Impact of Circadian Rhythm and Sleep Architecture Changes on Prognosis in Patients with Acute Hemorrhagic Stroke.

IF 3.4 2区医学 Q2 CLINICAL NEUROLOGY

Nature and Science of Sleep Pub Date : 2025-07-18 eCollection Date: 2025-01-01 DOI:10.2147/NSS.S533202

Xiaodong Yuan, Yongshan Fu, Ya Ou, Jing Xue, Na Yang, Hongrui Liu, Tiantian Wang, Jing Wang, Cuiping Yan, Pingshu Zhang

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引用次数: 0

Abstract

Objective: Research is limited on whether circadian rhythm and sleep architecture alterations during acute intracerebral hemorrhage (ICH) influence patient outcomes. This study aims to characterize these changes and explore their association with clinical prognosis, offering new insights for diagnosis and treatment.

Methods: We enrolled 100 acute hemorrhagic stroke patients who underwent continuous, contactless sleep monitoring via a smart mattress for 3-5 consecutive days. Prognosis was evaluated at discharge using the modified Rankin Scale (mRS), and patients were classified into favorable or unfavorable outcome groups. Circadian rhythm parameters (IS, IV, RA) and sleep metrics (eg, total sleep time, sleep latency, REM latency) during day and night were compared between groups. Multivariate logistic regression identified independent prognostic factors, and ROC analysis evaluated their predictive value.

Results: Group comparisons revealed statistically significant differences in RA and nighttime sleep latency between the favorable and unfavorable prognosis groups (P < 0.05). Binary logistic regression analysis identified nighttime sleep latency as an independent predictor of functional outcome (95% CI: 1.066 ~ 1.128, P < 0.05), which remained significant after adjusting for potential confounders (95% CI: 1.016 ~ 1.148, P < 0.05). The mean nighttime sleep latency was 18.14 minutes in the favorable group and 12.30 minutes in the unfavorable group. The area under the ROC curve (AUC) for nighttime sleep latency was 0.642 (95% CI: 0.526-0.757, P = 0.028), with an optimal cutoff value of 10.95 minutes, yielding a sensitivity of 72.2% and specificity of 53.6%.

Conclusion: Hemorrhagic stroke patients show disrupted circadian stability, with greater RA reductions in those with worse outcomes. Nighttime sleep latency independently predicts poor prognosis with moderate accuracy. Circadian rhythm stability may serve as a prognostic marker in hemorrhagic stroke to avoid implying causality.

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昼夜节律和睡眠结构变化对急性出血性卒中患者预后的影响。

目的：急性脑出血（ICH）期间昼夜节律和睡眠结构改变是否影响患者预后的研究有限。本研究旨在表征这些变化并探讨其与临床预后的关系，为诊断和治疗提供新的见解。方法：我们招募了100名急性出血性中风患者，他们通过智能床垫连续3-5天进行连续的非接触式睡眠监测。出院时采用改良Rankin量表（mRS）评估预后，并将患者分为预后良好组和预后不良组。比较各组白天和夜间的昼夜节律参数（IS、IV、RA）和睡眠指标（如总睡眠时间、睡眠潜伏期、REM潜伏期）。多因素logistic回归确定独立预后因素，ROC分析评价其预测价值。结果：组间比较，预后良好组与预后不良组RA、夜间睡眠潜伏期差异有统计学意义（P < 0.05）。二元logistic回归分析发现，夜间睡眠潜伏期是功能预后的独立预测因子（95% CI: 1.066 ~ 1.128, P < 0.05），在调整潜在混杂因素后仍具有显著性（95% CI: 1.016 ~ 1.148, P < 0.05）。对照组夜间平均睡眠潜伏期为18.14分钟，对照组为12.30分钟。夜间睡眠潜伏期的ROC曲线下面积（AUC）为0.642 (95% CI: 0.526 ~ 0.757, P = 0.028)，最佳截断值为10.95分钟，敏感性为72.2%，特异性为53.6%。结论：出血性卒中患者表现出昼夜节律稳定性的破坏，结果较差的患者RA减少幅度较大。夜间睡眠潜伏期独立预测预后不良，准确度中等。昼夜节律稳定性可作为出血性中风的预后指标，以避免暗示因果关系。

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来源期刊

Nature and Science of Sleep Neuroscience-Behavioral Neuroscience

CiteScore

5.70

自引率

5.90%

发文量

245

审稿时长

16 weeks

期刊介绍： Nature and Science of Sleep is an international, peer-reviewed, open access journal covering all aspects of sleep science and sleep medicine, including the neurophysiology and functions of sleep, the genetics of sleep, sleep and society, biological rhythms, dreaming, sleep disorders and therapy, and strategies to optimize healthy sleep. Specific topics covered in the journal include: The functions of sleep in humans and other animals Physiological and neurophysiological changes with sleep The genetics of sleep and sleep differences The neurotransmitters, receptors and pathways involved in controlling both sleep and wakefulness Behavioral and pharmacological interventions aimed at improving sleep, and improving wakefulness Sleep changes with development and with age Sleep and reproduction (e.g., changes across the menstrual cycle, with pregnancy and menopause) The science and nature of dreams Sleep disorders Impact of sleep and sleep disorders on health, daytime function and quality of life Sleep problems secondary to clinical disorders Interaction of society with sleep (e.g., consequences of shift work, occupational health, public health) The microbiome and sleep Chronotherapy Impact of circadian rhythms on sleep, physiology, cognition and health Mechanisms controlling circadian rhythms, centrally and peripherally Impact of circadian rhythm disruptions (including night shift work, jet lag and social jet lag) on sleep, physiology, cognition and health Behavioral and pharmacological interventions aimed at reducing adverse effects of circadian-related sleep disruption Assessment of technologies and biomarkers for measuring sleep and/or circadian rhythms Epigenetic markers of sleep or circadian disruption.