急性脑梗死患者的睡眠障碍研究

Research on sleep disorders in patients with acute cerebral infarction

目的观察急性脑梗死患者睡眠障碍特点。方法选择首次发作的急性脑梗死患者101例(脑梗死组),以本院非脑梗死患者86例为对照,采用匹兹堡睡眠质量指数(PSQI)及爱泼沃斯嗜睡量表(ESS)进行睡眠量表评估,并行多导睡眠监测,观察总睡眠时间(TST)、睡眠效率(SE),第一、二、三及四期睡眠(S1、S2、S3及S4,S3+S4为深睡眠时间)、快速眼动睡眠时间(REM)、觉醒期时间(WASO)、睡眠潜伏期时间(SL)及快动眼睡眠潜伏期(RL)等情况。S1、S2、S3+S4、REM及WASO分别记录为占总睡眠时间的百分数。分析脑梗死患者睡眠障碍的发病率及特点,并比较脑梗死患者中,不同性别患者,不同大脑半球梗死患者,前、后循环梗死患者,以及丘脑和其他非丘脑部位梗死患者睡眠障碍情况。结果 (1)脑梗死组睡眠障碍的发生率〔77.23%(78/101)〕高于对照组〔27.91%(24/86);t=6.31,P=0.00〕。脑梗死组睡眠呼吸紊乱比例〔65.35%(66/101)〕高于对照组〔11.62%(10/86);t=36.50,P=0.00〕。(2)脑梗死组患者TST为(31.07±91.33)min,S1为(14.70±14.59)%,S3+S4为(10.30±7.30)%,PSQI为(9.10±4.80),均少于对照组〔分别为TST(421.00±100.70)min、S1(24.07±19.12)%、S3+S4(11.40±6.70)%、PSQI(14.70±5.90),均P<0.05〕;脑梗死组WASO为(19.55±22.96)%,ESS为(6.30±5.20),REM为(59.51±49.31)%,SL(46.80±34.60)min,RL为(136.00±87.30)min,均多于对照组〔分别为WASO(6.92±14.05)%、ESS(1.00±1.60)、REM(38.39±52.02)%,SL(31.30±30.60)min,RL(114.00±75.30)min,均P<0.05〕。(3)女性患者TST为(262.50±87.00)min,REM为(11.90±12.07)%,SL为(11.00±5.30)min,均少于男性〔分别为TST(328.00±104.80)min、REM(13.60±10.06)%、SL(35.00±11.20)min,均P<0.05〕;女性患者S1为(15.70±13.70)%,RL(83.00±12.60)min,均多于男性〔分别为S1(7.90±9.30)%和RL(22.00±7.90)%,均P<0.01〕。(4)左侧半球梗死者S1为(16.80±16.44)%,ESS为(7.41±6.50),均多于右侧半球梗死者〔分别为S1(10.29±9.39)%、ESS(4.85±4.09),均P<0.05〕。(5)前循环梗死组患者S3+S4、REM〔分别为(17.36±14.57)%、(9.22±1.68)%〕亦均较后循环梗死组〔分别为(32.11±17.89)%、(16.36±13.66)%〕减少(均P<0.05)。(6)丘脑组S2〔(32.56±18.70)%〕、SL〔(10.30±4.98)min〕均低于非丘脑梗死组〔分别为(40.39±13.94)%和(23.76±10.73)min〕,丘脑组S3+S4〔(46.03±27.01)%〕高于非丘脑组〔(41.25±17.61)%〕(均P<0.05)。结论急性脑梗死患者睡眠障碍发生率高,可出现多种类型的睡眠障碍及睡眠结构紊乱,且不同性别、不同梗死部位患者睡眠障碍情况存在差异。

Objective To investigate the incidence and characteristic of sleep disorders（SD）in patients with acute cerebral infarction.Methods One hundred and one first-episode patients with acute cerebral infarction were selected as the experimental group,86 patients without cerebral infarction were selected as the control group.Pittsburgh Sleep Quality Index（PSQI）and Epworth Sleepiness Scale（ESS）were adopted to evaluate sleep quality.total sleep time（TST）,sleep efficiency（SE）,the first,second,third and fourth stages sleep（S1,S2,S3 and S4,S3＋S4were deep sleep time）,rapid eye movement（REM）sleep time,wake after sleep onset（WASO）,sleep latency（SL）,rapid eye movement latency（RL）were observed by polysomnography（PSG）.S1、S2、S3＋S4、REM and WASO were recorded as percentage of TST respectively.The incidence and characteristics of sleep disorders in patients with cerebral infarction were analyzed.The sleep disorders status of patients with different gender,different cerebral hemispheres infarction,anterior and posterior circulation infarction and thalamic infarction or infarctions in other positions were compared.Results（1）The incidence rate of SD in the experimental group [77.23%（78/101）]was higher than that of the control group [27.91%（24/86）;t=6.31,P=0.00].Proportion of respiratory disorder in the experimental group 〔65.35 %（66/101）〕was higher than that of the control group [11.62%（10/86）;t=36.5,P=0.00].（2）TST,S1,S3＋S4and PSQI of patients in the experimental group [（31.07±91.33）min,（14.70±14.59）%,（10.30±7.30）% and（9.10±4.80）,respectively]were lower than those in the control group [（421.00±100.70）min,（24.07±19.12）%,（11.40±6.70）% and（14.70±5.90）,P〈0.05,respectively].WASO,ESS,REM,SL and RL of patients in the experimental group [（19.55±22.96）%,（6.30±5.20）,（59.51±49.31）%,（46.80±34.60）min and（136.00±87.30）min]were higher than those of the control group [（6.92±14.05）%,（1.00±1.60）,（38.39±52.02）%,（31.30±30.60）min and（114.00±75.30）min,P〈0.05,respectively].（3）TST,REM and SL of the female patients [（262.50±87.00）min,（11.90±12.07）% and（11.00±5.30）min]were lower than those of the male patients [（328.00±104.80）min,（13.60±10.06）% and（35.00±11.20）min,P〈0.05,respectively].S1 and RL of the female patients [（15.70±13.70）% and（83.00±12.60）min]were higher than those of the male patients [（7.90±9.30）% and（22.00±7.90）%,P〈0.01,respectively].（4）S1and ESS of the patients with left cerebral hemisphere infarction 〔（16.80±16.44）% and（7.41±6.50）〕were higher than those of the patients with right cerebral hemisphere infarction [（10.29±9.39）% and（4.85±4.09）,P〈0.05,respectively].（5）S3＋S4and REM of the patients with anterior circulation infarction [（17.36±14.57）% and（9.22±1.68）%]were lower than those of the patients with posterior circulation infarction [（32.11±17.89）%,（16.36±13.66）%,P〈0.05,respectively].（6）S2and SL of the patients with thalamic infarction [（32.56±18.70）% and（10.30±4.98）min]were lower than those of the patients with infarctions in other positions [（40.39±13.94）% and（23.76±10.73）min,P〈0.05,respectively]and S3＋S4of the patients with thalamic infarction [（46.03±27.01）%]was higher than that of the patients with infarctions in other positions [（41.25±17.61）%,P〈0.05].Conclusions The prevalence of sleep disorders was relatively higher in acute cerebral infraction patients,and the detailed classification of sleep disorders in acute cerebral infraction patients included trouble falling asleep,waking up early,maintaining sleep disorder and sleep breathing disorders.Sleep disorder is related to sex and NIHSS and the morbidit of SD in female is higher than male.In addition,sleep quality of patients with different parts cerebral infarction were different.The sleep quality of left hemisphere infarction and anterior circulation patients are poor.