卒中后睡眠障碍
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摘要
睡眠障碍是卒中后常见的并发症之一,会影响卒中患者的预后及生活质量。卒中后睡眠障碍的原因不完全清楚,主要与梗死部位、神经递质、社会心理因素等有关。它主要分为呼吸相关性睡眠障碍和非呼吸相关性睡眠障碍两类,其中呼吸相关性睡眠障碍是较常见的类型。在卒中后睡眠障碍的治疗方面,药物治疗和非药物治疗相辅相成。临床医师应增强意识,尽早识别卒中后睡眠障碍类型,予以干预,以期改善患者预后,提高患者生活质量。
Sleep disorders are a kind of common complications after stroke, which can affect the prognosis and life quality of stroke patients. The pathogenetic mechanism of poststroke sleep disorders(PSSD) is unclear, and PSSD occurrence may be related with lesion area, neurotransmitters and social psychological factors and etc. PSSD include two categories: respiratory related sleep disorders and non-respiratory related sleep disorders, and the former is more common. The therapy of PSSD includes pharmacotherapy and non-pharmacotherapy. Neurologists should pay more attention to PSSD, recognize PSSD as early as possible and give active intervention, to improve neurological function and life quality of patients.
Sleep disorders are a kind of common complications after stroke, which can affect the prognosis and life quality of stroke patients. The pathogenetic mechanism of poststroke sleep disorders(PSSD) is unclear, and PSSD occurrence may be related with lesion area, neurotransmitters and social psychological factors and etc. PSSD include two categories: respiratory related sleep disorders and non-respiratory related sleep disorders, and the former is more common. The therapy of PSSD includes pharmacotherapy and non-pharmacotherapy. Neurologists should pay more attention to PSSD, recognize PSSD as early as possible and give active intervention, to improve neurological function and life quality of patients.
引文
[1]WALLACE D M,RAMOS A R,RUNDEK T.Sleep disorders and stroke[J].Int J Stroke,2012,7(3):231-242.
[2]MIMS K N,KIRSCH D.Sleep and stroke[J].Sleep Med Clin,2016,11(1):39-51.
[3]DE PAOLIS F,COLIZZI E,MILIOLI G,et al.Acute shift of a case of moderate obstructive sleep apnea syndrome towards one of severe central sleep apnea syndrome after an ischemic stroke[J].Sleep Med,2012,13(6):763-766.
[4]KIM W H,JUNG H Y,CHOI H Y,et al.The associations between insomnia and health-related quality of life in rehabilitation units at 1month after stroke[J/OL].J Psychosom Res,2017,96:10-14.https://doi.org/10.1016/j.jpsychores.2017.02.008.
[5]DAVIES D P,RODGERS H,WALSHAW D,et al.Snoring,daytime sleepiness and stroke:a casecontrol study of first-ever stroke[J].J Sleep Res,2003,12(4):313-318.
[6]LEE S J,KIM J S,SONG I U,et al.Poststroke restless legs syndrome and lesion location:anatomical considerations[J].Mov Disord,2009,24(1):77-84.
[7]PASIC Z,SMAJLOVIC D,DOSTOVIC Z,et al.Incidence and types of sleep disorders in patients with stroke[J].Med Arh,2011,65(4):225-227.
[8]TANG WK,HERMANN DM,CHEN YK,et al.Brainstem infarcts predict REM sleep behavior disorder in acute ischemic stroke[J/OL].BMC Neurol,2014,14:88.https://doi.org/10.1186/1471-2377-14-88.
[9]BASSETTI C L.Sleep and stroke[J].Semin Neurol,2005,25(1):19-32.
[10]BASSETTI C,ALDRICH M S.Sleep apnea in acute cerebrovascular diseases:final report on 128patients[J].Sleep,1999,22(2):217-223.
[11]MORRELL M J,HEYWOOD P,MOOSAVI SH,et al.Unilateral focal lesions in the rostrolateral medulla influence chemosensitivity and breathing measured during wakefulness,sleep,and exercise[J].J Neurol Neurosurg Psychiatry,1999,67(5):637-645.
[12]LEE M C,KLASSEN A C,HEANEY L M,et al.Respiratory rate and pattern disturbances in acute brain stem infarction[J].Stroke,1976,7(4):382-385.
