国家神经系统疾病临床医学研究中心数据管理与共享系统

Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

《国家中心数据管理与共享系统操作说明书 —— 研究者部分》

Association between pre-stroke subjective sleep status and post-stroke cognitive impairment: A nationwide multi-center prospective registry

第一作者：Jia-Li Zhang,An-Xin Wang

通讯作者：Ning Zhang,Chunxue Wang

subjective sleep status cognitive impairment ischemic stroke

基本信息

2022-11-02

已发表文章

发表杂志：Nature and Science of Sleep

发表类型: Original Contributions

影响因子(IF): 3.384

PMID: PMC9637338 Pubmed原文链接 全文下载

主要研究背景及目的

睡眠障碍患者出现认知障碍的风险约是正常人的2到4倍。研究表明较差的睡眠质量可能会进一步损害卒中患者的认知功能，无论在缺血性卒中急性期或恢复期，良好的睡眠质量均与更好的认知表现相关。除了睡眠质量外，睡眠持续时间与认知功能密切相关，睡眠时间过短或过长均可能会导致不同认知领域的损害。目前针对急性缺血性卒中患者睡眠状况与认知功能关系的研究相对较少，且以阻塞型睡眠呼吸暂停多见。另一方面，基于多导睡眠监测、体动记录仪的客观睡眠评估不能代表患者实际睡眠感受，且受首夜效应、个体化差异、单次评估有效性的影响，难以反映患者真实睡眠状况。探索急性缺血性卒中患者睡眠状况与卒中后认知功能的关系有助于卒中二级预防，减少卒中复发，协助卒中患者回归家庭与社会，改善卒中患者生活质量。因此本研究的目的是探索主观睡眠状况（包括卒中后3个月睡眠质量、睡眠持续时间、睡眠片段化、日间嗜睡、催眠药物使用）与卒中后3个月认知功能的关系。

方法

Data were analyzed for 1,759 AIS patients from the Impairment of Cognition and Sleep after Acute Ischemic Stroke or Transient Ischemic Attack in Chinese Patients Study (ICONS). Pre-stroke subjective sleep status was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Greater sleep fragmentation was defined as waking up in the middle of the night or early morning ≥3 times a week. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) at 3 months after stroke. Primary endpoint was the incidence of post-stroke cognitive impairment (PSCI) at 3 months after stroke. The association between subjective sleep status and PSCI was evaluated using multivariable logistic regression.

结论

Very bad sleep quality and greater sleep fragmentation before stroke were identified as independent risk factors for PSCI at 3 months after stroke.

主要结果

PSCI occurred in 52.1% at 3 months after stoke. Patients with very bad sleep quality before stroke were at increased risk of PSCI (OR, 2.11; 95% CI, 1.11-4.03; P=0.03). Subgroup analysis found that the association between very bad sleep quality and PSCI was more evident among patients with high school education or above (OR, 5.73; 95% CI, 1.92-17.10; P for interaction=0.02). In addition, patients with greater sleep fragmentation before stroke were also at higher risk of PSCI (OR, 1.55; 95% CI, 1.20-2.01; P<0.01). Similarly, subgroup analysis showed that the risk of PSCI was more pronounced among patients without employment (OR, 2.45; 95% CI, 1.59-3.77; P for interaction=0.01).