睡眠呼吸障碍对脑卒中发病和预后的影响与治疗
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摘要
睡眠呼吸障碍是易忽视的脑卒中危险因素之一,在脑卒中患者和脑卒中高危人群中极为常见。若不及时治疗,可能成为影响脑卒中住院时间、康复、预后和复发的重要不利因素。
Sleep-disordered breathing(SDB) is one of the easily overlooked risk factors of stroke. Ithas a high incidence among the patients suffering from stroke and those who with high risk factors forstroke. If SDB was not cured on time, it will hinder the rehabilitation process of stroke, prolong the lengthof stay in hospital, affect outcomes of treatment and increase the recurrence rate.
Sleep-disordered breathing(SDB) is one of the easily overlooked risk factors of stroke. Ithas a high incidence among the patients suffering from stroke and those who with high risk factors forstroke. If SDB was not cured on time, it will hinder the rehabilitation process of stroke, prolong the lengthof stay in hospital, affect outcomes of treatment and increase the recurrence rate.
引文
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[2]Wallace DM,Ramos AR,Rundek T.Sleep disorders andstroke.Int J Stroke,2012,7:231-242.
[3]Meschia JF,Bushnell C,Boden-Albala B,Braun LT,Bravata DM,Chaturvedi S,Creager MA,Eckel RH,Elkind MS,FornageM,Goldstein LB,Greenberg SM,Horvath SE,Iadecola C,JauchEC,Moore WS,Wilson JA;American Heart Association StrokeCouncil;Council on Cardiovascular and Stroke Nursing;Councilon Clinical Cardiology;Council on Functional Genomics andTranslational Biology;Council on Hypertension.Guidelines forthe primary prevention of stroke:a statement for healthcareprofessionals from the American Heart Association/American
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[5]Baldwin CM,Ervin AM,Mays MZ,Robbins J,Shafazand S,Walsleben J,Weaver T.Sleep disturbances,quality of life,andethnicity:the Sleep Heart Health Study.J Clin Sleep Med,2010,6:176-183.
[6]Wang YP.Alzheimer disease and sleep apnea syndrome.Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi,2008,8:193-195.[王玉平.阿尔茨海默痴呆与睡眠呼吸暂停综合征.中国现代神经疾病杂志,2008,8:193-195.]
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[8]Redline S,Yenokyan G,Gottlieb DJ,Shahar E,O'Connor GT,Resnick HE,Diener-West M,Sanders MH,Wolf PA,GeraghtyEM,Ali T,Lebowitz M,Punjabi NM.Obstructive sleep apnea-hypopnea and incident stroke:the sleep heart health study.AmJ Respir Crit Care Med,2010,182:269-277.
[9]Johnson KG,Johnson DC.Frequency of sleep apnea in strokeand TIA patients:a meta-analysis.J Clin Sleep Med,2010,6:131-137.
[10]Shaikh ZF,Jaye J,Ward N,Malhotra A,de Villa M,Polkey MI,Mullen MJ,Morrell MJ.Patent foramen ovale in severeobstructive sleep apnea:clinical features and effects of closure.Chest,2013,143:56-63.
[11]Goyal SK,Sharma A.Atrial fibrillation in obstructive sleepapnea.World J Cardiol,2013,5:157-163.
[12]Lau EM,Yee BJ,Grunstein RR,Celermajer DS.Patent foramenovale and obstructive sleep apnea:a new association?SleepMed Rev,2010,14:391-395.
[13]Wang MH,Zhao XY,Cong HL,Liu YJ,Ren N,Li XM.Relationship of OSAHS with SYNTAX score.Tianjin Yi Yao,2013,41:438-440[.王明辉,赵晓赟,丛洪良,刘玉洁,任宁,李曦铭.OSAHS与SYNTAX积分的关系.天津医药,2013,41:438-440.]
[14]Nishibayashi M,Miyamoto M,Miyamoto T,Suzuki K,Hirata K.Correlation between severity of obstructive sleep apnea and prevalence of silent cerebrovascular lesions.J Clin Sleep Med,2008,4:242-247.
