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急性缺血性脑卒中病人存在多种难以治愈的临床表现,既往人们多关注于肢体偏瘫、失语、大小便失禁以及步态不稳等运动症状,近年来,卒中后睡眠障碍、认知功能障碍、焦虑抑郁等非运动症状引起临床的重视。脑卒中后合并睡眠障碍患病率约38.2%[1],若不及时发现及治疗,会引起严重的认知功能障碍甚至痴呆的发生[2]。目前国内外针对卒中后睡眠障碍与认知功能关系的研究甚多。执行功能是认知功能的重要组成部分,但单独针对与执行功能关系的研究较少,反映受试者日常环境下生活状态的“生态学”研究未见报道。既往对执行功能的研究[3]多运用威斯康辛测试、数字广度测验、Stroop ABC卡片测验、伦敦塔测验等实验性“操作”式的神经-心理评估。ROTH等[4]修订的执行功能行为评估量表成人版(BRIEF-A)能更全面体现执行功能的生态学维度,已在癫痫、焦虑抑郁、精神分裂症、颅脑外伤等疾病的研究中应用[5]。本研究旨在探讨急性缺血性脑卒中后睡眠障碍与生态学执行功能的特点及关联性。
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2组病人性别、受教育程度、年龄、NIHSS评分、吸烟史、大量饮酒史、高血压病史、冠心病及糖尿病史差异均无统计学意义(P>0.05)。睡眠障碍组病人PSQI总分明显高于睡眠正常组(P < 0.01)(见表 1)。
分组 n 男 女 受教育程度/年 年龄/岁 NIHSS评分/分 PSQI总分/分 高血压史 冠心病史 糖尿病史 吸烟史 大量饮酒史 有 无 有 无 有 无 有 无 有 无 睡眠障碍组 55 26 29 8.89±2.18 64.58±7.97 3.55±1.69 13.38±3.83 38 17 13 42 15 40 13 42 12 43 睡眠正常组 48 25 23 9.19±1.93 64.27±7.40 3.43±1.58 3.50±1.35 36 12 13 35 11 37 12 36 10 38 t — 0.24△ 0.73 0.20 0.33 16.98 0.44△ 0.16△ 0.26△ 0.03△ 0.02△ P — >0.05 >0.05 >0.05 >0.05 < 0.01 >0.05 >0.05 >0.05 >0.05 >0.05 △示χ2值 表 1 2组一般资料比较(x±s)
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睡眠障碍组BRIEF-A量表GEC、MI及其因子(组织、计划、工作记忆、任务启动、任务监控)、BRI及其因子(转换、抑制、自我监控、感情控制)评分均高于睡眠正常组(P < 0.05~P < 0.01)(见表 2)。
分组 n GEC MI 组织 计划 工作记忆 任务启动 任务监控 BRI 转换 抑制 自我监控 感情控制 睡眠障碍组 55 54.36±5.57 54.47±6.25 53.29±7.67 52.49±6.26 58.13±6.51 52.62±5.32 55.44±6.57 54.16±5.12 58.89±4.82 50.25±5.25 50.33±6.94 54.93±5.93 睡眠正常组 48 47.33±4.45 47.13±4.44 47.15±5.26 47.60±4.95 49.06±5.08 46.69±4.73 48.56±5.48 48.13±4.86 50.02±5.25 47.92±4.32 46.25±5.93 49.31±4.61 t — 7.01 6.78 4.67 4.35 7.8 5.94 5.72 6.11 8.94 2.44 3.18 5.31 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.05 < 0.01 < 0.01 表 2 2组BRIEF-A量表评分的比较(x±s;分)
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与睡眠正常组相比,TST缩短,SE下降,NREM3%减少,RL、SL、WASO、NREM1%、REM%增加,差异有统计学意义(P < 0.05~P < 0.01)(见表 3)。
分组 n TST/min SE SL/min RL/min WASO/min NREM1% NREM2% NREM3% REM% 睡眠障碍组 55 233.20±56.94 61.27±4.09 38.16±8.99 111.07±8.66 84.42±8.43 9.65±2.53 51.19±4.09 10.04±2.51 26.16±3.31 睡眠正常组 48 403.00±28.07 88.35±2.32 4.44±1.58 83.75±4.14 42.85±6.46 5.38±1.78 49.29±7.22 19.94±4.62 22.54±3.27 t — 18.76 40.49 25.63 19.96 27.77 9.78 1.61 13.76 5.57 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 >0.05 < 0.01 < 0.01 表 3 2组PSG睡眠参数比较(x±s)
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分别以BIREF-A量表中的GEC、MI和BRI为因变量,以多导睡眠图睡眠参数TST、SE、SL、RL、WASO、NREM1%、NREM2%、NREM3%及REM%为自变量,多元逐步线性回归分析结果显示,GEC、MI、BRI与TST、SE均呈负相关关系(P < 0.05~P < 0.01);GEC、MI与NREM3%均呈负相关关系(P < 0.01和P < 0.05),与REM%均呈明显正相关关系(P < 0.01);GEC与REM%均呈明显正相关关系(P < 0.01)(见表 4)。
