基于烟雾病慢性脑缺血患者主观睡眠质量的影响因素分析

Analysis of Factors Influencing Subjective Sleep Quality in Patients with Chronic Cerebral Ischemia Represented by Moyamoya Disease

目的初步探明以无卒中型烟雾病为代表的慢性脑缺血患者的睡眠质量及影响因素,分析睡眠质量与术后缺血症状和卒中的相关性。方法前瞻性纳入138例经影像学确认的无卒中型烟雾病患者,收集患者的性别、年龄、首发症状、合并基础疾病等临床资料。使用匹兹堡睡眠质量指数量表评估患者的术前睡眠质量,使用HAMD-17和MoCA分别评估患者的术前抑郁状态和认知功能。比较睡眠质量正常组和睡眠质量下降组患者的临床特征、认知功能与抑郁状态,使用多因素logistic回归分析影响患者睡眠质量的危险因素,并对接受脑血管重建术治疗的患者进行随访,分析两组患者术后缺血症状发作、卒中发生率的差异。结果共52例(37.7%)烟雾病患者存在睡眠质量下降。睡眠质量下降组患者较睡眠质量正常组具有更高的年龄(P=0.002)、更差的认知功能(P=0.017)和更明显的抑郁倾向(P=0.012)。多因素logistic回归分析结果显示,年龄(OR 1.05,95%CI 1.01~1.09,P=0.021)和HAMD-17评分(OR 1.11,95%CI 1.01~1.23,P=0.035)是患者睡眠质量下降的独立危险因素。在术后随访中,术前存在睡眠质量下降的患者有更高的缺血症状发生率(P=0.008)。两组患者术后新发卒中率差异无统计学意义。结论无卒中型烟雾病患者存在较高比例的睡眠障碍,且与患者术后缺血事件发生相关,在临床诊疗中应加强对烟雾病患者睡眠质量的评估和干预。

Objective To explore the sleep quality and influencing factors in patients with chronic cerebral ischemia represented by Moyamoya disease without stroke,and analyze the correlation between sleep quality and postoperative ischemic symptoms and stroke.Methods A total of 138 Moyamoya disease patients without stroke confirmed by imaging were prospectively included,and clinical data including gender,age,initial symptoms,and comorbidities were collected.The Pittsburgh sleep quality index scale was used to assess the patient’s preoperative sleep quality,and the HAMD-17 and MoCA were used to evaluate preoperative depression status and cognitive function,respectively.Clinical characteristics,cognitive function,and depression status were compared between the normal sleep quality group and the decreased sleep quality group.Multivariate logistic regression analysis was used to analyze the risk factors affecting patient’s sleep quality.Patients who underwent cerebral revascularization were followed up to determine the differences in the incidence of postoperative ischemic events and stroke between the normal and decreased sleep quality groups.Results A total of 52(37.7%)patients with Moyamoya disease experienced decreased sleep quality.Patients with decreased sleep quality were older(P=0.002),had poorer cognitive function(P=0.017),and exhibited more significant depressive tendencies(P=0.012)than those with normal sleep quality.Multivariate analysis suggested that age(OR 1.05,95%CI 1.01-1.09,P=0.021)and HAMD-17 score(OR 1.11,95%CI 1.01-1.23,P=0.035)were independent risk factors for decreased sleep quality.Additionally,during the postoperative follow-up,patients with a preoperative decrease in sleep quality had a higher incidence of ischemic symptoms(P=0.008).There was no significant difference in stroke recurrence rates between the two groups.Conclusions Patients with Moyamoya disease without stroke have a higher proportion of sleep disorders,which are associated with postoperative ischemic events,highlighting the need for enhanced assessment and intervention of sleep quality in clinical practice.