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OBJECTIVE: To determine the impact of a solitary lifestyle on health-related quality of life (HRQoL) in adults with obstructive sleep apnea (OSA). METHODS: This was a prospective cohort study; patients diagnosed with OSA but not receiving continuous positive airway pressure (CPAP) therapy were enrolled in our study. These participants completed basic information and the Short Form-36 Health Survey (SF-36) at baseline and were divided into the living alone and living with others groups. Telephone follow-up was performed 1 year later to re-evaluate the SF-36. Differences in health status between and within groups were assessed. In addition, variables associated with changes in the health of the whole population were examined. RESULTS: A total of 402 patients with OSA were enrolled, including 120 in the living alone group and the rest in the living with others group. After a year, mental health scores of the living alone group decreased (55.7 ± 21.5 versus 54.1 ± 22.7, p = 0.001), while physical functioning scores of the living with others group increased significantly (82.1 ± 24.7 versus 82.6 ± 24.2, p = 0.006). In the whole population, the determinants of mental health change after 1 year from baseline were alcohol drinking (beta coefficient - 1.169, 95% CI - 2.03 to - 0.309, p = 0.008) and solitary living (beta coefficient - 1.135, 95% CI - 2.072 to - 0.199, p = 0.018). CONCLUSION: Regarding all initial variables, alcohol drinking and solitary living seem to be the predictors of mental health change of patients with OSA in China. We speculate that to improve the quality of life of such people, the medical staff could provide certain social support for them.
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Qualidade de Vida , Apneia Obstrutiva do Sono , Humanos , Adulto , Qualidade de Vida/psicologia , Estudos de Coortes , Estudos Prospectivos , Ambiente Domiciliar , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/complicaçõesRESUMO
The original objective was to explore the potential benefiting effects of three prebiotics in hybrid grouper (Epinephelus lanceolatusâ × Epinephelus fuscoguttatusâ). Therefore, three experimental diets (basal diet + 1% fructooligosaccharide, Diet F; basal diet + 1% inulin, Diet I; basal diet + 0.3% mannan-oligosaccharide, Diet M) and one basal diet (Diet C) were prepared and a feeding trial was conducted. However, at the end of the fourth week into the feeding experiment, a water-leaking accident occurred and fishes of all groups went through an unexpected air exposure event. Surprisingly, different prebiotic-supplemented groups showed significantly different air exposure tolerance: the mortality of M group was significantly lower (P ≤ 0.05) than all the other groups. Examination of antioxidant, non-specific immunity, and stress parameters revealed that comparing to control group, M group showed significantly increased catalase (CAT), acid phosphatase (ACP), and alkaline phosphatase (AKP) activities, decreased superoxide dismutase (SOD) activity, and similar cortisol level (P ≤ 0.05). Real-time PCR experiment revealed that M group significantly increased the expression of CAT, glutathione peroxidase (GPx), and manganese superoxide dismutase (MnSOD) genes in head kidney (P ≤ 0.05). Overall, M exhibited the best anti-air exposure/antioxidative stress effects among the three prebiotics and could be considered a promising feed additive to relieve air exposure/oxidative stress in hybrid grouper culture.
