急性脑卒中并睡眠障碍患者的临床特点及其影响因素研究

Clinical Features and Influencing Factors of Sleep Disorders in Patients with Acute Stroke

目的分析急性脑卒中并睡眠障碍患者的临床特点,并探讨其影响因素。方法选取2014年5月—2015年5月长沙市第一医院神经内科收治的急性脑卒中患者285例,根据匹兹堡睡眠质量指数(PSQI)分为睡眠障碍组116例和非睡眠障碍组169例。比较两组患者的临床资料,包括性别、年龄、卒中类型(出血性脑卒中、缺血性脑卒中)、美国国立卫生研究院卒中量表(NIHSS)评分、既往史(高血压、冠心病、糖尿病等)、卒中部位(左半球、右半球)、并发症(肺部感染、尿路感染)等,分析急性脑卒中患者睡眠障碍的影响因素。结果 285例患者中出现睡眠障碍116例,睡眠障碍发生率为40.7%,包括出血性脑卒中51例和缺血性脑卒中65例。出血性脑卒中并睡眠障碍患者表现为睡眠过多者29例,入睡困难者13例,睡眠维持困难及早醒者6例,打鼾、多梦、睡眠倒错者3例;缺血性脑卒中并睡眠障碍患者表现为不同形式失眠者46例,睡眠过多者15例,其他类型睡眠障碍者4例。两组患者性别、年龄、卒中部位比较,差异无统计学意义(P>0.05);睡眠障碍组患者NIHSS评分及出血性脑卒中、高血压、冠心病、糖尿病、肺部感染、尿路感染发生率高于非睡眠障碍组(P<0.05)。多因素logistic回归分析结果显示,NIHSS评分>15分〔OR=2.15,95%CI(1.65,5.85)〕、冠心病〔OR=1.55,95%CI(1.01,3.06)〕、肺部感染〔OR=1.86,95%CI(1.21,3.48)〕、尿路感染〔OR=1.53,95%CI(1.03,2.77)〕是急性脑卒中患者睡眠障碍的影响因素(P<0.05)。结论急性脑卒中患者睡眠障碍发生率较高,其中出血性脑卒中患者睡眠障碍以睡眠过多为主,缺血性脑卒中患者睡眠障碍以失眠为主;NIHSS评分>15分、冠心病、肺部感染、尿路感染是急性脑卒中患者睡眠障碍的影响因素。

Objective To analyze the clinical features and influencing factors of sleep disorders in patients with acute stroke. Methods From May 2014 to May 2015, a total of 285 patients with acute stroke were selected in the Department of Neurology, the First Hospital of Changsha, and they were divided into A group （with sleep disorders, n = 116） and B group （without sleep disorders, n = 169 ） according to the PSQI. Clinical data was compared between the two groups, including gender, age, stroke types （hemorrhagic stroke or ischemic stroke ）, NIHSS score, past medical history （including hypertension, coronary heart disease and diabetes）, diseased regions （left hemisphere or right hemisphere ）, incidence of complications （ including pulmonary infection and urinary tract infection ） , and the influencing factors of sleep disorders in patients with acute stroke were analyzed. Results Of the 285 patients, 116 cases occurred sleep disorders, the incidence of sleep disorders was 40. 7%. Of the 116 patients with sleep disorders, 51 cases were hemorrhagic stroke, 65 cases were ischemic stroke. Of hemorrhagic stroke patients with sleep disorders, 29 cases performed as excessive sleep, 13 cases performed as falling asleep difficuleies, 6 cases performed as maintaining sleep difficulties and early - wake, 3 cases performed as snore, dreaminess and sleep inversion; of ischemic stroke patients with sleep disorders, 46 cases performed as different forms of insomnia, 15 cases performed as excessive sleep, 4 cases performed as other types of sleep disorders. No statistically significant differences of gender, age or diseased regions was found between the two groups （P 〉 0. 05 ）; NIHSS score, incidence of hemorrhagic stroke,hypertension, coronary heart disease, diabetes, pulmonary infection and urinary tract infection of A group were statistically significantly higher than those of B group （ P 〈 0. 05 ）. Multivariate logistic regression analysis results showed that, NIHSS score over 15 （ OR =2. 15, 95% CI （ 1.65, 5.85） ], coronary heart disease （ OR = 1.55, 95% CI （ 1.01, 3.06） ], pulmonary infection [OR= 1.86, 95%CI （1.21, 3.48）] and urinary tract infection [OR= 1.53, 95%CI （1.03, 2. 77）] were influencing factors of sleep disorders in patients with acute stroke （P 〈 0. 05 ）. Conclusion The incidence of sleep disorders is relatively high in patients with acute strok, thereinto hemorrhagic stroke patients mainly performed as excessive sleep, while ischemic stroke patients mainly performed as insomnia; NIHSS score over 15, coronary heart disease, pulmonary infection and urinary tract infection are influencing factors of sleep disorders in patients with acute stroke.