急性脑梗死患者合并睡眠障碍与认知功能及血压变异性的关系

Relationship between sleep disturbance and cognitive function and blood pressure variability in patients with acute cerebral infarction

目的分析急性脑梗死(ACI)患者合并睡眠障碍与认知功能及血压变异性(BPV)的关系。方法回顾性分析2018年2月至2019年12月延安大学咸阳医院收治的124例ACI患者的临床资料,于发病2周时根据匹兹堡睡眠质量指数量表(PSQI)评分结果分为PSQI≥7分组(睡眠障碍组,32例)及PSQI<7分组(非睡眠障碍组,92例),比较两组患者的认知功能[蒙特利尔认知评估量表(MoCA)、简易精神状态量表(MMSE)]及BPV[24 h收缩压变异系数(24 h SBPCV)、24 h舒张压变异系数(24 hDBPCV)]的差异,并采用Pearson相关性分析评估ACI患者PSQI评分与MoCA、MMSE评分及24 hSBPCV、24 hDBPCV的相关性,使用受试者工作曲线(ROC)评估MoCA、MMSE评分、24 hSBPCV、24 hDBPCV及其联合检测对ACI患者合并睡眠障碍的诊断价值。结果两组患者的性别、年龄、受教育程度、合并高血压、糖尿病及吸烟史比例比较差异均无统计学意义(P>0.05);睡眠障碍组患者的MoCA、MMSE评分明显低于非睡眠障碍组[(21.25±1.76)分vs(23.74±2.05)分、(23.56±1.66)分vs(25.45±1.82)分],而4 hSBPCV、24 hDBPCV则明显高于非睡眠障碍组[(18.56±3.40)%vs(14.06±3.09)%、(13.26±2.21)%vs(10.17±1.98)%],差异均有统计学意义(P<0.05);经Pearson相关性分析结果显示,ACI患者PSQI评分与MoCA、MMSE评分呈显著负相关(r=-0.396、-0.377,P<0.05),与24 hSBPCV、24 hDBPCV呈显著正相关(r=0.419、0.442,P<0.05);经ROC曲线分析结果显示,MoCA、MMSE评分、24 hSBPCV、24 hDBPCV均对ACI患者合并睡眠障碍具有较高诊断价值(AUC=0.818、0.773、0.849、0.841),其cut-off值分别为22.50分、24.50分、16.13%、10.98%,且四项联合检测诊断价值最高(AUC=0.978)。结论认知功能及BPV异常越严重的ACI患者合并睡眠障碍风险越高,临床应及时纠正患者睡眠障碍,以改善ACI预后。

Objective To analyze the relationship between sleep disturbance and cognitive function and blood pressure variability(BPV)in patients with acute cerebral infarction(ACI).Methods The clinical data of 124 patients with ACI in Xianyang Hospital of Yan’an University were retrospectively analyzed between February 2018 and December 2019.According to the Pittsburgh Sleep Quality Index(PSQI)score after 2 weeks of onset,they were divided into PSQI≥7 points group(sleep disturbance group,32 cases)and PSQI<7 points group(non-sleep disturbance group,92 cases).The differences in cognitive function[Montreal Cognitive Assessment Scale(MoCA),Mini-Mental State Examination(MMSE)]and BPV[24 h systolic blood pressure coefficient of variation(24 hSBPCV),24 h diastolic blood pressure coefficient of variation(24 hDBPCV)]were compared between the two groups,and the correlation between PSQI score and MoCA score,MMSE score,24 hSBPCV,and 24 hDBPCV was analyzed in patients with ACI by Pearson correlation analysis.Receiver operating characteristic curve(ROC curve)was used to evaluate the diagnostic value of MOCA score,MMSE score,24 hSBPCV,24 hDBPCV and their combined detection on sleep disturbance in patients with ACI.Results There were no statistically significant differences in the gender,age,education level,and proportions of hypertension,diabetes,and smoking history between the two groups(P>0.05).The MoCA score and MMSE score in sleep disturbance group were(21.25±1.76)points,(23.56±1.66)points,which were significantly lower than(23.74±2.05)points,(25.45±1.82)points in non-sleep disturbance group,while the 24 hSBPCV and 24 hDBPCV were(18.56±3.40)%,(13.26±2.21)%,significantly higher than(14.06±3.09)%,(10.17±1.98)%in non-sleep disturbance group(P<0.05).Pearson correlation analysis showed that PSQI score of patients with ACI was significantly negatively correlated with MOCA score and MMSE score(r=-0.396,-0.377,P<0.05),and were positively correlated with 24 hSBPCV and 24 hDBPCV(r=0.419,0.442,P<0.05).ROC curve analysis showed that MoCA score,MMSE score,24 hSBPCV,and 24 hDBPCV had high diagnostic value on sleep disturbance in patients with ACI(AUC=0.818,0.773,0.849,0.841),and their cut-off values were 22.50 points,24.50 points,16.13%,and 10.98%.The combined detection of the four indexes had the highest diagnostic value(AUC=0.978).Conclusion The more severe the cognitive function and BPV abnor-malities,the higher the risk of sleep disturbance in patients with ACI.In clinical practice,it is necessary to correct the sleep disturbance in time,so as to improve the prognosis of ACI.