脑卒中部位与睡眠障碍相关性研究进展
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摘要
卒中后睡眠障碍的发生及临床表现与卒中损伤部位有关。脑干卒中导致快速动眼睡眠行为障碍、睡眠呼吸紊乱、不宁腿综合征及睡眠周期性肢动;丘脑卒中多为睡眠增多;下丘脑卒中相关睡眠障碍表现为嗜睡及发作性睡病;额叶皮质卒中引起失眠。觉醒-睡眠周期的调节依赖于皮质和皮质下神经网络解剖和功能的完整性,卒中后睡眠障碍的发生机制主要与不同部位卒中后解剖纤维联系及神经递质功能受损有关,因其影响神经功能改善,应尽早引起临床医生关注。
The occurrence and clinical manifestations of post-stroke sleep disorders are related to the injury site of stroke. Brain stem stroke leads to rapid eye movement sleep behavior disorder, sleep-disordered breathing, restless leg syndrome and periodic limb movement in sleep. Patients with thalamic stroke often show increased sleep. Hypothalamic stroke related sleep disorders manifest as somnolence and narcolepsy. Prefrontal cortical stroke causes insomnia. The regulation of the wake-sleep cycle depends on the anatomical and functional integrity of the cortical and subcortical neural networks. The mechanisms of post-stroke sleep disorders are mainly associated with the destruction of anatomical fibers and impaired neurotransmitter function after stroke in different locations. As post-stroke sleep disorders affect the improvement of neurological function, clinicians should pay attention to this as early as possible.
The occurrence and clinical manifestations of post-stroke sleep disorders are related to the injury site of stroke. Brain stem stroke leads to rapid eye movement sleep behavior disorder, sleep-disordered breathing, restless leg syndrome and periodic limb movement in sleep. Patients with thalamic stroke often show increased sleep. Hypothalamic stroke related sleep disorders manifest as somnolence and narcolepsy. Prefrontal cortical stroke causes insomnia. The regulation of the wake-sleep cycle depends on the anatomical and functional integrity of the cortical and subcortical neural networks. The mechanisms of post-stroke sleep disorders are mainly associated with the destruction of anatomical fibers and impaired neurotransmitter function after stroke in different locations. As post-stroke sleep disorders affect the improvement of neurological function, clinicians should pay attention to this as early as possible.
引文
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[27]Koenigs M,Holliday J,Solomon J,et al.Left dorsomedial frontal brain damage is associated with insomnia[J].JNeurosci,2010,30(47):16041-16043.
[28]DubéJ,Lafortune M,Bedetti C,et al.Cortical thinning explains changes in sleep slow waves during adulthood[J].J Neurosci,2015,35(20):7795-7807.
[29]Ioannides AA,Liu L,Poghosyan V,et al.Using MEG to Understand the Progression of Light Sleep and the Emergence and Functional Roles of Spindles and K-Complexes[J].Front Hum Neurosci,2017,11:313.
[30]Zhang RX,Han Y,Chen C,et al.EphB2 in the Medial Prefrontal Cortex Regulates Vulnerability to Stress[J].Neuropsychopharmacology,2016,41(10):2541-2556.
[2]李勇.AASM睡眠及其相关事件判读规则[C]//中国睡眠研究会青年学术论坛暨四川省医学会第四次睡眠医学学术会议,2015.
[3]Tang WK,Hermann DM,Chen YK,et al.Brainstem infarcts predict REM sleep behavior disorder in acute ischemic stroke[J].Bmc Neurology,2014,14(1):1-5.
[4]Garcia SV,Brischoux F,Clément O,et al.Ventromedial medulla inhibitory neuron inactivation induces REM sleep without atonia and REM sleep behavior disorder[J].Nat Commun,2018,9(1):504.
[5]陈健华,黄颜,刘秀琴,等.脑干病变快速动眼期睡眠行为障碍[J].中华医学杂志,2013,93(37):2942-2945.
[6]Baglioni C,Nissen C,Schweinoch A,et al.Polysomnographic Characteristics of Sleep in Stroke:A Systematic Review and Meta-Analysis[J].PLoS One,2016,11(3):e0148496.
[7]Brown DL,Mollie MD,Ashkan M,et al.Brainstem infarction and sleep-disordered breathing in the BASIC sleep apnea study[J].Sleep Med,2014,15(8):887-891.
[8]张学谦,台立稳.以呼吸障碍为主的延髓半侧梗死1例报告[J].中风与神经疾病,2016,33(1):72-73.
