Improvement in nocturnal disordered breathing after first-ever ischemic stroke -: Role of dysphagia
Improvement in nocturnal disordered breathing after first-ever ischemic stroke -: Role of dysphagia
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DOI：
10.1378/chest.129.2.238
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发表时间：
2006-02-01
期刊：
影响因子：
9.6
通讯作者：
Román-Sánchez, P
中科院分区：
文献类型：
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作者：
Martínez-García, MA;Galiano-Blancart, R;Román-Sánchez, P
研究目的：本研究的目的是分析吞咽困难作为咽肌功能障碍模型在首次缺血性中风患者夜间呼吸障碍 (NDB) 时间过程中的作用。设计：前瞻性研究。患者和干预措施：对 59 名连续患者（平均年龄，73.2 岁；SD，12.8 岁）进行研究。记录临床睡眠和神经系统数据以及血管危险因素。使用便携式自动滴定装置（AutoSet Portable Plus II 系统；ResMed；悉尼，新南威尔士州，澳大利亚）进行了两项夜间研究，在所有患者神经系统事件的急性期（平均持续时间 1.23 天；SD，0.7 天）和稳定期（平均持续时间 65.9 天；SD，12.5 天）进行。急性期自动滴定装置的值为 34.9（SD，25.2），稳定期为 20.1（SD，21.7），两者均以阻塞性呼吸暂停为主。吞咽困难患者 (n = 30) 在急性期表现出最多次数的阻塞性呼吸暂停发作 (AHI，40 次；OAI，30.4 次)，而在卒中稳定期此类呼吸暂停显着减少 (AHI，24.7 次；OAI，17.7 次)，与咽部肌肉功能的恢复一致。相比之下，非吞咽困难患者 (n = 29) 从中风急性期到稳定期 NDB 没有显着变化。 Logistic 回归分析发现，吞咽困难是 AHI 较基线降低 > 50% 的最佳独立预测因子（比值比，13.4；95% 置信区间，3.3 至 39.6；p = 0.001）。 结论：本研究表明，继发于神经系统疾病的短暂性咽肌改变的患者，首次缺血性卒中稳定期发生的阻塞性呼吸暂停事件数量显着改善。病变。
Study objective: The aim of this study was to analyze the role of dysphagia as a model of pharyngeal muscle dysfunction in the time course of nocturnal disordered breathing (NDB) in patients who experienced a first-ever ischemic stroke.Design: Prospective study.Patients and interventions: Fifty-nine consecutive patients (mean age, 73.2 years; SD, 12.8 years) were studied. Clinical sleep and neurologic data and vascular risk factors were recorded. Two nocturnal studies using a portable autotitration device (AutoSet Portable Plus II system; ResMed; Sydney, NSW, Australia) were performed in both the acute phase (mean duration, 1.23 days; SD, 0.7 day) and the stable phase (mean duration 65.9 days; SD, 12.5 days) of the neurologic event in all patients.Results: The mean total apnea-hypopnea index (AHI) measured with the autotitration device in the acute phase was 34.9 (SD, 25.2) vs 20.1 (SD, 21.7) in the stable phase, both with predominance of obstructive apnea. Patients with dysphagia (n = 30) showed the largest number of obstructive apneic episodes (OAIs) in the acute phase (AHI, 40 episodes; OAI, 30.4 episodes), with a significant reduction in this type of apnea during the stable phase of stroke (AHI, 24.7 episodes; OAI, 17.7 episodes), coinciding with the recovery of pharyngeal muscle function. In contrast, nondysphagic patients (n = 29) showed no significant changes in NDB from the acute to the stable phase of stroke. Logistic regression analysis found dysphagia to be the best independent predictor of AHI reduction of > 50% from baseline (odds ratio, 13.4; 95% confidence interval, 3.3 to 39.6; p = 0.001).Conclusion: The present study shows significant improvement in the number obstructive apneic events occurring in the stable phase of a first-ever ischemic stroke in patients with transient pharyngeal muscle alterations secondary to the neurologic lesion.