调节睡眠结构可预防脑小血管病患者基底节区血管周围间隙扩大

Modulation of sleep structure can prevent enlargement of the perivascular spaces in the basal ganglia in patients with cerebral small-vessel disease

目的应用多导睡眠图探讨脑小血管病(CSVD)患者基底节区血管周围间隙扩大(BG-EPVS)与睡眠结构的关系。方法纳入2023年2月~2024年6月在南方医科大学第三附属医院神经内科住院治疗并完成3.0T磁共振的95例CSVD患者。采用视觉量化评估法对基底节区血管周围间隙进行评估分级,并根据评级将患者分为无-轻度BG-EPVS组(n=45)和中重度BG‑EPVS组(n=50)。所有患者均接受整夜多导睡眠监测,并记录相关数据,比较两组患者的一般临床资料及多导睡眠图参数。结果两组性别、BMI、吸烟和饮酒史的差异无统计学意义(P>0.05)。与无-轻度BG-EPVS组相比,中重度BG-EPVS组的年龄更高,腔隙性脑梗死、肾功能不全所占比例更高(P<0.05)。与无-轻度BG-EPVS组相比,中重度BG‑EPVS组的REM睡眠持续时间、REM睡眠占总睡眠时间百分比降低(P<0.05)。两组在睡眠进程参数、睡眠质量参数和其他睡眠结构参数等方面差异无统计学意义(P>0.05)。Spearman相关性分析结果显示,REM睡眠持续时间、REM睡眠占总睡眠时间百分比与BG-EPVS等级呈负相关(P<0.05),NREM睡眠N1、N2、N3期睡眠持续时间及NREM睡眠N1、N2、N3期占总睡眠时间百分比与BG-EPVS等级无明显相关性(P>0.05)。多因素Logistic回归分析发现,年龄增加、腔隙性脑梗死、REM睡眠占总睡眠时间百分比降低是基底节区血管周围间隙中重度扩大的独立危险因素(P<0.05)。结论年龄较高、腔隙性脑梗死、REM睡眠占总睡眠时间百分比降低的患者更易发生BG-EPVS,提示调节睡眠结构尤其是改善REM睡眠质量,可能在预防BG‑EPVS中发挥重要作用。

Objective To explore the relationship between enlarged perivascular spaces in the basal ganglia(BG-EPVS)and sleep structure in patients with cerebral small-vessel disease(CSVD)by polysomnography.Methods Ninety-five CSVD patients who were hospitalized in the Department of Neurology of the Third Affiliated Hospital of Southern Medical University from February 2023 to June 2024 completed 3.0T magnetic resonance imaging were included.The perivascular spaces in the basal ganglia were evaluated and graded by visual quantitative assessment method,and the patients were divided into none to mild BG-EPVS group(n=45)and moderate to severe BG-EPVS group(n=50)according to the grading.All patients underwent overnight polysomnography monitoring and relevant data were recorded.The general clinical data and polysomnography parameters of the two groups were compared.Results There was no statistically significant difference in gender,BMI,smoking and drinking history between the two groups(P>0.05).Compared with the none to mild BG-EPVS group,patients in the moderate to severe BG-EPVS group were older,and the proportion of lacunar infarction and renal insufficiency was higher(P<0.05).Comparison of sleep parameters between the two groups showed that compared with the none to mild BG-EPVS group,the duration of REM sleep and the percentage of REM sleep in total sleep time were decreased in the moderate to severe BG-EPVS group(P<0.05).There was no statistically significant difference in sleep process parameters,sleep quality parameters and other sleep structure parameters between the two groups(P>0.05).Spearman correlation analysis showed that the duration of REM sleep and the percentage of REM sleep in total sleep time were negatively correlated with the BG-EPVS grade(P<0.05),and there was no significant correlation between the duration and percentage of sleep in NREM sleep stages and the BG-EPVS grade(P>0.05).Multivariate logistic regression analysis found that increased age,lacunar infarction,and decreased percentage of REM sleep in total sleep time were independent risk factors for moderate to severe enlargement of perivascular spaces in the basal ganglia(P<0.05).Conclusion Patients with higher age,lacunar infarction,and decreased percentage of REM sleep in total sleep time are more likely to develop BG-EPVS,suggesting that adjusting sleep structure,especially improving the quality of REM sleep,may play an important role in preventing BG-EPVS.