脑卒中伴睡眠期周期性肢体运动患者的睡眠结构研究

Effect of Periodic Limb Movements in Sleep on Sleep Structure in Stroke Patients

背景睡眠障碍为脑卒中常见的并发症,临床表现多种多样,其中,以睡眠期间反复刻板的肢体运动为表现的称之为睡眠期周期性肢体运动(PLMS)。PLMS发病机制及对脑卒中预后的影响仍处在探索阶段,临床资料较少,国内外鲜有PLMS对脑卒中患者睡眠影响的研究。目的探究脑卒中伴PLMS患者的睡眠结构。方法选取2020年12月至2022年2月于郑州大学第二附属医院就诊的伴睡眠障碍且行多导睡眠监测(PSG)的脑卒中患者81例。收集患者基本信息及PSG监测数据后,依据周期性肢体运动指数(PLMI)将患者分为非PLMS患者(对照组,PLMI<15次/h)和PLMS患者(试验组,PLMI≥15次/h)。比较两组清醒期PLMI、睡眠效率、N1期睡眠占总睡眠时间比例、N2期睡眠占总睡眠时间比例、N3期睡眠占总睡眠时间比例、REM期睡眠占总睡眠时间比例、睡眠呼吸暂停低通气指数(AHI)、睡眠潜伏期、觉醒指数、周期性肢体运动觉醒指数情况,分析PLMS与睡眠结构及相关参数的相关性。结果对照组42例,试验组39例。试验组清醒期PLMI、N1期睡眠占总睡眠时间比例、N2期睡眠占总睡眠时间比例、觉醒指数、周期性肢体运动觉醒指数高于对照组,睡眠效率、N3期睡眠占总睡眠时间比例低于对照组(P<0.05);两组患者睡眠潜伏期、AHI、REM期睡眠占总睡眠时间比例比较,差异无统计学意义(P>0.05)。Spearman秩相关分析结果显示,PLMS与清醒期PLMI、N2期睡眠占总睡眠时间比例、睡眠潜伏期、觉醒指数、周期性肢体运动觉醒指数呈正相关(r_(s)值分别为0.619、0.250、0.271、0.312、0.828,P值分别为<0.001、0.024、0.014、0.005、<0.001),与睡眠效率(r_(s)=-0.345,P=0.002)呈负相关。结论伴PLMS的脑卒中患者客观存在睡眠紊乱,睡眠效率降低,其可能是脑卒中预后不良的标志之一。

Background Sleep disorder is a common complication of stroke with various clinical manifestations.Among them,periodic limb movements in sleep(PLMS)are characterized by repetitive and stereotyped limb movements during sleep.Due to limited clinical date,the pathogenesis of PLMS and their impact on prognosis of stroke are still in the exploratory stage.Studies about the effect of PLMS on sleep in stroke patients are few in worldwide.Objective To explore the sleep structure of stroke patients with PLMS.Methods From December 2020 to February 2022,a total of 81 stroke patients with sleep disorders were selected from the Second Affiliated Hospital of Zhengzhou University,in which polysomnography(PSG)was performed.The clinical information and PSG sleep monitoring data of patients were collected.According to the Periodic Limb Movement Index(PLMI),the patients were divided into non-PLMS patients(control group,PLMI<15 times/h)and PLMS patients(experimental group,PLMI≥15 times/h).The parameters between two groups were compared.These parameters include awake PLMI,sleep efficiency,proportion of stage N1 sleep in total sleep time,proportion of stage N2 sleep in total sleep time,proportion of stage N3 sleep in total sleep time,REM sleep in total sleep time,sleep apnea hypopnea index(AHI),sleep latency,arousal index,and periodic limb movement arousal index(PLMAI).Moreover,the correlation between PLMS and sleep structure and related parameters was analyzed.Results There were 42 cases in the control group and 39 cases in the experimental group.The awake PLMI,proportion of stage N1 sleep in total sleep time,proportion of stage N2 sleep in total sleep time,arousal index and PLMAI in experimental group were higher than those in control group(P<0.05).However,the sleep efficiency and proportion of stage N3 sleep in total sleep time of experimental group were lower than those of control group(P<0.05).There was no significant difference between two groups in sleep latency,AHI and REM stage sleep in total sleep time(P>0.05).The results of Spearman rank correlation analysis showed that PLMS was positively correlated with awake PLMI,proportion of stage N2 sleep in total sleep time,sleep latency,arousal index,and PLMAI(r_(s) values were 0.619,0.250,0.271,0.312,0.828,respectively;P values were<0.001,0.024,0.014,0.005,<0.001),which were negatively correlated with sleep efficiency(r_(s)=-0.345,P=0.002).Conclusion Stroke patients with PLMS have objective sleep disturbance and reduced sleep efficiency,and PLMS may be one of the signs of poor prognosis of stroke.