缺血性卒中慢性期睡眠质量下降发生率及相关危险因素的前瞻性队列研究

摘要

目的：调查缺血性卒中患者发病1年睡眠质量下降发生率及睡眠质量下降的危险因素。方法连续入组住院治疗的急性缺血性卒中患者。收集患者的人口学资料、既往病史、临床指标及影像学资料（急性期病灶部位）。随访患者发病后14 d是否存在卒中后抑郁、抗抑郁药物使用与否、评定美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）、简易精神状态检查量表（Mini Mental State Examination，MMSE）、汉密尔顿抑郁量表（Hamilton Depression Rating Scale，HRSD）和汉密尔顿焦虑量表（Hamilton Anxiety Scale，HAMA）；发病1年后随访卒中复发、评定改良Rankin量表（modified Rankin Scale，mRS）、HRSD、HAMA和匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Indexs，PSQI）。以PSQI≥8分为患者存在睡眠质量问题，对可能影响睡眠的因素进行单因素和多因素分析。结果研究期间共入组并完成随访的患者共233例。1年随访时PSQI≥8分，提示存在睡眠质量问题的患者为31例（13.3%）。单因素分析结果显示睡眠质量下降与随访时患者是否服用抗抑郁药物（χ2＝3.9657，P＝0.0464）、发病14 d内的HRSD评分（Z＝1.9712，0.0487）、1年随访时HRSD评分（Z＝6.7303， P<0.0001）和HAMA评分有关（Z＝6.6807，P<0.0001）；多因素分析显示1年随访阶段的HAMA评分[比值比（odds ratio，OR）1.666，95%可信区间（confidence interval，CI）1.309～2.120，P<0.0001]是卒中患者慢性期睡眠质量下降的独立危险因素。结论睡眠障碍在卒中慢性期发生率仍较高，慢性期焦虑水平是睡眠质量下降的独立危险因素。%Objective To investigate the sleep quality of stroke patients in 1-year follow-up, with an attempt to understand the prevalence and risk factors of sleep quality. Methods Eligible inpatients with acute ischemic cerebrovascular diseases were treated in the stroke unit of the Department of Neurology. Demographic data, disease history, associated clinical indicators, and imaging data (sites of acute lesions) were collected. Two follow-up visits were carried out for all the enrolled patients: visit 1 (including National Institutes of Health Stroke Scale [NIHSS], Mini Mental State Examination [MMSE], Hamilton Depression Rating Scale [HRSD] and Hamilton Anxiety Scale [HAMA]), 14 days after onset; and visit 2 (including modiifed Rankin Scale [mRS], HRSD, HAMA and Pittsburgh Sleep Quality Indexs [PSQI]), 1 year after onset. A PSQI score8 was considered sleep disorder. Data were analyzed using SAS 9.2 software. Results A total of 233 cases of stroke patients completed the follow-up 1 year from the onset. The incidence of sleep disorders was 13.3% (39 cases) at one-year follow up. Univariate analysis showed that the sleep disorders were correlated with antidepressant medication at visits (χ2=3.9657, P=0.0464), HRSD scores within 14 days after onset (Z=1.9712,P=0.0487), HRSD scores at visit 2 (Z=6.7303,P<0.0001), and HAMA scores (Z=6.6807,P<0.0001). Multivariate analysis showed that the HAMA scores at visit 2 was an independent risk factor for sleep disorders in the chronic stage of stroke (odds ratio [OR] 1.666, 95% conifdence interval [CI] 1.309~2.120,P<0.0001). Conclusion The incidence of sleep disorder can be high at the chronic stages of stroke. The level of depression at the chronic stage (HAMA score) is the only independent risk factor for sleep disorders.