[15]Minoguchi K,Yokoe T,Tazaki T,Minoguchi H,Oda N,Tanaka A,Yamamoto M,Ohta S,O'Donnell CP,Adachi M.Silent braininfarction and platelet activation in obstructive sleep apnea.AmJ Respir Crit Care Med,2007,175:612-617.
[16]Ramos-Sepulveda A,Wohlgemuth W,Gardener H,Lorenzo D,Dib S,Wallace DM,Nolan B,Boden-Albala B,Elkind MS,Sacco RL,Rundek T.Snoring and insomnia are not associatedwith subclinical atherosclerosis in the Northern ManhattanStudy.Int J Stroke,2010,5:264-268.
[17]Minoguchi K,Yokoe T,Tazaki T,Minoguchi H,Tanaka A,OdaN,Okada S,Ohta S,Naito H,Adachi M.Increased carotidintima-media thickness and serum inflammatory markers inobstructive sleep apnea.Am J Respir Crit Care Med,2005,172:625-630.
[18]Kaneko Y,Hajek VE,Zivanovic V,Raboud J,Bradley TD.Relationship of sleep apnea to functional capacity and length ofhospitalization following stroke.Sleep,2003,26:293-297.
[19]Birkbak J,Clark AJ,Rod NH.The effect of sleep disorderedbreathing on the outcome of stroke and transient ischemicattack:a systematic review.J Clin Sleep Med,2014,10:103-[18]108.
[20]Alexandrov AV,Sharma VK,Lao AY,Tsivgoulis G,MalkoffMD,Alexandrov AW.Reversed Robin Hood syndrome in acute ischemic stroke patients.Stroke,2007,38:3045-3048.
[21]Robbins J,Redline S,Ervin A,Walsleben JA,Ding J,Nieto FJ.Associations of sleep-disordered breathing and cerebral changeson MRI.J Clin Sleep Med,2005,1:159-165.
[22]Rupprecht S,Hoyer D,Hagemann G,Witte OW,Schwab M.[20]Central sleep apnea indicates autonomic dysfunction inasymptomatic carotid stenosis:a potential marker ofcerebrovascular and cardiovascular risk.Sleep,2010,33:327-21333.
[23]Munoz R,Duran-Cantolla J,Martinez-Vila E,Gallego J,RubioR,Aizpuru F,De La Torre G.Severe sleep apnea and risk ofischemic stroke in the elderly.Stroke,2006,37:2317-2321.
[24]Boden-Albala B,Roberts ET,Bazil C,Moon Y,Elkind MS,Rundek T,Paik MC,Sacco RL.Daytime sleepiness and risk ofstroke and vascular disease:findings from the NorthernManhattan Study.Circ Cardiovasc Qual Outcomes,2012,5:500-507.
[25]Gangwisch JE,Rexrode K,Forman JP,Mukamal K,MalaspinaD,Feskanich D.Daytime sleepiness and risk of coronary heartdisease and stroke:results from the Nurses'Health StudyⅡ.Sleep Med,2014,15:782-788.
[26]Lee CH,Ng WY,Hau W,Ho HH,Tai BC,Chan MY,RichardsAM,Tan HC.Excessive daytime sleepiness is associated withlonger culprit lesion and adverse outcomes in patients withcoronary artery disease.J Clin Sleep Med,2013,9:1267-1272.
[27]Ryan CM,Bayley M,Green R,Murray BJ,Bradley TD.Influence of continuous positive airway pressure on outcomes ofrehabilitation in stroke patients with obstructive sleep apnea.Stroke,2011,42:1062-1067.
[28]Parra O,Sánchez-Armengol A,Bonnin M,Arboix A,Campos-Rodríguez F,Pérez-Ronchel J,Durán-Cantolla J,de la Torre G,González Marcos JR,de la Pe?a M,Carmen Jiménez M,MasaF,Casado I,Luz Alonso M,Macarrón JL.Early treatment ofobstructive apnoea and stroke outcome:a randomised controlledtrial.Eur Respir J,2011,37:1128-1136.
[29]Lamberts M,Nielsen OW,Lip GY,Ruwald MH,ChristiansenCB,Kristensen SL,Torp-Pedersen C,Hansen ML,GislasonGH.Cardiovascular risk in patients with sleep apnoea with orwithout continuous positive airway pressure therapy:follow-upof 4.5 million Danish adults.J Intern Med,2014,276:659-666.
