The Relationship between Insomnia and Internal Carotid Artery Stenosis and Cognitive Dysfunction by Magnetic Sensitivity Weighted Imaging Based on Wireless Network Communication.

The paper analyzes the detection of insomnia and carotid artery stenosis by magnetic sensitivity weighted imaging (SWI) based on radio communication and its relationship with cognitive dysfunction. A total of 148 patients with carotid artery stenosis and insomnia admitted to our hospital from January 2020 to June 2021 are selected. According to different detection methods, wireless communication combined with SWI group and conventional group are established respectively, with 74 cases in each group. The conventional group applies CT angiography (CTA) is in line with the intervention mode of patients complaining of sleep at night. In the wireless communication combined with SWI group, the sleep monitoring system of wireless communication combined with SWI detection method is used to observe the imaging detection rate, insomnia detection rate and diagnostic efficiency of the two groups. The differences of PSG index parameters, sleep quality (PSQI) score and cognitive function (MoCA) score of patients with different disease degrees are compared. Pearson correlation coefficient is used to analyze the correlation between PSQI score and MoCA score. SWI sequence scan based on wireless network communication has high efficiency in the diagnosis of carotid artery stenosis, and the sleep status of patients can be better understood by real-time monitoring of patients, which is of great significance for the follow-up development of effective diagnosis and treatment plans and recovery of patients' cognitive function, and worthy of clinical application.

1. Introduction

Existing clinical data shows that carotid artery stenosis is one of the important factors causing atherosclerosis, and with the development of the disease, the risk of stroke will increase, posing a serious threat to patients' life safety [1]. Other scholars have found that insomnia symptoms are one of the influencing factors for the occurrence of cardiovascular and cerebrovascular diseases, although finding effective diagnosis and treatment plans to better judge the disease development of patients with insomnia and carotid artery stenosis is one of the important clinical research topics at present [2]. There are no typical clinical manifestations in the early stage of mild and moderate carotid artery stenosis. At present, the gold standard for clinical diagnosis of carotid artery stenosis is Digital Subtraction Angiography (DSA), but the detection process will bring some damage to the patient's body, and may be accompanied by various adverse complications. In addition, DSA cannot be used as a routine detection mode for the follow-up of patients, so it is particularly important to select a more efficient and safe detection method [3]. Wireless network communication based on The Weighted imaging (SWI) is a significant leap forward in Magnetic Resonance imaging (MRI) technology in recent years. Compared with conventional sequence scanning, SWI scanning for paramagnetic material such as small veins and blood metabolites has higher sensitivity, the image also shows clear signal is missing, the image quality is higher, the current has important utility in the diagnosis of micro angiograms of the brain hemorrhage, prompt to degree of carotid artery stenosis disease is much earlier, is important for the prognosis of patients with early intervention and improve clinical significance [4, 5]. Based on this, this study combined the application of radio communication technology and SWI scanning to conduct comparative analysis with existing conventional CT angiography (CTA) to observe the diagnostic value of different detection methods for the degree of patients' disease, and carried out in-depth analysis based on the sleep quality and cognitive function of patients. This study aims to provide reference for the diagnosis and treatment of carotid artery stenosis patients with insomnia, as well as the basis for the etiological study of cognitive impairment. The results of this study are reported as follows. of the cognitive impairment, is presently as follows the results of the study report.

A total of 148 patients with carotid artery stenosis and insomnia admitted to our hospital from January 2020 to June 2021 are selected and divided into wireless communication combined WITH SWI group and conventional group according to different detection methods, with 74 patients in each group. In the wireless communication combined with SWI group, there are 43 males and 31 females, aged from 43 to 72 years, with an average of (58.62 ± 10.33) years. Body mass index (BMI) ranged from (19.84) to 29.17)kg/m2, with an average of (24.15 ± 2.81)kg/m2. In the conventional group, there are 39 males and 35 females, aged from 40 to 70 years old, with an average of (59.37 ± 10.64) years old, and BMI ranging from (20.03 to 28.76)kg/m2, with an average of (23.90 ± 2.53)kg/m2. There are no significant statistical differences in gender, age, BMI and other baseline data between the two groups (all P > 0.05), which confirmed that the comparison between groups is scientific and reasonable. Inclusion criteria includes as follows: (1) the clinical manifestations of patients met the diagnosis and treatment criteria for carotid artery stenosis [6], and all patients had received DSA test. (2) Pittsburgh Sleep Quality Index Sleep Quality Index (PSQI) ≥7; (3) All patients had unilateral carotid artery lesions; (4) Patients have high compliance and can cooperate with clinicians to complete all examinations involved in this study; (5) No mental illness or related signs or cognitive disorders. Exclusion criteria includes as follows:(1) incomplete clinical data; (2) patients with severe organic dysfunction such as liver and kidney; (3) patients with infectious diseases or respiratory failure; (4) Received cognitive function or sleep related drug therapy within 6 months before admission to our hospital.