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Antipsicóticos , Bass , Animais , Bass/genética , Mananas/farmacologia , Catalase , Ração Animal/análise , Antioxidantes/metabolismo , Inulina , Glutationa Peroxidase/genética , Fosfatase Alcalina , Hidrocortisona , Superóxido Dismutase , Acidentes , Fosfatase Ácida , ÁguaRESUMO
MnO2 -based material is one of the most promising cathode candidates of aqueous zinc-ion batteries (ZIBs), but its commercialization is hindered by the sluggish reaction kinetics and poor structural stability. Herein, a hierarchical framework consisting of core-shell structured carbon nanotubes@K-birnessite-MnO2 enwrapped by graphene/carbon black bicomponent networks (CNT@KMO@GC) via a simple method for ZIBs is designed and developed. The hierarchical framework characterized with favorable K+ preintercalation, δ-phase, and vertically aligned nanoflake arrays of KMO and 3D electrically conductive network shows the enhanced electronic/ionic conductivity and improved wettability with electrolyte, resulting in the fast charge/mass transport and stable structural stability of CNT@KMO@GC. When used as cathode in ZIBs, CNT@KMO@GC exhibits exciting electrochemical performance with remarkable capacity (405.5 mAh g-1 at 0.30 A g-1 ), high rate performance (166.6 mAh g-1 up to 10.0 A g-1 ), and impressive cycling stability (almost no capacity decay after 2000 cycles and 77.3% retention after 10 000 cycles at 10.0 A g-1 ). The energy storage mechanism of CNT@KMO@GC is clarified as H+ /Zn2+ coinsertion/extraction via electrochemical analysis and ex situ characterization. This study offers an innovative paradigm for the advance of ZIBs.
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Donkey milk fat globule membrane (MFGM) proteins are a class of membrane-bound secreted proteins with broad-spectrum biofunctional activities; however, their site-specific O-glycosylation landscapes have not been systematically mapped. In this study, an in-depth MFGM O-glycoproteome profile of donkey milk during lactation was constructed based on an intact glycopeptide-centered, label-free glycoproteomics pipeline, with 2137 site-specific O-glycans from 1121 MFGM glycoproteins and 619 site-specific O-glycans from 217 MFGM glycoproteins identified in donkey colostrum and donkey mature milk, respectively. As lactation progressed, the number of site-specific O-glycans from three glycoproteins significantly increased, whereas that of 11 site-specific O-glycans from five glycoproteins significantly decreased. Furthermore, donkey MFGM O-glycoproteins with core-1 and core-2 core structures and Lewis and sialylated branch structures may be involved in regulating apoptosis. The findings of this study reveal the differences in the composition of donkey MFGM O-glycoproteins and their site-specific O-glycosylation modification dynamic change rules during lactation, providing a molecular basis for understanding the complexity and biological functions of donkey MFGM protein O-glycosylation.
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Colostro , Proteoma , Animais , Feminino , Gravidez , Colostro/química , Equidae/metabolismo , Glicolipídeos/química , Glicoproteínas/química , Glicosilação , Gotículas Lipídicas/química , Proteínas de Membrana/metabolismo , Proteínas do Leite/química , Polissacarídeos/metabolismo , Proteoma/metabolismo , Espectrometria de Massas em TandemRESUMO
OBJECTIVES: This study aimed to examine the association between sensory impairment and the discordance between subjective/objective cognitive function among older adults and test the mediating effect of loneliness. METHODS: We used data from four cohort studies conducted in 16 countries (N = 19,119). Sensory impairment and subjective cognitive impairment were self-reported. Objective cognitive impairment was measured in three dimensions. Generalized estimating equations were conducted to examine the association between sensory impairment and discordance in subjective/objective cognitive function. Cross-lagged panel model and a bootstrap method with 2,000 samples were employed to verify the mediating effect. RESULTS: Sensory impairment was related to an increased risk of subjective cognitive impairment (OR = 4.70, 95 % CI 4.33-5.10), objective impairment (OR = 1.51, 95 %CI 1.31-1.74), as well as the discordance in subjective/objective cognitive function (OR = 1.35, 95 %CI 1.06-1.71 for older adults with normal subjective cognitive function). In contrast, sensory impairment was associated with a decreased risk of discordant subjective/objective cognitive function among those with subjective cognitive impairment (OR = 0.79, 95 %CI 0.66-0.94). Moreover, loneliness mediated the association between sensory impairment and subjective cognitive impairment (standardized indirect effect = 0.002, 95 %CI 0.001-0.004), objective cognitive impairment (standardized indirect effect = 0.005, 95 %CI 0.003-0.007) as well as the discordance in subjective/objective cognitive function (standardized indirect effect = 0.001, 95 %CI 0.001-0.003 for older adults with normal subjective cognitive function). CONCLUSIONS: Significant association between sensory impairment and discordance in subjective/objective cognitive function and the mediating role of loneliness were revealed, varying by subjective cognitive function. Early screening on sensory impairment and targeted interventions on loneliness should be considered in future policies on cognitive impairment.
