Post-stroke Sleep Disorders

doi:10.3969/j.issn.1673-5765.2019.04.009

Abstract

Abstract:

Sleep disorders are a kind of common complications after stroke, which can affect the prognosis and life quality of stroke patients. The pathogenetic mechanism of poststroke sleep disorders (PSSD) is unclear, and PSSD occurrence may be related with lesion area, neurotransmitters and social psychological factors and etc. PSSD include two categories: respiratory related sleep disorders and non- respiratory related sleep disorders, and the former is more common. The therapy of PSSD includes pharmacotherapy and non-pharmacotherapy. Neurologists should pay more attention to PSSD, recognize PSSD as early as possible and give active intervention, to improve neurological function and life quality of patients.

Key words: Stroke; Sleep disorder; Pathogenetic mechanism

摘要：

睡眠障碍是卒中后常见的并发症之一，会影响卒中患者的预后及生活质量。卒中后睡眠障碍的原因不完全清楚，主要与梗死部位、神经递质、社会心理因素等有关。它主要分为呼吸相关性睡眠障碍和非呼吸相关性睡眠障碍两类，其中呼吸相关性睡眠障碍是较常见的类型。在卒中后睡眠障碍的治疗方面，药物治疗和非药物治疗相辅相成。临床医师应增强意识，尽早识别卒中后睡眠障碍类型，予以干预，以期改善患者预后，提高患者生活质量。

关键词: 卒中; 睡眠障碍; 发病机制

WANG Ya-Li, PEI Shao-Fang, LIU Yi. Post-stroke Sleep Disorders[J]. Chinese Journal of Stroke, 2019, 14(04): 346-351.

王亚丽，裴少芳，刘毅. 卒中后睡眠障碍[J]. 中国卒中杂志, 2019, 14(04): 346-351.

References

[1] WALLACE D M，RAMOS A R，RUNDEK T. Sleep

disorders and stroke[J]. Int J Stroke，2012，7（3）：

231-242.

[2] MIMS K N，KIRSCH D. Sleep and stroke[J]. Sleep

Med Clin，2016，11（1）：39-51.

[3] DE PAOLIS F，COLIZZI E，MILIOLI G，et al.Acute shift of a case of moderate obstructive sleep

apnea syndrome towards one of severe central sleep

apnea syndrome after an ischemic stroke[J]. Sleep

Med，2012，13（6）：763-766.

[4] 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 1month after

stroke[J/OL]. J Psychosom Res，2017，96：10-14.

https：//doi.org/10.1016/j.jpsychores.2017.02.008.

[5] DAVIES D P，RODGERS H，WALSHAW D，et

al. Snoring，daytime sleepiness and stroke：a casecontrol

study of first-ever stroke[J]. J Sleep Res，

2003，12（4）：313-318.

[6] LEE S J，KIM J S，SONG I U，et al. Poststroke

restless legs syndrome and lesion location：

anatomical considerations[J]. Mov Disord，2009，24

（1）：77-84.

[7] PASIC Z，SMAJLOVIC D，DOSTOVIC Z，et al.

Incidence and types of sleep disorders in patients

with stroke[J]. Med Arh，2011，65（4）：225-227.

[8] TANG WK，HERMANN DM，CHEN YK，et

al. Brainstem infarcts predict REM sleep behavior

disorder in acute ischemic stroke[J/OL]. BMC Neurol，

2014，14：88. https：//doi.org/10.1186/1471-2377-14-

88.

[9] BASSETTI C L. Sleep and stroke[J]. Semin Neurol，

2005，25（1）：19-32.

[10] BASSETTI C，ALDRICH M S. Sleep apnea in

acute cerebrovascular diseases：final report on 128

patients[J]. Sleep，1999，22（2）：217-223.

[11] MORRELL M J，HEYWOOD P，MOOSAVI S

H，et al. Unilateral focal lesions in the rostrolateral

medulla influence chemosensitivity and breathing

measured during wakefulness，sleep，and

exercise[J]. J Neurol Neurosurg Psychiatry，1999，67

（5）：637-645.

[12] LEE M C，KLASSEN A C，HEANEY L M，et al.

Respiratory rate and pattern disturbances in acute

brain stem infarction[J]. Stroke，1976，7（4）：382-

385.

[13] GANGWISCH J E，HEYMSFIELD S B，BODENALBALA

B，et al. Sleep duration as a risk factor for

diabetes incidence in a large U. S. sample[J]. Sleep，

2007，30（12）：1667-1673.

[14] ZHANG W，LI F，ZHANG T. Relationship of

nocturnal concentrations of melatonin，gammaaminobutyric

acid and total antioxidants in

peripheral blood with insomnia after stroke：study

protocol for a prospective non-randomized controlled

trial[J]. Neural Regen Res，2017，12（8）：1299-1307.

