Evolution of Sleep Apnea and Arousals in Patients with Ischemic Stroke: A Longitudinal Follow-Up Study.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Annals of Indian Academy of Neurology Pub Date : 2024-11-01 Epub Date: 2024-12-05 DOI:10.4103/aian.aian_439_24

P R Srijithesh, Sivasubramanian Mythirayee, Doniparthi Venkata Seshagiri, Nitish L Kamble, Sanjib Sinha, Ravi Yadav

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引用次数: 0

Abstract

Background and objectives: Sleep-disordered breathing (SDB) is characterized by pauses or shallow breathing during sleep. It is linked to poorer outcomes and increased stroke recurrence in stroke patients. We aimed to evaluate the proportion, severity, type, and evolution of SDB and arousals in ischemic stroke patients.

Methods: Ischemic stroke patients were recruited to evaluate SDB. Patients underwent overnight polysomnography (PSG) twice - within 1 month of stroke onset and again after 3 months. Clinical outcomes were evaluated at 6, 18, and 24 months.

Results: Of 141 acute ischemic stroke patients screened, 111 patients recruited in the study and 105 patients had technically adequate polysomnography. The mean age of patients was 50.5 years (standard deviation [SD]: 12.30), 78.4% of the patients were males, and the mean body mass index was 26 (SD: 5.4). Results showed that 81.9% had an apnea-hypopnea index (AHI) ≥5, with 12.5% having an AHI >30. The median arousal index (ArI) was 15.4 (interquartile range [IQR]: 0.5-50.5), which increased as the apnea increased. During follow-up, 56.8% patients had an AHI ≥5, with 12.5% having severe apnea. The median ArI decreased from 15.4 (IQR: 0.5-50.5) initially to 11.54 (IQR: 0.5-21.1) at follow-up. Numerical change in AHI severity categories were noted during the follow-up (mild: 8 vs 15; moderate: 17 vs 11; severe 19vs 7). For AHI >30, ArI decreased from 24.63 (IQR: 0.7-50.05) to 10.54 (IQR: 7.1-15.07) at follow-up. Sleep efficiency and rapid eye movement (REM) sleep duration increased on follow-up.

Conclusions: The study showed a high proportion of SDB in acute ischemic stroke patients. In the follow-up, SDB improved, as reflected in AHI and ArI changes.

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缺血性脑卒中患者睡眠呼吸暂停和觉醒的演变：一项纵向随访研究。

背景与目的：睡眠呼吸障碍（SDB）以睡眠时呼吸暂停或呼吸浅为特征。它与卒中患者预后较差和卒中复发率增加有关。我们的目的是评估缺血性脑卒中患者SDB和觉醒的比例、严重程度、类型和演变。方法：选取缺血性脑卒中患者进行SDB评估。患者在中风发作1个月内和3个月后分别接受两次夜间多导睡眠图（PSG）检查。在6个月、18个月和24个月时评估临床结果。结果：141例急性缺血性脑卒中患者中，111例纳入研究，105例技术上足够多导睡眠图。患者平均年龄50.5岁（标准差[SD]: 12.30），男性占78.4%，平均体重指数为26 （SD: 5.4）。结果显示，81.9%患者的呼吸暂停低通气指数(AHI)≥5，其中12.5%患者的AHI指数≥30。唤醒指数（ArI）中位数为15.4（四分位数间距[IQR]: 0.5-50.5），随着呼吸暂停的加重而升高。随访期间，56.8%的患者AHI≥5,12.5%的患者有严重的呼吸暂停。中位ArI从最初的15.4 （IQR: 0.5-50.5）下降到随访时的11.54 （IQR: 0.5-21.1）。随访期间注意到AHI严重程度类别的数值变化(轻度：8 vs 15；中度：17 vs 11；重度19vs 7)。AHI指数为30时，ArI从24.63 （IQR: 0.7-50.05）降至10.54 （IQR: 7.1-15.07）。睡眠效率和快速眼动（REM）睡眠持续时间随随访而增加。结论：研究显示SDB在急性缺血性脑卒中患者中所占比例较高。在随访中，SDB得到改善，这反映在AHI和ArI的变化上。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Indian Academy of Neurology Nervous System Diseases-

CiteScore

2.20

自引率

11.80%

发文量

293

审稿时长

29 weeks

期刊介绍： The journal has a clinical foundation and has been utilized most by clinical neurologists for improving the practice of neurology. While the focus is on neurology in India, the journal publishes manuscripts of high value from all parts of the world. Journal publishes reviews of various types, original articles, short communications, interesting images and case reports. The journal respects the scientific submission of its authors and believes in following an expeditious double-blind peer review process and endeavors to complete the review process within scheduled time frame. A significant effort from the author and the journal perhaps enables to strike an equilibrium to meet the professional expectations of the peers in the world of scientific publication. AIAN believes in safeguarding the privacy rights of human subjects. In order to comply with it, the journal instructs all authors when uploading the manuscript to also add the ethical clearance (human/animals)/ informed consent of subject in the manuscript. This applies to the study/case report that involves animal/human subjects/human specimens e.g. extracted tooth part/soft tissue for biopsy/in vitro analysis.