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Disfunção Cognitiva , Solidão , Humanos , Solidão/psicologia , Idoso , Feminino , Masculino , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Estudos de Coortes , Cognição/fisiologia , Transtornos de Sensação/psicologia , Transtornos de Sensação/epidemiologia , Autorrelato , Idoso de 80 Anos ou mais , Fatores de RiscoRESUMO
INTRODUCTION: Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and dementia and poses a serious threat to public health worldwide; however, it might be reversible, representing the best opportunity for secondary prevention against serious cognitive impairment. As a non-pharmacological intervention for those patients, interventions that combine physical exercise and cognitive training, whether delivered simultaneously or sequentially, may have superior effects on various cognitive domains, including global cognition, memory, executive function and attention. The supportive evidence remains incomplete. This study aims to assess the effectiveness of a combined exercise and cognitive intervention in Chinese older adults with mild cognitive impairment (COGITO), empowered by digital therapy and guided by the Health Action Process Model and the Theory of Planned Behaviour (HAPA-TPB theory) in a home-based setting. METHODS AND ANALYSIS: This study is a randomised controlled, assessor-blinded multi-centre study. Four parallel groups will include a total of 160 patients, receiving either a combined exercise and cognitive intervention, an isolated exercise intervention, an isolated cognitive intervention or only health education. These interventions will be conducted at least twice a week for 50 min each session, over 3 months. All interventions will be delivered at home and remotely monitored through RehabApp and Mini-programme, along with an arm-worn heart rate telemetry device. Specifically, supervisors will receive participants' real-time training diaries, heart rates or other online monitoring data and then provide weekly telephone calls and monthly home visits to encourage participants to complete their tasks and address any difficulties based on their training information. Eligible participants are community-dwelling patients with no regular exercise habit and diagnosed with MCI. The primary outcome is cognitive function assessed by the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) and Community Screening Instrument for Dementia (CSI-D), with baseline and three follow-up assessments. Secondary outcomes include quality of life, physical fitness, sleep quality, intrinsic capacity, frailty, social support, adherence, cost-effectiveness and cost-benefit. ETHICS AND DISSEMINATION: The study was approved by the Institutional Review Board of Peking University. Research findings will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences. TRIAL REGISTRATION NUMBER: ChiCTR2300073900.
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Disfunção Cognitiva , Terapia por Exercício , Humanos , Disfunção Cognitiva/terapia , Idoso , Terapia por Exercício/métodos , Masculino , Feminino , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia Cognitivo-Comportamental/métodos , Serviços de Assistência Domiciliar , China , Qualidade de Vida , Estudos Multicêntricos como Assunto , Pessoa de Meia-IdadeRESUMO
N-glycosylation is a prevalent and complex post-translational modification of milk proteins with significant biological importance. However, the systematic characterisation of donkey milk fat globule membrane (MFGM) N-glycoproteins remains largely ill-defined. Here, 1443 intact N-glycopeptides from 336 MFGM glycoproteins in donkey colostrum (DC) and 489 intact N-glycopeptides from 86 MFGM glycoproteins in donkey mature milk (DM) were identified via label-free site-specific glycoproteomics. Mannosylation and fucosylation were predominant in DC MFGM N-glycoproteins compared to sialylation and mannosylation in DM. Among them, 22 site-specific N-glycans attached to 14 glycosites of eight glycoproteins were significantly increased, whereas 30 site-specific N-glycans attached to 19 glycosites of 16 glycoproteins were significantly decreased. Furthermore, the site-specific N-glycans with Neu5Gc moieties or simultaneous fucosylation and sialylation were not significantly increased, exhibiting significant site specificity. We provide new insights into the composition of donkey MFGM N-glycoproteins and their roles in donkey milk-related biological functions.
