Objective To assess the expression changes of serum fibrinogen, E-selectin, and tissue-type plasminogen activator (t-PA) in acute ischemic stroke (AIS) patients with varying degrees of obstructive sleep apnea syndrome (OSA), and evaluate their value in diagnosing AIS with OSA. Methods Data were gathered from 80 patients with AIS who were admitted to the First Hospital of Jilin University between January 2023 and December 2023. Out of these, 60 patients completed the NIHSS Scale, ESS Scale, STOP-Bang Scale, and underwent polysomnography within a week of symptom onset. Based on the apnea-hypopnea index (AHI) score, patients were categorized into three groups: 15 in the non-exposed group (AHI < 5), 15 in the mildly exposed group (5 ≤ AHI ≤ 15), and 30 in the moderately to severely exposed group (AHI > 15). Serum levels of fibrinogen, E-selectin, and t-PA were determined using enzyme-linked immunosorbent assay. Results Polysomnography results indicated AIS with OSA had an increased arousal index and oxygen desaturation index (P < 0.001). Additionally, serum levels of fibrinogen, E-selectin, and t-PA were markedly elevated in the moderately-severely exposed group compared to the non-exposed group (P < 0.001), and these levels positively correlated with the severity of OSA. ROC curves showed the sensitivities of serum of fibrinogen, E-selection, and t-PA was 84.4%, 80%, and 82.2%, respectively, and the specificities of 60%, 66.7%, and 66.7%, compared with that of PSG respectively. Conclusion The expression of serum fibrinogen, E-selectin, and t-PA is elevated in AIS with OSA and correlates with the severity of OSA.

Autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) is a recently discovered autoimmune inflammatory disease of the central nervous system. It presents with a variety of clinical symptoms, including fever, seizures, psychiatric symptoms, limber weakness, and sensory symptoms. However, the symptoms of sleep disorders have not been sufficiently addressed. Here, we report a case of GFAP-A in which the patient complained of excessive daytime sleepiness and an excessive need for sleep. Our patient was a 58-year-old male who experienced excessive daytime sleepiness for 50 days following SARS-CoV-2 infection. He was diagnosed with coronavirus disease 2019 on June 1st. On the 7th of June, he experienced excessive daytime sleepiness, nausea, reduced food intake, lower limb weakness, and dysuria. Subsequently, his sleepiness significantly deteriorated on July 21st. Five months prior, the patient underwent laparoscopic partial right nephrectomy for clear-cell renal cell carcinoma. Brain MRI revealed abnormal hyperintense lesions in the pontine brain and around the mesencephalic aqueduct on T2 and T2-fluid attenuated inversion recovery (T2-FLAIR) sequences However, these lesions did not exhibit any pathological enhancement. Spinal cord MRI revealed lesions in the C6–C7 and T2–T3 segments on the T2 sequence. His Epworth Sleepiness Scale (ESS) score was 16 (reference range, <10), and 24-hour polysomnography supported the diagnosis of rapid-eye-movement sleep disorder and severe sleep apnea-hypopnea syndrome. Glial fibrillary acidic protein IgG antibodies were detected in the cerebrospinal fluid (1:32, cell-based assay) but not in the serum. The level of hypocretin in the cerebrospinal fluid was 29.92 pg/mL (reference range ≥110 pg/mL), suggesting narcolepsy type 1. After treatment with corticosteroids for approximately 1 month, the patient showed considerable clinical and radiological improvement, as well as an increase in hypocretin levels. Although repeated polysomnography and multiple sleep latency tests suggested narcolepsy, his ESS score decreased to 8. Our findings broaden the range of clinical manifestations associated with GFAP-A, thereby enhancing diagnostic and therapeutic strategies for this disease. Additionally, our results indicate a potential common autoimmune mechanism involving GFAP-A and orexin system dysregulation, warranting further investigation.

抑郁症是一种严重危害人类身心健康的常见精神疾病,极大地影响了人类精神生活,其主要表现为情绪低落、反应迟钝,动机及兴趣缺乏,严重者甚至会出现自杀的想法和行为[1].根据世界卫生组织2019年的统计报告,全球约有3. 5亿人患有抑郁症,其中约有80％未得到有效治疗[2].为此,各个领域的学者从神经生物学、心理以及社会因素等多个方面探索抑郁症发病的原因,但其具体机制尚不十分清楚[3].目前已有研究表明,中脑皮质和边缘系统多巴胺能通路功能障碍是抑郁症的关键病理基础[4,5].

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是最常见的慢性疾病之一,也是导致发生卒中、卒中后功能恢复不良及卒中再发的独立危险因素.60％～70％的卒中患者在急性期出现睡眠呼吸暂停,其中以OSAS最常见.目前多导睡眠监测是OSAS诊断的"金标准",但其操作过程烦琐,需要大量的医务人员,检查费用较高,易致OSAS患者诊疗延迟.目前已经研发出一些OSAS的院外筛查设备,但其准确性仍有待提高.因此,寻求一种操作简便、快捷有效的诊断方法,定期筛查潜在OSAS患者仍具有重要的临床意义.目前OSAS血清诊断标志物筛查可能成为一个理想的筛查OSAS的方法并为预测卒中预后提供参考依据.本文对OSAS在卒中发病病理生理机制中生物标志物的研究进展进行综述,希望有助于指导卒中伴OSAS的诊断、治疗、预防和预后.