[13]GANGWISCH J E,HEYMSFIELD S B,BODEN-ALBALA B,et al.Sleep duration as a risk factor for diabetes incidence in a large U.S.sample[J].Sleep,2007,30(12):1667-1673.
[14]ZHANG W,LI F,ZHANG T.Relationship of nocturnal concentrations of melatonin,gammaaminobutyric acid and total antioxidants in peripheral blood with insomnia after stroke:study protocol for a prospective non-randomized controlled trial[J].Neural Regen Res,2017,12(8):1299-1307.
[15]KIM J S,LEE S B,PARK S K,et al.Periodic limb movement during sleep developed after pontine lesion[J].Mov Disord,2003,18(11):1403-1405.
[16]ULFBERG J,NYSTROM B,CARTER N,et al.Prevalence of restless legs syndrome among men aged 18 to 64 years:an association with somatic disease and neuropsychiatric symptoms[J].Mov Disord,2001,16(6):1159-1163.
[17]WALTERS A S,RYE D B.Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension,heart disease,and stroke[J].Sleep,2009,32(5):589-597.
[18]AUKERMAN M M,AUKERMAN D,BAYARDM,et al.Exercise and restless legs syndrome:a randomized controlled trial[J].J Am Board Fam Med,2006,19(5):487-493.
[19]RADHAKRISHNAN S,MENON U K,ANANDAKUTTAN A.A combined approach of bedside clinical examination and flexible endoscopic evaluation of swallowing in poststroke dysphagia:Apilot study[J].Ann Indian Acad Neurol,2013,16(3):388-393.
[20]SIEGEL J M.The neurobiology of sleep[J].Semin Neurol,2009,29(4):277-296.
[21]RIVERA V M,MEYER J S,HATA T,et al.Narcolepsy following cerebral hypoxic ischemia[J].Ann Neurol,1986,19(5):505-508.
[22]SCHENCK C H,MAHOWALD M W.Injurious sleep behavior disorders(parasomnias)affecting patients on intensive care units[J].Intensive Care Med,1991,17(4):219-224.
[23]BOEVE B F,SILBER M H,SAPER C B,et al.Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease[J].Brain,2007,130(Pt 11):2770-2788.
[24]American Academy of Sleep Medicine.The International Classification of Sleep Disorders,third edition[J].Nihon Rinsho,2015,73(6):916-923.
[25]CLARENBACH P,WESSENDORF T.Sleep and stroke[J].Rev Neurol(Paris),2001,157(11 Pt 2):S46-52.
[26]ROTENBERG B W,MURARIU D,PANG K P.Trends in CPAP adherence over twenty years of data collection:a flattened curve[J].J Otolaryngol Head Neck Surg,2016,45(1):43.
[27]北京神经内科学会睡眠障碍专业委员会,北京神经内科学会神经精神医学与临床心理专业委员会,中国老年学和老年医学学会睡眠科学分会.卒中相关睡眠障碍评估与管理中国专家共识[J].中华内科杂志,2019,58(1):17-26.
[28]STEVENS D,MARTINS R T,MUKHERJEES,et al.Post-stroke sleep-disordered breathingpathophysiology and therapy options[J/OL].Front Surg,2018,5:9.https://doi.org/10.3389/fsurg.2018.00009.
[29]SCHUTTE-RODIN S,BROCH L,BUYSSED,et al.Clinical guideline for the evaluation and management of chronic insomnia in adults[J].J Clin Sleep Med,2008,4(5):487-504.
[30]单丹丹.认知行为干预对缺血性脑卒中失眠患者的影响[J].中国实用神经疾病杂志,2017,20(22):97-100.
[31]LEE S H,LIM S M.Acupuncture for insomnia after stroke:a systematic review and meta-analysis[J/OL].BMC Complement Altern Med,2016,16:228.https://doi.org/10.1186/s12906-016-1220-z.
[32]罗海龙,王春梅,古剑珂.经颅磁刺激治疗脑卒中后失眠的效果观察[J].中华神经医学杂志,2016,15(4):403-405.
[33]OHAYON M M,ROTH T.Prevalence of restless legs syndrome and periodic limb movement disorder in the general population[J].J Psychosom Res,2002,53(1):547-554.
[34]王维治,王丽华.不宁腿综合征是卒中的危险因素[J].中国卒中杂志,2017,12(10):891-894.