[30]Svatikova A,Chervin RD,Wing JJ,Sanchez BN,Migda EM,Brown DL.Positional therapy in ischemic stroke patients withobstructive sleep apnea.Sleep Med,2011,12:262-266.
[31]Deane SA,Cistulli PA,Ng AT,Zeng B,Petocz P,DarendelilerMA.Comparison of mandibular advancement splint and tonguestabilizing device in obstructive sleep apnea:a randomizedcontrolled trial.Sleep,2009,32:648-653.
[32]Huang LZ.The medical treatment of obstructive sleep apnea.Guo Wai Yi Xue Yao Xue Fen Ce,2005,32:194-197[.黄灵芝.阻塞性睡眠呼吸暂停的药物治疗.国外医学药学分册,2005,32:194-197.]
[33]Menn SJ,Yang R,Lankford A.Armodafinil for the treatment ofexcessive sleepiness associated with mild or moderate closedtraumatic brain injury:a 12-week,randomized,double-blindstudy followed by a 12-month open-label extension.J ClinSleep Med,2014,10:1181-1191.
[34]Guo XF,Su J.Study on correlativity between changes ofrespiratory at sleep and TCM sydrome types in the patient ofcelebral infarction.Zhong Yi Za Zhi,2005,46:128-130[.郭湘芳,粟俊.脑梗死患者睡眠呼吸改变与中医证型的相关性研究.中医杂志,2005,46:128-130.]
[35]Wang Y,Geng HY,Ye YM,Li J.Follow-up study onacupuncture in treating stroke comorbid with sleep apneahypoventilation syndrome.Shanghai Zhen Jiu Za Zhi,2011,30:220-222[.王寅,耿慧瑶,叶永铭,李佳.针刺治疗脑卒中合并睡眠呼吸暂停低通气综合征随访分析.上海针灸杂志,2011,30:220-222.]Chen XK.Observations on the therapeutic effect of acupuncture
[36]Chen XK.Observations on the therapeutic effect of acupunctureon post-stroke excessive daytime sleepiness.Shanghai Zhen JiuZa Zhi,2010,29:565-566[.陈兴奎.针刺治疗脑卒中后日间过度倦睡症疗效观察.上海针灸杂志,2010,29:565-566.]
[2]Wallace DM,Ramos AR,Rundek T.Sleep disorders andstroke.Int J Stroke,2012,7:231-242.
[3]Meschia JF,Bushnell C,Boden-Albala B,Braun LT,Bravata DM,Chaturvedi S,Creager MA,Eckel RH,Elkind MS,FornageM,Goldstein LB,Greenberg SM,Horvath SE,Iadecola C,JauchEC,Moore WS,Wilson JA;American Heart Association StrokeCouncil;Council on Cardiovascular and Stroke Nursing;Councilon Clinical Cardiology;Council on Functional Genomics andTranslational Biology;Council on Hypertension.Guidelines forthe primary prevention of stroke:a statement for healthcareprofessionals from the American Heart Association/American
[4]Guilleminault C,Ramar K.Neurologic aspects of sleep apnea:is obstructive sleep apnea a neurologic disorder?Semin Neurol,2009,29:368-371.
[5]Baldwin CM,Ervin AM,Mays MZ,Robbins J,Shafazand S,Walsleben J,Weaver T.Sleep disturbances,quality of life,andethnicity:the Sleep Heart Health Study.J Clin Sleep Med,2010,6:176-183.
[6]Wang YP.Alzheimer disease and sleep apnea syndrome.Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi,2008,8:193-195.[王玉平.阿尔茨海默痴呆与睡眠呼吸暂停综合征.中国现代神经疾病杂志,2008,8:193-195.]
[7]FJ,O'Connor GT,Boland LL,Schwartz JE,Samet JM.Sleep-disordered breathing and cardiovascular disease:cross-sectionalresults of the Sleep Heart Health Study.Am J Respir Crit CareMed,2001,163:19-25.
