脑卒中合并昼间嗜睡对卒中后血压变异性的影响

Impact of Stroke with Excessive Daytime Sleepiness on Post-stroke Blood Pressure Variability

背景高血压作为脑卒中发病的重要独立危险因素,其影响心脑血管疾病发病与预后的相关生理病理机制已得到充分阐释,但探讨昼间嗜睡(EDS)与高血压之间关系的研究却鲜见报道。目的探讨脑卒中合并EDS对卒中患者血压变异性的影响。方法选取2014年9月—2016年8月在天津中医药大学第一附属医院特需针灸病房及门诊就诊的脑卒中患者为研究对象。根据是否合并EDS将所有患者分为EDS组(n=120)和非EDS组(n=124)。比较两组患者一般资料、生化指标及动态血压监测指标,并采用Pearson相关分析将EDS患者的Epworth嗜睡量表(ESS)评分与其动态血压监测指标进行相关性分析。结果 EDS组患者年龄大于非EDS组、卒中病程长于非EDS组,差异有统计学意义(P<0.05);两组患者性别、卒中类型、合并高血压情况、高血压病程、近3个月服用降压药情况比较,差异无统计学意义(P>0.05)。EDS组患者血清三酰甘油(TG)水平高于非EDS组,差异有统计学意义(P<0.05);两组患者血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)比较,差异无统计学意义(P>0.05)。EDS组患者的夜间收缩压均值、夜间舒张压均值、收缩压节律和舒张压节律的非杓形程度高于非EDS组患者,差异有统计学意义(P<0.05);两组患者昼间收缩压均值、昼间舒张压均值、24 h收缩压均值、24 h舒张压均值、脉压下降率比较,差异无统计学意义(P>0.05)。Pearson相关分析结果显示,ESS评分与收缩压节律、舒张压节律呈线性正相关(P<0.05);ESS评分与昼间收缩压均值、昼间舒张压均值、夜间收缩压均值、夜间舒张压均值、24 h收缩压均值、24 h舒张压均值、脉压下降率无相关性(P>0.05)。结论与单纯脑卒中相比,脑卒中合并EDS更好发于高龄人群,且脂代谢异常程度更严重;合并EDS会使脑卒中患者的夜间血压升高,导致血压昼夜节律非杓形及反杓形的程度加重,进而导致不良预后及卒中复发的风险上升。

Background Hypertension is an important independent risk factor for stroke.The physiopathologic mechanisms for its relationships with the onset and outcomes of cardiovascular and cerebrovascular diseases have been fully elucidated,but its relationship with excessive daytime sleepiness(EDS)has been rarely reported.Objective To investigate the effect of stroke with EDS on post-stroke blood pressure variability(BPV).Methods We recruited 244 stroke outpatients and inpatients from the ward and clinic of VIP Acupuncture&Moxibustion Department,First Teaching Hospital of Tianjin University of TCM during September 2014 to August 2016,including 120 with EDS(EDS group)and 124 without(non-EDS group).We compared the baseline clinical data,biochemical parameters and ambulatory blood pressure monitoring parameters(ABPMPs)of the two groups.Pearson's correlation analysis was performed to explore the correlations of the Epworth Sleepiness Scale(ESS)score with ABPMPs in stroke patients with EDS.Results Compared with non-EDS group,EDS group had a greater mean age,and a longer average course of stroke(P<0.05).Both groups had no significant differences in the distribution of sex,type of stroke,prevalence of hypertension,distribution of course of hypertension and prevalence of antihypertensive drugs use in the past 3 months in those with hypertension(P>0.05).EDS group had a higher mean serum triacylglycerol(TG)level(P<0.05),but showed similar mean serum levels of total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),and high density lipoprotein cholesterol(HDL-C)compared with non-EDS group(P>0.05).The mean nocturnal systolic blood pressure(SBP)and diastolic blood pressure(DBP),prevalence of non-dipping circadian patterns of SBP and DBP were higher in EDS group than those of the non-EDS group(P<0.05).Both groups showed no significant differences in mean daytime SBP and DBP,mean 24-hour SBP and DBP and rate of pulse pressure reduction(P>0.05).Pearson's correlation analysis showed that in stroke patients with EDS,the ESS score was linearly correlated with the circadian rhythms of SBP and DBP(P<0.05),but had no correlations with mean daytime SBP and DBP,mean nocturnal SBP and DBP,mean 24-hour SBP and DBP and rate of pulse pressure reduction(P>0.05).Conclusion Compared with simple stroke,stroke with EDS is more likely to occur in older people with more severe dyslipidemia.Moreover,the nocturnal blood pressure will be increased in stroke patients with EDS,which leads to higher possibilities of having non-dipping and reverse circadian patterns of blood pressure,resulting in higher risks of adverse outcomes and recurrence of stroke.