| Objective: We used the combinations of subjective and objective tools to analyze the clinical characteristics of sleep disorders in post-stroke patients and investigated differences and consistence between subjective and objective tools.Methods: This study was conducted in the neurology department of the Fourth Affiliated Hospital of Hebei Medical University in the period from January 2014 to January 2015, which collected sixty-one patients with first-ever stroke. All of them were confirmed by CT or MRI, and met the diagnostic criteria of The Fourth National Cerebrovascular Disease Conference. They had neither sleep disorders nor mental disorders before the onset of stroke. Their ages ranged from 35 to 79 years(mean age: 60.72±10.06 years). These patients, by gender, were divided into male(39 cases) and female(22 cases), the type of stroke to hemorrhagic(11cases) and ischemic(50 cases), the localization of the stroke to left side(31 cases) and right side(30 cases), and the vessel of stroke to anterior circulation(28 cases) and posterior circulation(33 cases). They had been completed the collection of basic data, such as name, gender, age, height, weight, affiliated diseases, NIHSS score, Rank Barthel Index, chemical and radiologic tests. All of them had a Pittsburgh Sleep Quality Index(PSQI) text and a Polysomnography(PSG) test to evaluate sleep quality in two weeks. Then, they were divided into sleep disorder group(case group: 33cases) and non-sleep disorder group(control group: 28cases) by the seven scores of PSQI text. The clinical characteristics(gender, age, Body Mass Index(BMI), neurological deficit and Activities of Daily Living(ADL) and PSG elements(sleep latency, Actual sleep time, sleep efficiency, awake times, the ratio of non-rapid eye movement 1, 2, 3,4 and rapid eye movement stage), were analyzed and compared by SPSS22.0 statistic software. The normal distribution measurement data used the t test and non-normal distribution used non-parameter test. The enumeration data used chi-square test. Pearson or Spearman correlation was used to analysis the relationship of two elements. P<0.05 was considered to having significant changes.Result:1 General statistics: There were 33 cases in sleep disorder group(case group) and 28 cases in non-sleep disorder group(control group). The average age(63.48±9.13 years) of sleep disorder group was older than non-sleep disorder group(58.39±10.06 years), and a statistically significant difference can be found(P<0.05). There were 20 males and 13 females in case group, 19 males and 9 females in control group, the difference could be found, but was not statistically significant(P>0.05). The strokes, which affiliated with hypertension, diabetes mellitus and coronary artery disease, had higher risk of PSSD, and the difference was statistically significant(P<0.05). The statistical differences was also significant on the comparison of the BMI, NIHSS scores and rank Barthel Index between sleep disorder and non-sleep disorder group(P<0.05).2 The stroke characteristics of sleep disorder and non-sleep disorder groups: The patients were divided into hemorrhagic group(n=11) and ischemic group(n=50) by the stroke type. The ratio of sleep disorders was 72.73%(8/11) in hemorrhagic strokes, and 50.00%(25/50) in ischemic ones. There were 31 patients who had left side stroke, and 30 patients who had right side stroke. The ratio of sleep disorders was 58.06%(18/31) in left side strokes, and 50.00%(15/30) in right side stroke. All strokes, by vessel, were divided into anterior circulation stroke group and posterior circulation group. The ratio of sleep disorders was 46.43%(13/28) in anterior circulation group, and 60.61%(20/33) in posterior circulation group.We could see that the ratio of sleep disorders in hemorrhagic strokes, left side strokes and posterior circulation group, was higher than the opposite ones, but the differences were not statistically significant(P>0.05).3 PSG elements: The PSG parameters of sleep disorder group were as follows, sleep latency(47.73±12.23min), sleep efficiency(65.66±8.54%), actual sleep time(354.55±46.10min), awake times(6(5,6)), ratio of S1 stage(21.27±4.11%), ratio of S2 stage(41.21±3.30%), ratio of S3,4 stage(19.27±3.88%), ratio of REM stage(17.24±3.45%).The PSG parameters of non-sleep disorder group were as follows, sleep latency(25.32±9.01min), sleep efficiency(76.15±7.35%), actual sleep time(411.21±39.72min), awake times(4.5(4,5)), ratio of S1 stage(19.32±3.29%), ratio of S2 stage(39.5±3.17%), ratio of S3,4 stage(21.96±4.53%), ratio of REM stage(19.21±4.14%).The differences between case and control group about PSG parameters(sleep latency, sleep efficiency, actual sleep time, awake times, ratio of S1 stage, ratio of S2 stage, ratio of S3,4 stage, ratio of REM stage) were statistically significant(P<0.05).4 The Spearman analysis, between the PSQI scores and PSG parameters, showed a negative correlation between PSQI scores and Actual Sleep Time, also between PSQI scores and Sleep Efficiency. A positive correlation could be found between PSQI scores and Sleep Latency, as well as Awake Times. There were no correlations between PSQI scores and ratio of every sleep stage.Conclusion:1 The post-stroke sleep disorders are associated with age, the anamnesis(hypertension, diabetes mellitus, coronary heart disease), BMI, NIHSS scores, BI scores. Moreover, the severity of post-stroke sleep disorder is correlated with age, BMI, NIHSS scores, and BI scores.2 The PSG parameters of post-stroke sleep disorders show some changes, such as longer sleep latency, lower sleep efficiency and actual sleep time, more awake times, higher ratio of S1 stage and S2 stage, and lower ratio of S3,4 stage and REM stage.3 Overall sleep quality of post-stroke patients assessed with the objective tool can be predicted by the subjective. However, to evaluate sleep architecture and other sleep disorders for stroke patients, the objective tools(such PSG) are necessary to be used. |
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