Sleep-disordered breathing and acute ischemic stroke - Diagnosis, risk factors, treatment, evolution, and long-term clinical outcome
Sleep-disordered breathing and acute ischemic stroke - Diagnosis, risk factors, treatment, evolution, and long-term clinical outcome
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DOI：
10.1161/01.str.0000208215.49243.c3
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发表时间：
2006-04-01
期刊：
影响因子：
8.3
通讯作者：
Gugger, M
中科院分区：
文献类型：
--
作者：
Bassetti, CL;Milanova, M;Gugger, M
背景与目的-睡眠呼吸障碍（SDB）是脑卒中患者的常见病。脑卒中患者SDB的危险因素、治疗反应、短期和长期预后尚不清楚。方法：我们前瞻性研究了152例急性缺血性卒中患者（平均年龄56±13岁）。评估心血管危险因素、Epworth嗜睡评分（ESS）、卒中严重程度/病因、卒中发病时间。在卒中发作后3 +/- 2天和6个月后（亚急性期）测定呼吸暂停低通气指数（AHI）。对急性SDB患者（AHI >= 15或AHI >= 10 + ESS >0）进行持续气道正压（CPAP）治疗。在60 +/- 16个月后（慢性期）评估CPAP依从性、血管事件发生率和卒中结局。结果-初始AHI为18 +/- 16(58%的患者>= 10,17%的患者>= 30)，在亚急性期下降（P < 0.001）。年龄、糖尿病和夜间卒中发作是AHI的独立预测因子（r(2) = 0.34）。在AHI >= 30的患者中，年龄、男性、体重指数、糖尿病、高血压、冠心病、ESS、卒中大血管病变病因均明显高于/多于AHI < 10的患者。两组血管事件的长期发生率和卒中结局相似。51%的SDB患者开始使用CPAP， 15%的SDB患者长期使用CPAP。长期卒中死亡率与初始AHI、年龄、高血压、糖尿病和冠心病相关。结论：SDB在老年卒中男性患者中尤其常见，糖尿病、夜间卒中、大血管病变是卒中的病因；急性期后病情改善，与卒中后死亡率增加有关，一小部分患者可采用CPAP治疗。
Background and Purpose - Sleep-disordered breathing (SDB) is frequent in stroke patients. Risk factors, treatment response, short-term and long-term outcome of SDB in stroke patients are poorly known.Methods - We prospectively studied 152 patients ( mean age 56 +/- 13 years) with acute ischemic stroke. Cardiovascular risk factors, Epworth sleepiness score (ESS), stroke severity/etiology, and time of stroke onset were assessed. The apnea-hypopnea index (AHI) was determined 3 +/- 2 days after stroke onset and 6 months later ( subacute phase). Continuous positive airway pressure ( CPAP) treatment was started acutely in patients with SDB ( AHI >= 15 or AHI >= 10 + ESS > 10). CPAP compliance, incidence of vascular events, and stroke outcome were assessed 60 +/- 16 months later ( chronic phase).Results - Initial AHI was 18 +/- 16 ( >= 10 in 58%, >= 30 in 17% of patients) and decreased in the subacute phase ( P < 0.001). Age, diabetes, and nighttime stroke onset were independent predictors of AHI (r(2) = 0.34). In patients with AHI >= 30, age, male gender, body mass index, diabetes, hypertension, coronary heart disease, ESS, and macroangiopathic etiology of stroke were significantly higher/more common than in patients with AHI < 10. Long-term incidence of vascular events and stroke outcome were similar in both groups. CPAP was started in 51% and continued chronically in 15% of SDB pts. Long-term stroke mortality was associated with initial AHI, age, hypertension, diabetes, and coronary heart disease.Conclusions - SDB is common particularly in elderly stroke male patients with diabetes, nighttime stroke onset, and macroangiopathy as cause of stroke; it improves after the acute phase, is associated with an increased poststroke mortality, and can be treated with CPAP in a small percentage of patients.