卒中康复中的睡眠障碍：机制、影响与多学科管理——一篇叙述性综述

文献信息

中文摘要

背景： 睡眠障碍与卒中之间存在双向关系。睡眠障碍是卒中的独立危险因素，也是卒中后常见的并发症。阻塞性睡眠呼吸暂停（OSA）通过间歇性缺氧、全身性炎症、内皮功能障碍和自主神经功能失调，使卒中风险增加约2至3倍。卒中后睡眠障碍影响高达59.9%的患者，阻碍神经功能恢复。
目的： 探讨睡眠障碍对卒中恢复的流行病学、病理生理学和临床影响，并总结循证管理策略。
方法： 本叙述性综述以基于临床观察和初步综合所形成的写作提纲为指导。于2026年3月10日至13日在PubMed、Embase、Cochrane、Web of Science、CNKI和万方数据库中使用针对性关键词（如“睡眠障碍”“阻塞性睡眠呼吸暂停”“康复”“卒中”）进行主题驱动的文献检索，限定为2000—2026年发表的英文或经核实的中文译文文献。同时筛查了参考文献列表。
结果： 卒中后睡眠障碍的患病率为25%至84%；OSA影响40%至78%的卒中患者。睡眠障碍与更差的功能结局、住院时间延长、认知功能下降和卒中复发率升高相关。在机制上，涉及间歇性缺氧、氧化应激、全身性炎症、类淋巴系统功能障碍、自主神经功能失调和神经可塑性受损。管理方面：CPAP是OSA的一线治疗；CBT-I可改善失眠症状；临床研究显示rTMS可改善睡眠质量；运动、褪黑素和光照疗法显示出新兴证据。RLS/PLMD的药物治疗需谨慎考虑跌倒风险和认知副作用。
结论： 睡眠障碍高度流行，并对卒中恢复产生负面影响。循证策略——CPAP、CBT-I和rTMS——可改善睡眠和功能结局，但证据存在异质性。需要高质量随机对照试验来优化个体化方案。

英文摘要

BACKGROUND: Sleep disorders and stroke share a bidirectional relationship. Sleep disturbances are independent stroke risk factors and frequent post-stroke complications. Obstructive sleep apnea (OSA), through intermittent hypoxia, systemic inflammation, endothelial dysfunction, and autonomic dysregulation, increases stroke risk by approximately 2- to 3-fold. Post-stroke sleep disorders affect up to 59.9% of patients, impeding neurological recovery.
OBJECTIVES: To examine the epidemiology, pathophysiology, and clinical impacts of sleep disorders on stroke recovery, and to summarize evidence-based management strategies.
METHODS: A narrative review was guided by a writing outline developed from clinical observations and preliminary synthesis. A theme-driven literature search was conducted in PubMed, Embase, Cochrane, Web of Science, CNKI, and Wanfang (March 10-13, 2026) using targeted keywords (e.g., "sleep disorders," "obstructive sleep apnea," "rehabilitation," "stroke"), limited to 2000-2026 publications in English or verified Chinese translations. Reference lists were also screened.
RESULTS: Post-stroke sleep disorder prevalence ranges from 25 to 84%; OSA affects 40-78% of stroke patients. Sleep disorders correlate with worse functional outcomes, prolonged hospitalization, cognitive decline, and elevated stroke recurrence. Mechanistically, intermittent hypoxia, oxidative stress, systemic inflammation, glymphatic dysfunction, autonomic dysregulation, and impaired neuroplasticity are implicated. Management: CPAP is first-line for OSA; CBT-I improves insomnia symptoms; rTMS has been shown to improve sleep quality in clinical studies; exercise, melatonin, and light therapy show emerging evidence. Pharmacotherapy for RLS/PLMD requires caution regarding fall risk and cognitive side effects.
CONCLUSION: Sleep disorders are highly prevalent and negatively impact stroke recovery. Evidence-based strategies-CPAP, CBT-I, and rTMS-improve sleep and functional outcomes, though evidence heterogeneity exists. High-quality RCTs are needed to optimize individualized protocols.