卒中后睡眠障碍研究进展

摘要/Abstract

摘要：

卒中后睡眠障碍（post-stroke sleep disorders，PSSD）是一种常见但较少引起重视的卒中后并发症，其发生与疾病本身包括卒中部位、神经生物学及社会心理学因素相关。PSSD临床表现形式多样，需要结合相应的诊断标准及量表评估作出诊断，根据具体情况制订相应的治疗策略，在临床实践中多采用药物及非药物综合治疗的方法。本文就PSSD的临床表现、流行病学、相关危险因素、诊断及治疗做一综述，以期为PSSD的诊疗提供参考。

文章导读： 本文对卒中后睡眠障碍的流行病学资料、相关危险因素、临床表现、诊断及治疗展开全面阐述，以期为卒中后睡眠障碍的诊疗提供参考。

关键词: 卒中; 睡眠障碍; 危险因素; 诊断; 治疗

Abstract:

Post-stroke sleep disorders (PSSD) is a frequent post-stroke complication but lack of attention. Its occurrence is related to stroke itself including lesion location and neurobiochemical changes as well as sociopsychological factors. It has several clinical forms, and the diagnosis should be based on the relative diagnostic criteria and scales evaluation. The therapeutic strategy depends on specific clinical condition. Pharmacotherapy combined with non-pharmacotherapy is usually applied. This review mainly focuses on the clinical features, epidemiology data, related risk factors, diagnosis and therapy of PSSD in order to provide a reference for the clinical practice.

Key words: Stroke; Sleep disorders; Risk factors; Diagnosis; Treatmen

白莹，张宁，王春雪. 卒中后睡眠障碍研究进展[J]. 中国卒中杂志, 2013, 8(05): 407-411.

BAI Ying, ZHANG Ning, WANG Chun-Xue.. Progress of Post-stroke Sleep Disorders[J]. Chinese Journal of Stroke, 2013, 8(05): 407-411.

参考文献

1 Pasic Z, Smajlovic D, Dostovic Z, et al. Incidence and types of sleep disorders in patients with stroke[J]. Med Arh, 2011, 65:225-227.

2 Bakken LN, Kim HS, Finset A, et al. Stroke patients' functions in personal activities of daily living in relation to sleep and socio-demographic and clinical variables in the acute phase after first-time stroke and at six months of follow-up[J]. J Clin Nurs, 2012, 12:1886-1895.

3 Terzoudi A, Vorvolakos T, Heliopoulos I, et al. Sleep architecture in stroke and relation to outcome[J]. Eur Neurol, 2009, 61:16-22.

4 Leppävuori A, Pohjasvaara T, Vataja R, et al. Insomnia in ischemic stroke patients[J]. Cerebrovasc Dis, 2002, 14:90-97.

5 陈璇, 杨期东, 张乐, 等. 急性脑卒中后睡眠障碍及相关因素研究[J]. 医学临床研究, 2009, 26:32-34.

6 Hui DS, Choy DK, Wong LK, et al. Prevalence of sleep-disordered breathing and continuous positive airway pressure compliance:results in Chinese patients with first-ever ischemic stroke[J]. Chest, 2002, 122:852-860.

7 Sandberg O, Franklin KA, Bucht G, et al. Sleep apnea, delirium, depressed mood, cognition, and ADL ability after stroke[J]. J Am Geriatr Soc, 2001, 49:391-397.

8 张晓玲, 官俏兵. 脑卒中患者的失眠问题调查[J]. 中华神经科杂志, 2005, 38:324-325.

9 Autret A, Lucas B, Mondon K, et al. Sleep and brain lesions:a critical review of the literature and additional new cases[J]. Neurophysiol Clin, 2001, 31:356-375.

10 江帆, 颜崇淮, 沈晓明. 与睡眠相关的中枢单胺类递质[J]. 国外医学:精神病学分册, 2001, 28:55-58.

11 吴士文, 杨光, 金民, 等. 脑梗死患者褪黑素节律改变与卒中后日间过度倦睡[J]. 中风与神经疾病杂志, 2004, 21:538-540.

12 Lu J, Sherman D, Devor M, et al. A putative flip-flop switch for control of REM sleep[J]. Nature, 2006, 441:589-594.

13 Riemann D, Spiegelhalder K, Feige B, et al. The hyperarousal model of insomnia:a review of the concept and its evidence[J]. Sleep Med Rev, 2010, 14:19-31.

14 蒋安杰, 裴正斌. 急性脑卒中病灶发生部位与患者的睡眠障碍[J]. 中国临床康复, 2005, 9:80-81.

15 Blanco M, Espinosa M, Arpa J, et al. Hypersomnia and thalamic and brain stem stroke:a study of seven patients[J]. Neurologia, 1999, 14:307-314.

16 Takehara M, Ishikawa K, Hiroi T, et al. Central type of sleep apnea syndrome caused by unilateral lateral medullary infarction[J]. Rinsho Shinkeigaku, 1992, 32:511-515.

17 Chen YK, Lu JY, Mok VC, et al. Clinical and radiologic correlates of insomnia symptoms in ischemic stroke patients[J]. Int J Geriatr Psychiatry, 2011, 26:451-457.

18 Imeri L, De Simoni MG, Giglio R, et al. Changes in the serotonergic system during the sleep-wake cycle:simultaneous polygraphic and voltammetric recordings in hypothalamus using a telemetry system[J]. Neuroscience, 1994, 58:353-358.

19 Braam W, Smits MG, Didden R, et al. Exogenous melatonin for sleep problems in individuals with intellectual disability:a meta-analysis[J]. Dev Med Child Neurol, 2009, 51:340-349.

20 Mayer G, Jennum P, Riemann D, et al. Insomnia in central neurologic diseases--occurrence and management[J]. Sleep Med Rev, 2011, 15:369-378.

21 Bakken LN. Sleep-Wake Patterns during the Acute Phase after First-Ever Stroke[EB/OL]. (2011-07-22)[2013-03-15]. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138134/.

22 英俊, 赵忠新. 脑卒中后睡眠障碍的临床特点、发病机制和治疗[J]. 中国现代神经疾病杂志, 2008, 8:200-202.

23 Palomäki H, Berg A, Meririnne E, et al. Complaints of poststroke insomnia and its treatment with mianserin[J]. Cerebrovasc Dis, 2003, 15:56-62.

24 Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index:a new instrument for psychiatric practice and research[J]. Psychiatry Res, 1989, 28:193-213.

25 Buysse DJ, Hall ML, Strollo PJ, et al. Relationships between the Pittsburgh Sleep Quality Index(PSQI), Epworth Sleepiness Scale(ESS), and clinical/polysomnographic measures in a community sample[J]. J Clin Sleep Med, 2008, 4:563-571.

26 Johns MW. A new method for measuring daytime sleepiness:the Epworth sleepiness scale[J]. Sleep, 1991, 14:540-545.

27 中华医学会神经病学分会睡眠障碍学组. 中国成人失眠诊断与治疗指南[J]. 中华神经科杂志, 2012, 45:534-540.

28 Smith I. Drug therapy for obstructive sleep apnoea in adults[EB/OL]. (2006-04-19)[2013-03-15]. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003002.pub2/abstract.

29 Wallace DM, Ramos AR, Rundek T. Sleep disorders and stroke[J]. Int J Stroke, 2012, 7:231-242.

30 李泰彪. 针刺治疗脑卒中后失眠疗效观察[J]. 中国康复理论与实践, 2007, 13:656-657.

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