Research Of The Sleep Architecture And Cerebral Arterial Stiffness In Acute Ischemic Stroke Patients With OSAHS

Objective:To investigate the incidence and clinical features of obstructive sleep apnea-hypopnea syndrome(OSAHS)in patients with acute ischemic stroke,and to analyze the changes of sleep architecture in these patients.Additionally,based on the correlation analysis between carotid-cerebral pulse wave velocity(ccPWV)and sleep data,this study aims to explore the potential influencing factors of cerebral artery stiffness in patients with acute ischemic stroke complicated with OSAHS.Method:We enrolled consecutive hospitalized stroke patients who admitted to the department of Neurology and underwent sleep testing between November 2021,and March,2022.According to the inclusion and exclusion criteria,85 patients with acute ischemic stroke were included in the study.Clinical data including age,sex,NIHSS score,STOP-BANG score and AHI were collected,the 85 patients were divided into three groups by AHI Index: mild OSAHS group(27 cases),moderate OSAHS group(32 cases),severe OSAHS group(14 cases),and non-OSAHS group(12 cases),the sleep architecture of12 patients was analyzed by polysomnography(PSG).All the patients were tested for ccPWV,and 46 patients were tested for ccPWV and sleep according to the criteria of nano-discharge.Patients were divided into two groups according to the change of ccPWV: elevation group(26 cases)and normal group(20 cases),the differences of age,sex,BMI,general clinical biochemical indexes,systolic blood pressure,diastolic blood pressure,mean arterial pressure and pulse pressure were compared between the two groups,to explore the possible influencing factors of the increase of ccPWV in OSAHS patients with acute ischemic stroke.Results:1.The incidence of OSAHS in patients with acute ischemic stroke was 85.88%(73/85),the scores of AHI,NIHSS and STOP-BANG were significantly different among acute ischemic stroke without OSAHS,acute ischemic stroke with mild OSAHS,acute ischemic stroke with moderate OSAHS,acute ischemic stroke with severe OSAHS(P <0.05),there was no significant difference in age and BMI.The correlation coefficient between AHI and STOP-BANG score was R = 0.765,P < 0.01.The correlation between AHI and STOP-BANG score was significant.2.The sleep architecture of OSAHS patients with acute ischemic stroke: the proportion of non-Rapid eye movement sleep N1 stage(36.15% ± 13.04%)was significantly higher than the reference value of normal sleep stage,the ratio of N 2 stage(48.37% ± 8.15%)was similar to the reference value of normal sleep stage,and the ratio of N 3 stage(9.52% ± 3.56%)was significantly lower than the reference value of normal sleep stage,the percentage of REM stage(5.95% ± 3.91%)was significantly lower than the reference value of normal sleep stage.3.The correlation coefficient between ccPWV and AHI was 0.73(P < 0.01)in acute ischemic stroke patients with OSAHS.The correlation coefficient between ccPWV and ODI was r = 0.33,P < 0.05.There was a weak positive correlation between ODI and ccPWV.The correlation coefficient between ccPWV and Hcy was R = 0.32,P < 0.05.There was a weak positive correlation between Hcy and ccPWV.There was no significant correlation between ccPWV and the lowest Oxygenation,mean Oxygenation and BMI(P > 0.05).4.Hcy,AHI and hypertension history were significantly different between ccPWV elevated group and ccPWV normal group(p < 0.05)The results of binary logistic regression analysis showed that Hcy:(OR = 2.998,95% CI: 1.177-7.634,P < 0.05)and Ahi:(OR = 1.765,95% CI: 1.131-2.755,P < 0.05)were statistically significant for the increase of ccPWV,these results suggest that AHI and Hcy are independent risk factors for ccPWV elevation.Conclusion:1.The prevalence rate of acute ischemic stroke complicated with OSAHS was high,acute ischemic stroke complicated with OSAHS was divided into light,medium and severe subgroups according to AHI,NIHSS and STOP-BANG were statistically significant,correlation analysis between AHI and NIHSS score and STOP-BANG score.The higher the STOP-BANG value,the more severe OSAHS.2.Sleep architecture abnormalities in patients with acute ischemic stroke complicated with OSAHS are mainly manifested as prolongation of light sleep N1,and shortening or even disappearance of deep sleep N3 and REM sleep.3.Hypertension is a risk factor for the increase of ccPWV in patients with OSAHS after acute ischemic stroke.AHI and Hcy are independent risk factors for the increase of ccPWV in patients with OSAHS after acute ischemic stroke.The more severe OSAHS and the higher Hcy,the higher carotid-cerebral arterial stiffness.