The remainder of this paper is organized as follows. Section 2 presents the experimental method. Section 3 provides the experimental result and Section 4 illustrates data analysis and result discussion. Finally, the conclusions of this study and some future recommendations are given in Section 5.

2. The Experimental Method

2.1. Detection Method

The routine group adopted THE CTA detection mode. During the study period, the hospital medical staff listened to the patients' sleep complaints every morning and recorded the specific steps of CTA detection. Dual-source Flash CT instrument (purchased from Siemens, Germany) and NeurDSA sequence are used to scan the aortic arch and cranial crown of the patient. The patient is guided to maintain supine position, and the cranial mandible is fixed with soft band assistance. First, plain scanning is performed. Then non-ionic contrast agent (ioprotamine 370 mgI/mL from Bayer Schering Pharma AG, 100 ml : 62.34 g) is injected into the anterior elbow vein using a double-barbed high-pressure syringe. The injection rate is controlled at 3.5–4.5 mL/s, and the dose is 40–60 mL. Application of contrast agent and automatic tracking scanning, scanning parameters: Voltage 120 kV, current automatic milliamps, pitch 1.5, layer acquisition setting parameter 128 × 0.6 mm, convolution kernel B30f, reconstruction layer thickness 0.6 mm, interval 0.5 mm, using NeurDSA for 2D and 3D reconstruction. Maximal Intensity projection (MIP), MULTIplane reconstruction (MPR), curved surface reconstruction (CPR), volume reconstruction (VRT), etc. In the wireless communication combined with SWI group, the sleep status of the patients is detected in real time by the polysomnography detector based on radio communication, and the carotid artery stenosis of the patients is detected by SWI. Sleep monitoring procedures: All patients are monitored overnight using SOMNOscreen Plus PSG + produced by SOMNOmedics, Germany, and the data are analyzed according to PSG interpretation standards [7]. Electrode impedance is monitored and recorded to obtain a stable graph and then calibrated. The lights are turned off and recording is started, and the patients are instructed to rest peacefully. At 6 am the next day, the electrode impedance is monitored and recorded again and calibrated, and then the recording is stopped. The monitoring is completed. The analysis indexes included bed time, total sleep time, sleep efficiency and sleep latency. SWI procedure: The patient's head is placed in an 8-channel phased front coil using the Siemens Magnetom Avanto1.5 T MRI scanner (manufactured by Siemens, Germany) with the following parameters: Repeat time (TR)2000 ms, echo time (TE)30 ms, scanning field (FOV)mm2, layer thickness 2 mm, slice 23, gap 1 mm, acquisition matrix 64 × 64.

2.2. DSA Detection of Carotid Artery Stenosis Degree and Subtype Grouping Method

Fd20-1125ma angiography machine (made by Philips in the Netherlands) is used to puncture the femoral artery of all patients and inject 30 mL contrast agent into the left side of the aortic arch at the injection rate of 15–25 ml/s. 10 mL contrast agent is injected into bilateral carotid arteries at the posterior part of the neck. Injection speed is controlled from 4 to 8 mL/s. Carotid artery stenosis rate <50% is mild stenosis; The stenosis rate is 50–69% moderate. Stenosis rate ≥70% is severe stenosis [8]. Carotid artery stenosis rate = (lumen diameter at distal end of stenosis-lumen diameter at stenosis)/lumen diameter at distal end of stenosis × 100%. According to the test results, all patients are divided into mild group, moderate group and severe group.

2.3. Evaluation Criteria

All patients received the Montreal Cognitive Assessment Scale (MoCA) Chinese version for cognitive function assessment. Including visual spatial executive ability, abstraction ability, orientation, language, memory, naming, attention and other cognitive areas, a total of 30 points, patients with a score <23 points are identified as having cognitive dysfunction [9]. All the procedures are evaluated by the same physician in the department of Neurology of our hospital [10-12].