[35]ROSENBERG R P.Recommended treatment strategies for patients with excessive daytime sleepiness[J].J Clin Psychiatry,2015,76(10):e1330.
[36]SIARNIK P,KLOBUCNIKOVA K,SURDA P,et al.Excessive daytime sleepiness in acute ischemic stroke:association with restless legs syndrome,diabetes mellitus,obesity,and sleep-disordered breathing[J].J Clin Sleep Med,2018,14(1):95-100.
[37]AURORA R N,ZAK R S,AUERBACH S H,et al.Best practice guide for the treatment of nightmare disorder in adults[J].J Clin Sleep Med,2010,6(4):389-401.
[38]费英俊,赵忠新.脑卒中后睡眠障碍的临床特点、发病机制和治疗[J].中国现代神经疾病杂志,2008,8(3):200-202.
[39]ANDERSEN L P.The analgesic effects of exogenous melatonin in humans[J/OL].Dan Med J,2016,63(10).pii:B5289.https://ugeskriftet.dk/dmj/B5289.
[2]MIMS K N,KIRSCH D.Sleep and stroke[J].Sleep Med Clin,2016,11(1):39-51.
[3]DE PAOLIS F,COLIZZI E,MILIOLI G,et al.Acute shift of a case of moderate obstructive sleep apnea syndrome towards one of severe central sleep apnea syndrome after an ischemic stroke[J].Sleep Med,2012,13(6):763-766.
[4]KIM W H,JUNG H Y,CHOI H Y,et al.The associations between insomnia and health-related quality of life in rehabilitation units at 1month after stroke[J/OL].J Psychosom Res,2017,96:10-14.https://doi.org/10.1016/j.jpsychores.2017.02.008.
[5]DAVIES D P,RODGERS H,WALSHAW D,et al.Snoring,daytime sleepiness and stroke:a casecontrol study of first-ever stroke[J].J Sleep Res,2003,12(4):313-318.
[6]LEE S J,KIM J S,SONG I U,et al.Poststroke restless legs syndrome and lesion location:anatomical considerations[J].Mov Disord,2009,24(1):77-84.
[7]PASIC Z,SMAJLOVIC D,DOSTOVIC Z,et al.Incidence and types of sleep disorders in patients with stroke[J].Med Arh,2011,65(4):225-227.
[8]TANG WK,HERMANN DM,CHEN YK,et al.Brainstem infarcts predict REM sleep behavior disorder in acute ischemic stroke[J/OL].BMC Neurol,2014,14:88.https://doi.org/10.1186/1471-2377-14-88.
[9]BASSETTI C L.Sleep and stroke[J].Semin Neurol,2005,25(1):19-32.
[10]BASSETTI C,ALDRICH M S.Sleep apnea in acute cerebrovascular diseases:final report on 128patients[J].Sleep,1999,22(2):217-223.
[11]MORRELL M J,HEYWOOD P,MOOSAVI SH,et al.Unilateral focal lesions in the rostrolateral medulla influence chemosensitivity and breathing measured during wakefulness,sleep,and exercise[J].J Neurol Neurosurg Psychiatry,1999,67(5):637-645.
[12]LEE M C,KLASSEN A C,HEANEY L M,et al.Respiratory rate and pattern disturbances in acute brain stem infarction[J].Stroke,1976,7(4):382-385.
[13]GANGWISCH J E,HEYMSFIELD S B,BODEN-ALBALA B,et al.Sleep duration as a risk factor for diabetes incidence in a large U.S.sample[J].Sleep,2007,30(12):1667-1673.
[14]ZHANG W,LI F,ZHANG T.Relationship of nocturnal concentrations of melatonin,gammaaminobutyric acid and total antioxidants in peripheral blood with insomnia after stroke:study protocol for a prospective non-randomized controlled trial[J].Neural Regen Res,2017,12(8):1299-1307.
[15]KIM J S,LEE S B,PARK S K,et al.Periodic limb movement during sleep developed after pontine lesion[J].Mov Disord,2003,18(11):1403-1405.
[16]ULFBERG J,NYSTROM B,CARTER N,et al.Prevalence of restless legs syndrome among men aged 18 to 64 years:an association with somatic disease and neuropsychiatric symptoms[J].Mov Disord,2001,16(6):1159-1163.
[17]WALTERS A S,RYE D B.Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension,heart disease,and stroke[J].Sleep,2009,32(5):589-597.
