Research Progress of Insomnia after Stroke

doi:10.3969/j.issn.1673-5765.2023.05.006

Abstract

Abstract: Post stroke insomnia (PSI) is a group of clinical syndromes that first appear after a stroke and meet the diagnostic criteria for insomnia. Similar to common clinical insomnia, the main manifestations are abnormal sleep depth and average sleep time less than 6 hours per night. Meta-analysis showed that 32.5%, 34.8% and 37.1% of patients in acute, subacute and convalescent stages of stroke met the diagnostic criteria for insomnia disorders, respectively. PSI not only increases the risk of stroke death and recurrence, but also has adverse effects on stroke rehabilitation and prognosis. This paper reviews the incidence, pathogenesis, and treatment of insomnia after stroke, in order to provide information for clinical practice and provide targeted intervention and treatment measures for insomnia after stroke.

Key words: Stroke; Insomnia; Sleep disorder; Depression; Incidence

摘要： 卒中后失眠是在卒中后首次出现并达到失眠诊断标准的一组临床综合征，与临床常见失眠相类似，主要表现为睡眠深度异常和平均每晚睡眠时间少于6 h。meta分析显示，卒中急性期、亚急性期及恢复期患者符合失眠障碍诊断标准的比例分别为32.5%、34.8%和37.1%。卒中后失眠不仅增加了卒中死亡及复发风险，而且对卒中康复与预后造成不利影响。本文对卒中后失眠的发病情况、发病机制及治疗等进行综述，以便为临床实践提供信息，并为卒中后失眠提供针对性干预治疗措施。

关键词: 卒中; 失眠; 睡眠障碍; 抑郁; 发病率

YANG Hangmei, HAN Meirong, JIANG Xuelong, HE Zhongming, HAN Fang.

Research Progress of Insomnia after Stroke

[J]. Chinese Journal of Stroke, 2023, 18(05): 527-533.

杨行妹, 韩美荣, 蒋雪龙, 何忠明, 韩芳. 卒中后失眠的研究进展[J]. 中国卒中杂志, 2023, 18(05): 527-533.