The PSQI scale is used to evaluate the sleep quality of patients, and the sleep quality, sleep time, sleep time, sleep efficiency, sleep disorders, sleeping drugs, daytime function and other 7 items are evaluated on the basis of 0∼3 points [13, 14]. The higher the score and the total score, the worse the sleep quality [15-18].

All relevant data involved in this study are incorporated into SPSS 26.0 software for statistical analysis. Mean ± standard deviation (‾x ± s) is used to represent measurement data confirmed to be in normal distribution, and data differences between groups are tested by F test. In this study, the diagnostic value of carotid artery stenosis and insomnia is evaluated by ROC curve. Pearson correlation coefficient is used to analyze the correlation between sleep quality and cognitive function in patients with carotid artery stenosis, and P < 0.05 proved that the difference is statistically significant.

3. The Experimental Results

3.1. Imaging Examination Results, Insomnia and Diagnostic Value of the Two Groups Are Compared

In the conventional group, 58 patients complained of inadequate sleep at night (detection rate 78.38%), and in the wireless communication combined with SWI group, 71 patients complained of inadequate sleep at night (detection rate 95.95%) according to PSG monitoring analysis. The comparison of the detection rate of insomnia between the two groups is statistically significant (P < 0.05). DSA results show 147 carotid artery stenosis are detected in the conventional group, including 21 cases of left stenosis, 17 cases of right stenosis and 36 cases of bilateral stenosis. DSA results showed that 162 carotid artery stenosis are detected in the wireless communication combined with SWI group, including 20 cases of left stenosis, 15 cases of right stenosis and 39 cases of bilateral stenosis. The detection rate of routine test mode is 93.24%, and that of SWI is 98.65%. There is no statistical significance between the two groups (P > 0.05). The area under ROC curve of SWI is higher than that of CTA, and the area under ROC curve of radio communication monitoring mode is higher than that of patient chief complaint mode. The imaging findings are shown in Table 1. Figure 1 is the ROC curves of the two imaging detection methods. Figure 2 is the ROC curves of the two insomnia detection methods. Table 2 presents the diagnostic value of CTA and SWI in carotid artery stenosis. Table 3 displays the diagnostic value analysis of radio communication and patient complaints for insomnia symptoms.

Table 1

Comparison of imaging examination results (n,%).

Group	On the left side of the narrow	On the right side of the narrow	Bilateral stenosis	Combined
Regular group	18 (24.32)	16 (21.62)	35 (47.30)	62 (93.24)
Wireless communications joint SWI group	19 (25.67)	15 (20.27)	39 (52.70)	70 (98.65)
x 2	—	—	—	2.779
P	—	—	—	0.095

Figure 1

ROC curves of the two imaging detection methods.

Figure 2

ROC curves of the two insomnia detection methods.

Table 2

Diagnostic value of CTA and SWI in carotid artery stenosis.

Testing way	AUC (95%CI)	Sensitivity (%)	Specific degrees (%)	About an index	Cutoff value
CTA	0.846 (0.787∼0.882)	80.500	78.500	0.590	0.82
SWI	0.892 (0.834∼0.933)	85.000	91.000	0.760	0.86

Table 3

Diagnostic value analysis of radio communication and patient complaints for insomnia symptoms.

Testing way	AUC (95%CI)	Sensitivity (%)	Specific degrees (%)	About an index	Cutoff value
Patients complained	0.769 (0.662∼0.835)	71.500	80.000	0.515	0.84
Wireless network communication	0.821 (0.778∼0.856)	84.000	79.500	0.635	0.76

3.2. Comparison of PSG Index Parameters of Patients with Different Degrees of Disease

According to DSA test results, all patients are divided into mild group (n = 43), moderate group (n = 69), severe group (n = 36).There is no significant difference in sleep latency between groups (P > 0.05). The sleep time, bed time and sleep efficiency among groups decreased with the severity of the disease (all P < 0.05), as shown in Table 4. Table 4 is the comparison of PSG index parameters in patients with different degrees of disease.

Table 4

Comparison of PSG index parameters in patients with different degrees of disease (‾x ± s).

