首次缺血性卒中后睡眠呼吸障碍的临床和通气敏感性特征

2021-12-01 小文子 MedSci原创

阻塞性睡眠呼吸暂停患者的临床表现与无SDB或轻度SDB患者有显著差异,而与共存和中枢性睡眠呼吸暂停患者无差异。

卒中后睡眠呼吸障碍(SDB)非常普遍。约三分之二的卒中患者有不同程度的SDB,高达五分之二的卒中后延迟(≥3个月)出现呼吸暂停低通气指数(AHI)高于20次/小时。Thorax杂志的一项研究描述了首次缺血性卒中后至少3个月SDB(阻塞性、中枢性睡眠呼吸暂停、共存中枢性和阻塞性睡眠呼吸暂停(共存睡眠呼吸暂停))的临床和通气敏感性特征。

在一所大学医院进行前瞻性、单中心队列的横断面研究。2016年12月至2019年12月期间,对380名连续卒中或短暂性脑缺血发作患者进行筛查卒中发作后中位时间134.5(97.0; 227.3)天,进行整晚多导睡眠监测和高通气反应。监测的参数包括脑电图、眼电图、颏下肌电图、胫骨肌电图、ECG。测量夜间血氧饱和度等。

185例首次中风患者被纳入分析。94例(50.8%)患者无SDB或只有轻度SDB(呼吸暂停低通气指数<15次/小时),91例(49.2%)为中度至重度SDB,其中52例(57.1%)为阻塞性睡眠呼吸暂停,39例(42.9%)为共存或中枢性睡眠呼吸暂停。阻塞性睡眠呼吸暂停患者的临床表现与无SDB或轻度SDB患者有显著差异,而与共存和中枢性睡眠呼吸暂停患者无差异。与无SDB或轻度SDB患者相比,后者表现出更高的小脑损伤以及高通气反应。

结果表明,首次卒中患者的SDB表现因其各自的临床特点和通气敏感性特征而不同。共存和中枢性睡眠呼吸暂停卒中患者的高碳酸通气反应增强可能会引导采取特定的通气支持。

原文出处:

Sébastien Baillieul, Sébastien Bailly, et al, Sleep- disordered breathing and ventilatory chemosensitivity in first ischaemic stroke patients: a prospective cohort study, thorax, 2021, http://dx.doi.org/10.1136/thoraxjnl-2021-218003.

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