中国急性脑梗死患者阻塞性睡眠呼吸暂停的独特特征：一项前瞻性观察性研究

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）是一种可改变的危险因素，及时检测和治疗有助于改善卒中后结局，但特定种族特征和实用筛查策略仍未被充分描述。我们评估了中国急性脑梗死患者中OSA的患病率、其与神经认知功能的关联以及筛查效能。
方法： 在这项前瞻性队列中，183例连续入组的汉族急性脑梗死住院患者在发病2周内接受了家庭睡眠呼吸暂停检测。中重度OSA定义为呼吸暂停低通气指数≥15次/小时。采用简易精神状态检查量表和美国国立卫生研究院卒中量表评估神经认知功能。评估了STOP-Bang问卷识别中重度OSA的诊断效能，包括敏感性、特异性、阳性预测值和阴性预测值。
结果： OSA患病率为79.2%，其中37.7%为中重度。认知障碍（简易精神状态检查量表<23）在无OSA患者中比OSA患者少见（15.8%对31.3%-40.8%，P=0.048）。按性别分层分析显示，女性中无OSA与轻度OSA相比认知障碍负担更高（P=0.040），而男性中未观察到类似关联（所有P=0.400）。STOP-Bang的区分能力有限（受试者工作特征曲线下面积为0.72），敏感性高（88.4%）但特异性低（39.5%）。
结论： 中国急性脑梗死患者OSA负担较高。按性别分层的结果提示女性可能对OSA相关认知障碍具有特异性易感性，值得开展更大规模队列研究。鉴于STOP-Bang特异性有限且分诊价值不足，在该人群中应尽可能进行客观睡眠呼吸暂停评估。
注册： 网址：https://www.chictr.org.cn/。标识符：ChiCTR2000038312。

英文摘要

BACKGROUND: Obstructive sleep apnea (OSA) is a modifiable risk factor that benefits from timely detection and treatment to improve poststroke outcomes, yet ethnic-specific features and practical screening strategies remain undercharacterized. We evaluated OSA prevalence, its association with neurocognitive function, and screening performance in Chinese patients with acute cerebral infarction.
METHODS: In this prospective cohort, 183 consecutive Han Chinese inpatients with acute cerebral infarction underwent home sleep apnea testing within 2 weeks of onset. Moderate to severe OSA was defined as an apnea-hypopnea index ≥15 events/h. Neurocognitive function was assessed by Mini-Mental State Examination and National Institutes of Health Stroke Scale. The diagnostic performance of the STOP-Bang questionnaire, including sensitivity, specificity, positive predictive value, and negative predictive value, was evaluated for identifying moderate to severe OSA.
RESULTS: OSA prevalence was 79.2%, with 37.7% moderate to severe. Cognitive impairment (Mini-Mental State Examination <23) was less frequent in patients without OSA than patients with OSA (15.8% versus 31.3%-40.8%, P=0.048). Sex-stratified analyses showed higher cognitive impairment burden in women comparing non-OSA versus mild OSA (P=0.040), with no parallel association observed in men (all P=0.400). STOP-Bang had limited discrimination (area under the receiver operating characteristic curve, 0.72), with high sensitivity (88.4%) but low specificity (39.5%).
CONCLUSIONS: Chinese patients with acute cerebral infarction have a high OSA burden. Sex-stratified results suggest potential female-specific vulnerability to OSA-related cognitive impairment, warranting larger cohorts. Given limited specificity and triage value of STOP-Bang, objective sleep apnea evaluation should be performed whenever feasible in this population.
REGISTRATION: URL: https://www.chictr.org.cn/. Identifier: ChiCTR2000038312.