阻塞型睡眠呼吸暂停低通气综合征对急性缺血性卒中患者脑血管反应性的影响

doi:10.3969/j.issn.1673-5765.2021.10.010

摘要/Abstract

摘要： 目的探讨阻塞型睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）对急性缺血性卒中患者脑血管反应性（cerebrovascular reactivity，CVR）的影响。方法前瞻性连续入组2017年10月-2020年8月住院治疗的急性缺血性卒中患者，入院2周内完善多导睡眠监测，根据是否合并OSAHS及呼吸暂停低通气指数（apnea hypopnea index，AHI）将患者分为非 OSAHS组、轻度OSAHS组（AHI 5～15次/小时）和中重度OSAHS组（AHI>15次/小时）。在完成多导睡眠监测后24 h内对患者进行TCD检查，检测CVR指标包括平静呼吸时、屏气后大脑中动脉的平均血流速度（Vm），计算屏气指数（breath holding index，BHI）。比较三组间CVR指标的差异，并在中重度OSAHS组中分析CVR指标与入院时和发病3个月时NIHSS评分的相关性。结果共纳入228例急性缺血性卒中患者，男性140例（61.4%），其中非OSAHS组49例，轻度OSAHS 组42例，中重度OSAHS组137例。中重度OSAHS组BMI、高血压比例、3个月时NIHSS评分均高于非OSAHS 组，差异有统计学意义。中重度OSAHS组平静呼吸时Vm低于非OSAHS组（57.4±10.6 cm/s vs 62.1±12.2 cm/s，P =0.010）和轻度OSAHS组（57.4±10.6 cm/s vs 59.6±11.2 cm/s，P =0.007），BHI 低于非OSAHS组（1.4%±0.6% vs 1.7%±0.7%，P =0.002）和轻度OSAHS组（1.4%±0.6% vs 1.5%±0.6%，P =0.001）。中重度OSAHS组发病3个月时NIHSS评分与平静呼吸时Vm（r =-0.696，P＜0.001）和BHI（r =-0.832，P＜0.001）呈负相关。结论伴中重度OSAHS的急性缺血性卒中患者CVR明显下降，而且CVR的下降可能与急性缺血性卒中患者的预后不良有关。

文章导读： 本研究从临床角度证实伴中重度OSAHS的急性缺血性卒中患者的CVR明显下降，而且CVR的下降可能与急性缺血性卒中患者的预后不良有关。

关键词: 阻塞型睡眠呼吸暂停低通气综合征; 缺血性卒中; 经颅多普勒超声; 血流速度; 脑血管反应性; 预后

Abstract: Objective To investigate the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on cerebrovascular reactivity (CVR) in patients with acute ischemic stroke (AIS). Methods This study prospectively enrolled consecutive inpatients with AIS from October 2017 to August 2020. All the patients underwent polysomnography (PSG) within 2 weeks after admission. According to having OSAHS or not and apnea hypopnea index (AHI), the patients were divided into

non-OSAHS group, mild OSAHS group (AHI 5-15 times/hour) and moderate-to-severe OSAHS

group (AHI>15 times/hour). TCD examination was performed within 24 hours after PSG. The CVR was evaluated by measuring the mean blood flow velocity (Vm) of middle cerebral artery (MCA) during calm breathing and after holding breath, and the breath holding index (BHI) was calculated. The differences of CVR among the three groups were compared, and the correlation between CVR and NIHSS score at admission and 3 months after stroke onset were analyzed in moderate-to-severe OSAHS group. Results A total of 228 AIS patients were included, with 140 males (61.4%), 49 cases in non-OSAHS group, 42 cases in mild OSAHS group and 137 cases in moderate-to-severe OSAHS group. The BMI, proportion of hypertension and 90-day NIHSS score in moderate-to-severe OSAHS group were higher than those in non-OSAHS group, and the differences were statistically significant. The Vm of MCA during calm breathing in moderate-to-severe OSAHS group was lower than that in non- OSAHS group (57.4±10.6 cm/s vs 62.1±12.2 cm/s, P =0.010) and mild OSAHS group (57.4±10.6 cm/s vs 59.6±11.2 cm/s, P =0.007); BHI was also lower than that in non-OSAHS group (1.4%±0.6% vs 1.7%±0.7%, P =0.002) and mild OSAHS group (1.4%±0.6% vs 1.5%±0.6%, P =0.001). The 90-day NIHSS score in moderate-to-severe OSAHS group was negatively correlated with the Vm (r =-0.696, P <0.001) of MCA during calm breathing and BHI (r =-0.832, P <0.001). Conclusions The CVR of AIS patients with moderate-to-severe OSAHS decreased significantly, and the decreased CVR may be correlated with the poor prognosis of AIS patients.

Key words: Obstructive sleep apnea hypopnea syndrome; Ischemic stroke; Transcranial Doppler; Blood flow velocity; Cerebrovascular reactivity; Prognosis

嵇朋, 屈雪萍, 江利敏, 郭向东, 孙根, 刘松灿, 孟凡超, 李小刚. 阻塞型睡眠呼吸暂停低通气综合征对急性缺血性卒中患者脑血管反应性的影响[J]. 中国卒中杂志, 2021, 16(10): 1034-1038.

JI Peng, QU Xue-Ping, JIANG Li-Min, GUO Xiang-Dong, SUN Gen, LIU Song-Can, MENG Fan-Chao, LI Xiao-Gang. Effect of Obstructive Sleep Apnea Hypopnea Syndrome on Cerebrovascular Reactivity in Patients with Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2021, 16(10): 1034-1038.

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