大脑中动脉供血区梗死后失眠的危险因素分析

Risk Factors of Insomnia after Cerebral Middle Artery Infarction

目的探讨脑卒中后失眠者的日周期类型,并寻找可能的危险因素。方法 2012年1月至2014年6月大脑中动脉供血区梗死患者,根据是否失眠分为失眠组(n=25)和对照组(n=25)。采集一般资料,用清晨型和夜晚型问卷(MEQ)、匹兹堡睡眠质量指数(PSQI)、失眠严重程度指数(ISI)、Epworth思睡量表(ESS)、疲劳程度量表(FSS)对患者进行评估。结果失眠组MEQ评分低于对照组(t=2.676,P<0.05),中度夜晚型(20%)和绝对夜晚型(4%)的比例均高于对照组。高美国国立卫生院卒中量表(NIHSS)评分(>11分)是卒中后失眠的独立危险因素(OR=1.463,95%CI=1.112~1.925)。失眠组ESS、FSS、PSQI及ISI评分均显著高于对照组(t>5.609,P<0.001)。ESS(r=0.334,P<0.05)、FSS(r=0.535,P<0.01)、PSQI(r=0.461,P=0.001)及ISI(r=0.504,P<0.01)评分与NIHSS评分间呈正相关。结论脑卒中后失眠患者存在显著的日周期障碍。高NIHSS评分是导致脑卒中后失眠的独立危险因素。

Objective To explore the type of circadian rhythms and risk factors for post-stroke insomnia. Methods From January,2012 to June,2014,the patients with cerebral middle artery infarction were divided into insomnia group（n=25） and control group（n=25）. The general characterizations of the patients were collected. They were assessed with Morning and Evening Questionnaire（MEQ）,Pittsburgh Sleep Quality Index（PSQI）,Insomnia Severity Index（ISI）,Epworth Sleepiness Scale（ESS） and Fatigue Severity Scale（FSS）. Results The MEQ score was lower in the insomnia group than in the control group（t=2.676,P〈0.05）. The frequency of moderate night type（20%） and absoluteness night type（4%） were higher in the insomnia group than in the control group. High score（〉11） of National Institutes of Health Stroke Scale（NIHSS） was the independent risk foctor for post- stroke insomnia（OR=1.463,95% CI=1.112- 1.925）. The scores of ESS,PSQI,ISI and FSS were higher in the insomnia group than in the control group（t〉5.609,P〈0.001）. The scores of ESS（r=0.334,P〈0.05）,FSS（r=0.535,P〈0.01）,PSQI（r=0.461,P=0.001） and ISI（r=0.504,P〈0.01） were positively correlated with the NIHSS score. Conclusion The patients with post-stroke insomnia impair in circadian rhythms. High NIHSS score is the independent risk factor for post-stroke insomnia.