脑梗死伴阻塞性睡眠呼吸暂停低通气综合征患者的睡眠结构与认知功能的关系研究

The Relationship between Sleep Structure and Cognitive Function in Cerebral Infarction Patients Combined with Obstructive Sleep Apnea Hypopnea Syndrome

目的探讨脑梗死伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的睡眠结构与认知功能的关系。方法选取2011年11月—2012年2月在我院就诊的脑梗死合并OSAHS患者(A组)23例及单纯脑梗死患者(B组)23例。对两组患者进行多导睡眠监测及采用简易智力状况检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)进行认知功能评价,并对认知功能与睡眠呼吸参数及分期采用Spearman相关分析进行相关性检验。结果睡眠结构及认知评分方面:A组非眼球快速运动睡眠(NREM)期、NREM 1期所占比例高于B组,NREM 3+4期、眼球快速运动睡眠(REM)期所占比例低于B组,A组MMSE、MoCA评分均低于B组,差异均有统计学意义(P<0.05)。认知功能与睡眠呼吸参数及分期相关性:A组患者MMSE评分与夜间平均血氧饱和度(SaO2)、夜间最低SaO2、NREM 3+4期呈正相关(r=0.445、0.430、0.491,P<0.05);与AHI、SaO2减低指数(ODI)、NREM 1+2期呈负相关(r=-0.428、-0.640、-0.436,P<0.05);与微觉醒指数、REM期无线性相关(P>0.05)。A组MoCA评分与夜间平均SaO2、夜间最低SaO2呈正相关(r=0.441、0.427,P<0.05),与AHI、ODI、NREM 1+2期呈负相关(r=-0.457、-0.463、-0.378,P<0.05),与微觉醒指数、NREM 3+4期和REM期无线性相关(P>0.05)。B组患者MMSE评分与夜间平均SaO2、夜间最低SaO2、AHI、ODI、微觉醒指数、NREM 1+2期、NREM 3+4期及REM期无线性相关(P>0.05)。B组MoCA评分与ODI、微觉醒指数呈负相关(r=-0.433、-0.448,P<0.05),与REM期呈正相关(r=0.440,P<0.05),与夜间平均SaO2、夜间最低SaO2、AHI、NREM 1+2期、NREM 3+4期无线性相关(P>0.05)。结论脑梗死伴OSAHS患者的睡眠结构紊乱,同时认知功能受损严重,表明OSAHS可能加重脑梗死患者的神经功能损伤和认知功能障碍。

Objective To discuss the correlation between sleep structure and cognitive function in cerebral infarction （CI） patients combined with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Polysomnography was per-formed and Mini - mental state examination （ MMSE）, Montreal Cognitive Assessment （MoCA） were used to evaluate cognitive function. A correlation test was performed by Spearman correlation analysis on cognitive function and parameter, staging of sleep apnea. Results In sleep structure and cognitive score, the proportion of non - rapid eye movement （ NREM ） staging and NREM 1 staging was higher in group A than in group B, that of NREM 3 ＋ 4 staging, rapid eye movement （REM） staging lower than in group B, MMSE, MoCA scores lower than in B group, the difference was significant （P 〈 0. 05 ）. MMSE was positively correlated with night mean Sa02, night lowest SaO2, NREM 3 ＋4 staging （r =0. 445, 0. 430, 0. 491, P 〈0.05）, negatively correlated with AHI, SaO2 reduction index （ ODI）, NREM 1 ＋ 2 staging （ r = - 0. 428, - 0. 640, - 0. 436, P 〈 0. 05 ）, and not correlated linearly with microarousal index, REM staging in group A （ P 〉 0. 05 ）. MoCA was positively correlated with night mean SaO2, night lowest SaO2 （ r = 0. 441, 0. 427, P 〈 0.05 ） , negatively correlated with AHI, ODI, NREM 1 ＋ 2 staging （ r = - 0. 457, - 0. 463, - 0. 378, P 〈 0. 05 ）, and not correlated linearly with microarousal index, NREM 3 ＋ 4 stag-ing, REM staging in group A （P 〉 0. 05）. MMSE was not correlated linearly with night mean SaO2, night lowest Sa02, AHI, ODI, microarousal index, NREM 1 ＋ 2 staging, NREM 3 ＋ 4 staging or REM staging in group B （ P 〉 0. 05）. MoCA was nega-tively correlated with ODI, microarousal index （ r = - 0. 433, - 0. 448, P 〈 0. 05 ）, positively with REM staging （r = 0. 440, P 〈 0. 05）, not correlated linearly with night mean SaO2, night lowest SaO2, AHI, NREM 1 ＋ 2 staging, NREM 3 ＋ 4 staging in group B （ P 〉 0.05）. Conclusion CI patients combined with OSAHS have obvious sleep structure disorders and severe dam-ages of cognitive function, showing that OSAHA may aggravate neurological damages and cognitive function disorders in CI pa-tients.