因变量 变量 B Sχ2 B′ t P GEC TST -2.034 0.653 -1.785 3.09 < 0.01 SE -0.453 0.170 -0.361 2.66 < 0.05 NREM3% -0.183 0.058 -0.192 3.18 < 0.01 REM% 0.531 0.065 0.514 8.16 < 0.01 MI TST -1.186 0.470 -1.098 4.93 < 0.01 SE -0.258 0.093 -0.194 2.78 < 0.01 NREM3% -0.106 0.046 -0.135 2.31 < 0.05 REM% 0.233 0.041 0.207 5.73 < 0.01 BRI TST -1.494 0.351 -1.056 4.93 < 0.01 SE -00.269 0.074 -0.327 3.62 < 0.01 表 4 BRIEF-A量表评分与PSG睡眠参数的多元线性回归分析
急性缺血性脑卒中后睡眠障碍与生态学执行功能的相关研究
Study on the relationship between sleep disturbance and ecological executive function after acute ischemic stroke
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摘要:
目的观察急性缺血性脑卒中后睡眠障碍与生态学执行功能的相关性。 方法选取急性缺血性脑卒中病人103例,根据匹兹堡睡眠质量指数量表评分将病人分为睡眠障碍组与睡眠正常组。采用多导睡眠图(PSG)、生态学执行功能行为评估量表成人版(BRIEF-A)评估睡眠质量和执行功能,比较其组间差异;运用多元逐步回归分析探讨PSG睡眠参数与BRIEF-A量表评分间的相关性。 结果睡眠障碍组BRIEF-A量表总分(GEC)、元认知指数(MI)及其因子(组织、计划、工作记忆、任务启动、任务监控)、行为管理指数(BRI)及其因子(转换、抑制、自我监控、感情控制)评分均高于睡眠正常组(P < 0.05~P < 0.01)。与睡眠正常组相比,睡眠障碍组睡眠总时间(TST)缩短,睡眠效率(SE)下降,非快速眼动睡眠相三期(NREM3)减少,快速眼动睡眠相期入睡潜伏期(RL)、入睡潜伏期(SL)、入睡后觉醒时间、非快速眼动睡眠相一期占睡眠总时间的比例、快速眼动睡眠相期占睡眠总时间的比例(REM%)增加,差异均有统计学意义(P < 0.05~P < 0.01)。多元逐步线性回归分析显示,GEC、MI、BRI与TST、SE均呈负相关关系(P < 0.05~P < 0.01);GEC、MI与NREM3占睡眠总时间的比例均呈负相关关系(P < 0.01和P < 0.05),与REM%均呈明显正相关关系(P < 0.01);GEC与REM%呈明显正相关关系(P < 0.01)。 结论急性缺血性脑卒中后伴有睡眠障碍病人较不伴有睡眠障碍者存在生态学执行功能的损伤,且与睡眠-觉醒周期中睡眠参数相关。 Abstract:ObjectiveTo observe the correlation between sleep disturbance and ecological executive function after acute ischemic stroke. MethodsA total of 103 patients with acute ischemic stroke were selected and divided into sleep disturbance group and normal sleep group according to the Pittsburgh sleep quality index scores.Polysomnography(PSG) and ecological behavior rating inventory of executive function-adult version(BRIEF-A) were used to evaluate sleep quality and executive function, and the difference of which between the two groups was compared.Multiple stepwise regression analysis was applied to explore the correlation between PSG sleep parameters and BRIEF-A scores. ResultsThe total score(GEC), scores of metacognition index(MI) and its factors(organization, planning, working memory, task initiation, task monitoring), and scores of behavior regulation index(BRI) and its factors(conversion, inhibition, self-monitoring, emotional control) of BRIEF-A in sleep disturbance group were higher than those in normal sleep group(P < 0.05 to P < 0.01).Compared with the normal sleep group, the total sleep time(TST) was shortened, the sleep efficiency(SE) decreased, the non-rapid eye movement sleep phase 3(NREM3) decreased, and the rapid eye movement sleep latency(RL), sleep latency(SL), wake-up time after falling asleep, proportion of non-rapid eye movement sleep phase 1 to total sleep time, and proportion of rapid eye movement sleep