方立;张淑玲;周艳丽;朱太卿;刘瑞;肖悠美;滕军放;周俊超;

• 1:郑州人民医院
• 2:郑州大学第一附属医院

摘要(Abstract)：

目的探讨睡眠障碍性呼吸对老年脑梗死血压变异性及短期预后的影响。方法前瞻性纳入2012-06-2019-09在郑州人民医院神经内科二病区住院就诊的老年脑梗死患者226例。按照入院时及入院72 h NIHSS评分结果,按照是否发生终点事件分为进展组和对照组。入院后完成多导睡眠监测及动态血压监测。观察血压变异性及预后的差异,并分层分析不同睡眠紊乱指数下的血压变异性差异。结果进展组与对照组SE、TST、S3+S4/%、REM期睡眠比例及RDI、AHI、收缩压标准差比较,差异有统计学意义(P<0.05)。中高度睡眠呼吸紊乱指数组与对照组比较,高收缩压标准差、非杓型比例明显增多,差异有统计学意义(P<0.05)。结论睡眠呼吸暂停低通气指数、睡眠紊乱指数是预测睡眠障碍性呼吸老年脑梗死患者短期预后的可靠指标,原因可能与睡眠影响血压变异性有关。

关键词(KeyWords)： 睡眠障碍性呼吸;脑梗死;睡眠紊乱指数;血压变异性

Abstract:

Keywords:

基金项目(Foundation): 河南省科技攻关计划项目(编号:182102310241)

作者(Authors): 方立;张淑玲;周艳丽;朱太卿;刘瑞;肖悠美;滕军放;周俊超;