Group	Sleep latency (min)	The amount of sleep (h)	Bed time (h)	Sleep efficiency
Mild group (n = 43)	22.12 ± 7.28	7.34 ± 0.86	8.27 ± 0.49	0.87 ± 0.07
The moderate group (n = 69)	22.45 ± 7.31	6.48 ± 0.63	7.83 ± 0.42	0.76 ± 0.15
Severe group (n = 36)	22.96 ± 7.46	5.95 ± 0.54	7.25 ± 0.37	0.69 ± 0.18
F	−0.505	6.093	5.055	4.222
P	0.615	<0.001	<0.001	0.028

3.3. Comparison of PSQI Score Differences among Patients with Different Degrees of Disease

The index scores of patients with different degrees of disease, including sleep quality, sleep time, sleep time, sleep efficiency, sleep disorders, sleeping drugs, and daytime function scores, increased with the severity of the disease, and the total PSQI score also increased with the severity of the disease (all P < 0.05), as shown in Table 5. Table 5 shows the comparison of PSQI scores of patients with different degrees of disease.

Table 5

Comparison of PSQI scores of patients with different degrees of disease (score, ‾x ± s).

Group	The quality of sleep	Sleep time	The amount of sleep	Sleep efficiency	Sleep disorders	Sleeping pills	Daytime function	Total score
Mild group (n = 43)	1.26 ± 0.41	1.05 ± 0.37	1.36 ± 0.28	1.15 ± 0.19	1.26 ± 0.27	1.19 ± 0.36	0.94 ± 0.11	8.21 ± 2.17
The moderate group (n = 69)	1.87 ± 0.45	1.63 ± 0.46	1.78 ± 0.35	1.53 ± 0.31	1.57 ± 0.45	1.65 ± 0.41	1.47 ± 0.34	11.50 ± 2.76
Severe group (n = 36)	2.32 ± 0.47	2.08 ± 0.54	2.09 ± 0.47	1.81 ± 0.42	1.86 ± 0.49	2.07 ± 0.44	1.79 ± 0.48	14.02 ± 2.94
F	5.215	5.977	6.650	6.229	4.553	6.045	5.890	6.638
P	<0.001	<0.001	<0.001	<0.001	0.001	0.001	<0.001	<0.001

3.4. MoCA Scores of Patients with Different Disease Degrees Are Compared

Patients with different degree of disease cognition include visual space execution, abstract ability, directional force, such as language, memory, naming, attention rating score decline, since the degree of disease and contrast data statistically difference between groups, MoCA scores also decline since the degree of illness (all P < 0.05), as shown in Table 6. Table 6 presents the comparison of MoCA score in patients with different disease degrees.

Table 6

Comparison of MoCA score in patients with different disease degrees (score, ‾x ± s).

Group	Visual spatial execution	Abstract ability	Directional force	Language ability	Memory	Named	Attention	Total score
Mild group (n = 43)	4.32 ± 0.94	1.45 ± 0.47	5.24 ± 0.96	2.36 ± 0.62	3.85 ± 1.03	2.61 ± 0.57	5.25 ± 1.02	23.08 ± 4.11
The moderate group (n = 69)	3.42 ± 0.67	0.92 ± 0.39	4.38 ± 0.77	1.87 ± 0.54	2.82 ± 0.86	2.28 ± 0.43	4.49 ± 0.77	20.18 ± 5.64
Severe group (n = 36)	2.61 ± 0.83	0.63 ± 0.28	3.22 ± 0.58	1.24 ± 0.59	2.07 ± 0.64	1.78 ± 0.36	3.75 ± 0.68	15.30 ± 5.29
F	5.907	6.549	5.222	4.590	5.709	3.479	4.476	4.330
P	<0.001	<0.001	<0.001	<0.001	<0.001	0.001	<0.001	<0.001

3.5. To Analyze the Correlation between Sleep Quality and Cognitive Dysfunction in Patients with Carotid Artery Stenosis

Pearson correlation coefficient analysis showed a significant negative correlation between PSQI score and MoCA score in carotid artery stenosis patients (P < 0.05). as shown in Figure 3. Figure 3 is the correlation between PSQI score and MoCA score in patients with carotid artery stenosis and insomnia.

Figure 3

Correlation between PSQI score and MoCA score in patients with carotid artery stenosis and insomnia.

