Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke.
Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke.
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DOI：
10.1161/strokeaha.109.566463
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发表时间：
2010-03
期刊：
影响因子：
8.3
通讯作者：
Bradley TD
中科院分区：
文献类型：
--
作者：
Arzt M;Young T;Peppard PE;Finn L;Ryan CM;Bayley M;Bradley TD
阻塞性睡眠呼吸暂停（OSA）在中风后的诊断调查中很少被考虑，尽管它是中风的危险因素并且对中风后的预后有不良影响。原因之一可能是普通社区广泛使用的 OSA 检测临床标准不适用于中风患者。我们假设，与具有相同严重程度的 OSA 的社区样本受试者相比，中风患者的困倦程度和肥胖程度较低。我们对入住中风康复中心的 96 名连续中风患者以及 1,093 名无中风病史的社区样本进行了多导睡眠图检查。我们比较了两个样本之间通过 Epworth 嗜睡量表 (ESS) 评估的主观嗜睡程度，以及根据 OSA 类别评估的体重指数，该类别是通过每小时睡眠呼吸暂停和呼吸不足的频率评估的（<5，无 OSA；5 至 <15 轻度 OSA；≥15，中重度 OSA）。与社区样本相比，患有 OSA 的中风患者的 ESS 评分和 BMI 显着较低，轻度 OSA（ESS 9.3±0.3 对比 5.6±0.5，p<0.001，BMI 33.1±0.5 对比 28.5±1.1，p<0.048）和中重度 OSA（ESS 9.7±0.4 对比 7.1±0.9， p=0.043，BMI 36.4±0.8 对比 27.2±0.8 kg/m2，p<0.025）。对于给定严重程度的 OSA，中风患者比没有中风的受试者白天嗜睡较少，体重指数也较低。这些因素可能会使中风后阶段的 OSA 诊断变得难以捉摸，并使许多此类患者无法获得 OSA 治疗的潜在益处。
Obstructive sleep apnea (OSA) is seldom considered in the diagnostic investigation in the post-stroke period even though it is a stroke risk factor and has adverse prognostic implications following stroke. One reason might be that widely used clinical criteria for detection of OSA in the general community are not applicable in stroke patients. We hypothesized that stroke patients report less sleepiness and are less obese than subjects from a community sample with the same severity of OSA. We performed polysomnography in 96 consecutive stroke patients admitted to a stroke rehabilitation unit and in a community sample of 1,093 subjects without a history of stroke. We compared the degrees of subjective sleepiness assessed by the Epworth Sleepiness Scale (ESS) and body-mass index between the two samples according OSA-categories assessed by the frequency of apneas and hypopneas per hour of sleep (<5, no OSA; 5 to <15 mild OSA; and ≥15, moderate-severe OSA). Compared to the community sample, stroke patients with OSA had significantly lower ESS scores and BMI for mild OSA (ESS 9.3±0.3 versus 5.6±0.5, p<0.001, and BMI 33.1±0.5 versus 28.5±1.1, p<0.048), and for moderate-severe OSA (ESS 9.7±0.4 versus 7.1±0.9, p=0.043, and BMI 36.4±0.8 versus 27.2±0.8 kg/m2, p<0.025). For a given severity of OSA, stroke patients had less daytime sleepiness and lower BMI than subjects without stroke. These factors may make the diagnosis OSA elusive in the post-stroke period, and preclude many such patients from the potential benefits of OSA therapy.