Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector47310.17816/ACEN.2017.2.1Original articlesОригинальные статьиUnknownOptimization of early rehabilitation of patients with ischemic stroke and sleep-disordered breathingОптимизация ранней реабилитации больных с ишемическим инсультом и нарушением дыхания во снеLutokhinGleb M.ЛутохинГлеб М.
Russian Federation
neurocor@mail.ruGeraskinaLudmila A.ГераскинаЛюдмила Александровна
Russian Federation
neurocor@mail.ruFonyakinAndrey V.ФонякинАндрей Викторович
Russian Federation
neurocor@mail.ruhttps://orcid.org/0000-0002-7682-6672MaksimovaMarina Yu.МаксимоваМарина Юрьевна
Russian Federation
neurocor@mail.ruResearch Center of NeurologyФГБНУ «Научный центр неврологии»0608201711251406082017Copyright ©; 2017, Lutokhin G.M., Geraskina L.A., Fonyakin A.V., Maksimova M.Y.Copyright ©; 2017, Lutokhin G.M., Geraskina L.A., Fonyakin A.V., Maksimova M.Y.2017Lutokhin G.M., Geraskina L.A., Fonyakin A.V., Maksimova M.Y.Lutokhin G.M., Geraskina L.A., Fonyakin A.V., Maksimova M.Y.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/473

Introduction. Sleep-disordered breathing (SDB) is detected in 70% of stroke patients and impedes functional rehabilitation; it also increases the length of hospital stay and the risk of stroke recurrence and fatal outcome.

Objective: to study the dynamics of SDB in its correlation with neurological disorders in stroke patients and to develop the approaches to optimization of early rehabilitation.

Materials and methods. A total of 78 patients with acute ischemic stroke were examined. SDB was verified by cardiorespiratory monitoring; the neurological deficit was assessed using the NIHSS and mRS scales. Examination was carried out upon admission (days 2–5 post stroke) and again after 3 weeks. The effect of SDB correction on effectiveness of neurological recovery was studied using positional therapy (position elevated by 30о) in combination with oxygen therapy (insufflation of O2 with the saturation level maintained no less than 95% under control of a digital sensor).

Results. Upon admission, SDB was revealed in 88% of patients; moderate and severe disorders being predominant (the apnea/hypopnea index (AHI) ≥15 h-1), most frequently presenting as obstructive apnea. In patients with AHI < 15 h-1, the positive dynamics of neurological disorders (p<0.04) were observed along with stable SDB parameters. Neurological improvement (р<0.05) was observed in patients with AHI ≥ 15 h-1, which was associated with decreased severity of SDB. A direct correlation between the severity of neurological disorders and AHI after 3 weeks was revealed: RNIHSS/AHI = 0.45 (р=0.003), RmRS/AHI = 0.44 (р=0.004). Patients with AHI ≥ 15 h-1 were distributed into 2 groups: group A (without corrective interventions) and group B (the use of positional and oxygen therapy during the night sleep during 7 days). A positive effect of the course of corrective therapy on restoration of neurological functions, along with a decrease in AHI, was revealed.

Conclusions. SDB is a frequent and persistent disorder in patients with ischemic stroke. Early detection and correction of SDB should be regarded as an important component of post-stroke rehabilitation.

Введение. Нарушения дыхания во сне (НДС) регистрируются у 70% больных с инсультом и ухудшают функциональное восстановление, увеличивают сроки госпитализации, риск повторного инсульта и смертности.

Цель: изучить динамику НДС во взаимосвязи с неврологическими нарушениями у больных ишемическим инсультом и разработать подходы к оптимизации ранней реабилитации.

Материалы и методы. Обследовано 78 больных с острым ишемическим инсультом. НДС верифицировали с помощью кардиореспираторного мониторирования, неврологический дефицит оценивали с использованием шкал NIHSS и mRS. Исследования выполняли при поступлении (2-5 сутки инсульта) и повторно через 3 недели. Изучали влияние коррекции НДС на эффективность неврологического восстановления, для чего применяли позиционное лечение (приподнятое на 30о положение) в сочетании с оксигенотерапией (инсуффляция О2 с поддержанием уровня сатурации не менее 95% под контролем дигитального датчика).

Результаты. При поступлении НДС выявлены у 88% пациентов, с преобладанием умеренных и тяжелых нарушений (индекс апноэ/гипопноэ (ИАГ) ≥15 час-1), чаще по типу обструктивного апноэ. У пациентов с ИАГ<15 час-1 наблюдалась положительная динамика неврологических нарушений (p<0,04) на фоне стабильных показателей НДС. У больных с ИАГ≥15 час-1 также отмечено неврологическое улучшение (р<0,05), которое ассоциировалось с уменьшением тяжести НДС. Выявлена прямая корреляция между выраженностью неврологических нарушений и ИАГ через 3 недели: RNIHSS/ИАГ=0,45 (р=0,003), RmRS/ИАГ=0,44 (р=0,004). Больные с ИАГ≥15 час-1 были распределены в 2 группы: группа А (без корректирующих вмешательств) и группа Б (применение позиционной и оксигенотерапии во время ночного сна, в течение 7 суток). Выявлено положительное влияние курса коррекционной терапии на восстановление неврологических функций на фоне уменьшения ИАГ.

Заключение. При ишемическом инсульте НДС являются частым и стойким нарушением. Раннее выявление и коррекцию НДС следует рассматривать как важнейшее звено постинсультной реабилитации.

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