脑卒中伴睡眠期周期性肢体运动患者的睡眠结构研究

何胜燕; 蒋淑贞; 金飞妹

doi:10.16766/j.cnki.issn.1674-4152.003949

脑卒中伴睡眠期周期性肢体运动患者的睡眠结构研究

doi: 10.16766/j.cnki.issn.1674-4152.003949

1.
金华市中心医院康复科，浙江金华 321000
2.
金华市中心医院呼吸科

基金项目:

浙江省医药卫生科技计划项目 2022KY426

详细信息

通讯作者:
何胜燕，E-mail：13868996841@163.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2024-04-25
- 网络出版日期: 2025-06-30

Study on sleep structure in stroke patients with periodic limb movements during sleep

1.
Department of Rehabilitation, Jinhua Central Hospital, Jinhua, Zhejiang 321000, China

摘要

摘要: 目的分析脑卒中伴睡眠期周期性肢体运动(PLMS)患者的睡眠结构特点，探讨PLMS对脑卒中患者睡眠的影响。方法选取2022年4月—2023年6月在金华市中心医院康复科诊治的脑卒中伴睡眠障碍患者99例，根据患者是否伴有PLMS将其分为PLMS组(48例)和非PLMS组(51例)。收集患者一般资料及多导睡眠监测(PSG)数据，比较2组睡眠结构及相关参数，并分析PLMS与睡眠结构及各参数之间的相关性。结果 PLMS组清醒期周期性肢体运动指数(PLMI)、N1睡眠占比、N2睡眠占比、觉醒指数、周期性肢体运动觉醒指数(PLMAI)分别为(61.45±3.86)次/h、(13.35±2.13)%、(57.42±3.55)%、(29.73±2.68)次/h、(1.27±0.29)次/h，均明显高于非PLMS组的(28.85±2.92)次/h、(8.36±2.35)%、(52.51±3.52)%、(15.93±2.59)次/h、(0.86±0.25)次/h(P＜0.05)；PLMS组N3睡眠占比、睡眠效率分别为(12.52±2.16)%、(83.79±5.83)%，均明显低于非PLMS组的(23.25±2.25)%、(95.52±7.73)%(P＜0.05)；PLMS与清醒期PLMI、N1睡眠占比、N2睡眠占比、觉醒指数、PLMAI均呈正相关关系(r_s=0.529、0.213、0.398、0.251、0.529，P＜0.05)，与睡眠效率呈负相关关系(r_s=-0.329，P＜0.05)。结论脑卒中伴PLMS患者常出现睡眠结构紊乱和睡眠效率下降，PLMS可能是脑卒中预后不良的预测因子，临床应监测脑卒中伴有PLMS患者的睡眠状况，并给予干预措施以提高患者的生活质量。
- 脑卒中 /
- 睡眠期周期性肢体运动 /
- 多导睡眠监测 /
- 睡眠结构
Abstract: Objective To analyze the characteristics of sleep structure in stroke patients with periodic limb movements disorder in sleep (PLMS) and to explore the effect of PLMS on sleep in stroke patients, providing a basis for improving the quality of life in stroke patients with PLMS. Methods A total of 99 stroke patients with sleep disorders, diagnosed and treated at Jinhua Central Hospital from April 2022 to June 2023, were selected. According to whether the patients had PLMS, they were divided into the PLMS group (48 cases) and the non-PLMS group (51 cases). General data and PSG data of patients were collected. Sleep structure and related parameters were compared between the two groups, and the correlation between PLMS and sleep parameters was analyzed. Results The PLMS groups showed significantly higher values for the awake periodic limb movement of sleep index (PLMI), N1 sleep proportion, N2 sleep proportion, arousal index and periodic limb movement arousal index (PLMAI) with values of (61.45±3.86) times/h, (13.35±2.13)%, (57.42±3.55)%, (29.73±2.68) times/h, and (1.27±0.29) times/h, respectively, compared to the non-PLMS group [(28.85±2.92) times/h, (8.36±2.35)%, (52.51±3.52)%, (15.93±2.59) times/h, and (0.86±0.25) times/h, P < 0.05]. The N3 sleep proportion and sleep efficiency were significantly lower in the PLMS group, at (12.52±2.16)% and (83.79±5.83)%, respectively, compared to the non-PLMS group [(23.25±2.25)% and (95.52±7.73)%, P < 0.05]. PLMS was positively correlated with awake PLMI, N1 sleep proportion, N2 sleep proportion, wake index, and PLMAI (r_s=0.529, 0.213, 0.398, 0.251, 0.529, P < 0.05), while negatively correlated with sleep efficiency (r_s=-0.329, P < 0.05). Conclusion Stroke patients with PLMS often exhibit sleep structure disorders and decreased sleep efficiency. PLMS may serve as a predictor of poor prognosis in stroke patients. Clinical monitoring of sleep status in stroke patients with PLMS is recommended, along with appropriate intervention measures to improve patient quality of life.
- Stroke /
- Periodic limb movement during sleep /
- Polysomnosis monitoring /
- Sleep structure