[15] KIM J S，LEE S B，PARK S K，et al. Periodic limb

movement during sleep developed after pontine

lesion[J]. Mov Disord，2003，18（11）：1403-1405.

[16] ULFBERG J，NYSTROM B，CARTER N，et al.

Prevalence of restless legs syndrome among men

aged 18 to 64 years：an association with somatic

disease and neuropsychiatric symptoms[J]. Mov

Disord，2001，16（6）：1159-1163.

[17] WALTERS A S，RYE D B. Review of the

relationship of restless legs syndrome and periodic

limb movements in sleep to hypertension，heart

disease，and stroke[J]. Sleep，2009，32（5）：589-

597.

[18] AUKERMAN M M，AUKERMAN D，BAYARD

M，et al. Exercise and restless legs syndrome：a

randomized controlled trial[J]. J Am Board Fam Med，

2006，19（5）：487-493.

[19] RADHAKRISHNAN S，MENON U K，

ANANDAKUTTAN A. A combined approach of

bedside clinical examination and flexible endoscopic

evaluation of swallowing in poststroke dysphagia：A

pilot study[J]. Ann Indian Acad Neurol，2013，16（3）：

388-393.

[20] SIEGEL J M. The neurobiology of sleep[J]. Semin

Neurol，2009，29（4）：277-296.

[21] RIVERA V M，MEYER J S，HATA T，et al.

Narcolepsy following cerebral hypoxic ischemia[J].

Ann Neurol，1986，19（5）：505-508.

[22] SCHENCK C H，MAHOWALD M W. Injurious

sleep behavior disorders（parasomnias）affecting

patients on intensive care units[J]. Intensive Care

Med，1991，17（4）：219-224.

[23] BOEVE B F，SILBER M H，SAPER C B，et al.

Pathophysiology of REM sleep behaviour disorder

and relevance to neurodegenerative disease[J]. Brain，

2007，130（Pt 11）：2770-2788.

[24] American Academy of Sleep Medicine. The

International Classification of Sleep Disorders，third

edition[J]. Nihon Rinsho，2015，73（6）：916-923.

[25] CLARENBACH P，WESSENDORF T. Sleep and

stroke[J]. Rev Neurol（Paris），2001，157（11 Pt 2）：

S46-52.

[26] ROTENBERG B W，MURARIU D，PANG K P.

Trends in CPAP adherence over twenty years of data

collection：a flattened curve[J]. J Otolaryngol Head

Neck Surg，2016，45（1）：43.

[27] 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. 卒中相关睡

眠障碍评估与管理中国专家共识[J]. 中华内科杂志，

2019，58（1）：17-26.

[28] STEVENS D，MARTINS R T，MUKHERJEE S，et al. Post-stroke sleep-disordered breathingpathophysiology

and therapy options[J/OL].

Front Surg，2018，5：9. https：//doi.org/10.3389/

fsurg.2018.00009.

[29] SCHUTTE-RODIN S，BROCH L，BUYSSE

D，et al. Clinical guideline for the evaluation and

management of chronic insomnia in adults[J]. J Clin

Sleep Med，2008，4（5）：487-504.

[30] 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.

[31] LEE S H，LIM S M. Acupuncture for insomnia after

stroke：a systematic review and meta-analysis[J/OL].

BMC Complement Altern Med，2016，16：228. https：

//doi.org/10.1186/s12906-016-1220-z.

[32] 罗海龙，王春梅，古剑珂. 经颅磁刺激治疗脑卒中

后失眠的效果观察[J]. 中华神经医学杂志，2016，15

（4）：403-405.

[33] OHAYON M M，ROTH T. Prevalence of restless

legs syndrome and periodic limb movement disorder

in the general population[J]. J Psychosom Res，2002，

53（1）：547-554.

[34] 王维治，王丽华. 不宁腿综合征是卒中的危险因素

[J]. 中国卒中杂志，2017，12（10）：891-894.

[35] ROSENBERG R P. Recommended treatment

strategies for patients with excessive daytime

sleepiness[J]. J Clin Psychiatry，2015，76（10）：

e1330.

[36] SIARNIK P，KLOBUCNIKOVA K，SURDA P，et

al. Excessive daytime sleepiness in acute ischemic

stroke：association with restless legs syndrome，

diabetes mellitus，obesity，and sleep-disordered

breathing[J]. J Clin Sleep Med，2018，14（1）：95-

100.

[37] AURORA R N，ZAK R S，AUERBACH S H，et al.

Best practice guide for the treatment of nightmare

disorder in adults[J]. J Clin Sleep Med，2010，6（4）：

389-401.

[38] 费英俊，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

（3）：200-202.

[39] ANDERSEN L P. The analgesic effects of exogenous

melatonin in humans[J/OL]. Dan Med J，2016，63

（10）. pii：B5289. https：//ugeskriftet.dk/dmj/B5289.