参考文献(References)：

• [1] 易阳,董选,熊建新,等.睡眠呼吸障碍儿童数学认知能力的ERP研究[J].中华行为医学与脑科学杂志,2016,25(7).DOI:10.3760/cma.j.issn.1674-6554.2016.07.010.
• [2] 王兰琴,荣良群,刘海艳,等.急性脑梗死合并阻塞性睡眠呼吸暂停综合征患者的危险因素分析[J].中国实用神经疾病杂志,2019,22(21):2369-2374.DOI:10.12083/SYSJ.2019.21.388.
• [3] BEAUDIN A E,WALTZ X,HANLY P J,et al.Impact of obstructive sleep apnoea and intermittent hypoxia on cardiovascular and cerebrovascular regulation[J].Exp Physiol,2017,102(7):743-763.DOI:10.1113/EP086051.
• [4] ARZT M,YOUNG T,FINN L,et al.Association of sleep-disordered breathing and the occurrence of stroke[J].Am J Respir Crit Care Med,2005,172(11):1447-1451.DOI:10.1164/rccm.200505-702OC.
• [5] TSIVGOULIS G,ALEXANDROV A V,KATSANOS A H,et al.Noninvasive Ventilatory Correction in Patients With Acute Ischemic Stroke:A Systematic Review and Meta-Analysis[J].Stroke,2017,48(8):2285-2288.DOI:10.1161/STROKEAHA.117.017661.
• [6] 北京神经内科学会睡眠障碍专业委员会,北京神经内科学会神经精神医学与临床心理专业委员会,中国老年学和老年医学学会睡眠科学分会.卒中相关睡眠障碍评估与管理中国专家共识[J].中华内科杂志,2019,58(1):17-26.DOI:10.3760/cma.j.issn.0578-1426.2019.01.004.
• [7] JOHANSSON J K,KRONHOLM E,JULA A M,et al.Variability in home-measured blood pressure and heart rate:Associations with self-reported insomnia and sleep duration[J].J Hypertens,2011,29:1897-1905.DOI:10.1097/HJH.0b013e32834abccd.
• [8] 袁水生,马芳杰,韩丽华.急性缺血性脑卒中患者远期预后的预测因子分析[J].中国实用神经疾病杂志,2018,21(18):2063-2068.DOI:10.12083/SYSJ.2018.18.451.
• [9] 刘冬冬,郭丹,吴慧莉,等.基于经验模式分解的心肺耦合技术在儿童睡眠分析中的应用[J].中国医疗设备,2019,34(8):32-36,41.DOI:10.3969/j.issn.1674-1633.2019.08.006.
• [10] 邰胜,王翎,钱惠英.高龄老年高血压患者动态血压特点[J].中华老年心脑血管病杂志,2019,21(8):822-825.DOI:10.3969/j.issn.1674-4055.2010.01.006.10.12998/wjcc.v4.i2.33.
• [13] MATTHEWS K A,KAMARCK T W,HALL M H,et al.Blood pressure dipping and sleep disturbance in African-American and Caucasian men and women[J].Am J Hypertens,2008,21:826-831.DOI:10.1038/ajh.2008.183
• [14] HAJJAR I,ZHAO P,ALSOP D,et al.Association of blood pressure elevation and nocturnal dipping with brain atrophy,perfusion and functional measures in stroke and nonstroke individuals[J].Am J Hypertens,2010,23:17-23.DOI:10.1038/ajh.2009.187.
• [15] HERMIDA R C,AYALA D E,SMOLENSKY M H,et al.Sleep-time blood pressure:unique sensitive prognostic marker of vascular risk and therapeutic target for prevention[J].Sleep Med Rev M,2017,33:17-27.DOI:10.1016/j.smrv.2016.04.001.
• [16] KASTARINEN H,VASUNTA R L,UKKOLA O,et al.Glomerular filtration rate is related to dipping pattern in ambulatory blood pressure monitoring:a cross-sectional population-based study[J].J Hum Hypertens,2010,24:247-253.DOI:10.1038/jhh.2009.66.
• [17] JOHNSON K G,JOHNSON D C.Frequency of sleep apnea in stroke and TIA patients:a meta-analysis[J].J Clin Sleep Med,2010,6:131-137.DOI:10.1016/j.pnpbp.2010.02.007.
• [18] BONNIN-VILAPLANA M,ARBOIX A,PARRA O,et al.Sleep-related breathing disorders in acute lacunar stroke[J].J Neurol,2009,256:2036-2042.DOI:10.1007/s00415-009-5236-x.
• [19] BONNIN-VILAPLANA M,ARBOIX A,PARRA O,et al.Sleep-related breathing disorders:impact on mortality of cerebrovascular disease[J].J Neurol,2009,256:2036-2042.DOI:10.1183/09031936.04.00061503.
• [20] ARBOIX A,BLANCO-ROJAS L,MARTI-VILALTA J L.Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke:translation of knowledge to prevention strategies[J].Expert Rev Neurother,2014,14:261-276.DOI:10.1586/14737175.2014.884926.
• [21] PARRA O,ARBOIX A,MONTSERRAT J M,et al.Sleep-related breathing disorders:impact on mortality of cerebrovascular disease[J].Eur Respir J,2004,24:267-272.DOI:10.1183/09031936.04.00061503.
• [22] SAHLIN C,SANDBERG O,GUSTAFSON Y,et al.Obstructive sleep apnea is a risk factor for death in patients with stroke:a 10-year follow-up[J].Arch Intern Med,2008,168:297-301.DOI:10.1001/archinternmed.2007.70.
• [23] VALIPOUR A,MCGOWNA D,MAKKER H,et al.Some factors affecting cerebral tissue saturation during obstructive sleep apnoea[J].Eur Respir J,2002,20:444-450.DOI:10.1183/09031936.02.00265702.
• [24] WALTZ X,BEAUDIN A E,HANLY P J,et al.Effects of continuous positive airway pressure and isocapnic-hypoxia on cerebral autoregulation in patients with obstructive sleep apnoea[J].J Physiol,2016,594:7089-7104.DOI:org/10.1113/JP272967.
• [25] AN S,BAO M,WANG Y,et al.Relationship between cardiovascular health score and year-to-year blood pressure variability in China:A prospective cohort study[J].BMJ Open,2015,5:e008730.DOI:10.1136/bmjopen-2015-008730.