睡眠呼吸障碍与急性缺血性卒中及TIA的不良短期和长期结局相关：来自伯尔尼睡眠-卒中登记处的回顾性队列研究
Sleep-Disordered Breathing Is Associated With Adverse Short- and Long-Term Outcomes in Acute Ischemic Stroke and TIA: A Retrospective Cohort Study From the Bern Sleep-Stroke Registry.
文献信息
| PMID | 42922436 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Xiaoli Yang |
| 作者单位 | Department of Neurology (X.Y., J.L., S.B.-G., T.M., C.B., M.H.S., D.J.S., M.A., U.F.). |
| 期刊 | Stroke |
| SCI 分区 | Q1 |
| IF | 9.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 睡眠呼吸障碍（SDB）在缺血性卒中后常见，并与不良结局相关，但来自大型卒中队列的证据仍然有限。我们评估了SDB严重程度与全因死亡率、主要不良心脑血管事件（MACCE）以及3个月功能结局之间的关联。
方法： 这项回顾性队列研究纳入了2017年至2021年间连续入住伯尔尼Inselspital的缺血性卒中或短暂性脑缺血发作患者，这些患者接受了院内呼吸多导描记。SDB严重程度根据呼吸暂停低通气指数分为轻度（5-<15次/小时）、中度（15-<30次/小时）或重度（≥30次/小时）。结局包括全因死亡率、首次指数事件后MACCE以及3个月时的改良Rankin量表评分。多变量Cox和logistic回归模型对年龄、性别、体重指数、血管危险因素、入院时美国国立卫生研究院卒中量表评分、静脉溶栓和机械取栓进行了校正。
结果： 在1083例患者中（平均年龄66.0±14.5岁；62.6%为男性），819例患者（75.6%）存在SDB（呼吸暂停低通气指数≥5次/小时），包括轻度（29.8%）、中度（22.9%）和重度（22.9%）。死亡结局的中位随访时间为51.1个月（四分位距39.1-67.8），首次指数事件后MACCE的中位随访时间为47.7个月（四分位距36.9-65.5）；178例死亡，880例患者中有153例发生首次指数事件后MACCE。重度SDB与全因死亡率增加独立相关（校正风险比1.73[95% CI，1.04-2.89]）。轻度、中度和重度SDB与首次指数事件后MACCE相关（校正风险比分别为1.78[95% CI，1.03-3.06]；2.20[95% CI，1.26-3.84]；2.16[95% CI，1.23-3.78]；趋势P=0.009）。中度和重度SDB与不良的3个月功能结局相关（校正比值比分别为1.74[95% CI，1.01-3.04]和2.48[95% CI，1.45-4.31]；趋势P<0.001）。
结论： 重度SDB与全因死亡率独立相关，而SDB严重程度与首次指数事件后MACCE和不良的3个月功能结局相关。急性期SDB评估可能改善预后风险分层。
英文摘要
BACKGROUND: Sleep-disordered breathing (SDB) is common after ischemic stroke and has been associated with adverse outcomes, yet evidence from large stroke cohorts remains limited. We evaluated the association of SDB severity with all-cause mortality, major adverse cardio- and cerebrovascular events (MACCE), and 3-month functional outcome.
METHODS: This retrospective cohort study included consecutive patients with ischemic stroke or transient ischemic attack admitted to Inselspital Bern between 2017 and 2021 who underwent in-hospital respiratory polygraphy. SDB severity was classified according to the apnea-hypopnea index as mild (5-<15 events/h), moderate (15-<30 events/h), or severe (≥30 events/h). Outcomes included all-cause mortality, first postindex MACCE, and modified Rankin Scale scores at 3 months. Multivariable Cox and logistic regression models adjusted for age, sex, body mass index, vascular risk factors, admission National Institutes of Health Stroke Scale, intravenous thrombolysis, and mechanical thrombectomy.
RESULTS: Among 1083 patients (mean age, 66.0±14.5 years; 62.6% male), SDB (apnea-hypopnea index ≥5 events/h) was present in 819 patients (75.6%), including mild (29.8%), moderate (22.9%), and severe (22.9%). Median follow-up was 51.1 months (interquartile range, 39.1-67.8) for mortality and 47.7 months (interquartile range, 36.9-65.5) for first postindex MACCE; 178 deaths and 153 of 880 patients experienced a first postindex MACCE. Severe SDB was independently associated with increased all-cause mortality (adjusted hazard ratio, 1.73 [95% CI, 1.04-2.89]). Mild, moderate, and severe SDB were associated with first postindex MACCE (adjusted hazard ratio, 1.78 [95% CI, 1.03-3.06]; 2.20 [95% CI, 1.26-3.84]; and 2.16 [95% CI, 1.23-3.78], respectively; P for trend=0.009). Moderate and severe SDB were associated with unfavorable 3-month functional outcome (adjusted odds ratio, 1.74 [95% CI, 1.01-3.04] and 2.48 [95% CI, 1.45-4.31], respectively; P for trend <0.001).
CONCLUSIONS: Severe SDB was independently associated with all-cause mortality, whereas SDB severity was associated with first postindex MACCE and unfavorable 3-month functional outcome. Acute-phase SDB assessment may improve prognostic risk stratification.