References

[1] FEIGIN V L，FOROUZANFAR M H，KRISHNAMURTHI R，et al. Global and regional burden of stroke during 1990-2010：findings from the global burden of disease study 2010[J]. Lancet，2014，383（9913）：245-255.
[2] WU M P，LIN H J，WENG S F，et al. Insomnia subtypes and the subsequent risks of stroke：report from a nationally representative cohort[J]. Stroke，2014，45（5）：1349-1354.
[3] HACKETT M L，PICKLES K. Part I：frequency of depression after stroke：an updated systematic review and meta-analysis of observational studies[J]. Int J Stroke，2014，9（8）：1017-1025.
[4] PALOMÄKI H，BERG A，MERIRINNE E，et al. Complaints of poststroke insomnia and its treatment with mianserin[J]. Cerebrovasc Dis，2003，15（1/2）：56-62.
[5] SATEIA M J. International classification of sleep disorders-third edition：highlights and modifications[J]. Chest，2014，146（5）：1387-1394.
[6] OHAYON M M. Epidemiology of insomnia：what we know and what we still need to learn[J]. Sleep Med Rev，2002，6（2）：97-111.
[7] LEPPÄVUORI A，POHJASVAARA T，VATAJA R，et al. Insomnia in ischemic stroke patients[J]. Cerebrovasc Dis，2002，14（2）：90-97.
[8] RIEMANN D，BAGLIONI C，BASSETTI C，et al. European guideline for the diagnosis and treatment of insomnia[J]. J Sleep Res，2017，26（6）：675-670.
[9] CHEN Y K，LU J Y，MOK V C T，et al. Clinical and radiologic correlates of insomnia symptoms in ischemic stroke patients[J]. Int J Geriatr Psychiatry，2011，26（5）：451-457.
[10] GLOZIER N，MOULLAALI T J，SIVERTSEN B，et al. The course and impact of poststroke insomnia in stroke survivors aged 18 to 65 years：results from the psychosocial outcomes in stroke（POISE） study[J]. Cerebrovasc Dis Extra，2017，7（1）：9-20.
[11] HERMANN D M，BASSETTI C L. Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery[J]. Neurology，2016，87（13）：1407-1416.
[12] DUSS S B，BRILL A K，BARGIOTAS P，et al. Sleep-wake disorders in stroke-increased stroke risk and deteriorated recovery? An evaluation on the necessity for prevention and treatment[J/OL]. Curr Neurol Neurosci Rep，2018，18（10）：72[2023-01-16]. https://doi.org/10.1007/s11910-018-0879-6.
[13] 中国睡眠研究会. 中国失眠症诊断和治疗指南[J]. 中华医学杂志，2017，97（24）：1844-1856.
[14] LEINO A，WESTEREN-PUNNONEN S，TÖYRÄS J，et al. Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea[J]. Sleep Breath，2020，24（4）：1495-1505.
[15] BENBIR G，DEMIR A U，AKSU M，et al. Prevalence of insomnia and its clinical correlates in a general population in Turkey[J]. Psychiat Clin Neuros，2015，69（9）：543-552.
[16] ZHANG B，WING Y K. Sex differences in insomnia：a meta-analysis[J]. Sleep，2006，29（1）：85-93.
[17] JOA K L，KIM W H，CHOI H Y，et al. The effect of sleep disturbances on the functional recovery of rehabilitation inpatients following mild and moderate stroke[J]. Am J Phys Med Rehabil，2017，96（10）：734-740.
[18] BAYLAN S，GRIFFITHS S，GRANT N，et al. Incidence and prevalence of post-stroke insomnia：a systematic review and meta-analysis[J/OL]. Sleep Med Rev，2020，49：101222[2023-01-16]. https://doi.org/10.1016/j.smrv.2019.101222.
[19] KARACA B. Factors affecting poststroke sleep disorders[J]. J Stroke Cerebrovasc，2016，25（3）：727-732.
[20] TANG W K，GRACE LAU C，MOK V，et al. Insomnia and health-related quality of life in stroke[J]. Top Stroke Rehabil，2015，22（3）：201-207.
[21] PHILLIPS B，MANNINO D M. Do insomnia complaints cause hypertension or cardiovascular disease?[J]. Clin Sleep Med，2007，3（5）：489-494.
[22] BONNET M H，ARAND D L. Cardiovascular implications of poor sleep[J]. Sleep Medicine Clinics，2007，2（4）：529-538.
[23] OHAYON M M，CARSKADON M A，GUILLEMINAULT C，et al. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals：developing normative sleep values across the human lifespan[J]. Sleep，2004，27（7）：1255-1273.
[24] KIM W H，JUNG H Y，CHOI H Y，et al. The associations between insomnia and health-related quality of life in rehabilitation units at 1 month after stroke[J/OL]. J Psychosom Res，2017，96：10-14[2023-04-02]. https://doi.org/10.1016/j.jpsychores.2017.02.008.
[25] BAGLIONI C，NISSEN C，SCHWEINOCH A，et al. Polysomnographic characteristics of sleep in stroke：a systematic review and meta-analysis[J/OL]. PLoS One，2016，11（3）：e0148496[2023-01-16]. https://doi.org/10.1371/journal.pone.0148496.
[26] DE VIVO L，BELLESI M，MARSHALL W，et al. Ultrastructural evidence for synaptic scaling across the wake/sleep cycle[J]. Science，2017，355（6324）：507-510.
[27] ROLLO E，BRUNETTI V，SCALA I，et al. Impact of delirium on the outcome of stroke：a prospective，observational，cohort study[J]. J Neurol，2022，269（12）：6467-6475.
[28] NAKAMIZO T，KANDA T，KUDO Y，et al. Efects of uncomfortable care and histamine H2-antagonists on delirium in acute stroke：a propensity score analysis[J/OL]. J Neurol Sci，2021，420：117251[2023-01-16]. https://doi.org/10.1016/j.jns.2020.117251.
[29] LI L J，YANG Y，GUAN B Y，et al. Insomnia is associated with increased mortality in patients with first-ever stroke：a 6-year follow-up in a Chinese cohort study[J]. Stroke Vasc Neurol，2018，3（4）：197-202.
