Effects Of Sleep-disordered Breathing And That In Different Sleep Stages On Sleep Structure And Outcome Of Acute Ischemic Stroke

PART I Effects of sleep-disordered breathing on sleep structure and outcome of acute ischemic stroke patientsObjectives:Sleep-disordered breathing(SDB)is associated with many risk factors of ischemic stroke,such as hypertension,diabetes,hyperlipidemia and atrial fibrillation.It is not only a risk factor of ischemic stroke but also an important factor influencing stroke prognosis.This study aimed at analyzing the clinical features of acute ischemic stroke patients with SDB and the effect of SDB on sleep structure and stroke outcome.Methods:This retrospective study included acute ischemic stroke patients finishing polysomnography within 14 days of stoke onset in the Second Affiliated Hospital of Soochow University from April 2010 to August 2018.Clinical characteristics at baseline and polysomnographic parameters were collected.The assessments of acute ischemic stroke included National Institutes of Health stroke scale(NIHSS),TOAST classification,infarct location and modified Rankin Scale(mRS).Patients were divided into two groups according to apnea-hypopnea index(AHI),acute ischemic stroke without SDB(AHI<5)and with SDB(AHI?5).Results:Of the 118 patients finally enrolled,97(82.2%)were male and 89(75.42%)combined with SDB.The mean age was 59.60(range from 29 to 82).Compared with patients without SDB,those with SDB had higher body mass index(P=0.013).The proportion of patients with risk factors of ischemic stroke such as hypertension,diabetes,hyperlipidemia,atrial fibrillation,smoking,alcohol consumption,and infarct location of diencephalon and brain stem were higher in patients with SDB although they were not statically significant.Patients with SDB had longer stage 1 sleep of non-rapid eye movement sleep(P=0.004)and shorter slow wave sleep(P=0.009).The mRS scores were not significantly different between two groups.In Logistic analysis,NIHSS score(P<0.001;OR 1.781;95%CI 1.444-2.195)and AHI(P=0.012;OR 1.025;95%CI 1.005-1.046)were independently associated with the mRS score.Conclusion:Patients with SDB after acute ischemic stroke are prone to obesity and have longer light sleep,shorter deep sleep.NIHSS score and AHI were independently associated with functional recovery.PART ? Effects of sleep-disordered breathing during rapid eye movement and non-rapid eye movement sleep on sleep structure and outcome of acute ischemic strokeObjectives:Sleep-disordered breathing(SDB)adversely impacts stroke outcome.The characteristics of SDB in rapid eye movement(REM)and non-REM(NREM)sleep are different.Previous studies focused more on SDB in overall sleep rather than that in different sleep stages.We investigated whether SDB during REM and NREM sleep differentially influences the outcome of acute ischemic stroke.Methods:This study included a historical cohort of patients who underwent polysomnography within 14 days of an acute ischemic stroke in the Second Affiliated Hospital of Soochow University between April 2010 and August 2018.Patients were divided into three groups according to apnea-hypopnea index during REM(AHIREM)and NREM sleep(AHINREM):those without SDB(AHIREM<5 and AHINREM<5),those with SDB during REM sleep only(AHIREM?5 and AHINREM<5)and those with SDB during NREM sleep only(AHIREM<5 and AHINREM?5).Short-term outcome was evaluated according to the mRS score 90 days after stroke onset.Long-term outcome was evaluated according to the mRS score,stroke-specific quality-of-life scale,stroke recurrence and death at the last follow-up between January and April 2019.Results:Of the 53 patients enrolled in the study,33 were included in the analysis for long-term outcome.The medium follow-up time was 33.00 months.AHIREM of patients with SDB during REM sleep only and AHINREM of patients with SDB during NREM sleep only were not statistically different but AHI in the latter group were significantly higher(P<0.001).Compared with patients without SDB,those with SDB during REM sleep only did not show significant changes in sleep structures while those with SDB during NREM sleep only spent more time in NREM1 sleep(P=0.009)and less time in slow wave sleep(P=0.046).Their arousal index was higher than that in patients without SDB or with SDB during REM sleep only(P<0.001).No significant difference of short-term outcome or long-term outcome were found between three groups.Age(P=0.011;OR 1.121;95%CI 1.027-1.225)and REM latency(P=0.028;OR 1.012;95%CI 1.001-1.023)were independently associated with mRS score at last follow-up.Conclusion:Sleep structure of patients with SDB during NREM sleep is disturbed.The outcomes of patients with SDB during REM sleep and NREM sleep are not significantly different.Age and REM latency are independently associated with long-time functional status of acute ischemic stroke.