Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery.
Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery.
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DOI：
10.1212/wnl.0000000000003037
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发表时间：
2016-09-27
期刊：
影响因子：
9.9
通讯作者：
Bassetti CL
中科院分区：
文献类型：
--
作者：
Hermann DM;Bassetti CL
睡眠呼吸障碍（SDB）和睡眠-觉醒障碍（SWD）在脑卒中患者中非常普遍。最近的研究表明，它们既是中风的危险因素，也是中风的后果，并影响中风的恢复、结局和复发。文献综述。一些研究已经证明SDB是中风的独立危险因素。鉴于SDB的患病率非常高（>50%）（II类B，证据等级B），建议对TIA和卒中患者进行睡眠研究。考虑到越来越多的证据支持对结局的积极影响，建议采用持续气道正压通气治疗阻塞性SDB（II类B，证据等级B）。中心性SDB患者可考虑吸氧、双相气道正压通气和适应性伺服通气。最近，睡眠时间的减少和增加，以及嗜睡、失眠和不宁腿综合征（RLS）也被认为会增加中风的风险。主要的实验研究发现，SWD还可能损害神经可塑性过程和功能性卒中恢复。使用催眠药和镇静抗抑郁药（失眠）、激活抗抑郁药或兴奋剂（嗜睡）、多巴胺能药物（RLS）和氯硝西泮（异眠症）治疗SWD基于单个病例观察，应谨慎使用。SDB和SWD增加了普通人群中卒中的风险，并影响短期和长期卒中恢复和结局。目前的知识支持卒中单元系统实施卒中后SDB和SWD诊断和治疗的临床程序。
Sleep-disordered breathing (SDB) and sleep-wake disturbances (SWD) are highly prevalent in stroke patients. Recent studies suggest that they represent both a risk factor and a consequence of stroke and affect stroke recovery, outcome, and recurrence. Review of literature. Several studies have proven SDB to represent an independent risk factor for stroke. Sleep studies in TIA and stroke patients are recommended in view of the very high prevalence (>50%) of SDB (Class IIb, level of evidence B). Treatment of obstructive SDB with continuous positive airway pressure is recommended given the strength of the increasing evidence in support of a positive effect on outcome (Class IIb, level of evidence B). Oxygen, biphasic positive airway pressure, and adaptive servoventilation may be considered in patients with central SDB. Recently, both reduced and increased sleep duration, as well as hypersomnia, insomnia, and restless legs syndrome (RLS), were also suggested to increase stroke risk. Mainly experimental studies found that SWD may in addition impair neuroplasticity processes and functional stroke recovery. Treatment of SWD with hypnotics and sedative antidepressants (insomnia), activating antidepressants or stimulants (hypersomnia), dopaminergic drugs (RLS), and clonazepam (parasomnias) are based on single case observations and should be used with caution. SDB and SWD increase the risk of stroke in the general population and affect short- and long-term stroke recovery and outcome. Current knowledge supports the systematic implementation of clinical procedures for the diagnosis and treatment of poststroke SDB and SWD on stroke units.