目的:连续动态监测脑梗死急性期患者的睡眠状况,探讨急性脑梗死(ACI)合并睡眠呼吸紊乱(SDB)的特点,睡眠结构的变化,和睡眠昼夜节律的变化。
方法:选取2020年11月至2022年12月开滦总医院神经内科收治的发病48h内的ACI患者。详细的基线信息,如年龄、性别,吸烟史,饮酒史,为选定的参与者记录。从他们住院开始,使用基于智能床垫的睡眠监测平台系统(IMSMPS)连续5天监测入选参与者的睡眠状态.根据从监测中获得的心率数据,计算了睡眠昼夜节律的每日稳定性(IS)和每日变异性(IV)。
结果:选择了1,367例ACI患者。超过5天的监测结果显示147例(10.75%)没有SDB,SDB1,220例(89.25%)。在与SDB的小组中,有248例(18.14%)持续轻度SDB,395例(28.90%)中度SDB,重症SDB295例(21.58%),282例(20.63%)在不同严重程度之间波动。在这个波动的群体中,152例(53.90%)在两个严重程度之间波动,三级之间120例(42.55%),在所有四个级别中,有10例(3.55%)。睡眠潜伏期差异有统计学意义(P<0.05)。睡眠效率,非快速眼动阶段1-2,快速眼动,非快速眼动的比例,快速眼动的比例,入睡后醒来,起床时间,觉醒的次数,呼吸变异性指数,第1天至第5天监测ACI患者的心率变异性指数。然而,其他监测的睡眠结构参数差异无统计学意义(P>0.05)。所有睡眠监测参数的变异系数介于14.54%和36.57%之间。SDB组IV高于无SDB组(P<0.05),IS低于无SDB组(P<0.05)。
结论:脑梗死急性期患者合并SDB的概率较高。这些患者的睡眠结构根据中风的发病时间显示出明显的变异性,一些患者在SDB的不同严重程度之间出现波动。ACI伴SDB可进一步降低患者睡眠昼夜节律的IS,增加其IV。
OBJECTIVE: To continuously and dynamically monitor the sleep status of patients in the acute phase of cerebral infarction, and to investigate the characteristics of acute cerebral infarction(ACI)associated with sleep-disordered breathing (SDB), variations in sleep structure, and changes in sleep circadian rhythms.
METHODS: Patients with ACI within 48 h of onset who were admitted to the Department of Neurology at Kailuan General Hospital from November 2020 to December 2022 were selected. Detailed baseline information such as age, gender, smoking history, drinking history, were recorded for the selected participants. From the beginning of their hospitalization, the selected participants were monitored for their sleep status continuously for 5 days using the Intelligent Mattress-based Sleep Monitoring Platform System(IMSMPS). Based on the heart rate data obtained from the monitoring, the interdaily stability (IS) and intradaily variability (IV) of the sleep circadian rhythm were calculated.
RESULTS: 1,367 patients with ACI were selected. Monitoring results over 5 days indicated 147 cases (10.75%) without SDB, and 1,220 cases (89.25%) with SDB. Among the group with SDB, there were 248 cases (18.14%) with continuous mild SDB, 395 cases (28.90%) with moderate SDB, 295 cases (21.58%) with severe SDB, and 282 cases (20.63%) that fluctuated between different severity levels. Within this fluctuating group, 152 cases (53.90%) fluctuated between two severity levels, 120 cases (42.55%) between three levels, and 10 cases (3.55%) among all four levels. There were statistically significant differences (P < 0.05) in the sleep latency, sleep efficiency, non-rapid eye movement stages 1-2, rapid eye movement, proportion of non-rapid eye movement, proportion of rapid eye movement, wake after sleep onset, time out of bed, number of awakenings, respiratory variability index, and heart rate variability index among patients with ACI monitored from day 1 to 5. However, other monitored sleep structure parameters did not show statistically significant differences (P > 0.05). The coefficient of variation for all sleep monitoring parameters ranged between 14.54 and 36.57%. The IV in the SDB group was higher than in the group without SDB (P < 0.05), and the IS was lower than in the group without SDB (P < 0.05).
CONCLUSIONS: Patients in the acute phase of cerebral infarction have a high probability of accompanying SDB. The sleep structure of these patients shows significant variability based on the onset time of the stroke, and some patients experience fluctuations among different severity levels of SDB. ACI accompanied by SDB can further reduce the IS of a patient\'s sleep circadian rhythm and increase its IV.