阻塞性睡眠呼吸暂停对急性缺血性卒中患者转归的影响

Impact of obstructive sleep apnea on outcome in patients with acute ischemic stroke

目的探讨阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)对急性缺血性卒中(acute ischemic stroke,AIS)患者发病后90 d时神经功能转归的影响。方法前瞻性纳入2022年9月至2023年6月在合肥市第二人民医院住院的AIS患者,根据发病后90 d时改良Rankin量表评分分为转归良好组(0~2分)和转归不良组(>2分)。比较两组间人口统计学资料、血管危险因素、基线实验室检查、入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、OSA严重程度及呼吸暂停低通气指数(apnea-hypopnea index,AHI)等的差异。应用多变量logistic回归分析确定转归不良的独立危险因素。结果共纳入104例AIS患者,男性62例(59.6%),中位年龄65.5岁(四分位数间距57.0~72.0岁),中位基线NIHSS评分3.00分(四分位数间距2.00~4.00分)。中位AHI为18.14次/h(四分位数间距11.34~27.88次/h),无/轻度OSA患者43例(41.35%),中重度OSA患者61例(58.65%)。74例(71.2%)转归良好,30例(28.8%)转归不良。将AHI作为分类变量引入logistic回归模型时,基线NIHSS评分较高[优势比(odds ratio,OR)3.041,95%置信区间(confidence interval,CI)1.797~5.145;P<0.001]和中重度OSA(OR 4.413,95%CI 1.032~18.877;P=0.045)为转归不良的独立危险因素;将AHI作为连续变量引入logistic回归模型时,基线NIHSS评分较高(OR 3.176,95%CI 1.844~5.472;P<0.001)、年龄(OR 1.093,95%CI 1.014~1.177;P=0.020)和AHI(OR 1.044,95%CI 1.002~1.089;P=0.042)为转归不良的独立危险因素。结论中重度OSA是AIS患者发病后90 d时功能转归不良的独立危险因素,AHI较高提示患者转归不良。

Objective To investigate the impact of obstructive sleep apnea(OSA)on neurological function outcome in patients with acute ischemic stroke(AIS)at 90 days after onset.Methods Patients with AIS admitted to Hefei Second People's Hospital from September 2022 to June 2023 were prospectively included.According to the modified Rankin Scale score at 90 days after onset,they were divided into a good outcome group(0-2)and a poor outcome group(>2).The demographic data,vascular risk factors,baseline laboratory tests,National Institutes of Health Stroke Scale(NIHSS)scores at admission,severity of obstructive sleep apnea(OSA),and apnea hypopnea index(AHI)were compared between the two groups.Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcomes.Results A total of 104 patients with AIS were enrolled,including 62 males(59.6%),with a median age of 65.5 years(interquartile range,57.0-72.0 years).The median baseline NIHSS score was 3.00(interquartile range,2.00-4.00).The median AHI was 18.14/h(interquartile range,11.34-27.88/h),43 patients(41.35%)with no/mild OSA and 61 patients(58.65%)with moderate to severe OSA.Seventy-four patients(71.2%)had good outcome,and 30 patients(28.8%)had poor outcome.When introducing AHI as a categorical variable into the logistic regression model,the higher baseline NIHSS score(odds ratio[OR]3.041,95%confidence interval[CI]1.797-5.145;P<0.001)and moderate to severe OSA(OR 4.413,95%CI 1.032-18.877;P=0.045)were independent risk factors for poor outcome;When introducing AHI as a continuous variable into the logistic regression model,higher baseline NIHSS score(OR 3.176,95%CI 1.844-5.472;P<0.001),age(OR 1.093,95%CI 1.014-1.177;P=0.020),and AHI(OR 1.044,95%CI 1.002-1.089;P=0.042)were independent risk factors for poor outcome.Conclusion Moderate to severe OSA is an independent risk factor for poor functional outcome in patients with AIS at 90 days after onset,and a higher AHI indicates poor outcome in patients.