红细胞压积与海拔梯度对中高海拔地区轻型缺血性卒中患者卒中后睡眠障碍的影响研究

doi:10.3969/j.issn.1673-5765.2025.09.006

摘要/Abstract

摘要： 目的探讨中高海拔地区轻型缺血性卒中（minor ischemic stroke，MIS）患者卒中后睡眠障碍的影响因素，重点分析高原缺氧环境与红细胞压积（hematocrit，HCT）、卒中病灶部位及卒中后焦虑、抑郁的交互作用。
方法采用回顾性队列研究设计，数据来源于中国国家卒中登记Ⅲ青海省人民医院分中心数据库（时间范围：2016年10月—2019年7月）。使用匹兹堡睡眠质量指数（Pittsburgh sleep quality index，PSQI）评估MIS患者卒中后6周的睡眠质量（PSQI总分≥7分定义为卒中后睡眠障碍）。结合神经影像学、血液流变学指标及心理评估量表评分等数据，采用多因素logistic回归分析筛选卒中后睡眠障碍的独立危险因素，通过ROC曲线评估HCT的预测效能。
结果共纳入152例MIS患者，卒中后睡眠障碍的发生率为54.6%（83/152）。多因素logistic回归分析显示，常住地海拔≥3000 m（OR 4.550，95%CI 2.499～4.588，P=0.011）、后循环梗死（OR 2.089，95%CI 1.961～4.762，P=0.042）、HCT≥55%（OR 8.545，95%CI 4.708～15.500，P=0.001）及卒中后抑郁（OR 1.991，95%CI 1.082～3.660，P=0.048）为卒中后睡眠障碍的独立危险因素。ROC曲线分析表明，HCT预测卒中后睡眠障碍的AUC为0.731（95%CI 0.630～0.833，P=0.009），最佳截断值为55.5%，对应的敏感度为0.806，特异度为0.634。
结论中高海拔地区MIS患者卒中后睡眠障碍的发生率较高，常住地海拔≥3000 m、后循环梗死、HCT≥55%及卒中后抑郁是其独立影响因素，整合上述指标有助于早期识别MIS患者卒中后睡眠障碍的高危人群，并为制订适用于高原地区的特异性睡眠管理策略提供依据。

文章导读： 本研究聚焦中高海拔地区轻型缺血性卒中患者，揭示了高原缺氧环境与卒中后睡眠障碍的交互机制，将红细胞压积作为卒中后睡眠障碍的核心预测指标，并验证了其预测效能。同时，本研究整合常住地海拔高度、梗死部位及卒中后抑郁等关键因素，建立了涵盖环境、生理与心理的多因素风险评价体系，有望为中高海拔地区轻型缺血性卒中患者卒中后睡眠障碍的早期识别与分层干预提供依据，具有较强的临床适用性和地域特色。

关键词: 中高海拔地区; 轻型缺血性卒中; 睡眠障碍; 卒中后抑郁; 红细胞压积

Abstract: Objective To explore the influencing factors of post-stroke sleep disorders in patients with minor ischemic stroke (MIS) in moderate-to-high altitude areas, focusing on the interaction between the high-altitude hypoxic environment and hematocrit (HCT), stroke lesion location, as well as post-stroke anxiety and depression.
Methods A retrospective cohort design was adopted, with data derived from the Qinghai Provincial People’s Hospital sub-center database of the China national stroke registry-Ⅲ from October 2016 to July 2019. The Pittsburgh sleep quality index (PSQI) was used to assess sleep quality of the MIS patients at 6 weeks after stroke, with a total PSQI score≥7 defined as post-stroke sleep disorder. By integrating data from neuroimaging, hemorheological indicators, and scores of psychological assessment scales, multivariate logistic regression analysis was used to identify independent risk factors for post-stroke sleep disorders. The predictive efficacy of HCT was evaluated using ROC curves.
Results A total of 152 MIS patients were included, and the incidence of post-stroke sleep disorders was 54.6% (83/152). Multivariate logistic regression analysis showed that permanent residence at an altitude≥3000 meters (OR 4.550, 95%CI 2.499-4.588, P=0.011), posterior circulation infarction (OR 2.089, 95%CI 1.961-4.762, P=0.042), HCT≥55% (OR 8.545, 95%CI 4.708-15.500, P=0.001), and post-stroke depression (OR 1.991, 95%CI 1.082-3.660, P=0.048) were independent risk factors for post-stroke sleep disorders. ROC curve analysis revealed that the AUC of HCT for predicting post-stroke sleep disorders was 0.731 (95%CI 0.630-0.833, P=0.009), with the optimal cut-off value of 55.5%, corresponding to a sensitivity of 0.806 and a specificity of 0.634.
Conclusions The incidence of post-stroke sleep disorders is relatively high in MIS patients in moderate-to-high altitude areas. Permanent residence at an altitude≥3000 meters, posterior circulation infarction, HCT≥55%, and post-stroke depression are important influencing factors. Integrating the above indicators is conducive to the early identification of high-risk populations and provides a basis for formulating plateau-specific sleep management strategies.

Key words: Moderate-to-high altitude area; Minor ischemic stroke; Sleep disorder; Post-stroke depression; Hematocrit

中图分类号:

柴昌, 胡全忠. 红细胞压积与海拔梯度对中高海拔地区轻型缺血性卒中患者卒中后睡眠障碍的影响研究[J]. 中国卒中杂志, 2025, 20(9): 1113-1120.

CHAI Chang, HU Quanzhong. Study on the Effects of Hematocrit and Altitude Gradient on Post-Stroke Sleep Disorders in Patients with Minor Ischemic Stroke in Moderate-to-High Altitude Areas[J]. Chinese Journal of Stroke, 2025, 20(9): 1113-1120.

