Effect Of Obstructive Sleep Apnea On Sleep Architecture Of Acute Ischemic Stroke Patients

Obejecive:To investigate the effect of obstructive sleep apnea（OSA）on sleep architecture,location of ischemic lesions and prognosis in acute ischemic stroke（AIS）patients.And to further explore the effect factors of the prognosis in AIS patients.Methods:Seventy AIS patients with polysomnography examination from June 2014to April 2016 were collected in the Second Affiliated Hospital of Soochow University.Twenty-seven healthy controls during the same period were chosen as control group.According to apnea-hypopnea index（AHI）,AIS patients were divided into AIS group（AHI<5/h）and AIS+OSA group（AHI≥5/h）.Their general conditions,Neurological function defect（national institutes of health stroke scale,NIHSS）on admission and at discharge and self-care ability（modified Rankin Scale,mRS）at discharge and 3 months later（mRS score<2 reflected good prognosis,and mRS score≥2 reflected unfavorable prognosis）were collected.SPSS22.0 was performed to analysis if there was a statistically significant difference between the above indicators.Logistic regression was performed to evaluate the effect factors of the prognosis at 3 months.Results:Fifty-two patients（74.3%）had OSA in total seventy AIS patients.Total sleep time（TST）was significantly shorter and sleep efficiency（SE）was lower in AIS group than the control group（P=0.007,0.008,respectively）.AIS+OSA group had longer non-rapid eye movement（NREM）1 than control group[24.9（21.3）vs 14.3（10.6）,P=0.044].Compared with AIS group,AIS+OSA group had shorter NREM3[13.0（13.2）vs 19.6（12.8）,P=0.039].There was no significant difference between the infarct location of AIS group and AIS+OSA group.However,AIS+OSA group had higher mRS score observed at 3months through follow-up visit than AIS group（P=0.027）.Spearman correlation analysis showed a positive correlation between stroke unfavorable prognosis at 3 months and atrial fibrillation,the oxygen desaturation index（ODI）,percentage of oxygen saturation<90%of total recording time（TS90%）,AHI,longest time of apnea and hypopnea,respiratory related microarousal,NIHSS while a negative correlation between stroke unfavorable prognosis and NREM3,lowest nocturnal oxygen saturation（L-SaO₂）.On logistic analysis,the unfavorable prognosis was independently predicted by AHI and NIHSS.Conclusions:Sleep architecture of cerebral infarction patients are disturbed with its characteristic of total sleep time and sleep eficiency reduced.AIS patients have higher prevalence of OSA and AIS patients with OSA group have longer NREM1 and shorter NREM3.OSA can sharpen the decrease of slow-wave sleep of AIS patients.The reduced slow-wave sleep is correlated with poor functional outcome.OSA has no relationship with the location of stroke,but a worse functional outcome at 3 months is predicted by AHI and NIHSS.