惯性睡眠-觉醒模式与急性缺血性脑卒中短期预后关系的研究

Association between inertial sleep-wake pattern and the short-term prognosis of acute ischemic stroke

目的 探讨惯性睡眠-觉醒模式对急性缺血性脑卒中患者发病90 d神经功能、认知和情绪的影响。方法 分析2021年4月—2023年4月于海军军医大学第二附属医院神经内科住院的急性缺血性脑卒中患者,依据发病前惯性睡眠-觉醒昼夜节律进行分组,详细记录各组人口学数据及病变位置、危险因素、90 d结局等,比较各组差异。结果 共51例患者纳入研究,年龄30~68岁,平均(47.750±9.104)岁;其中男性40例(78.43%),男:女=3.64∶1;绝对夜晚型9例(17.65%)、轻度夜晚型18例(35.29%)、中间型22例(43.14%)、轻度清晨型2例(3.92%)、绝对清晨型0例。各组基线一致(P>0.05),单因素分析示各组间发病90 d MMSE评分(P=0.021)及HAMA评分(P=0.008)差异具有统计学意义,两两比较示差异均来源于绝对夜晚型与中间型。Spearman相关分析同样提示急性卒中发病90 d认知功能(r=0.492,P<0.001)与焦虑状况(r=-0.428,P=0.002)均与睡眠-觉醒模式显著相关。多因素分析示睡眠-觉醒模式(P=0.018)、发病14 dMMSE(P=0.001)是急性缺血性脑卒中90 d认知下降的独立危险因素;睡眠-觉醒模式(P=0.040)、发病14 d HAMA(P<0.001)是90 d焦虑障碍的独立影响因素。结论 惯性睡眠-觉醒模式是急性缺血性脑卒中短期认知和焦虑情绪不良预后的独立危险因素,建议积极干预。

Objective To investigate the effect of inertial sleep-wake pattern on neurological function,cognition,and emotion in patients with acute ischemic stroke on day 90 after disease onset.Methods The patients with acute isch-emic stroke who were admitted to Department of Neurology in the Second Affiliated Hospital of Navy Medical University from April 2021 to April 2023 were analyzed,and they were divided into groups according to the circadian rhythm of inertial sleep-wake before disease onset.Demographic data,location of lesion,risk factors,and 90-day outcome were recorded and compared between groups.Results A total of 51 patients,aged 30 to 68 years,were enrolled in this study,with a mean age of(47.750±9.104)years.There were 40 male patients(78.43%),with a male/female ratio of 3.64∶1.Among the 51 patients,there were 9 patients(17.65%)with definitely evening type,18(35.29%)with mild evening type,22(43.14%)with intermediate type,and 2(3.92%)with mild morning type,and there were no patients with absolute morning type.There were no significant differences in baseline data between groups(P>0.05);the univariate analysis showed significant differences between groups in 90-day Mini-Mental State Examination(MMSE)score(P=0.021)and Hamilton Anxiety Scale(HAMA)score(P=0.008),and comparison between any two groups showed that the differences mainly came from absolute evening type and intermediate type.The Spearman correlation analysis showed that cognitive function(r=0.492,P<0.001)and anxiety(r=-0.428,P=0.002)on day 90 after the onset of acute stroke were signifi-cantly associated with sleep-wake pattern.The multivariate analysis showed that sleep-wake pattern(P=0.018)and MMSE score on day 14 after disease onset(P=0.001)were independent risk factors for cognitive decline on day 90 in acute ischemic stroke,and sleep-wake pattern(P=0.040)and HAMA score on day 14 after disease onset(P<0.001)were independent influencing factors for anxiety disorder on day 90.Conclusion Inertial sleep-wake pattern is an inde-pendent risk factor for the poor short-term prognosis of cognitive and anxiety outcomes in acute ischemic stroke,and it is recommended to adopt active intervention measures.