Analysis of Risk Factors Associated with Excessive Daytime Sleepiness after Stroke and Cerebral Small Vessel Disease

目的：有关导致卒中后日间过度嗜睡(excessive daytime sleepiness, EDS)的危险因素尚不明确，本研究旨在探究卒中后日间过度嗜睡的相关危险因素。方法：前瞻性收集本院152例发病时间72小时内的首次卒中患者，获得其一般临床资料。所有患者在入院后7~14天内接受Epworth嗜睡量表评估。头颅磁共振(MRI)用于评估白质高信号(WMH)、脑微出血(CMB)、腔隙及血管周围间隙(PVS)。采用二元Logistic回归分析卒中后日间过度嗜睡的危险因素。结果：在单因素分析中，NIHSS评分、吸烟史、脑梗死、白细胞计数、脑微出血与日间过度嗜睡之间存在潜在相关性，将其纳入多因素Logistic回归分析。在多因素Logistic回归分析中，调整相关变量后，吸烟(OR = 4.104, 95% CI = 1.430~11.775, P = 0.009)，NIHSS评分(OR = 1.202, 95% CI = 1.038~1.391, P = 0.014)，脑梗死(OR = 0.222, 95% CI = 0.075~0.662, P = 0.007)，脑微出血(OR = 0.316, 95% CI = 0.113~0.885, P = 0.028)仍然是日间过度嗜睡的独立危险因素。结论：卒中后日间过度嗜睡在吸烟、脑梗死、NIHSS评分高、白细胞计数高、存在脑微出血患者中较为常见。其中吸烟，NIHSS评分，脑微出血、脑梗死可以作为EDS的独立危险因素，其联合预测模型较单个预测因素有更高的预测价值。Objective: Risk factors for excessive daytime sleepiness (EDS) after stroke are unclear, and the aim of this study was to investigate the risk factors associated with excessive daytime sleepiness after stroke. Methods: General clinical data were prospectively collected from 152 patients with first stroke within 72 hours of onset at our institution. All patients were evaluated with Epworth Sleepiness Scale within 7~14 days of admission. Magnetic resonance imaging (MRI) was used to assess white matter high signal (WMH), cerebral microbleeds (CMB), lacunar and perivascular spaces (PVS). Binary logistic regression was used to analyze risk factors for excessive daytime sleepiness after stroke. Results: In univariate analysis, potential correlations among NIHSS score, smoking history, cerebral infarction, white blood cell count, cerebral microhemorrhage, and excessive daytime sleepiness were included in multifactorial Logistic regression analysis. In the multifactorial Logistic regression analysis, after adjusting for relevant variables, smoking (OR = 4.104, 95% CI = 1.430~11.775, P = 0.009), NIHSS score (OR = 1.202, 95% CI = 1.038~1.391, P = 0.014), cerebral infarction (OR = 0.222, 95% CI = 0.075~0.662, P = 0.007), and cerebral microhemorrhage (OR = 0.316, 95% CI = 0.113~0.885, P = 0.028) remained independent risk factors for excessive daytime sleepiness. Conclusions: Excessive daytime sleepiness after stroke is more common in patients with smoking, cerebral infarction, high NIHSS score, high white blood cell count, and presence of cerebral microhemorrhage. Among them, smoking, NIHSS score, cerebral microhemorrhage, and cerebral infarction can be used as independent risk factors for EDS, and their joint prediction model has higher predictive value than individual predictors.