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表 1 2组脑卒中伴睡眠障碍患者临床资料比较

Table 1. Comparison of clinical characteristics between two groups of stroke patients with sleep disorders

组别	例数	性别[例(%)]		年龄(x±s，岁)	BMI(x±s)	卒中类型[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	BMI(x±s)	出血性	缺血性
PLMS组	48	27(56.25)	21(43.75)	51.98±2.86	24.79±1.95	11(22.92)	37(77.08)
非PLMS组	51	32(62.75)	19(37.25)	52.26±2.91	24.83±1.97	13(25.49)	38(74.51)
统计量		0.433^a		0.482^b	0.101^b	0.089^a
P值		0.510		0.631	0.919	0.765
注：^a为χ²值，^b为t值。

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表 2 2组脑卒中伴睡眠障碍患者睡眠结构及相关参数比较(x±s)

Table 2. Comparison of sleep patterns and associated parameters in two groups of stroke patients with sleep disorders

组别	例数	清醒期PLMI(次/h)	N1睡眠占比(%)	N2睡眠占比(%)	N3睡眠占比(%)	REM睡眠占比(%)	睡眠效率(%)	AHI(次/h)	觉醒指数(次/h)	睡眠潜伏期(min)	PLMAI(次/h)
PLMS组	48	61.45±3.86	13.35±2.13	57.42±3.55	12.52±2.16	18.52±2.89	83.79±5.83	10.63±3.68	29.73±2.68	12.24±1.53	1.27±0.29
非PLMS组	51	28.85±2.92	8.36±2.35	52.51±3.52	23.25±2.25	17.95±2.97	95.52±7.73	9.67±3.26	15.93±2.59	11.89±1.61	0.86±0.25
t值		47.172	11.047	6.908	24.178	0.967	8.556	1.376	26.053	1.107	7.548
P值		＜0.001	＜0.001	＜0.001	＜0.001	0.336	＜0.001	0.172	＜0.001	0.271	＜0.001

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表 3 PLMS与睡眠结构及相关参数的关系分析

Table 3. Analysis of the relationship between PLMS and sleep patterns and related parameters

统计量	清醒期PLMI	N1睡眠占比	N2睡眠占比	N3睡眠占比	REM睡眠占比	睡眠效率	AHI	觉醒指数	睡眠潜伏期	PLMAI
r_s值	0.529	0.213	0.398	-0.165	0.157	-0.329	0.162	0.251	0.116	0.529
P值	＜0.001	0.035	＜0.001	0.125	0.148	0.001	0.147	0.024	0.242	＜0.001

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参考文献(18)

