Effect Of Non-rapid Eye Movement Sleep Disorders On Cognitive Function Of Patients With Acute Cerebral Infarction

To investigate the effect of non-rapid eye movement sleep disorderson cognitive function and its possible mechanism in patients with acutecerebral infarction, to provide the objective basis for the prognosis ofpatients with acute cerebral infarction of sleep disorders.This investigation adopts56cases of patients who suffered atwo-week course of acute cerebral infarction with non-REM sleep (casegroup) and35same cases of patients without non-REM sleep disorder, allthe cases were continuously selected between March2012and November2013, and verified by cranial magnetic resonance imaging (MRI), Montrealcognitive assessment scale (Montreal cognitive assessment, MOCA)andPolysomnography(PSG). Of56patients (case group),26male,30female,average age (68.0±8.7) years old; The35patients (control group),19malesand16females, average age (65.1±10.0) years old, in the same period ofage, gender, level of education that match (case group) cases. All patientswere selected after the inclusion criteria:①According to guidelines fordiagnosis and management of acute ischemic stroke China(2010)points inthe diagnosis of acute cerebral infarction, and confirmed by cranial MRIexamination;②The patients had good ability of social adaptation beforethe onset and can be matched with the cognitive function tested after theonset of the disease;③T he duration of cerebral infarction after2weeks;④The age between60to80years old. Patients can cooperate in theinspection with conscious, no severe aphasia, no hearing, visualimpairment, right upper extremity strength≥3.⑤Willing to participate inthe study and sign informed consent. Exclusion criteria:①TIA, various cerebral hemorrhage;②o bvious depression and anxiety;③malignanttumor; hydrocephalus; hypothyroidism; vitamin B12or folate deficiencyand syphilis patients;④cognitive impairment,encephalitis, brain traumahistory, or suffer from other diseases can cause dementia, such asHuntington’s disease, Parkinson’s disease;⑤interfere with certain cognitivefunction evaluation of disease, including alcohol, some psychiatric drugabusers;⑥serious heart disease, liver and kidney dysfunction;⑦contraindications to MRI examination;⑧sleep disorders such as sleepapnea, periodic limb movement;⑨coma or can not match the sleepmonitor;⑩cerebral infarction before diagnosis or sleep disorders aretreated patients. All patients were selected after strict screening, andcognitive function in the case group and control group were compared. Tounderstand the relationship between the non REM sleep disorder andcognitive function in patients with acute cerebral infarction.We found the change of sleep parameters by polysomnography,Montreal cognitive assessment scale (MOCA) scores:①n on rapid eyemovement (NREM) sleep stage S1[case group (159.68±54.42) min,control group (147.49±69.68) min; t=0.598, P<0.05]. NREM sleep stageS2[case group (108.89±28.23) min, control group (112.00±38.20) min;t=3.538, P<0.05]. NREM sleep stage S3+S4[case group (15.45±13.41)min, control group (30.83±16.45) min; t=8.788, P<0.05]. REM[case group(92.82±16.12) min, control group (117.18±23.11) min, t=6.649, P<0.05].sleep efficiency[case group (65.21±4.60)%, control group (78.12±6.23)%;t=15.263, P<0.05]. sleep latency[case group (52.92±11.71) min, controlgroup (50.91±12.01) min; t=17.899, P<0.05], the number of awakening[case group (5.00±1.92), control group (4.78±0.18); t=5.423, P<0.05]. totalsleep time [case group (382.16±65.98) min, control group (421.10±80.51)min; t=13.881, P<0.05].②c hanges of Montreal cognitive assessment scalescore: the total score of MOCA [control group (24.7±3.7), case group (23.1±4.2), P<0.05], MOCA executive function score [control group (4.3±0.9), case group (3.5±1.5); P<0.05]. memory score [control group (2.3±1.7),case group (1.9±1.6); P<0.05]. attention score [control group (5.7±0.6),case group (5.4±0.9), P<0.05], directional force score [control group (5.7±0.7), case group (4.9±0.8), P<0.05]. The cognitive function and sleepparameters: Spearman correlation analysis showed that, MOCA scores hadthe positive correlation with NREM sleep stage S3+S4total time(r=0.234,P=0.006). Executive function had the positive correlation with NREM S2sleep time(r=0.295, P=0.002), Memory had the positive correlation withthe total time of NREM sleep stage S3+S4(r=-0.343, P=0.021). Attentionhad the positive correlation with the total time of NREM sleep stage S3+S4(r=0.270, P=0.040). Directional force had the positive correlation withNREM S2sleep time(r=0.244, P=0.047).The character of non REM sleep disorder of acute cerebral infarctionpatients:①NREM sleep stage S2and S3+S4sleep period were changedshortly.②C ognitive function of the patients decreased by the Montrealcognitive assessment scale, The changes of non rapid eye movement sleepmay lead to cognitive function decline.