[9]Bonninvilaplana M,Arboix A,Parra O,et al.Sleep-related breathing disorders in acute lacunar stroke[J].J Neurol,2009,256(12):2036-2042.
[10]Fisse AL,Kemmling A,Teuber A,et al.The Association of Lesion Location and Sleep Related Breathing Disorder in Patients with Acute Ischemic Stroke[J].PloS One,2017,12(1):e0171243.
[11]Szücs A,Vitrai J,Janszky J,et al.Pathological sleep apnoea frequency remains permanent in ischaemic stroke and it is transient in haemorrhagic stroke[J].Eur Neurol,2002,47(1):15-19.
[12]Ruppert E,Kilichuck U,Wolff V,et al.Brainstem strokerelated restless legs syndrome:frequency and anatomical considerations[J].Eur Neurol,2015,73(1/2):113-118.
[13]Tuo HZ,Tian ZL,Cui YN,et al.Restless legs syndrome secondary to pontine infarction:Clinical analysis of five cases[J].Chronic Dis Transl Med,2017,3(3):186-190.
[14]Woo HG,Lee D,Hwang KJ,et al.Post-stroke restless leg syndrome and periodic limb movements in sleep[J].Acta Neurol Scand,2016,135(2):204-210.
[15]Ozawa H,Yamaguchi T,Hamaguchi S,et al.Three Types of A11 Neurons Project to the Rat Spinal Cord[J].Neurochem Res,2017,42(8):2142-2153.
[16]Gadodia G,Rangaraju S,Raza SA,et al.Frequency of and Factors Associated With Obstructive Sleep Apnea and Periodic Limb Movements in Stroke and TIA Patients[J].Neurologist,2018,23(2):67-70.
[17]Wei W,Cui L,Ying F,et al.Sleep and Cognitive Abnormalities in Acute Minor Thalamic Infarction[J].Neurosci Bull,2016,32(4):341-348.
[18]Sacchetti ML,Di MM,Tinelli E,et al.Resting state functional thalamic connectivity abnormalities in patients with post-stroke sleep apnoea:a pilot case-control study[J].Eur Rev Med Pharmacol Sci,2017,21(11):2676-2689.
[19]Li Q,Zhao X,Gong DH,et al.Sleep disorders of acute thalamic stroke and its influence on plasma IL-17[J].JBiol Regul Homeost Agents,2017,31(3):745.
[20]Tan EK,Chan LL,Chang HM.Severe bruxism following basal ganglia infarcts:insights into pathophysiology[J].JNeurol Sci,2004,217(2):229-232.
[21]Sagnier S,Coulon P,Chaufton C,et al.Lucid dreams,an atypical sleep disturbance in anterior and mediodorsal thalamic strokes[J].Rev Neurol(Paris),2015,171(11):768-772.
[22]Oudiette D,Dodet P,Ledard N,et al.REM sleep respiratory behaviours mental content in narcoleptic lucid dreamers[J].Sci Rep,2018,8(1):2636.
[23]Chieffi S,Carotenuto M,Monda V,et al.Orexin System:The Key for a Healthy Life[J].Front Physiol,2017,8:357.
[24]Scammell TE,Nishino S,Mignot E,et al.Narcolepsy and low CSF orexin(hypocretin)concentration after a diencephalic stroke[J].Neurology,2001,56(12):1751-1753.
[25]Suzuki K,Miyamoto T,Miyamoto M,et al.Hypocretin-1levels in the cerebrospinal fluid of patients with Percheron artery infarction with or without midbrain involvement:Acase series[J].Medicine,2016,95(29):e4281.
[26]Chen YK,Lu JY,Mok VC,et al.Clinical and radiologic correlates of insomnia symptoms in ischemic stroke patients[J].Int J Geriatr Psychiatry,2011,26(5):451-457.
[27]Koenigs M,Holliday J,Solomon J,et al.Left dorsomedial frontal brain damage is associated with insomnia[J].JNeurosci,2010,30(47):16041-16043.
[28]DubéJ,Lafortune M,Bedetti C,et al.Cortical thinning explains changes in sleep slow waves during adulthood[J].J Neurosci,2015,35(20):7795-7807.
[29]Ioannides AA,Liu L,Poghosyan V,et al.Using MEG to Understand the Progression of Light Sleep and the Emergence and Functional Roles of Spindles and K-Complexes[J].Front Hum Neurosci,2017,11:313.
[30]Zhang RX,Han Y,Chen C,et al.EphB2 in the Medial Prefrontal Cortex Regulates Vulnerability to Stress[J].Neuropsychopharmacology,2016,41(10):2541-2556.