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Equidae , Proteínas de Membrana , Animais , Feminino , Glicosilação , Proteínas de Membrana/metabolismo , Glicolipídeos/química , Lactação , Glicoproteínas/química , Gotículas Lipídicas/metabolismo , Proteínas do Leite/química , GlicopeptídeosRESUMO
Human milk fat globule membrane (MFGM) proteins, which are N-glycosylated, play essential roles in neonatal development and physiological health. However, the profiles and landscape changes in the site-specific N-glycosylation of human MFGM proteins during lactation remain unclear. Therefore, in this study, based on an intact glycopeptide-centred strategy, 2617 unique site-specific N-glycans of 221 MFGM glycoproteins in human colostrum and 986 unique site-specific N-glycans of 200 MFGM glycoproteins in mature milk were characterised and quantified using label-free glycoproteomics. With milk maturation, 33 site-specific N-glycans on 10 N-glycoproteins increased significantly, and 113 site-specific N-glycans on 25 N-glycoproteins decreased significantly. Moreover, human MFGM glycoproteins with core-α1,6-fucosylated structures and Lewis and sialylated branching structures play a role in the biological processes of antigen processing and presentation. This study reveals the dynamic changes in human MFGM protein N-glycosylation patterns during lactation. Meanwhile, the study deepens our understanding of site-specific N-glycosylation of human MFGM glycoproteins. The results of the study provide a background reference for the development of infant formulas.
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Colostro , Proteínas de Membrana , Feminino , Gravidez , Recém-Nascido , Humanos , Colostro/química , Colostro/metabolismo , Proteínas de Membrana/metabolismo , Proteínas do Leite/química , Espectrometria de Massas em Tandem , Glicoproteínas/química , Leite Humano/químicaRESUMO
Milk fat globule membrane (MFGM) proteins are highly glycosylated and involved in various biological processes within the body. However, information on site-specific N-glycosylation of MFGM glycoproteins in donkey and human milk remains limited. This study aimed to map the most comprehensive site-specific N-glycosylation fingerprinting of donkey and human MFGM glycoproteins using a site-specific glycoproteomics strategy. We identified 1,360, 457, 2,617, and 986 site-specific N-glycans from 296, 77, 214, and 196 N-glycoproteins in donkey colostrum (DC), donkey mature milk (DM), human colostrum (HC), and human mature milk (HM), respectively. Bioinformatics was used to describe the structure-activity relationships of DC, DM, HC, and HM MFGM N-glycoproteins. The results revealed differences in the molecular composition of donkey and human MFGM N-glycoproteins and the dynamic changes to site-specific N-glycosylation of donkey and human MFGM glycoproteins during lactation, deepening our understanding of the composition of donkey and human MFGM N-glycoproteins and their potential physiological roles.
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Colostro , Proteoma , Animais , Feminino , Humanos , Gravidez , Colostro/metabolismo , Equidae , Glicolipídeos , Glicoproteínas/metabolismo , Glicosilação , Gotículas Lipídicas/metabolismo , Proteínas do Leite/metabolismo , Leite Humano/metabolismo , Proteoma/metabolismo , Proteômica , Espectrometria de Massas em TandemRESUMO
Donkey colostrum milk fat globule membrane (DCMFGM) proteins are involved in multiple biological functions. However, the effect of N-glycosylation on their physiological properties are unknown. The aim of this study was to map the DCMFGM protein site-specific N-glycosylation landscape using a label-free glycoproteomic approach. A total of 1,443 unique intact N-glycopeptides mapping to 453 unique N-glycosites on 336 N-glycoproteins were identified. The macro- and microheterogeneity of DCMFGM glycoproteins were explored at the N-glycosite level and the site-specific N-glycan level, respectively, and it was found that the N-glycosylation profiles of the DCMFGM proteins varied based on subcellular localisation and protein domain types. Our findings reveal the heterogeneity and functional diversity of N-glycosylation of DCMFGM proteins and provide theoretical support for the promotion of DCMFGM proteins as a functional food ingredient.
