阻塞性睡眠呼吸暂停综合征老年人的认知损害

Cognitive impairment in the elderly with obstructive sleep apnea syndrome

目的:利用多导睡眠图(PSG)进行家庭睡眠监测,并结合睡眠及神经心理量表,探讨老年阻塞性睡眠呼吸暂停综合征(OSAS)认知损害特点.方法:受检老年人36例,18例OSAS,18例正常对照,均进行PSG家庭睡眠监测,匹兹堡(PSQI),爱泼沃斯(ESS)睡眠量表测试,并进行简短智力状态检查(MMSE),画钟测验、词表学习、符号数字测验等认知检查.结果:①OSAS组Delta睡眠比例、最低及平均血氧饱和度明显减少、呼吸暂停及低通气指数(AHI)及低氧指数明显增加(P<0.05).②OSAS组MMSE、记忆商、数字符号测验、画钟测验成绩较差(P<0.05).③OSAS组MMSE成绩与年龄相关(r=-0.533,P<0.05),与平均血氧水平相关(r=0.409,P<0.05).记忆商(MQ)与MMSE,入睡潜伏期,氧减指数均正相关(r=0.726,0.495,0.645,P均<0.05).④伴有轻度认知损害(MCI)的OSAS老年人MMSE成绩下降,日间明显嗜睡,入睡潜伏期缩短,其ESS成绩与体重指数(BMI)相关(r=0.802,P=0.0094).结论:OSAS老年人深睡眠减少、夜间血氧降低,MMSE,MQ,视空间及操作学习能力等认知功能受损.

AIM： To explore the relationship between obstructive sleep apnea syndrome （OSAS） and cognitive impairment in the elderly using neuropsychological test and polysomnography at home. METHODS： Eighteen patients with OSAS and 18 controls were tested by polysomnography at home, Pittsburgh Sleep Quality Index （ PSQI ）, Epworth Sleepiness Scale （ ESS ） , mini-mental state examination （MMSE）, Wechsler Memory Scale, clock drawing, word list recall and digital symbol test. RESULTS： The OSAS subjects were decreased significantly in delta sleep ratio, minimum and mean saturation of blood oxygen, and increased in apnea and hypopnea index （ P 〈 0. 05 ）. Performances on the MMSE, Wechsler Memory Scale, digital symbol test, clock drawing in the OSAS were impaired significantly compared with the control group. The results of MMSE were significantly associated with age （ r = - 0.533 ,P 〈 0.05 ） and mean saturation （ r = 0.409, P 〈 0.05 ）. The results of memory quotient （ MQ ） were significantly associated with MMSE （ r = 0. 726, P 〈 0.05 ） and sleep latency （ r = 0. 495, P 〈 0. 05 ） and desaturation index （r =0.645 ,P 〈0.05）. The mild cognitive impairment subjects accompanied with OSAS were decreased in the sleep latency, increased in ESS（P 〈0.05）, and the results of ESS were significandy correlated with BMI （ r = 0.802, P = 0.0094 ）. CONCLUSION： The elderly with OSAS has less deep sleep and decreased blood oxygen level at night. There is a relationship between OSAS and cognitive impairment in the elderly.