患者脑微出血的临床及影像学特征。结果入选49名患者,其中脑梗死合并OSAHS者27人(55.1%),脑梗死未合并OSAHS组22人(44.9%)。危险因素比较显示OSAHS组高血压、吸烟史和既往卒中史明显高于非OSAHS组,而且临床下卒中OSAHS组为37.0%(10/27),非OSAHS组为9.0%(2/22)。影像学研究显示OSAHS组微出血病灶77.8%分布在皮质-皮质下区,55.6%在基底节区,幕下区为25.9%;非OSAHS组皮质-皮质下区为50.0%、基底节区为40.9%、幕下区为50.0%,(P<0.05);脑梗死病因分型分析显示OSAHS组40.7%患者合并脑白质疏松,48.1%的患者为≥2个病因,而非OSAHS组合并脑白质疏松为13.6%,≥2个病因的为18.2%(P<0.05)。结论 OSAHS可能是脑微出血的危险因素。脑梗死合并OSAHS者的脑微出血病灶更多、更广,病因更复杂,卒中再发几率高。

Objective To investigate the impact of obstructive sleep apnea-hypopnea syndrome （OSAHS） on cerebral microbleeds （CMBs） in patients with cerebral infarction. Methods Consecutive patients with acute cerebral infarction who had cerebral microbleeds shown by susceptibility-weighted imaging （SWI） were enrolled to undergo polysomnography （PSG）. The patients were divided into two groups, namely non-OSAHS group with apnea-hypopnea index （AHI） less than 5 and OSAHS group with greater AHI, and the clinical and radiological features of cerebral microbleeds were compared between them. Results Forty-nine patients were enrolled in this study, including 27 （55.1%） with both cerebral infarction and OSAHS and 22 （44.9%） with cerebral infarction but not OSAHS. A comparison of the risk factors showed that hypertension, a smoking histor~ and a history of stroke were more prevalent in patients with OSAHS than in those without OSAHS （P〈0.05）. The incidences of subclinical stroke in OSAHS and non-OSAHS patients were 37.0% （10/27） and 9.0% （2/22） （P〈0.05）, respectively. Neurological imaging revealed a greater number of cerebral microbleeds in OSAHS group than in non-OSAHS group （P〈0.05）. In OSAHS patients, 77.8% of the microbleeds were distributed in cortical-subcortical areas, 55.6% in the basal ganglia area, and 25.9% in the infratentorial area, as compared to the percentages of 50.0%, 40.9% ＂and 50.0% in non-OSAHS patients, respectively （P〈 0.05）. In OSAHS patients, 40.7% also had leukoaraiosis, and 48.1% had two or more causes, as compared to the percentages of 13.6% and 18.2% in non-OSAHS patients, respectively （P〈0.05）. Conclusions OSAHS can be a risk factor for cerebral microbleeds. Patients with both cerebral infarction and OSAHS tend to have greater and more extensive lesions of cerebral microbleeds, more complicated cause of the disease, and a grater likeliness of stroke recurrence.