适应性病房照明与标准病房照明下住院缺血性卒中患者打鼾患病率：一项序贯两队列观察性研究

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中文摘要

研究目的： 探讨打鼾（上气道不稳定性的客观标志）在标准荧光病房照明下住院的急性缺血性卒中患者与安装适应性、随时间变化的LED系统后住院的患者之间是否存在差异。
临床依据： 睡眠呼吸障碍影响大多数急性卒中期患者，并与较差的神经功能结局、复发和死亡率独立相关。病房照明是一个可改变的环境因素，但其与客观记录的打鼾（上气道不稳定性的声学标志）的关系此前尚未在卒中中研究过。
材料与方法： 在这项单中心、序贯两队列观察性研究中，比较了两组非重叠的急性缺血性卒中患者：一组在标准照明下入院（n=47），另一组在安装适应性照明后入院（n=46）。没有患者在两种条件下均被研究。使用WatchPAT 300（ZOLL Itamar Medical，Caesarea，Israel）记录打鼾，分析在患者层面进行。主要比较是打鼾超过45 dB的患病率（Fisher精确检验）；次要比较是睡眠时间比例和超过阈值打鼾的持续时间（Mann-Whitney U检验）。比较呼吸指数和睡眠结构以评估组间平衡。
结果： 标准照明组47例患者中有47例（100%）观察到超过阈值的打鼾，适应性照明组46例患者中有37例（80%）（p=1.1×10-3）。适应性照明组打鼾的睡眠时间比例（p=7.8×10-4）和打鼾持续时间（p=1.1×10-3）均较低。在打鼾的患者中，平均打鼾强度在两组间无差异（p=0.09）。两组在所有测量的呼吸指数和睡眠结构上均具有可比性（所有p>0.05）。
结论与临床意义： 在呼吸严重程度和睡眠结构匹配良好的两个队列中，适应性病房照明下住院的队列打鼾患病率和负担较低。非随机设计排除了因果推断，但这种关联支持将适应性照明作为一种低风险、非药物候选干预措施，值得在具有多导睡眠图终点的随机试验中进行测试。

英文摘要

AIM OF THE STUDY: To examine whether snoring, an objective marker of upper-airway instability, differs between acute ischemic stroke patients hospitalized under standard fluorescent ward lighting and those hospitalized after installation of an adaptive, time-of-day-varying LED system.
CLINICAL RATIONALE FOR THE STUDY: Sleep-disordered breathing affects most patients in the acute stroke period and is independently associated with worse neurological outcomes, recurrence, and mortality. Ward lighting is a modifiable environmental factor, but its relationship to objectively recorded snoring, an acoustic marker of upper-airway instability, has not previously been examined in stroke.
MATERIAL AND METHODS: In this single-center, sequential two-cohort observational study, two non-overlapping groups of acute ischemic stroke patients were compared: one admitted under standard lighting (n = 47) and one admitted after installation of adaptive lighting (n = 46). No patient was studied under both conditions. Snoring was recorded with the WatchPAT 300 (ZOLL Itamar Medical, Caesarea, Israel), and the analysis was performed at the patient level. The primary comparison was the prevalence of snoring above 45 dB (Fisher's exact test); secondary comparisons were the proportion of sleep time and the duration spent snoring above threshold (Mann-Whitney U test). Respiratory indices and sleep architecture were compared to assess group balance.
RESULTS: Snoring above threshold was observed in 47 of 47 patients (100%) in the standard-lighting group and 37 of 46 patients (80%) in the adaptive-lighting group (p = 1.1 × 10-3). Both the proportion of sleep time spent snoring (p = 7.8 × 10-4) and the duration of snoring (p = 1.1 × 10-3) were lower in the adaptive-lighting group. Among patients who snored, mean snoring intensity did not differ between groups (p = 0.09). The two groups were comparable on all measured respiratory indices and on sleep architecture (all p > 0.05).
CONCLUSIONS AND CLINICAL IMPLICATIONS: Snoring prevalence and burden were lower in the cohort hospitalized under adaptive ward lighting, in the context of two groups well matched on respiratory severity and sleep architecture. The non-randomized design precludes causal inference, but the association supports adaptive lighting as a low-risk, non-pharmacological candidate intervention worth testing in a randomized trial with polysomnographic endpoints.