| Objective:To investigate the clinical characteristics of sleep disordersand cognitive impairment after stroke.Methods:We screened a cohort of62patients diagnosed with strokeaccording to the revised diagnostic criteria of the Chinese society of the fourthsession of national cerebrovascular disease academic meeting in1995at theFourth Affiliated Hospital of Hebei Medical University from May2013toJanuary2014.This cohort included41males and21female, with a mean ageof68.61±9.75years(range,51-90years). Complications included hypertension(n=46), diabetes mellitus (n=32) and coronary heart disease (n=20). Thehemorrhagic cases were12and the ischemic cases were50. These patients hadneither sleep disorders nor cognitive impairment before the onset of stroke,and were examined with Pittsburgh Sleep Quality Index (PSQI), Mini-mentalState Examination(MMSE), Event-related potentials(P300) and monitored byPolysomnography(PSG)within two weeks after hospitalization. The totalglobal PSQI score was21. A PSQI global score greater than7was classifiedas the sleep disorder. The maximal point of MMSE was30, The raw scoremay also need to be corrected for educational attainment and age,illiteracy≤17points, primary school≤20points, above the middle school≤24points. The stroke clinical neurological deficit rating scale (NDS) score was45points,0-15points as mild neurological deficit,16-30as moderate neurologicaldeficit,31-45as severe neurological deficit. The patients were divided intotwo groups according to PSQI:①22cases in the sleep disorders group (14males,8females,52-90years of age, mean age70.82±10.76years),②40cases in the non-sleep disorders group (27males,13females,51-88years ofage, mean age67.40±9.07years). The patients were divided into two groupsaccording to MMSE.①20cases in the cognitive impairment group (11males,9females,53-88years of age, mean age71.55±9.46years),②42cases in the non-cognitive impairment group (30males,12females,51-90years of age,mean age67.21±9.69years).The clinical data (including gender, age,anamnesis, stroke type, stroke location, neurological deficit), PSG (the sleeplatency, actual sleep time, sleep efficiency, awake times, the ratio of non-rapideye movement1,2,3,4and rapid eye movement) and P300(The latency andamplitude) was analyzed, and SPSS13.0software was used for all analysis.The data is expressed as a percentage, and campared by chi-square test forcategorical variables, and2-sample t test depending on the distribution ofcontinuous variable. a P value <0.05was considered as statisticallysignificant.Results:1Sleep disorders1.1Common data: The sleep disorders patients (n=22) weremales(14/22,63.64%), females (8/22,36.36%) and the non-sleep disorderspatients(n=40) were males(27/40,67.50%),females (13/40,32.50%),The genderwas not statistically associated with the sleep disorders. The mean age was70.82±10.76years (range52-90years) in patients with sleep disorders and67.40±9.07years(range51-88years) without sleep disorders. It showed thatthere was no statistically significant (P>0.05) at the average age. Less than60years(5/16,31.25%),61～70years(6/18,33.33%),71～80years(4/19,21.05%),more than80years(7/9,77.78%),we found statistically significant(P<0.05) in all ages.1.2Clinical features: Compared the two groups for the anamnesis(hypertension, diabetes mellitus, coronary heart disease), stroke type, strokelocation and neurological deficit. In sleep disorders group, hypertension(20/22,90.91%),diabetes mellitus(16/22,72.73%),coronary heart disease(11/22,50.00%). In the non-sleep disorders group, hypertension(26/40,65.00%),diabetes mellitus (16/40,40.00%), coronary heart disease (9/40,22.50%).Prevalence of sleep disorders was significantly (P<0.05) related to theanamnesis (hypertension,diabetes mellitus,coronary heart disease). Theischemic stroke were50cases (17/50,34.00%) and hemorrhagic stroke were 12cases (5/12,41.67%), and there was no statistically significant (P>0.05).The left cerebral hemisphere32cases (17/32,53.13%), the right cerebralhemisphere30cases (5/30,16.67%), there was statistically significant (P<0.05)at the stroke side. The incidence of sleep disorders group for the frontal, thetemporal, the parietal, the occipital, the basal ganglia, the brainstem, and thethalamus stroke were (1/4,25.00%),(1/3,33.33%),(2/2,100%),(1/3,33.33%),(8/28,28.57%),(8/14,57.14%）,(1/5,20.00%),The data can not be statisticallyanalyzed because of the small sample