急性缺血性卒中睡眠障碍与执行功能障碍的相关性分析

Relationship between Sleep Disorders and Executive Dysfunction in Patients with Acute Ischemic Stroke

目的探究急性缺血性卒中睡眠障碍与执行功能障碍的相关性。方法连续收集2017年5-11月西南医科大学附属医院神经内科住院治疗的急性缺血性卒中患者105例,发病2周时采用匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)进行评分,分为睡眠障碍组与非睡眠障碍组,采用stroop实验、2-back任务、画钟试验(clock-drawingtest,CDT)、连线测验(trail making test,TMT)评价全部患者的执行功能,观察睡眠障碍与执行功能的相关性。结果 (1)stroop实验结果:睡眠障碍组在冲突条件下的反应时为(344.31±23.16)ms,明显长于非睡眠障碍组的(283.92±29.20)ms;前者反应时干扰量为(61.58±16.10)ms,较后者的(51.04±21.16)ms明显延长;前者正确数干扰量为3.00(2.00～5.00),较后者6.00(4.75～8.00)降低,比较差异均具有统计学意义(P<0.001,P=0.005,P<0.001)。(2)2-back任务结果:睡眠障碍组错误率为50%(46%～52%),较非睡眠障碍组的19%(17%～20%)明显增加,比较差异具有统计学意义(Z=8.771,P<0.001)。(3)TMT结果:睡眠障碍组连线A测验84.00(79.00～89.00)s长于非睡眠障碍组的65.00(61.75～69.00)s;连线B测验时间为184.00(173.00～199.00)s,明显长于非睡眠障碍组的130.00(107.00～147.50)s;睡眠障碍组TMT干扰量为(101.91±20.31)s,明显长于非睡眠障碍组的(64.34±29.62)s,比较差异均具有统计学意义(均P<0.001)。(4)睡眠障碍组CDT时间为3.00(3.00～3.00)s,长于非睡眠障碍组的2.00(2.00～3.00)s,比较差异具有统计学意义(Z=6.260,P<0.001)。(5)PSQI得分与stroop实验反应时干扰量无明显相关,与正确数干扰量呈负相关(r=-0.424,P<0.001),与2-back任务错误率呈显著正相关(r=0.750,P<0.001),与TMT干扰量呈正相关(r=0.503,P<0.001),与CDT时间呈正相关(r=0.503,P<0.001)。结论急性缺血性卒中伴有睡眠障碍较不伴有睡眠障碍者更容易出现执行功能障碍,睡眠障碍越严重,执行功能损害也越严重。

Objective To explore the relationship between sleep disorders and executive dysfunction in patients with acute ischemic stroke(AIS).Methods A total of 105 consective AIS patients in Department of Neurology of Southwest Medical University Affiliated Hospital from May 2017 to November 2017 were collected.Based on the Pittsburgh sleep quality index(PSQI)at 2 weeks from onset,all patients were divided into two groups:sleep disorder group and non-sleep disorder group.The executive function of all patients were evaluated by Stroop test,2-back task,clock-drawing test(CDT)and trail making test(TMT).The relationship between sleep disorders and executive dysfunction in AIS patients was investigated.Results(1)The results of Stroop test:under the conflict conditions,the response time in sleep disorder group [(344.31±23.16)ms] was longer than that in non-sleep disorder group [(283.92±29.20)ms](P<0.001);the interference amount of response time in sleep disorder group [(61.58±16.10)ms] was longer than that in non-sleep disorder group [(51.04±21.16)ms](P=0.005).The interference amount of correct number in sleep disorder group [3.00(2.00-5.00)] was lower than that in non-sleep disorder [6.00(4.75-8.00)](P<0.001).(2)The results of the 2-back task:the incorrect rate in sleep disorder group [50%(46%-52%)] was higher than that in non-sleep disorder group [19%(17%-20%)](Z=8.771,P<0.001).(3)The results of TMT:the completion time of line A test in sleep disorder group [84.00(79.00-89.00)s] was longer than that in non-sleep disorder group [65.00(61.75-69.00)s];the completion time of line B test in sleep disorder group [184.00(173.00-199.00)s] was longer than that in non-sleep disorder group [130.00(107.00-147.50)s](both P<0.001).The interference amount of the line test in sleep disorder group [(101.91±20.31)s] was significantly longer than that in nonsleep disorder group [(64.34±29.62)s](P<0.001).(4)In CDT,the finish time in sleep disorder group [3.00(3.00-3.00)s] was longer than that in non-sleep disorder group [2(2.00-3.00)s](Z=6.260,P<0.001).(5)PSQI score was not correlated with the interference amount of response time in Stroop test,while negatively correlated with the interference amount of correct number(r=-0.424,P<0.001),had significant positive correlation with the incorrect rate in 2-back task(r=0.750,P<0.001),and had positive correlation with the interference amount of TMT(r=0.503,P<0.001)as well as the CDT time(r=0.503,P<0.001).Conclusions AIS patients with sleep disorders are more likely to have executive function impairment compared to those without sleep disorders.The more serious sleep disorders are,the more worse executive function will be.