Article record

卒中/TIA后OSA患者的CPAP依从性与抑郁症状

CPAP adherence and depressive symptoms in post-stroke/TIA patients with OSA.

临床研究耳科IF 4.5Q1

文献信息

PMID	42800142
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Hephzibah O Ali 查看其他 12 位作者 Michelle Gyenes；Henry T H Xie；Maneesha Kamra；David R Colelli；Nardin Kirolos；David J Gladstone；Karl Boyle；Arun N E Sundaram；Julia J Hopyan；Richard H Swartz；Brian J Murray；Mark I Boulos
作者单位	Undergraduate MD Program, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada. Electronic address: hephzibah.ali@mail.utoronto.ca. 查看其他 12 条单位信息 Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada. Electronic address: m.gyenes@mail.utoronto.ca.；Undergraduate MD Program, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: henryth.xie@mail.utoronto.ca.；Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: maneeshakamra22@yahoo.com.；Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada. Electronic address: colellid@gmail.com.；Department of Pediatrics & Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: nardinkirolos@gmail.com.；Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: david.gladstone@sunnybrook.ca.；Stroke Medicine, Beaumont Hospital, Dublin, Ireland. Electronic address: karl.boyle@me.com.；Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: dr_arun72@yahoo.com.；Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: julia.hopyan@sunnybrook.ca.；Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: rick.swartz@sunnybrook.ca.；Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: brian.murray@utoronto.ca.；Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: mark.boulos@sunnybrook.ca.
期刊	Sleep medicine
SCI 分区	Q1
IF	4.5
研究类型	临床研究 · 临床
所属专科	耳科

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）在卒中及短暂性脑缺血发作（TIA）患者中高度流行，并与不良结局包括卒中后抑郁相关。持续气道正压通气（CPAP）是OSA的标准治疗，然而依从性较低。CPAP依从性与卒中后抑郁及其他结局之间的关系尚未明确。本研究旨在评估CPAP依从性是否与抑郁症状变化及其他卒中/TIA后结局相关。方法：这是一项前瞻性收集的队列研究的二次分析，纳入112例经影像学确诊的卒中或医生诊断的TIA患者，这些患者通过实验室多导睡眠监测或家庭睡眠呼吸暂停检测被诊断为OSA。在112例患者中，36例（32.1%）对CPAP依从，76例（67.9%）不依从。当CPAP依从性以连续变量建模时，在控制我们感兴趣的协变量后，每周CPAP使用时间越长与抑郁症状减轻相关（β = -0.07/小时/周；95% CI -0.14至-0.003；p = 0.04）。基于模型的预测表明，抑郁症状的估计变化在每周约31小时CPAP使用时开始与无变化有统计学差异。卒中复发仅发生在不依从组（依从组：0/36，0%；不依从组：3/76，3.9%）。结果：观察到CPAP使用越多与抑郁症状改善之间存在剂量依赖关系，提示获益超出常规CPAP依从性阈值。结论：这些发现强调了在卒中/TIA后人群中鼓励使用CPAP的重要性，因为它可能带来具有临床意义的情绪获益。

英文摘要

Obstructive sleep apnea (OSA) is highly prevalent among patients with stroke and transient ischemic attack (TIA) and is associated with poor outcomes including post-stroke depression. Continuous positive airway pressure (CPAP) is the standard treatment for OSA, however, adherence is low. The relationship between CPAP adherence with post-stroke depression and other outcomes has not been well-defined. This study aimed to evaluate whether CPAP adherence was associated with changes in depressive symptoms and other post-stroke/TIA outcomes. This was a secondary analysis of a prospectively collected cohort study of 112 patients with imaging-confirmed stroke or physician-diagnosed TIA who were diagnosed with OSA via in-laboratory polysomnography or home sleep apnea testing. Of 112 patients, 36 (32.1%) were adherent to CPAP and 76 (67.9%) were non-adherent. When CPAP adherence was modeled continuously, greater weekly CPAP use was associated with reduced depressive symptoms (β = -0.07 per hour/week; 95% CI -0.14 to -0.003; p = 0.04) while controlling for our covariates of interest. Model-based predictions indicated that the estimated change in depressive symptoms became statistically different from no change at approximately 31 h of CPAP use per week. Stroke recurrence occurred only in the non-adherent group (adherent: 0/36, 0%; non-adherent: 3/76, 3.9%). A dose-dependent relationship was observed between greater CPAP use and improvement in depressive symptoms, suggesting benefits beyond a conventional CPAP adherence threshold. These findings highlight the importance of encouraging CPAP use in post-stroke/TIA populations as it may confer clinically meaningful mood benefits.