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

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。

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