4. The Experimental Result Discussion

In recent years, the number of patients with cardiovascular and cerebrovascular diseases has been increasing and the incidence has increased significantly in China, and clinical data show that in addition to hypertension, diabetes, smoking, obesity and other risk factors for cardiovascular and cerebrovascular adverse events, insomnia symptoms have also been determined as one of the factors that promote the continuous development of atherosclerosis and induce acute cerebral infarction. Shen et al. showed that changes in people's living habits lead to prominent problems such as insufficient sleep or decreased sleep quality, which further aggravate the probability of stroke. Sleep activity is closely related to the normal metabolic activity of human body. Maintaining adequate sleep time and high sleep quality can promote the recovery of the body's neurological, physiological and metabolic functions. The probability of long-term insomnia patients complicated with atherosclerosis and other cardiovascular and cerebrovascular diseases is greatly increased, and the corresponding effective prevention measures are to carry out early and effective diagnosis of arterial lesions, and then adopt effective diagnosis and treatment plans at the best time to improve the prognosis of patients.

This paper analyzes the diagnostic detection rate of patients with carotid artery stenosis by different detection methods, and showed that the detection rate of CAROTID artery by SWI sequence scan is slightly higher than that by CTA method, and the diagnostic efficiency is higher, which is similar to that of Bai et al. Scanning mode is SWI sequence MRI technology in recent years that one of the important product of the development of magnetic sensitivity can be through the body of different organizations to capture and clearly reflected in the image, its mechanism of action is to analyze blood oxygen level detection area and surrounding tissue lesions present situation more obvious difference image, and show that endovascular material deposition, The specificity of lesions and normal tissues can be better compared to improve the detection rate of lesions and the detection rate of microvascular malformations and other small vascular lesions, thus having higher diagnostic efficacy than other conventional sequence scanning methods. At the same time, the PSG system is used as an intervention method to monitor patients' sleep status based on wireless communication technology in this study. Compared with patients' complaints of insomnia, SWI detection scheme based on wireless communication could more accurately reflect patients' sleep status, and the difference is statistically significant.

Carotid artery stenosis disease to a certain stage will lead to a plaques in the arteries, the carotid artery hemodynamics index level change, continues to supply adequate conditions increase the risk of brain ischemia, hypoxia, it brings bad effect on the central nervous function, as the illness progress can cause a cognitive dysfunction in patients with bad signs. Studies on patients with acute cerebral infarction show that short sleep duration, sleep disorder and sleep quality decline are closely related to atherosclerosis, and patients with insomnia are more serious in clinical neurological deficit score than those without insomnia, and the more serious the neurological deficit degree, the higher the incidence of insomnia. Insomnia not only affects patients' neurological rehabilitation, physical and mental health and quality of life, but also aggravates the risk factors of stroke, such as hypertension and diabetes, and even induces stroke recurrence. Results similar to previous research conclusion, this study on patients with different degree of carotid stenosis of SWI sequence scanning at the same time to sleep all night sleep PSG real-time monitoring to observe patients index, and USES the PSQI scale for patients with sleep two aspects of subjective and objective analysis, found that patients with carotid artery stenosis degree is closely related to the quality of sleep, The more advanced the disease, the worse the patient's sleep. Analysis of the reasons may be that the positive degree of carotid artery stenosis has a direct impact on intravascular blood return and perfusion, and is involved in the cognitive impairment of patients at the micro level. Although the existing research of the mechanism of action of carotid stenosis leading to cognitive dysfunction is not yet clear, but clinical common cerebrovascular long-term low perfusion state is one of the factors that affect cognitive function, and a study in most of patients with mild carotid stenosis, and no significant change in cerebral blood flow dynamics, the results still observed and cognitive dysfunction associated with the degree of carotid stenosis, It may be related to long-term hypoperfusion.

5. Conclusion

Based on the wireless network communication way of SWI sequence scan for insomnia and internal carotid artery stenosis in patients with early diagnosis and a forecast of the development of high effect, the way of lesions in patients with higher detection rate than traditional sequence scan, in a joint wireless networks at the same time to sleep monitoring index can capture the patients in all kinds of sleep, Thus, the cognitive function of patients can be accurately judged and targeted treatment can be carried out, which has a positive effect on the improvement of patients' prognosis and is worthy of clinical application.