phase to total sleep time(REM%) increased in the sleep disturbance group(P < 0.05 to P < 0.01).Multiple stepwise linear regression analysis showed that GEC, MI, BRI were negatively correlated with TST and SE(P < 0.05 to P < 0.01), GEC and MI were negatively correlated with the proportion of NREM3 to total sleep time(P < 0.01 and P < 0.05), GEC and MI were significantly positively correlated with REM%(P < 0.01), and GEC was significantly positively correlated with REM%(P < 0.01). ConclusionsPatients with sleep disturbance after acute ischemic stroke have ecological executive function compared with those without sleep disturbance, which are related to sleep parameters in the sleep-wake cycle. -
Key words:
- acute ischemic stroke /
- sleep disturbance /
- ecology /
- executive function
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表 1 2组一般资料比较(x±s)
分组 n 男 女 受教育程度/年 年龄/岁 NIHSS评分/分 PSQI总分/分 高血压史 冠心病史 糖尿病史 吸烟史 大量饮酒史 有 无 有 无 有 无 有 无 有 无 睡眠障碍组 55 26 29 8.89±2.18 64.58±7.97 3.55±1.69 13.38±3.83 38 17 13 42 15 40 13 42 12 43 睡眠正常组 48 25 23 9.19±1.93 64.27±7.40 3.43±1.58 3.50±1.35 36 12 13 35 11 37 12 36 10 38 t — 0.24△ 0.73 0.20 0.33 16.98 0.44△ 0.16△ 0.26△ 0.03△ 0.02△ P — >0.05 >0.05 >0.05 >0.05 < 0.01 >0.05 >0.05 >0.05 >0.05 >0.05 △示χ2值 表 2 2组BRIEF-A量表评分的比较(x±s;分)
分组 n GEC MI 组织 计划 工作记忆 任务启动 任务监控 BRI 转换 抑制 自我监控 感情控制 睡眠障碍组 55 54.36±5.57 54.47±6.25 53.29±7.67 52.49±6.26 58.13±6.51 52.62±5.32 55.44±6.57 54.16±5.12 58.89±4.82 50.25±5.25 50.33±6.94 54.93±5.93 睡眠正常组 48 47.33±4.45 47.13±4.44 47.15±5.26 47.60±4.95 49.06±5.08 46.69±4.73 48.56±5.48 48.13±4.86 50.02±5.25 47.92±4.32 46.25±5.93 49.31±4.61 t — 7.01 6.78 4.67 4.35 7.8 5.94 5.72 6.11 8.94 2.44 3.18 5.31 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.05 < 0.01 < 0.01 表 3 2组PSG睡眠参数比较(x±s)
分组 n TST/min SE SL/min RL/min WASO/min NREM1% NREM2% NREM3% REM% 睡眠障碍组 55 233.20±56.94 61.27±4.09 38.16±8.99 111.07±8.66 84.42±8.43 9.65±2.53 51.19±4.09 10.04±2.51 26.16±3.31 睡眠正常组 48 403.00±28.07 88.35±2.32 4.44±1.58 83.75±4.14 42.85±6.46 5.38±1.78 49.29±7.22 19.94±4.62 22.54±3.27 t — 18.76 40.49 25.63 19.96 27.77 9.78 1.61 13.76 5.57 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 >0.05 < 0.01 < 0.01 表 4 BRIEF-A量表评分与PSG睡眠参数的多元线性回归分析
因变量 变量 B Sχ2 B′ t P GEC TST -2.034 0.653 -1.785 3.09 < 0.01 SE -0.453 0.170 -0.361 2.66 < 0.05 NREM3% -0.183 0.058 -0.192 3.18 < 0.01 REM% 0.531 0.065 0.514 8.16 < 0.01 MI TST -1.186 0.470 -1.098 4.93 < 0.01 SE -0.258 0.093 -0.194 2.78 < 0.01 NREM3% -0.106 0.046 -0.135 2.31 < 0.05 REM% 0.233 0.041 0.207 5.73 < 0.01 BRI TST -1.494 0.351 -1.056 4.93 < 0.01 SE -00.269 0.074 -0.327 3.62 < 0.01 -
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