Study On Characteristic Of Sleep Architecture And Chinese Medicine Syndrome In Patients With Post-ischemic Stroke Sleep Disorders

ObjectiveThe study aims to explore the characteristic of sleep architecture and types of sleep disorders in patients with Post-Ischemic Stroke Sleep Disorders(PSSD).Besides,it's intended to better guide the clinical application of the principles,methods,formulas and medicinals of Chinese medicine in PSSD by investigating its distribution law of Chinese Medicine Syndrome.MethodsA total of 35 ischemic stroke patients in Cerebropathy Department of The First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2017 to January 2018 were enrolled.After PQSI assessment,18 patients of PQSI ?7 were divided into the sleep disorder group,and 17 patients of PQSI <7 were divided into the non-sleep disorder group.Two groups were required to conduct polysomnography monitoring and NIHSS scores.Furthermore,the scores of six patterns(wind pattern,fire pattern,phlegm pattern,blood stasis pattern,qi deficiency pattern,yin deficiency with yang hyperactivity pattern)were evaluated in both of them according to the Diagnostic criteria of stroke syndrome differentiation in 1991.The total score of each pattern?7 means the pattern exist.Finally,analysis the scores of six patterns,sleep architecture and types of sleep disorders in both groups.Using independent samples t-test to compare the differences between two groups in sleep parameters and pattern scores,and Fisher's exact test was used to compare the distribution law of Chinese Medicine pattern and qualitative variables.ResultsIt's found that total sleep time(257.06±76.94 min),N2 sleep phase(120.33±57.19 min),REM sleep phase(30.97±19.67 min)and sleep efficiency(52.68±16.11 %)reduced,REM latency(168.94±124.14 min)prolonged,awake time(240.11±99.78 min)increased in PSSD group.The difference was statistically significant compared with the non-PSSD group(P<0.05).Both groups' N1 sleep phase prolonged,N3 sleep phase decreased,arousal frequency increased.The difference was no statistically significant(P>0.05).One patient in sleep disorder group had REM sleep phase loss and two patients had N3 sleep phase loss.Moreover,it came out 6 mild OSAHS,2 moderate OSAHS and 3 severe OSAHS in sleep disorder group while 4 mild OSAHS,4 moderate OSAHS and 2 severe OSAHS in the other group.The difference was no statistically significant(P>0.05).There was no significant difference in sleep parameters between the two groups of OSAHS patients(P>0.05).In sleep disorder group,compared with mild OSAHS,severe OSAHS patients in total sleep time and sleep efficiency were higher,the difference was statistically significant(P<0.05)but no difference when compared with the moderate patients(P>0.05).Whereas there was no significant difference in sleep parameters among mild,moderate and severe OSAHS patients in non-sleep disorder group(P>0.05).The number of sleep cycles in sleep disorder group(2.22 ± 1.11)was less than that in non-sleep disorder group,the difference was statistically significant(P<0.05).The scores of fire pattern(7.28 ± 4.59)and phlegm pattern(10.94 ± 4.02)in the sleep disorder group were higher than those in the non-sleep disorder group(P<0.05),but there's no statistically significant in wind pattern,blood stasis pattern,qi deficiency pattern and yin deficiency with yang hyperactivity pattern between two groups.When came to the distribution law of Chinese Medicine pattern,it appeared 9 wind pattern,10 fire pattern,16 phlegm pattern,6 blood stasis pattern,8 qi deficiency pattern and 2 yin deficiency with yang hyperactivity pattern in sleep disorder group while 7 wind pattern,5 fire pattern,7 phlegm pattern,2 blood stasis pattern,7 qi deficiency pattern and3 yin deficiency with yang hyperactivity pattern in the other group.The phlegm pattern was statistically significant between two groups(P<0.05).Conclusion1.There was a significant change of sleep structure in patients with sleep disorders after ischemic stroke.The changes were as follows: reduced total sleep time,decreased sleep in N2 and REM,decreased sleep efficiency,latency to REM,prolonged awakening and decreased sleep cycle.2.Post-Ischemic StrokeSleep Disorders mainly as a disturbance of sleep structure,insomnia and sleep apnea.3.Patients with severe OSAHS had higher total sleep time and sleep efficiency than mild OSAHS.This might be related to the impairment of ischemic preconditioning and cerebrovascular autoregulation.4.Chinese Medicine pattern of patients with PSSD is mainly fire and phlegm pattern,especially the latter one.Phlegm pattern exists in those who have a fire pattern.Therefore,it can be speculated that phlegm pattern is the main pattern among post-ischemic stroke sleep disorders patients,which might transform into fire pattern with time goes by.