阻塞性睡眠呼吸暂停低通气综合征患者事件相关电位P300及其影响因素分析

Event-related potential P300 in patients with obstructive sleep apnea hypopnea syndrome and its influencing factors

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者事件相关电位（ERP）P300的特点及其影响因素。方法选取OSAHS患者22例（病例组）和健康正常人18例（对照组）为研究对象，分别进行P300测定，采用相关性分析和逐步多元回归分析法对OSAHS患者睡眠模式、睡眠呼吸暂停低通气指数（AHI）、平均血氧饱和度（MSaO：）、最低血氧饱和度（LSaO2）、非快速眼动（NREM）睡眠第I、Ⅱ、Ⅲ、Ⅳ期和快速眼动（REM）睡眠占总睡眠时间的百分比、氧饱和度低于90％的睡眠时间（90％SaO2）等指标与P300潜伏期和波幅问的关系进行探讨。结果病例组P300中P3波的潜伏期[（344．24±23．99）ms]大于对照组P3波的潜伏期[（311．17±15．65）ms]（P〈0．05），其P3波的波幅[（3．66±1．49）μV]低于对照组P3波的波幅[（6．26±1．48）μV]（P〈0．05）。P3波潜伏期与NREMI＋Ⅱ占总睡眠时间的百分比（r=0．492，P〈0．05）、90％Sa02（r=0．627，P〈0．01）、AHI（r=0．882，P〈0．01）呈正相关，与NREMm＋Ⅳ占总睡眠时间的百分比（r=-0．558，P〈0．01）、LSaO2（r=0．479，P〈0．05）、MSaO2（r=-0．519，P〈0．05）呈负相关。P3波的波幅与NREMI＋Ⅱ占总睡眠时间的百分比（r=-0．491，P〈0．05）、90％SaO2（r=-0．626，P〈0．01）、AHI（r=-0．866，P〈0．01）呈负相关，与NREMⅢ＋Ⅳ占总睡眠时间的百分比（r=0．516，P〈0．05）、LSaO2（r=0．475，P〈0．05）、MSaO2（r=0．514，P〈0．05）呈正相关。经过多元线性回归分析后，发现AHI对PS00的影响较大。结论OSAHS患者P300存在异常，其变化与OSAHS患者的病情严重程度具有相关性，其中AHI对P300的影响较大。

Objective To study the characteristics and influencing factors of event-related potential （ERP） P300 in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Twenty-two OSAHS pa- tients （OSAHS group） and 18 healthy subjects （control group） were recruited, and the ERP P300 was recorded with all the subjects. The correlation between latency and amplitude of P300 and influencing factors including variation of sleep mode, apnea hypopnea index （AHI） , mean oxyhemoglobin saturation level（ MSaO2 ） , the lowest of oxyhemo- globin saturation level （ LSaO2 ） , time of non-rapid eye movement （NREM） sleep I , II , III, IV stage and rapid eye movement （ REM ） sleep over total sleep time and total sleep time of SaO2 〈 90% （90% SaO2 ） were analyzed by using linear regression correlation analysis and multiple stepwise regression analysis. Results The latencies of P3 compo- nent of P300 in OSAHS group were longer than that of control group [ （ 344.24 ± 23.99 ） ms versus （ 311.17 ± 15.65 ） ms] （P〈 0.05）, while the amplitudes were decreased and lower in OSAHS group than that in control group [ （ 3.66 ± 1.49） μV versus （6.26 ± 1.48 ） μV ] （ P 〈 O. 05 ）. There revealed positive correlations between P3 latency and NREM I and II （r=0.492, P〈0.05）, 90%SaO2（r=0.627,P〈0.01）, AHI（r=0.882,P〈0.01）; nega- tive correlation between P3 latency and NREM m and IV （ r = - O. 558, P 〈 0.01 ） , LSaO2 , （ r = - 0. 479, P 〈 0.05 ） , MSaO2 （ r = - 0. 519, P 〈 0.05 ） was shown. There also revealed negative correlation between P3 amplitude and NREM I and 11 （r= -0.491,P〈0.05） , 90% SaO2（r = -0.626,P〈0.01） , AHI（r = -0.866,P〈0.01） , and positive correlation between P3 amplitude and NREM HI and XV （ r = 0. 516, P 〈 0.05 ） , LSaO2 （ r = 0. 475 ,P 〈 0.05 ） ,MSaO2 （ r = 0. 514 ,P 〈 0.05 ）. Stepwise regression and multivariate analysis revealed that AHI was one of the most significant influencing factors for latency and amplitude of P300 （P 〈 0.01 ）. Conclusion The OSAHS pa- tients have cognitive dysfunction as reflected by the abnormalities of event-related potential P300 and the scale of its changes are correlated with the severity of OSAHS. The AHI is the most influential factor of P300.