慢性肾衰竭并发阻塞性睡眠呼吸暂停综合征对认知功能的影响

Influence of chronic renal failure complicating obstructive sleep apnea syndrome on cognitive function

目的评估慢性肾衰竭(CRF)并发阻塞性睡眠呼吸暂停综合征(OSAS)患者的认知功能变化情况。方法选取2013年9月至2015年1月该院非透析CRF住院患者62例,将其分为O组(伴有OSAS组,31例)和N组(不伴有OSAS组,31例),另选取同期行健康体检者33例作为对照组(C组),采用蒙特利尔认知评估量表(MoCA)对所有受试者进行评分,采用多导睡眠初筛仪测试其夜间最低脉搏血氧饱和度(LSpO2)与呼吸暂停低通气指数(AHI),并进行比较分析。结果 O组中MoCA总分小于26分者14例(45.16%),多于N组的3例(9.68%),差异有统计学意义(P<0.05)。O组与N组患者MoCA总分、执行与视空间、注意力、延迟回忆及定向评分均低于C组,O组患者MoCA总分、注意力、延迟回忆评分均低于N组,语言评分低于N组与C组,差异均有统计学意义(P<0.05)。MoCA总分与血清肌酐水平及AHI呈负相关(相关系数r值分别为-0.374、-0.408,P<0.05),与GFR水平及夜间LSpO2呈正相关(相关系数r值分别为0.382、0.519,P<0.05)。结论合并OSAS的CRF患者认知障碍风险增加。

Objective To evaluate the change situation of cognitive function in the patients with chronic renal failure（CRF） complicating obstructive sleep apnea syndrome（OSAS）. Methods Sixty-two inpatients with non-dialysis CRF in our hospital from September 2013 to January 2015 were selected and divided into the group O（eomplicating OSAS,31 cases） and group N（without complicating OSAS,31 cases）,and contemporaneous 33 individuals undergoing the physical examination were taken as the control group（group C）. The cognitive function was evaluated by the Montreal cognitive assessment（MoCA）. The apnea hypopnea index （AHI） and lowest pulse oxygen saturation（LSpO2 ） at night were measured with a portable sleep monitor. The comparative analysis was performed. Results In the group O,there was 14 cases of patients（45.16%） whose MoCA total score was less than 26 points, while there was only 3 cases（9.68 %） in the group N,the difference was statistically significant（P〈0.05）. The MoCA total score, scores of visuospatial and executive function, attention,delayed recall and orientation in the group O and N were lower than those in the group C, while the MoCA total score, attention and delayed recall in he group O were lower than those in the group N, the score of language was lower than that in the group N and C, the differences were statistically significant（P〈0.05）. The MoCA total score was negatively correlated with serum creatinine and AHI（r=- 0. 374, r=- 0. 408,P〈0.05）, and positively correlated with the GFR level and night LSpO2（r= 0. 382, r=0. 519, P〈0.05）. Conclusion The patients with CRF complicating OSAS increase the risk of cognitive impairment.