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Colostro , Proteínas de Membrana , Feminino , Gravidez , Animais , Glicosilação , Equidae , GlicoproteínasRESUMO
In order to explore the characteristics and treatment status of obstructive sleep apnea (OSA) patients with hypertension, a retrospective study was conducted on 306 patients admitted from October 2018 to December 2019. According to the apnea hypopnea index (AHI), OSA patients with hypertension were divided into three groups. 69 cases were mild OSA (5 ≤ AHI < 15), 86 cases were moderate (15 ≤ AHI < 30), and 151 cases were severe (AHI ≥ 30). Compared with patients in the mild and moderate groups, the severe group had more male patients, with higher body mass index (BMI) and non-rapid eye movement stage 1 accounted for total sleep time (N1%), and lower non-rapid eye movement stage 2 accounted for total sleep time (N2%), average and minimum blood oxygen. Among all the patients, those who underwent the titration test accounted for 20.6% (63/306). Multivariate analysis showed that sleep efficiency (p < 0.001) and AHI (p < 0.001) were independent factors for patients to accept titration test. OSA patients with hypertension had a low acceptance of titration therapy. These people with higher sleep efficiency and AHI were more likely to receive autotitration.
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The molecular interactions of xylitol (XY) with α-casein (α-CN) and κ-casein (κ-CN) at pH 7.4 as a function of temperature (298, 308, and 318 K) were characterized by multispectral techniques and molecular docking. The fluorescence results showed that XY strongly quenched the intrinsic fluorescence of α- and κ-CN by static quenching, as well as the presence of a single binding site for XY on both proteins with a binding constant value of â¼105 L/mol. The binding affinity of both proteins for XY decreased with increasing temperature, and Van der Waals forces, hydrogen bonding and protonation were the key forces in the interactions. The addition of XY altered the polarity of the microenvironment of proteins and changed their secondary structure from ordered to disordered. The molecular docking results showed that XY had different binding sites to α- and κ-CN, with several amino acids involved in the binding processes.
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Caseínas , Xilitol , Sítios de Ligação , Caseínas/metabolismo , Ligação de Hidrogênio , Simulação de Acoplamento Molecular , Ligação Proteica , Espectrometria de Fluorescência , TermodinâmicaRESUMO
OBJECTIVE: To explore how subjective and objective sleep parameters respond to bilateral subthalamic nucleus-deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). METHODS: Thirty DBS sleep studies were included by searching PubMed, Embase, and the Cochrane Library, and only 21 prospectively designed studies, including 541 patients, were eligible for the main analysis. We evaluated sleep disturbance using 1 objective measurement, polysomnography (PSG), and 4 subjective scales, including PD Sleep Scale (PDSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and restless legs syndrome (RLS). We pooled data using the standard mean difference (SMD). The primary outcome was a change in sleep parameters 6 months postoperatively. Outcomes from <12 months to ≥12 months follow-up were compared in the subgroup analysis. Meta-regression was further conducted. RESULTS: STN-DBS significantly improved all 4 subjective sleep scales in the 6-month follow-up: ESS (SMD = 0.234), PDSS (SMD = 0.724), PSQI (SMD = 1.374) and RLS (SMD = 1.086), while most PSG parameters remained unchanged, except for shortened rapid eye movement sleep latency (RSL) (SMD = 0.520). In the over-12-month follow-up, improvement persisted in PDSS but not in ESS. Dopamine drug reduction (p = 0.009) and motor improvement (p = 0.036) were correlated with ESS improvement and PDSS improvement, respectively. CONCLUSIONS: Bilateral STN-DBS continuously improved subjective nocturnal sleep, while its effect on ESS lasted for only 1 year. Medication reduction and motor improvement may contribute to improved daytime sleepiness and better subjective nocturnal sleep, respectively. Except for a shortened RSL, STN-DBS did not change PSG parameters, including sleep efficiency and sleep architecture. REGISTRATION: Open Science Framework: DOI 10.17605/OSF.IO/3EGRC.
