神经心理量表联合事件相关电位对中、重度阻塞性睡眠呼吸暂停低通气综合征患者轻度认知功能障碍的评价

The evaluation on mild cognitive impairment in patients with moderate-severe obstructive sleep apnea and hypopnea syndrome using neuropsychological scales and event related potential

目的通过神经心理量表和事件相关电位中的P300检测评价中、重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的轻度认知功能障碍(MCI)。方法对多导睡眠呼吸监测(PSG)确诊的中重度OSAHS患者30例(患者组)、志愿者20例(对照组),分别以蒙特利尔认知评估量表(Mo CA)评分判断参加者是否存在MCI,并行Epworth嗜睡量表(ESS)和事件相关电位中的P300检测,PSG检查记录呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(LSa O2)、夜间平均血氧饱和度(MSa O2)和血氧饱和度低于90%的时间占整个睡眠时间的百分比(CT90%)、氧减指数(ODI)、呼吸性微觉醒指数(RMI)和睡眠结构。分别比较患者组与对照组的各项指标,相关分析Mo CA评分与各项指标和P300相关参数的相关性。结果与对照组比较,中、重度OSAHS患者年龄和受教育年限差异无统计学意义,BMI和ESS评分明显增加,Mo CA总评分明显降低,M o CA亚项分析中记忆/延迟回忆评分明显降低,AHI明显增加,LSa O2和MSa O2明显降低,CT90%增加,ODI和RMI指数明显增加,浅睡眠(S1、S2期)延长、深睡眠(S3、S4期)及快动眼睡眠期(REM)减少;在P300检测中,Cz、C3、C4、Pz点P300潜伏期明显延长,直线相关分析Mo CA亚项中记忆/延迟回忆评分与ESS、AHI、MSa O2、Cz、C3、C4点潜伏期无相关性,与LSa O2正相关,与RMI、ODI、CT90%与Pz点潜伏期和Fz点波幅负相关,Pz点P300潜伏期及Fz点P300波幅对Mo CA评分影响较大。结论中、重度OSAHS患者存在MCI,OSAHS患者的记忆功能变化是由夜间微觉醒所致。P300检测可作为评价OSAHS患者认知功能障碍的电生理指标之一,结合M o CA评分能对OSAHS患者认知能力及时测评。

Objective To investigate the mild cognitive impairment measured by necropsy ecological scales and the P300 of ERP in the patients with moderate-severe obstructive sleep apnea and hypopnea syndrome（ OSAHS）. Methods A total of 30 patients（ patients group） who were monitored by Polysomnography（ PSG） and 20 volunteers（ controls groups） were enrolled,the 30 patients were carried out to determine whether the participants have mild Cognitive Impairment（ MCI） by Montréal cognitive assessment scale（ MoCA）.Parallel Epworth sleepiness scale（ ESS） and P300.All of them were monitored for apnea/hyponea index（ AHI） 、lowest oxygen saturation（ LSaO2） 、mean oxygen saturation（ MSaO2） during sleep and the total sleep time of SaO2 90%（ CT90）,the oxygen saturation index（ ODI） 、the respiratory micro arousal（ RMI） and sleep structure. And compare the parameter one by one.Compare the various indicators and correlation the MoCA score,P300 parameters and the PSG parameters. Results Compared with the control group,the moderate-severe OSAHS patients,there was no significant statistically different in age and educational level.The BMI and ESS increased, the score of MoCA in OSAHS group strikingly lower than that of the control group,the MoCA analysis showed that memory/delayed recall score was significantly decreased,the AHI increased.the score of LSaO_2 and MSaO_2 decreased,CT90% increased,ODI and RMI increased significantly,the S1 and S2 prolonged,the S3、S4 and REM shortened,the Cz,C3,C4,Pz P300 latency was significantly prolonged in P300. Correlation analysis showed that the MoCA memory/delayed not associated with ESS,AHI,MSaO_2,CT90%,Cz,C3,C4,and was positively related to LSaO_2,and was negatively the RMI,ODI,CT90%,the latent period of Pz,the amplitude of Fz,Pz P300 latency and Fz P300 amplitude had significant influence on the Mo-CA. Conclusion Moderate-severe OSAHS patients existing MCI,the memory function of patients with OSAHS was significantly associated with the RMI which caused by the sleep structure disorder,P300 detection can be used as electric physiological indicator of cognitive dysfunction in OSAHS patients,combined the MoCA score can promptly evaluate the cognitive dysfunction in OSAHS patients,and promptly make a diagnosis and give treatment according to the evaluation result.