[8]Redline S,Yenokyan G,Gottlieb DJ,Shahar E,O'Connor GT,Resnick HE,Diener-West M,Sanders MH,Wolf PA,GeraghtyEM,Ali T,Lebowitz M,Punjabi NM.Obstructive sleep apnea-hypopnea and incident stroke:the sleep heart health study.AmJ Respir Crit Care Med,2010,182:269-277.
[9]Johnson KG,Johnson DC.Frequency of sleep apnea in strokeand TIA patients:a meta-analysis.J Clin Sleep Med,2010,6:131-137.
[10]Shaikh ZF,Jaye J,Ward N,Malhotra A,de Villa M,Polkey MI,Mullen MJ,Morrell MJ.Patent foramen ovale in severeobstructive sleep apnea:clinical features and effects of closure.Chest,2013,143:56-63.
[11]Goyal SK,Sharma A.Atrial fibrillation in obstructive sleepapnea.World J Cardiol,2013,5:157-163.
[12]Lau EM,Yee BJ,Grunstein RR,Celermajer DS.Patent foramenovale and obstructive sleep apnea:a new association?SleepMed Rev,2010,14:391-395.
[13]Wang MH,Zhao XY,Cong HL,Liu YJ,Ren N,Li XM.Relationship of OSAHS with SYNTAX score.Tianjin Yi Yao,2013,41:438-440[.王明辉,赵晓赟,丛洪良,刘玉洁,任宁,李曦铭.OSAHS与SYNTAX积分的关系.天津医药,2013,41:438-440.]
[14]Nishibayashi M,Miyamoto M,Miyamoto T,Suzuki K,Hirata K.Correlation between severity of obstructive sleep apnea and prevalence of silent cerebrovascular lesions.J Clin Sleep Med,2008,4:242-247.
[15]Minoguchi K,Yokoe T,Tazaki T,Minoguchi H,Oda N,Tanaka A,Yamamoto M,Ohta S,O'Donnell CP,Adachi M.Silent braininfarction and platelet activation in obstructive sleep apnea.AmJ Respir Crit Care Med,2007,175:612-617.
[16]Ramos-Sepulveda A,Wohlgemuth W,Gardener H,Lorenzo D,Dib S,Wallace DM,Nolan B,Boden-Albala B,Elkind MS,Sacco RL,Rundek T.Snoring and insomnia are not associatedwith subclinical atherosclerosis in the Northern ManhattanStudy.Int J Stroke,2010,5:264-268.
[17]Minoguchi K,Yokoe T,Tazaki T,Minoguchi H,Tanaka A,OdaN,Okada S,Ohta S,Naito H,Adachi M.Increased carotidintima-media thickness and serum inflammatory markers inobstructive sleep apnea.Am J Respir Crit Care Med,2005,172:625-630.
[18]Kaneko Y,Hajek VE,Zivanovic V,Raboud J,Bradley TD.Relationship of sleep apnea to functional capacity and length ofhospitalization following stroke.Sleep,2003,26:293-297.
[19]Birkbak J,Clark AJ,Rod NH.The effect of sleep disorderedbreathing on the outcome of stroke and transient ischemicattack:a systematic review.J Clin Sleep Med,2014,10:103-[18]108.
[20]Alexandrov AV,Sharma VK,Lao AY,Tsivgoulis G,MalkoffMD,Alexandrov AW.Reversed Robin Hood syndrome in acute ischemic stroke patients.Stroke,2007,38:3045-3048.
[21]Robbins J,Redline S,Ervin A,Walsleben JA,Ding J,Nieto FJ.Associations of sleep-disordered breathing and cerebral changeson MRI.J Clin Sleep Med,2005,1:159-165.
[22]Rupprecht S,Hoyer D,Hagemann G,Witte OW,Schwab M.[20]Central sleep apnea indicates autonomic dysfunction inasymptomatic carotid stenosis:a potential marker ofcerebrovascular and cardiovascular risk.Sleep,2010,33:327-21333.
[23]Munoz R,Duran-Cantolla J,Martinez-Vila E,Gallego J,RubioR,Aizpuru F,De La Torre G.Severe sleep apnea and risk ofischemic stroke in the elderly.Stroke,2006,37:2317-2321.
