Usual Sleep-wake Patterns To The Influence Of Blood Pressure Circadian Rhythm After Acute Cerebral Infarction

Objective:Through the research and analysis of the relationship between the circadian rhythm of blood pressure and the circadian rhythm of the usual sleep-wake pattern and time of onset in patients with acute cerebral infarction,increasing the understanding of the pathophysiology of cerebral infarction and providing new ideas and ways for the prevention and treatment of stroke.Methods:with acute cerebral infarction and with non cerebral stroke(with essential hypertension)confirmed by MRI hospitalized in the Second Affiliated Hospital of Nanchang University between December 2014 and December 2015 were collected continuously,then the usual sleep-wake pattern of all patients were scored and typed with the international Morningness-Eveningness Questionnaire(MEQ).the patients were divided into morning-type group(MEQ≥59),intermediate-type group(41<MEQ<59)and evening-type group(MEQ≤41).And Then,20 morning type patients,middle type patients,and night type patients with acute cerebral infarction respectively were selected as the experimental group,15 morning type patients,middle type patients,and night type patients with non cerebral stroke(with primary hypertension)respectively were selected as the control group,and Ambulatory Blood Pressure Monitoring was performed in all patients.Lastly,circadian rhythm of blood pressure in patients with acute cerebral infarction and its relation to time of onset and usual sleep wake pattern is analyzed.Result:1.Usual sleep-wake patterns are associated with common risk factors for cerebral infarction:the lower the MEQ score(evening types),the younger the age at onset(p=0.000),the more common bad habits,such as smoking(p=0.029),drinking(p=0.048),and so on.The higher the MEQ score(morning types),the older the age,and the incidence of carotid atherosclerotic plaque was higher(p=0.034).Compared with middle types and morning types,and evening types had no differences in statistical characteristics(p>0.05).2.The circadian rhythm of blood pressure was related to the usual sleep wake pattern in patients with acute cerebral infarction.①86.7 percent(52/60)in cerebral infarction group showed 24 hour blood pressure were non dipper or anti dipper,and three types were mainly non dipper,the night types were 75%(15/20),morning types 50%,middle types 60%.② There were statistically significant differences in 24hADBP and dADBP between patients with different sleep wake patterns,24hADBP and dADBP were the highest in the patients with middle types,while those with night types were the lowest in 24hADBP and dADBP(p<0.05).③ Compared with non infarction group,the correlation between MEQ score and blood pressure variability in patients with acute cerebral infarction was lost.3.The sleep wake pattern is associated with the onset time of acute cerebral infarction.The peak incidence of morning types patients was 06:00-11:59(40%),Sub peak was 00:00-05:59(35%),Minimum period of onset was 18:00-23:59(5%).The peak incidence of middle types patients was 06:00-11:59(50 percent),Sub peak was 12:00-17:59(35%),Minimum period of onset was 00:00-05:59(5%).The peak incidence of evening types patients was 12:00-17:59(45%),Sub peak was 18:00-23:59(25%).Conclusion:The circadian rhythm of blood pressure was related to the usual sleep wake pattern in patients with acute cerebral infarction.The risk factors and time of acute cerebral infarction can be affected by the usual sleep wake pattern.