[30] PALOMAKI H，BERG A，MERIRINNE E，et al. Complaints of poststroke insomnia and its treatment with mianserin[J]. Cerebrovasc Dis，2003，15（1/2）：56-62.
[31] FLEMING M K，SMEJKA T，HENDERSON S D，et al. Self-reported and objective sleep measures in stroke survivors with incomplete motor recovery at the chronic stage[J]. Neurorehabil Neural Repair，2021，35（10）：851-860.
[32] DONG L，WILLIAMS L S，BROWN D L，et al. Prevalence and course of depression during the first year after mild to moderate stroke[J/OL]. J Am Heart Assoc，2021，10（13）：e020494[2023-04-02]. https://doi.org/10.1161/JAHA.120.020494.
[33] FALCK R S，BEST J R，DAVIS J C，et al. Sleep and cognitive function in chronic stroke：a comparative cross-sectional study[J/OL]. Sleep，2019，42（5）：zsz040[2023-04-02]. https://doi.org/10.1093/sleep/zsz040.
[34] JARAMILLO V，JENDOUBI J，MARIC A，et al. Thalamic infuence on slow wave slope renormalization during sleep[J]. Ann Neurol，2021，90（5）：821-833.
[35] LI W，TASKIN T，GAUTAM P，et al. Is there an association among sleep duration，nap，and stroke? Findings from the China health and retirement longitudinal study[J]. Sleep Breath，2021，25（1）：315-323.
[36] ZHOU L，YU K，YANG L L，et al. Sleep duration，midday napping，and sleep quality and incident stroke：the Dongfeng-Tongji cohort[J/OL]. Neurology，2020，94（4）：e345-e356[2023-04-02]. https://doi.org/10.1212/WNL.0000000000008739.
[37] LU C，LIAO B，NIE J，et al. The association between sleep duration and chronic diseases：a population-based cross-sectional study[J/OL]. Sleep Med，2020，73：217-222[2023-01-16]. https://doi.org/10.1016/j.sleep.2020.05.005.
[38] WANG H X，SUN J，SUN M J，et al. Relationship of sleep duration with the risk of stroke incidence and stroke mortality：an updated systematic review and dose-response meta-analysis of prospective cohort studies[J/OL]. Sleep Med，2022，90：267-278[2023-01-16]. https://doi.org/10.1016/j.sleep.2021.11.001.
[39] LI W Z，WANG D M，CAO S Y，et al. Sleep duration and risk of stroke events and stroke mortality：a systematic review and meta-analysis of prospective cohort studies[J/OL]. Int J Cardiol，2016，223：870-876[2023-01-16]. https://doi.org/10.1016/j.ijcard.2016.08.302.
[40] TITOVA O E，YUAN S，BARON J A，et al. Sleep-disordered breathing-related symptoms and risk of stroke：cohort study and Mendelian randomization analysis[J]. J Neurol，2022，269（5）：2460-2468.
[41] LI J W，ZHENG D N，LOFER K A，et al. Sleep duration and risk of cardiovascular events：the SAVE study[J]. Int J Stroke，2020，15（8）：858-865.
[42] HE Q，ZHANG P，LI G X，et al. The association between insomnia symptoms and risk of cardio-cerebral vascular events：a meta-analysis of prospective cohort studies[J]. Eur J Prev Cardiol，2017，24（10）：1071-1082.
[43] KWOK C S，KONTOPANTELIS E，KULIGOWSKI G，et al. Self-reported sleep duration and quality and cardiovascular disease and mortality：a dose-response meta-analysis[J/OL]. J Am Heart Assoc，2018，7（15）：e008552[2023-01-16]. https://doi.org/10.1161/JAHA.118.008552.
[44] TOBALDINI E，FIORELLI E M，SOLBIATI M，et al. Short sleep duration and cardiometabolic risk：from pathophysiology to clinical evidence[J]. Nat Rev Cardiol，2019，16（4）：213-224.
[45] GRANDNER M A，SANDS-LINCOLN M R，PAK V M，et al. Sleep duration，cardiovascular disease，and proinfammatory biomarkers[J/OL]. Nat Sci Sleep，2013，5：93-107[2023-01-16]. https://doi.org/10.2147/NSS.S31063.
[46] BRUNETTI V，ROLLO E，BROCCOLINI A，et al. Sleep and stroke：opening our eyes to current knowledge of a key relationship[J]. Curr Neurol Neurosci Rep，2022，22（11）：767-779.
[47] WANG X Y，CHEN J，LIU Y E，et al. The effect of acceptance and commitment therapy on psychological nursing of acute cerebral infarction with insomnia，anxiety，and depression[J/OL]. Comput Math Methods Med，2022，2022：8538656[2023-01-16]. https://doi.org/10.1155/2022/8538656.
[48] 单丹丹. 认知行为干预对缺血性脑卒中失眠患者的影响[J]. 中国实用神经疾病杂志，2017，20（22）：97-100.
[49] NGUYEN S，WONG D，MCKAY A，et al. Cognitive behavioural therapy for post-stroke fatigue and sleep disturbance：a pilot randomised controlled trial with blind assessment[J]. Neuropsychol Rehabil，2019，29（5）：723-738.
[50] 北京神经内科学会睡眠障碍专业委员会，北京神经内科学会神经精神医学与临床心理专业委员会，中国老年学和老年医学学会睡眠科学分会，等. 卒中相关睡眠障碍评估与管理中国专家共识2023[J]. 中国卒中杂志，2023，18（2）：221-239.
[51] KALBOUNEH H M，TOUBASI A A，ALBUSTANJI F H，et al. Safety and efficacy of SSRIs in improving poststroke recovery：a systematic review and meta-analysis[J/OL]. J Am Heart Assoc，2022，11（13）：e025868[2023-01-16]. https://doi.org/10.1161/JAHA.122.025868.
[52] YANG J L. Acupuncture treatment for post-stroke insomnia：a systematic review and meta-analysis of randomized controlled trials[J/OL]. Complement Ther Clin Pract，2021，44：101396[2023-01-16]. https://doi.org/10.1016/j.ctcp.2021.101396.
[53] XIAO M J，FENG L，WANG Q Z，et al. The therapeutic efects and safety of bright light therapy combined with escitalopram oxalate on insomnia in patients with poststroke depression[J]. Int J Geriatr Psychiatry，2021，36（1）：182-189.