参考文献

[1] LI Z H，HU Q Z，JI W Z，et al. Prevalence of stroke and associated risk factors：a population-based
cross-sectional study from the Qinghai-Tibet Plateau of China[J/OL]. BMJ Open，2022，12（11）：e065605[2025-03-18]. https://doi.org/10.1136/bmjopen-2022-065605.
[2] 王果，吕诚，徐蕊，等. 高原睡眠障碍研究进展（综述）[J]. 中国健康心理学杂志，2024，32（10）：1462-1466.
WANG G，LYU C，XU R，et al. Research progress on high altitude sleep disturbance[J]. China Journal of Health Psychology，2024，32（10）：1462-1466.
[3] JIA N N，YAO M F，ZHU C X，et al. Chronic intermittent hypoxia-induced neural injury：pathophysiology，neurodegenerative implications，and therapeutic insights[J/OL]. CNS Neurosci Ther，2025，31（4）：e70384[2025-06-18]. https://doi.org/10.1111/cns.70384.
[4] 荆京. 第三次中国国家卒中登记研究方案[J]. 中国卒中杂志，2020，15（2）：184-185.
JING J. Protocol for the third China national stroke registry[J]. Chin J Stroke，2020，15（2）：184-185.
[5] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 轻型卒中临床诊疗中国专家共识（2024版）[J]. 中华神经科杂志，2025，58（5）：462-474.
Chinese Society of Neurology，Chinese Stroke Society. Chinese expert consensus on clinical diagnosis and treatment of minor stroke（2024 edition）[J]. Chin J Neurol，2025，58（5）：462-474.
[6] AKSEL G，ÇORBACIOĞLU Ş K，ÖZEN C. High-altitude illness：management approach[J]. Turk J Emerg Med，2019，19（4）：121-126.
[7] HACKETT P H，ROACH R C. High-altitude illness[J]. N Engl J Med，2001，345（2）：107-114.
[8] 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.
Beijing Neurology Association Sleep Disorder Committee，Beijing Neurology Association Neuropsychiatry and Clinical Psychology Committee，Chinese Association of Geriatric Sleep Science，et al. Chinese expert consensus on the assessment and management of stroke-related sleep disorders 2023[J]. Chin J Stroke，2023，18（2）：221-239.
[9] KATZAN I L，THOMPSON N R，WALIA H K，et al. Sleep-related symptoms in patients with mild stroke[J]. J Clin Sleep Med，2020，16（1）：55-64.
[10] XU Y F，HUA Q Y，CHEN W，et al. Human adaptation to high altitude：acclimatization and reversibility of haemodynamics[J/OL]. Natl Sci Rev，2025，12（7）：nwaf203[2025-06-18]. https://doi.org/10.1093/nsr/nwaf203.
[11] 徐莉，岳增文，史润泽，等. 不同海拔地域对高原官兵睡眠质量影响的调查研究[J]. 西南军医，2016，18（1）：29-33.
XU L，YUE Z W，SHI R Z，et al. Investigation on the effect of different altitudes on the sleep quality of plateau officers and soldiers[J]. Journal of Military Surgeon in Southwest China，2016，18（1）：29-33.
[12] 庞怀霞，郝丽娟，林建生，等. 不同海拔高度慢性高原病患者睡眠质量比较[J]. 世界睡眠医学杂志，2023，10（1）：31-34.
PANG H X，HAO L J，LIN J S，et al. Comparison of sleep quality in patients with chronic high altitude disease at different altitudes[J]. World Journal of Sleep Medicine，2023，10（1）：31-34.
[13] HOILAND R L，BAIN A R，RIEGER M G，et al. Hypoxemia，oxygen content，and the regulation of cerebral blood flow[J/OL]. Am J Physiol Regul Integr Comp Physiol，2016，310（5）：R398-R413[2025-03-18]. https://doi.org/10.1152/ajpregu. 00270.2015.
[14] SNYDER B，SHELL B，CUNNINGHAM J T，et al. Chronic intermittent hypoxia induces oxidative stress and inflammation in brain regions associated with early-stage neurodegeneration[J/OL]. Physiol Rep，2017，5（9）：e13258[2025-03-18]. https://doi.org/10.14814/phy2.13258.
[15] 中华医学会血液学分会红细胞疾病学组，中国医院协会血液学机构分会. 高原红细胞增多症诊断与治疗中国专家共识（2025年版）[J]. 中华血液学杂志，2025，46（7）：593-600.
Red Blood Cell Disease Group，Chinese Society of Hematology，Chinese Medical Association；Chinese Hospital Association Hematology Branch. Chinese expert consensus on the diagnosis and treatment of high-altitude polycythemia（2025）[J]. Chin J Hematol，2025，46（7）：593-600.
[16] LAVIE L. Oxidative stress inflammation and endothelial dysfunction in obstructive sleep apnea[J]. Front Biosci（Elite Ed），2012，4（4）：1391-1403.
[17] SUH M，CHOI-KWON S，KIM J S. Sleep disturbances after cerebral infarction：role of depression and fatigue[J]. J Stroke Cerebrovasc Dis，2014，23（7）：1949-1955.
[18] 茅爱平，张鸣宇. 探究急性脑卒中病灶发生部位与患者的睡眠障碍[J]. 系统医学，2016，1（8）：30-32.
MAO A P，ZHANG M Y. Explore the occurrence of acute stroke lesion site in patients with sleep disorders[J]. Systems Medicine，2016，1（8）：30-32.