pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2018-28-1-69-74pulmo-963Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESНарушения дыхания во время сна у пациентов в остром периоде мозгового инсультаSleep-disordered breathing in patients with acute cerebral strokeТазартуковаА. Д.TazartukovaA. D.

Тазартукова Аминат Джанбековна – аспирант кафедры неврологии, нейрохирургии и медицинской генетики.

117997, Москва, ул. Островитянова, 1.

Aminat D. Tazartukova, postgraduate student, Department of Neurology, Neurosurgery and Clinical Genetics.

ul. Ostrovityanova 1, Moscow, 117997.

atazartukova@gmail.comФедеральное государственное бюджетное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской Федерации.РоссияN.I.Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia.Russian Federation2018270420182816974Copyright © Тазартукова А.Д., 20182018Тазартукова А.Д.Tazartukova A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/963

Актуальной проблемой на стыке современной неврологии и пульмонологии является выявление часто встречающихся нарушений дыхания во время сна (НДВС) у пациентов в остром периоде мозгового инсульта (ОПМИ), а также их влияние на исход заболевания. Целью исследования явилось изучение распространенности и структуры НДВС у пациентов в ОПМИ. Материалы и методы. Пациенты были разделены на 2 группы: основную (n = 56) составили больные, переживающие ОПМИ; контрольную (n = 28) – здоровые добровольцы. В рамках обследования проводился физикальный осмотр, тяжесть инсульта оценивалась по шкале инсульта Национального института здоровья( США) (National Institutes of Health Stroke Scale – NIHSS), степень функциональной независимости – по шкале Рэнкина; выполнялись также компьютерная и / или магнитно-резонансная томография головного мозга, а также полисомнография. Результаты. Отмечено, что НДВС чаще наблюдались у пациентов основной группы по сравнению с контрольной (67,9 и 10,7 % соответственно; p = 0,001), при этом среднее значение индекса апноэ / гипопноэ в основной группе было выше, чем в контрольной (p = 0,001). Частота НДВС значимо не различалась в группах больных с ишемическим и геморрагическим инсультом (p = 0,487). В группе пациентов c НДВС чаще встречались лица мужского пола (p = 0,04), больные были значимо старше (p = 0,031), чаще страдали хронической сердечной недостаточностью (ХСН) (p = 0,016), у них отмечался более высокий балл по шкале Рэнкина через 1 год после инсульта (p = 0,033) по сравнению с пациентами без НДВС. Частота НДВС не зависела от локализации очага поражения. В основной группе в 65,8 % случаев установлен преимущественно обструктивный характер НДВС, в 34,2 % – преимущественно центральный. Пациенты с центральным апноэ были старше (p = 0,005), у них чаще отмечались фибрилляция предсердий (p = 0,005) и ХСН (p < 0,001), а также более низкий индекс массы тела (p = 0,014) и более высокий балл по шкале Рэнкина через 1 год после инсульта. Заключение. Установлена более высокая частота НДВС в ОПМИ. У пациентов с НДВС отмечается худшее функциональное восстановление через 1 год после инсульта.

The aim of the study was to investigate prevalence and types of sleep-disordered breathing (SDB) in patients with acute stroke. Methods. We prospectively enrolled 56 patients with acute stroke and 28 age- and gender-matched controls. The assessment included physical examination, brain computer tomography or magnetic resonance imaging or both, and full polysomnography. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) and outcomes ere assessed by the modified Rankin scale (mRS). Results. SDB was more prevalent in stroke patients than in control subjects (67.9% vs 10.7%, respectively; p = 0.001). Median apnea-hypopnea index (AHI) was higher in stroke patients compared to the control group (p = 0.001). SDB prevalence did not differ significantly between patients with ischemic or hemorrhagic stroke (p = 0.487). Compared to stroke patients without SDB, stroke patient with SDB were older (p = 0.031), more often were male (p = 0.04), more often had chronic heart failure (p = 0.016) and had higher mRS score 1 year after stroke (p = 0.033). No correlation was found between the prevalence of SDB and lesion location. SDB was predominantly obstructive in 65.8% and predominantly central in 34.2% of patients. Patients with central sleep apnea were older (p = 0.005), had lower BMI (p = 0.014) and more often suffered from atrial fibrillation (p = 0.005) and chronic heart failure (p < 0.001). Conclusion. SDB is highly prevalent in patients with acute stroke. Patients with SDB have worse functional outcome one year after stroke.

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The authors declare that there are no conflicts of interest present.