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Estimulação Encefálica Profunda , Doença de Parkinson , Transtornos do Sono-Vigília , Núcleo Subtalâmico , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/terapia , Sono , Transtornos do Sono-Vigília/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear, this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke. METHODS: We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study. Follow-up assessments were performed at the following time points after stroke: in person, 2 weeks, 3 months, 6 months, and 1 year; by telephone, 5 years. National Institutes of Health Stroke Scale (NIHSS) score on admission, recurrence, disability, depression, QoL, and chronic complications were recorded. Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. QoL was measured using short form-12 (SF-12). Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12. RESULTS: Of the 801 patients evaluated in this study, 80 had persistent depression. The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29-0.81) and disability at 5 years (OR: 0.34; 95% CI: 0.23-0.49) were associated with poor MCS scores at 5 years. Old age, a high NIHSS score on admission, disability at 5 years, and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up. CONCLUSIONS: Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up. The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.
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Depressão/fisiopatologia , Depressão/psicologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , China , Estudos de Coortes , Depressão/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Acidente Vascular Cerebral/epidemiologiaRESUMO
Objectives: This study aimed to examine the rate of remission in individuals experiencing early-onset poststroke depression (PSD) in China and to identify predictors of remission during a 3-month follow-up. This study also explored the interaction between cognitive impairment and depression. Methods: A total of 820 patients with PSD from a massive multicenter prospective cohort project in China (PRIOD) were included in the present study. Depressive symptoms were measured with the Hamilton Depression Rating Scale (17 Items, HDRS-17) at 2 weeks and the endpoint of the 3-month follow-up. The cut-off score of HDRS-17 (< 8) was used to define remission of depression at the endpoint. The Mini-Mental State Exam (MMSE) was used to evaluate the cognitive impairment of the patients (at the 2-week follow-up and 3-month endpoint). The National Institutes of Health Stroke Scale (NIHSS) was used to measure the severity of stroke. Results: (1) Six hundred and forty-two patients completed the 3-month follow-up, and 332 (51.7%) patients remitted by the end of the study. Univariate analyses indicated that there was a higher proportion of patients who had hypertension, frontal lobe lesion, basal ganglia lesion, poor outcome at 2 weeks, high scores on the NIHSS at 2 weeks, major life events within 3 months, and major medical diseases within 3 months in the nonremission group. In stepwise multiple logistic regression analyses, remission was significantly predicted by lower NIHSS scores at 2 weeks (p = 0.001, OR = 1.086, 95% CI 1.035-1.139), fewer major life events (p = 0.036, OR = 5.195, 95% CI 1.111-27.283), fewer major medical comorbidities (p = 0.015, OR = 2.434, 95% CI 1.190-4.979), and fewer frontal lobe lesions (p = 0.042, OR = 1.717, 95% CI 1.019-2.891). (2) After controlling for confounding variables, repeated measures analysis of variance revealed a significant interaction between time (2 weeks vs. 3 months) and group (remitters vs. nonremitters) on MMSE scores [F (1, 532) = 20.2, p < 0.001]. Conclusions: Early-onset PSD patients with milder neurological impairment, fewer major life events, fewer major medical comorbidities and no frontal lobe lesion at baseline were more likely to achieve remission 3 months after stroke. Only remitters of PSD improved significantly in cognitive impairment after stroke. The PRIOD trial is registered at http://www.isrctn.com/, number ISRCTN62169508.