[1]	范滕滕, 郭丹, 陈洁, 等. 周期性肢体运动障碍患者快速眼球运动密度特征分析[J]. 中国药物依赖性杂志, 2022, 31(4): 280-284. FAN T T, GUO D, CHEN J, et al. Characteristic analysis of rapid eye movement density in patients with periodic limb movement disorder[J]. Chin J Drug Depend, 2022, 31(4): 280-284.
[2]	WANG Q J, LI Y Z, LI J, et al. Low arousal threshold: a potential bridge between OSA and periodic limb movements of sleep[J]. Nat Sci Sleep, 2021, 13: 229-238. doi: 10.2147/NSS.S292617
[3]	民福利, 邱恒峰. 伴有周期性肢体运动障碍的脑卒中患者的多导睡眠图分析[C]//中国睡眠研究会. 中国睡眠研究会第十二届全国学术年会论文汇编, 2020: 44-45. MIN F L, QIU H F. Polysomnography analysis of stroke patients with periodic limb movement disorder[C]//Chinese Sleep Research Society. Compilation of papers of the 12th National Academic Annual Meeting of China Sleep Research Society, 2020: 44-45.
[4]	LIN J, MORRONE K, MANWANI D, et al. Association between periodic limb movements in sleep and cerebrovascular changes in children with sickle cell disease[J]. J Clin Sleep Med, 2019, 15(7): 1011-1019. doi: 10.5664/jcsm.7884
[5]	NANNAPANENI S, RAMAR K. Periodic limb movements during sleep and their effect on the cardiovascular system: is there a final answer[J]. Sleep Med, 2014, 15(4): 379-384. doi: 10.1016/j.sleep.2013.12.014
[6]	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. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715. Chinese Society of Neurology, Cerebrovascular Group, Chinese Society of Neurology. Diagnostic points of various major cerebrovascular diseases in China 2019[J]. Chin J Neurol, 2019, 52(9): 710-715.
[7]	张鹏, 李雁鹏, 吴惠涓, 等. 中国成人失眠诊断与治疗指南(2017版)[J]. 中华神经科杂志, 2018, 51(5): 324-335. doi: 10.3760/cma.j.issn.1006-7876.2018.05.002 ZHANG P, LI Y P. WU H J, et al. Guidelines for the diagnosis and treatment of insomnia in Chinese adults (2017 edition)[J]. Chin J Neurol, 2018, 51(5): 324-335. doi: 10.3760/cma.j.issn.1006-7876.2018.05.002
[8]	DRAKATOS P, OLAITHE M, VERMA D, et al. Periodic limb movements during sleep: a narrative review[J]. J Thorac Dis, 2021, 13(11): 6476-6494. doi: 10.21037/jtd-21-1353
[9]	LIN C Y, TSAI S J, PENG C K, et al. Sleep state instabilities in patients with periodic limb movements in sleep-detection and quantification with heart rate variability[J]. Psychiatry Res, 2020, 293: 113454. DOI: 10.1016/j.psychres.2020.113454.
[10]	黄隽英, 沈赟, 韩菲, 等. 伴周期性肢体运动急性脑梗死患者的临床特征初步分析[J]. 中国脑血管病杂志, 2020, 17(5): 231-236. HUANG J Y, SHEN Z, HAN F, et al. Preliminary analysis of clinical features of acute cerebral infarction with periodic limb movement[J]. Chin J Cerebrovas Dis, 2020, 17(5): 231-236.
[11]	李巍峰, 张晓钰. 脑干卒中后低氧血症患者单胺类神经递质的变化因素与卒中后睡眠障碍的关系分析[J]. 中国现代医生, 2021, 59(36): 45-48. doi: 10.3969/j.issn.1673-9701.2021.36.zwkjzlml-yyws202136012 LI W F, ZHANG X Y. Relationship between changes of monoamine neurotransmitters and sleep disorders in patients with brain stem hypoxemia after stroke[J]. Mod Doc China, 2021, 59(36): 45-48. doi: 10.3969/j.issn.1673-9701.2021.36.zwkjzlml-yyws202136012
[12]	原向军. 脑卒中后睡眠障碍对预后影响相关研究[J]. 中国药物与临床, 2021, 21(22): 3747-3749. YUAN X J. Study on the influence of sleep disorders on prognosis after stroke[J]. Chin Remed Clin, 2021, 21(22): 3747-3749.
[13]	陈海弘. 半睡眠周期性肢体运动的帕金森病患者睡眠结构分析[J]. 中风与神经疾病杂志, 2021, 38(5): 404-406. CHEN H H. Sleep structure analysis of Parkinson's disease patients with semi-sleep periodic limb movement[J]. J Apopl Nerv Dis, 2021, 38(5): 404-406.
[14]	胡娅娅, 周宁, 薛孟周. 脑卒中伴睡眠期周期性肢体运动患者的睡眠结构研究[J]. 中国全科医学, 2022, 25(35): 4389-4393. doi: 10.12114/j.issn.1007-9572.2022.0468 HU Y Y, ZHOU N, XUE M Z. Sleep structure in patients with cerebral apoplexy and periodic limb movement during sleep[J]. Chin Gen Prac, 2022, 25(35): 4389-4393. doi: 10.12114/j.issn.1007-9572.2022.0468
[15]	NOEL V P, BAGA K, WALTERS A. Cardiovascular comorbidity in patients with restless legs syndrome: current perspectives[J]. Journal of Parkinsonism and Restless Legs Syndrome, 2017, 7: 13-28. doi: 10.2147/JPRLS.S99322
[16]	张仁伟, 刘振兴, 欧阳克妮, 等. 急性前循环缺血性脑卒中机械取栓成功再通后无效再通的危险因素分析[J]. 中华实用诊断与治疗杂志, 2023, 37(6): 605-609. ZHANG R W, LIU Z X, OUYANG K N, et al. Risk factors of futile recanalization after mechanical thrombectomy for acute anterior circulation stroke[J]. Journal of Chinese Practical Diagnosis and Therapy, 2023, 37(6): 605-609.
[17]	HASEGAWA E, MIYASAKA A, SAKURAI K, et al. Rapid eye movement sleep is initiated by basolateralamygdala dopamine signaling in mice[J]. Science, 2022, 375(6584): 994-1000. doi: 10.1126/science.abl6618
[18]	孙奕, 郑慧芬. 失眠伴轻度认知功能障碍老年患者的睡眠分析[J]. 中华全科医学, 2023, 21(10): 1640-1642, 1809. doi: 10.16766/j.cnki.issn.1674-4152.003188 SUN Y, ZHENG H F. Analysis of sleep characteristics in elderly patients with insomnia and mild cognitive impairment[J]. Chinese Journal of General Practice, 2023, 21(10): 1640-1642, 1809. doi: 10.16766/j.cnki.issn.1674-4152.003188