[24]Boden-Albala B,Roberts ET,Bazil C,Moon Y,Elkind MS,Rundek T,Paik MC,Sacco RL.Daytime sleepiness and risk ofstroke and vascular disease:findings from the NorthernManhattan Study.Circ Cardiovasc Qual Outcomes,2012,5:500-507.
[25]Gangwisch JE,Rexrode K,Forman JP,Mukamal K,MalaspinaD,Feskanich D.Daytime sleepiness and risk of coronary heartdisease and stroke:results from the Nurses'Health StudyⅡ.Sleep Med,2014,15:782-788.
[26]Lee CH,Ng WY,Hau W,Ho HH,Tai BC,Chan MY,RichardsAM,Tan HC.Excessive daytime sleepiness is associated withlonger culprit lesion and adverse outcomes in patients withcoronary artery disease.J Clin Sleep Med,2013,9:1267-1272.
[27]Ryan CM,Bayley M,Green R,Murray BJ,Bradley TD.Influence of continuous positive airway pressure on outcomes ofrehabilitation in stroke patients with obstructive sleep apnea.Stroke,2011,42:1062-1067.
[28]Parra O,Sánchez-Armengol A,Bonnin M,Arboix A,Campos-Rodríguez F,Pérez-Ronchel J,Durán-Cantolla J,de la Torre G,González Marcos JR,de la Pe?a M,Carmen Jiménez M,MasaF,Casado I,Luz Alonso M,Macarrón JL.Early treatment ofobstructive apnoea and stroke outcome:a randomised controlledtrial.Eur Respir J,2011,37:1128-1136.
[29]Lamberts M,Nielsen OW,Lip GY,Ruwald MH,ChristiansenCB,Kristensen SL,Torp-Pedersen C,Hansen ML,GislasonGH.Cardiovascular risk in patients with sleep apnoea with orwithout continuous positive airway pressure therapy:follow-upof 4.5 million Danish adults.J Intern Med,2014,276:659-666.
[30]Svatikova A,Chervin RD,Wing JJ,Sanchez BN,Migda EM,Brown DL.Positional therapy in ischemic stroke patients withobstructive sleep apnea.Sleep Med,2011,12:262-266.
[31]Deane SA,Cistulli PA,Ng AT,Zeng B,Petocz P,DarendelilerMA.Comparison of mandibular advancement splint and tonguestabilizing device in obstructive sleep apnea:a randomizedcontrolled trial.Sleep,2009,32:648-653.
[32]Huang LZ.The medical treatment of obstructive sleep apnea.Guo Wai Yi Xue Yao Xue Fen Ce,2005,32:194-197[.黄灵芝.阻塞性睡眠呼吸暂停的药物治疗.国外医学药学分册,2005,32:194-197.]
[33]Menn SJ,Yang R,Lankford A.Armodafinil for the treatment ofexcessive sleepiness associated with mild or moderate closedtraumatic brain injury:a 12-week,randomized,double-blindstudy followed by a 12-month open-label extension.J ClinSleep Med,2014,10:1181-1191.
[34]Guo XF,Su J.Study on correlativity between changes ofrespiratory at sleep and TCM sydrome types in the patient ofcelebral infarction.Zhong Yi Za Zhi,2005,46:128-130[.郭湘芳,粟俊.脑梗死患者睡眠呼吸改变与中医证型的相关性研究.中医杂志,2005,46:128-130.]
[35]Wang Y,Geng HY,Ye YM,Li J.Follow-up study onacupuncture in treating stroke comorbid with sleep apneahypoventilation syndrome.Shanghai Zhen Jiu Za Zhi,2011,30:220-222[.王寅,耿慧瑶,叶永铭,李佳.针刺治疗脑卒中合并睡眠呼吸暂停低通气综合征随访分析.上海针灸杂志,2011,30:220-222.]Chen XK.Observations on the therapeutic effect of acupuncture
[36]Chen XK.Observations on the therapeutic effect of acupunctureon post-stroke excessive daytime sleepiness.Shanghai Zhen JiuZa Zhi,2010,29:565-566[.陈兴奎.针刺治疗脑卒中后日间过度倦睡症疗效观察.上海针灸杂志,2010,29:565-566.]