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Objective: Insomnia is a highly prevalent disorder among patients suffering from stroke. The association between insomnia and stroke mortality is less studied, particularly using the latest diagnostic criteria. The current study examined the relationship between insomnia and mortality among patients with first-evonal hazard models were used to calculate HRs for stroke er stroke in China. Methods: Patients with acute cerebrovascular diseases (stroke) were recruited from 56 hospitals in mainland China. Insomnia was defined as difficulty falling asleep, or difficulty staying asleep or waking up early, for at least two consecutive visits. Demographic data, medical history and clinical data were collected. Four follow-up visits occurred within the first year after stroke, and the last follow-up call was conducted 6 years later. Cox proportional hazard models were used to calculate HRs for stroke mortality. Results: Insomnia was reported by 38.4% (489/1273) of patients at baseline. During the 6 years of follow-up, after adjusting for all confounders, insomnia was found to be associated with increased mortality (HR=1.66, 95% CI 1.10 to 2.48). Old age (HR=1.08, 95% CI 1.06 to 1.10), stroke recurrence in the first year of follow-up (HR=2.53, 95% CI 1.48 to 4.31) and stroke survivors with hypertension (HR=1.62, 95% CI 1.04 to 2.53) had substantially higher risk of mortality. Conclusions: Besides old age, stroke recurrence in the first year of follow-up and hypertension, insomnia is associated with increased risk of mortality in patients with first-ever stroke in China. More studies about prompt and efficient interventions for insomnia are expected in the future. Trial registration number: rctn62169508.
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Distúrbios do Início e da Manutenção do Sono/mortalidade , Sono , Acidente Vascular Cerebral/mortalidade , Idoso , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de TempoRESUMO
BACKGROUND: Post-stroke depression (PSD) is a common and important comorbidity in patients after stroke. It negatively impacts stroke survivors' outcomes. Plenty of studies have investigated risk factors for PSD, especially sex differences. However, the results remain inconsistent. In this study, we explored the prevalence and risk factors for PSD both in the acute phase and the chronic phase of stroke, emphasizing on the impact of gender in PSD. METHODS: About 1094 patients with first-ever ischemic stroke were included in the study. Patients were followed up, respectively, 2 weeks, 3 months, and 12 months after stroke. Data collected included demographic and stroke-related factors, and whether patients still suffer from PSD at each time points. T-test, chi-square test, and Wilcoxon rank-sum test were used to explore the group differences between patients with PSD and without PSD, and between female and male patients. Logistic regression was performed to investigate the risk factors for PSD both in the acute and the chronic stage of stroke. RESULTS: The prevalence of PSD was 25.4, 17.6, and 12.4%, respectively 2 weeks, 3 months, and 12 months after stroke. Female patients had higher prevalence of PSD compared with male patients (31.4 vs. 22.4% 2 weeks after stroke; 20.05 vs. 16.22% 3 months after stroke; 15.04 vs. 11.05% 12 months after stroke). In the acute stage of stroke, female gender (OR 1.686 95%CI 1.155-2.462) and National Institutes of Health Stroke Scale (NIHSS) score (OR 1.118 95%CI 1.076-1.162) were independent risk factors for PSD. However, in the chronic stage of stroke, risk factors for PSD were different. At 3 months, NIHSS score (OR 1.082 95%CI 1.037-1.128), smoking (OR 1.772 95%CI 1.163-2.701), and frontal lobe lesion (OR 2.331 95%CI 1.472-3.692) were independent risk factors for PSD. On the other hand, education level (OR 0.693 95%CI 0.486-0.998) was a protective factor. About 12 months after stroke onset, NIHSS score (OR 1.113 95%CI 1.062-1.167) and living alone (OR 3.608 95%CI 1.538-8.466) were risk factors for PSD. CONCLUSION: PSD is common in stroke survivors, and female patients have higher prevalence of PSD. Risk factors for PSD in the acute phase are different from that in the chronic phase of stroke. Female gender is an independent risk factor for PSD in the acute stage of stroke. Smoking, frontal lobe lesion, and living alone are predictive factors for PSD in the chronic stage of stroke. NIHSS score is a risk factor for PSD both in the acute and in the chronic stage of stroke. Further studies are needed to understand the mechanisms underlying the elevated prevalence of PSD in female.