睡眠状况与脑卒中后认知功能障碍风险的相关性

旷咏梅; 胡乐静; 柯雪雪; 练红; 邹泽慧; 虞瑜

doi:10.16766/j.cnki.issn.1674-4152.004197

睡眠状况与脑卒中后认知功能障碍风险的相关性

doi: 10.16766/j.cnki.issn.1674-4152.004197

温州医科大学附属第二医院神经内科, 浙江温州 325000

基金项目:

浙江省自然科学基金项目 LY21H090015

详细信息

通讯作者:
旷咏梅，E-mail：lovexianzai@sina.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2025-02-21

The correlation between sleep status and the risk of cognitive impairment after stroke

Department of Neurology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的睡眠障碍是脑卒中后常见的并发症之一，对患者的康复和生活质量有显著影响。本研究旨在探讨睡眠状况与脑卒中后认知功能障碍(PSCI)之间的相关性，以期为临床诊断和治疗提供科学依据。方法选取2021年1月—2024年1月于温州医科大学附属第二医院进行治疗的146例脑卒中患者作为研究对象。随访3个月后，采用蒙特利尔认知评估量表(MoCA)评估其认知功能，根据评分结果分为PSCI组(72例)及非PSCI组(74例)。比较2组患者一般资料，并采用匹兹堡睡眠质量指数量表(PSQI)评价患者睡眠状况。采用多因素logistic回归模型筛选患者卒中后PSCI相关影响因素，并采用限制性立方样条图(RCS)拟合睡眠状况与卒中后PSCI的关系。结果 PSCI组患者PSQI、美国国立卫生研究院卒中量表(NIHSS)评分高于非PSCI组(P<0.05)；PSCI组患者血尿酸(BUA)、胱抑素C(CysC)、超敏C反应蛋白(hs-CRP)水平均高于非PSCI组(P<0.05)；多因素logistic回归分析显示，PSQI、NIHSS、CysC、BUA、hs-CRP均是脑卒中后发生PSCI的独立影响因素；绘制RCS显示，睡眠状况与患者脑卒中后发生PSCI呈显著非线性关系(χ²=21.380，P<0.001)。结论睡眠状况与脑卒中后PSCI发生风险有相关性。
- 脑卒中 /
- 认知功能障碍 /
- 睡眠状况 /
- 相关性
Abstract: Objective Sleep disorders are one of the common complications after stroke, which have a significant impact on the recovery and quality of life of patients. The study aims to explore the correlation between sleep status and post-stroke cognitive impairment (PSCI), in order to provide a scientific basis for clinical diagnosis and treatment. Methods The 146 stroke patients who received treatment at the Second Affiliated Hospital of Wenzhou Medical University from January 2021 to January 2024 were selected as the research subjects. After a 3-month follow-up, their cognitive function was evaluated using the Montreal cognitive assessment scale (MoCA), and they were divided into a PSCI group (72 cases) and a non-PSCI group (74 cases) based on the scoring results. General information of the two groups of patients was compared, and the pittsburgh sleep quality index (PSQI) was used to evaluate their sleep status. A multifactor logistic regression model was used to screen for factors related to PSCI after stroke, and a restricted cubic spline (RCS) was used to fit the relationship between sleep status and PSCI after stroke. Results The PSQI and National Institutes of Health stroke scale (NIHSS) scores of patients in the PSCI group were higher than those in the non PSCI group (P<0.05); The levels of blood uric acid (BUA), cystatin C (CysC), and high-sensitivity C-reactive protein (hs-CRP) in the PSCI group were higher than those in the non PSCI group (P<0.05); Multivariate logistic regression analysis showed that PSQI, NIHSS, CysC, BUA, and hs-CRP are independent influencing factors for PSCI after stroke; The RCS plot showed a significant non-linear relationship between sleep status and the occurrence of PSCI in patients after stroke (χ²=21.380, P<0.001). Conclusion Sleep status is associated with the risk of PSCI after stroke.
- Stroke /
- Cognitive impairment /
- Sleep condition /
- Relevance
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图 1 睡眠状况与脑卒中后发生认知功能障碍的限制性立方条图

Figure 1. A restricted cubic spline plot of sleep status and cognitive dysfunction after stroke

