阻塞性睡眠呼吸暂停低通气综合征对患者认知功能的影响

Effect of obstructive sleep apneahypopnea syndrome on cognitive function of patients

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对患者认知功能的影响。方法采用多导睡眠图及蒙特利等认知量表测试(MoCA)、正序和逆序数字广度(DS)测试、词语流畅性测试、Stroop色词测试、记忆障碍量表(ADS)、ESS嗜睡量表等,对75例OSAHS患者(OSAHS组)和33例同期健康体检者(对照组)进行睡眠监测和认知功能比较。以MoCA≥26分为认知功能正常,比较MoCA≥26分和MoCA<26分的测试者在病程、BMI、睡眠呼吸暂停低通气指数(AHI)、氧减指数、最长呼吸暂停时间、最低血氧饱和度(SaO2)和平均SaO2方面的差异,并分析认知障碍的影响因素。结果与对照组比较,OSAHS组S1、S2浅睡眠时间延长、S3+4深睡眠和快速动眼睡眠期(REM)睡眠时间缩短(P<0.01),AHI、氧减指数、平均SaO2、最低SaO2、最长呼吸暂停时间比较差异均有统计学意义(P<0.01)。OSAHS组的MoCA、DS、词语流畅性测试、ADS、ESS嗜睡量表得分与对照组相比差异均有统计学意义(P<0.05)。在MoCA量表各项指标比较中,OSAHS组在注意力方面差异有统计学意义(P<0.05)。认知功能正常患者与认知功能障碍患者的AHI、氧减指数、最长呼吸暂停时间、最低SaO2和平均SaO2比较差异有统计学意义(P<0.05)。Logistic回归分析显示,认知功能障碍与最低SaO2和最长呼吸暂停时间呈正相关(r=0.084、0.044,P=0.046、0.009)。结论夜间低氧和睡眠结构紊乱可能是引起OSAHS患者认知功能障碍的主要因素,最低SaO2与认知功能障碍密切相关。

Objective To explore the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on patients′ cognitive function.Methods A total of 75 patients with OSAHS (the OSAHS group) and 33 healthy people (the control group) were tested for sleep monitoring and cognitive function by polysomnography and Montreal Cognitive Assessment (MoCA),positive and reverse digital span (DS) test,verbal fluency test,Stroop color-word test,memory disorder scale (ADS) and ESS sleepiness scale.MoCA≥26 scores was considered as normal cognitive function.The differences in duration,BMI,sleep apnea hypopnea index (AHI),oxygen subtraction index,maximum apnea hypopnea time,minimum blood oxygen saturation (SaO 2) and average SaO 2 were compared between the people in the MoCA ≥26 scores group and the MoCA<26 scores group,and the influencing factors of cognitive impairment were analyzed.Results Compared with the control group,the sleep time of light sleep S1 and S2 in the OSAHS group was longer,and the sleep time of deep sleep S3+4 and rapid eye movement(REM) was shorter ( P <0.01).There were significant differences in AHI,oxygen subtraction index,maximum apnea hypopnea time,minimum SaO 2 and average SaO 2 between the two groups ( P <0.05).MoCA,DS,verbal fluency test,ADS and ESS sleepiness scale scores in the OSAHS group were significantly different from those in the control group ( P <0.05).In the comparison of MoCA scale indexes,the OSAHS group showed statistically significant differences in attention ( P <0.05).The AHI,oxygen subtraction index,maximum apnea hypopnea time,minimum SaO 2 and average SaO 2 showed statistically significant differences between the patients with normal cognitive function and the patients with cognitive dysfunction ( P <0.05).Logistic regression analysis showed that cognitive dysfunction was positively correlated with minimum SaO 2 and maximum apnea hypopnea time ( r =0.084 and 0.044,P =0.046 and 0.009).Conclusion Nocturnal hypoxia and sleep disorder may be the main factors causing cognitive impairment in OSAHS patients,especially the minimum SaO 2 is closely related to cognitive impairment.