| Background and aimsStroke-related insomnia is a common sleep disorder after acute ischemic stroke(AIS).The overall incidence rate of stroke-related insomnia is about 40.1%,which might adversely affect the outcome of AIS rehabilitation as well as emotional state,then increasing the risk of poor prognosis of AIS.Hypocretin-1(Hcrt-1)is a neuropeptide secreted by the posterior lateral part of hypothalamus that can maintain arousal.Besides,it also plays a certain role in neuroprotection,inhibition of inflammatory reaction and regulation of autonomic nervous function.Thus,it may be closely related to sleep,neurological recovery and atherosclerotic process in AIS patients.This study aims to explore the correlation between serum Hcrt-1 level and stroke-related insomnia as well as the early neurological outcome in AIS patients.Further clarify the role of Hcrt-1 in carotid atherosclerosis and blood pressure regulation,to provide clues for the management of stroke-related insomnia in AIS patients.MethodsWe consecutively enrolled AIS patients hospitalized in the Department of Neurology of Shenzhen Second People’s Hospital within 48 hours of onset since Mar 2021.Fasting blood samples were collected at 8:00 a.m.the next day after admission,and serum Hcrt-1 level was detected by Hcrt-1(Orexin-A)ELISA kit.Early onset of stroke-related insomnia was defined as Athens Insomnia Scale(AIS*)score≥6 on day 7 of sleep evaluation.The short-term neurological improvement was definedΔNIHSS(admission NIHSS-7-day NIHSS)>1 at day 7 since disease onset.The severity of carotid atherosclerosis was evaluated by carotid intima thickness,plaque properties and plaque burden under Doppler ultrasound.Blood pressure was assessed by indicators of 24-hour ambulatory blood pressure monitoring completed within 72 hours of admission.Multivariate logistic regression analysis was used to verify whether serum Hcrt-1 level was independently correlated with stroke-related insomnia,short-term neurological improvement,and carotid plaque properties.Linear regression was used to evaluate whether there was a correlation between serum Hcrt-1 and blood pressure related parameters.p<0.05 was statistically significant.ResultA total of 163 AIS patients were enrolled,and the incidence rate of stroke-related insomnia was 33.7%at 7-day follow-up,which decreased to 13.2%at 3-month follow-up.Serum Hcrt-1 level was increased in patients with stroke-related insomnia.After adjusting for other confounders,the risk of stroke-related insomnia was 5.7 times higher in the highest quartile of serum Hcrt-1 level compared to the lowest quartile(95%CI 1.84-24.33,P=0.004).Meanwhile,increased serum Hcrt-1 level was also detected in AIS patients with short-term neurological improvement.Patients in serum Hcrt-1 quartile 4 level were 7.4 times more likely to have improved early neurological function than patients in quartile 1(95%CI 2.35-23.33,p=0.001).Serum Hcrt-1 was used to construct ROC curve for short-term neurological improvement,and AUC was 0.678(p<0.001).A total of 151 patients with AIS were included in the carotid atherosclerosis study subgroup.After adjusting for confounders,the risk of unstable carotid atherosclerotic plaque in quartile 1 patients was 6.48 times higher than that in quartile 4(OR 6.48,95%CI 2.12-19.85,P=0.001).In the blood pressure analysis subgroup,a total of 89 patients with AIS were included,serum Hcrt-1 level was independently associated with morning diastolic blood pressure(B=0.024,P=0.028).ConclusionIncreased serum Hcrt-1 is an independent risk factor for stroke-related insomnia.However,serum Hcrt-1 is positively correlated short-term neurological improvement in patients with mild to moderate AIS.Meanwhile,serum Hcrt-1 was negatively related with the severity of carotid atherosclerosis,which showed a certain role in neuroprotection and alleviating the progression of atherosclerosis.Therefore,Hcrt-1 receptor antagonists are reliable choice for patients with stroke-related insomnia,but caution should be exercised in elderly patients with AIS. |
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