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表 1 2组脑卒中患者临床资料比较

Table 1. Comparison of clinical data between two groups of stroke patients

组别	例数	性别[例(%)]		年龄(x±s，岁)	受教育年限(x±s，年)	吸烟史[例(%)]	饮酒史[例(%)]	糖尿病[例(%)]	高血压[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	受教育年限(x±s，年)	吸烟史[例(%)]	饮酒史[例(%)]	糖尿病[例(%)]	高血压[例(%)]
PSCI组	72	33(45.83)	39(54.17)	65.54±4.11	7.32±1.11	10(13.89)	8(11.11)	9(12.50)	16(22.22)
非PSCI组	74	36(48.65)	38(51.35)	66.25±3.25	7.14±1.02	12(16.22)	11(14.86)	12(16.22)	10(13.51)
统计量		1.156^a		0.044^b	1.021^b	0.154^a	0.454^a	0.409^a	1.891^a
P值		0.250		0.965	0.309	0.694	0.500	0.522	0.169

组别	例数	高脂血症[例(%)]	病变部位[例(%)]				PSQI (x±s，分)		NIHSS (x±s，分)
组别	例数	高脂血症[例(%)]	基底节	脑干	额叶	丘脑	PSQI (x±s，分)		NIHSS (x±s，分)
PSCI组	72	8(11.11)	11(15.28)	16(22.22)	20(27.78)	25(34.72)	12.58±1.95		7.61±1.04
非PSCI组	74	9(12.16)	13(17.57)	15(20.27)	19(25.68)	27(36.49)	10.24±1.32		6.97±1.01
统计量		0.039^a	0.274^a				8.513^b		3.764^b
P值		0.843	0.965				<0.001		<0.001
注：^a为χ²值，^b为t值。

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表 2 2组脑卒中患者实验室指标比较(x±s)

Table 2. Comparison of laboratory indicators between two groups of stroke patients(x±s)

组别	例数	FPG(mmol/L)	HbA1c(mmol/L)	TC(mmol/L)	TG(mmol/L)	LDL-C(mmol/L)	HDL-C(mmol/L)
PSCI组	72	6.32±1.44	6.21±1.85	4.48±1.02	1.68±0.37	2.65±0.54	1.35±0.41
非PSCI组	74	5.87±1.43	5.77±1.69	4.33±1.04	1.58±0.31	2.51±0.49	1.40±0.38
t值		1.894	1.499	0.880	1.768	1.639	0.764
P值		0.058	0.136	0.379	0.079	0.103	0.446

组别	例数	Hcy(mmol/L)	PLT(×10⁹/L)	IL-6(mmol/L)	CysC(mg/L)	BUA(μmol/L)	hs-CRP(mg/L)
PSCI组	72	14.88±2.54	215.36±41.02	9.12±1.88	1.25±0.18	368.25±9.02	9.01±2.25
非PSCI组	74	15.32±2.11	220.25±39.63	9.01±1.46	0.96±0.14	345.59±6.36	6.28±1.02
t值		1.137	0.732	0.394	10.086	17.591	9.510
P值		0.258	0.465	0.694	<0.001	<0.001	<0.001

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表 3 变量赋值情况

Table 3. Variable assignment

变量	赋值方法
PSQI	连续变量，以实际值赋值
NIHSS	连续变量，以实际值赋值
CysC	连续变量，以实际值赋值
BUA	连续变量，以实际值赋值
hs-CRP	连续变量，以实际值赋值
脑卒中后发生认知功能障碍	PSCI=1，非PSCI=0

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表 4 脑卒中后发生认知功能障碍影响因素的logistic回归分析

Table 4. Logistic regression analysis of factors influencing cognitive dysfunction after stroke

变量	B	SE	Waldχ²	P值	OR值	95% CI
PSQI	0.810	0.384	4.443	0.035	2.247	1.058~4.770
NIHSS	2.406	0.790	9.264	0.002	11.085	2.655~52.175
CysC	2.365	0.847	7.792	0.005	10.644	2.023~56.008
BUA	0.254	0.099	6.638	0.010	1.290	1.063~1.565
hs-CRP	1.309	0.542	5.822	0.016	3.702	1.279~10.721

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