[18]AUKERMAN M M,AUKERMAN D,BAYARDM,et al.Exercise and restless legs syndrome:a randomized controlled trial[J].J Am Board Fam Med,2006,19(5):487-493.
[19]RADHAKRISHNAN S,MENON U K,ANANDAKUTTAN A.A combined approach of bedside clinical examination and flexible endoscopic evaluation of swallowing in poststroke dysphagia:Apilot study[J].Ann Indian Acad Neurol,2013,16(3):388-393.
[20]SIEGEL J M.The neurobiology of sleep[J].Semin Neurol,2009,29(4):277-296.
[21]RIVERA V M,MEYER J S,HATA T,et al.Narcolepsy following cerebral hypoxic ischemia[J].Ann Neurol,1986,19(5):505-508.
[22]SCHENCK C H,MAHOWALD M W.Injurious sleep behavior disorders(parasomnias)affecting patients on intensive care units[J].Intensive Care Med,1991,17(4):219-224.
[23]BOEVE B F,SILBER M H,SAPER C B,et al.Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease[J].Brain,2007,130(Pt 11):2770-2788.
[24]American Academy of Sleep Medicine.The International Classification of Sleep Disorders,third edition[J].Nihon Rinsho,2015,73(6):916-923.
[25]CLARENBACH P,WESSENDORF T.Sleep and stroke[J].Rev Neurol(Paris),2001,157(11 Pt 2):S46-52.
[26]ROTENBERG B W,MURARIU D,PANG K P.Trends in CPAP adherence over twenty years of data collection:a flattened curve[J].J Otolaryngol Head Neck Surg,2016,45(1):43.
[27]北京神经内科学会睡眠障碍专业委员会,北京神经内科学会神经精神医学与临床心理专业委员会,中国老年学和老年医学学会睡眠科学分会.卒中相关睡眠障碍评估与管理中国专家共识[J].中华内科杂志,2019,58(1):17-26.
[28]STEVENS D,MARTINS R T,MUKHERJEES,et al.Post-stroke sleep-disordered breathingpathophysiology and therapy options[J/OL].Front Surg,2018,5:9.https://doi.org/10.3389/fsurg.2018.00009.
[29]SCHUTTE-RODIN S,BROCH L,BUYSSED,et al.Clinical guideline for the evaluation and management of chronic insomnia in adults[J].J Clin Sleep Med,2008,4(5):487-504.
[30]单丹丹.认知行为干预对缺血性脑卒中失眠患者的影响[J].中国实用神经疾病杂志,2017,20(22):97-100.
[31]LEE S H,LIM S M.Acupuncture for insomnia after stroke:a systematic review and meta-analysis[J/OL].BMC Complement Altern Med,2016,16:228.https://doi.org/10.1186/s12906-016-1220-z.
[32]罗海龙,王春梅,古剑珂.经颅磁刺激治疗脑卒中后失眠的效果观察[J].中华神经医学杂志,2016,15(4):403-405.
[33]OHAYON M M,ROTH T.Prevalence of restless legs syndrome and periodic limb movement disorder in the general population[J].J Psychosom Res,2002,53(1):547-554.
[34]王维治,王丽华.不宁腿综合征是卒中的危险因素[J].中国卒中杂志,2017,12(10):891-894.
[35]ROSENBERG R P.Recommended treatment strategies for patients with excessive daytime sleepiness[J].J Clin Psychiatry,2015,76(10):e1330.
[36]SIARNIK P,KLOBUCNIKOVA K,SURDA P,et al.Excessive daytime sleepiness in acute ischemic stroke:association with restless legs syndrome,diabetes mellitus,obesity,and sleep-disordered breathing[J].J Clin Sleep Med,2018,14(1):95-100.
[37]AURORA R N,ZAK R S,AUERBACH S H,et al.Best practice guide for the treatment of nightmare disorder in adults[J].J Clin Sleep Med,2010,6(4):389-401.
[38]费英俊,赵忠新.脑卒中后睡眠障碍的临床特点、发病机制和治疗[J].中国现代神经疾病杂志,2008,8(3):200-202.
[39]ANDERSEN L P.The analgesic effects of exogenous melatonin in humans[J/OL].Dan Med J,2016,63(10).pii:B5289.https://ugeskriftet.dk/dmj/B5289.
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