content. The mild neurological deficitwere35(7/35,20.00%), the moderate neurological deficit were19(9/19,47.37%), the severe neurological deficit were8(6/8,75.00%), and there wasstatistically significant (P<0.05).1.3PSG the sleep latency were52.86±13.85min (the sleep disorders group),31.43±9.19min(the non-sleep disorders group) and the actual sleep time were387.59±31.96min versus410.48±15.71min. The sleep efficiency were80.75±6.66%versus85.72±3.29%. The awake times were6.05±2.01versus4.45±2.18. The ratio of NREM1,2,3,4and REM as follows:22.22±6.47%,44.24±4.93%,11.97±4.36%,10.38±3.98%(the sleep disordersgroup)and14.91±5.18%,41.69±4.71%,15.05±4.58%,13.34±4.24%(the non-sl-eep disorders group). We found statistically significant(P<0.05) between thetwo groups.1.4Event-related potentials (P300) The latency and the amplitude were386.95±68.75ms,6.45±1.83uV (the sleep disorders group)and359.05±51.89ms,7.23±1.63uV(the non-sleep disorders group). There was no statisticallysignificant (P>0.05).2Cognitive impairment2.1Common data The cognitive impairment group (n=20),11males(11/20,55.00%),9females (9/20,45.00%), mean age71.55±9.46years (range53-88years) and30males (30/42,71.43%),12females (12/42,28.57%), meanage67.21±9.69years (range51-90years) in the non-cognitive impairmentgroup. We found there was no statistically significant (P>0.05). In all ages:less than60years(2/16,12.50%),61～70years(5/18,27.78%),71～80years (7/19,36.84%), more than80years (6/9,66.67%) and there was statisticallysignificant (P<0.05)in all ages.2.2Clinical features Compared the two groups for the anamnesis(hypertension, diabetes mellitus, coronary heart disease), stroke type, strokelocation and neurological deficit. The cognitive impairment patients withhypertension(19/20,95.00%), diabetes mellitus(15/20,75.00%), coronary heartdisease (10/20,50.00%) and hypertension (27/42,64.29%), diabetes mellitus(17/42,40.48%), coronary heart disease (10/42,23.81%) in the non-cognitiveimpairment group, the anamnesis showed significant association withprevalence of cognitive impairment(P<0.05). The prevalence of cognitiveimpairment(14/50,28.00%)in ischemic stroke and (6/12,50.00%) inhemorrhagic stroke, and there was no statistically significant(P>0.05). The leftcerebral hemisphere were32(14/32,43.75%), the right cerebral hemispherewere30(6/30,20.00%）and there was statistically significant (P<0.05) at thestroke side. The incidence of the cognitive impairment group for the frontal,the temporal, the occipital, the basal ganglia, the brainstem, the cerebellumand the thalamus were(2/4,50.00%),(2/3,66.67%),(1/3,33.33%),(8/28,28.57%),(3/14,21.43%),(1/3,33.33%),(3/5,60.00%).The data can not be statisticallyanalyzed because of the small sample content. The mild neurological deficitwere35(8/35,22.86%), the moderate neurological deficit were19(6/19,31.58%), the severe neurological deficit were8(6/8,75.00%), andthere was statistically significant(P<0.05).2.3Event-related potentials (P300) The latency was437.90±40.08ms andthe amplitude was6.42±1.24uV (the cognitive impairment group) and336.12±32.94ms,7.25±1.86uV(the non-cognitive impairment group). Therewas statistically significant(P<0.05).2.4PSG The cognitive impairment group, the sleep latency43.55±17.47min,the actual sleep time395.25±33.32min, the sleep efficiency82.35±6.94%,awake times5.60±2.01, the ratio of NREM1,2,3,4and REM were20.93±7.90%,43.76±5.02%,13.65±4.21%,10.69±3.87%.The non-cognitive impairmentgroup were36.88±13.48min,405.74±19.71min,84.53±4.11%,4.83±2.38, 42.04±4.81%,14.11±4.96%,13.05±4.41%. We found statistically significant atthe ratio of NREM1and REM(P<0.05). The sleep latency, the actual sleeptime, the sleep efficiency, awake times and the ratio of NREM2, NREM3,4were no statistically significant(P>0.05).Conclusion:1The sleep disorders was associated with the anamnesis(hypertension,diabetes mellitus, coronary heart disease), stroke side and neurological deficit.2The sleep disorders showed the reduced actual sleep time, sleepefficiency, the ratio of NREM3,4, REM and prolonged sleep latency, awaketimes, the ratio of NREM1,2.3The cognitive impairment patients were related to the anamnesis(hypertension,diabetes mellitus,coronary heart disease),stroke side andneurological deficit.4The cognitive impairment patients had prolonged latency, reducedamplitude and increased ratio of NREM1, decreased ratio of REM. |
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