脑小血管病患者睡眠与认知功能相关性研究

Study on correlation between sleep and cognitive function in patients with cerebral small vessel disease

目的探究脑小血管病(CSVD)患者睡眠质量及其与认知功能的关系。方法使用匹兹堡睡眠质量指数量表(PSQI)、蒙特利尔认知评估量表(MoCA)和中国CSVD临床评估研究成套神经心理学量表评估33例CSVD患者和30名正常对照者的一般睡眠质量、总体认知功能及各单项认知功能。结果CSVD组在日间功能得分上显著高于正常对照组[(1.42±1.56)VS.(0.77±0.90),P<0.05],在MoCA[(22.38±3.64)VS.(25.20±2.73,P<0.05]、中文听觉词语学习测试[即刻:(6.52±2.16)VS.(10.27±2.68),P<0.001;延迟:(5.90±2.54)VS.(10.47±2.19),P<0.001]、数字广度[正背:(6.41±1.46)VS.(7.24±1.68),P<0.05;倒背:(4.03±1.26)VS.(4.86±1.55),P<0.05]得分上显著低于正常对照组,彩色数字连线试验(CTT)[CTT-A:(83.79±28.13)VS.(58.16±16.37),P<0.001;CTT-B:(159.35±57.04)VS.(110.71±39.22),P<0.001]和Stroop色词测验[点:(27.99±15.69)VS.(21.74±5.61),P<0.05]完成时间显著长于正常对照组;在校正年龄、性别、教育程度、卒中史、吸烟史、饮酒史、高血压病史、糖尿病病史后,多元线性回归分析提示CSVD组PSQI总得分与CTT-A(β=3.62,95%CI:1.20~6.05)、CTT-B(β=5.35,95%CI:-0.63~11.34)均存在显著相关性,而正常对照组不存在此种相关(CTT-A:β=-0.27,95%CI:-1.71~1.18;CTT-B:β=-1.36,95%CI:-4.63~1.91;交互作用均P<0.05);进一步分析发现CSVD组日间功能障碍与多项认知存在相关性(均P<0.05),而在正常对照组不存在相关性。结论日间功能受损可能是CSVD患者睡眠功能受损的原因,并与认知功能存在一定相关。

Objective To explore the correlation between sleep quality and cognitive function in patients with cerebral small vessel disease ( CSVD).Methods The neuropsychological scales which include pittsburgh sleep quality index ( PSQI),Montreal cognitive assessment scale ( MoCA) and a neuropsychological battery designed for Chinese cerebral small vessel disease clinical evalution were used to evaluate the general sleep quality,global cognitive function and each individual cognitive function of 33 CSVD patients and 30 normal controls.Results The score of CSVD patients group in daytime function were higher than normal controls group [( 1.42 ± 1.56) VS.( 0.77 ± 0.90),P < 0. 05],and the scores of CSVD patients group in MoCA [( 22.38 ± 3. 64) VS.( 25.20 ± 2.73, P < 0. 05],Chinese Auditory Verbal Learning Test[immediate:( 6.52 ± 2.16) VS.( 10.27 ± 2. 68),P < 0. 001;delay:( 5.90 ± 2.54) VS.( 10.47 ± 2. 19),P < 0. 001]and Digital Span [forward:( 6.41 ± 1.46) VS.( 7.24 ± 1. 68),P < 0. 05;backward:( 4.03 ± 1.26) VS.( 4. 86 ± 1. 55),P < 0. 05]were significantly lower than the scores of normal controls,and the completion time of color trail test ( CTT)[CTT-A:( 83.79 ± 28.13) VS.( 58.16 ± 16.37),P < 0. 001;CTT-B:( 159.35 ± 57.04) VS.( 110.71 ± 39.22),P < 0. 001]and Stroop's Color Word Test [dot:( 27.99 ± 15.69) VS.( 21.74 ± 5. 61),P < 0. 05]were significantly longer than that of the normal control group.After adjusting for age,gender,education level,history of stroke,smoking,drinking,high blood pressure and diabetes,multiple linear regression analysis suggested that the PSQI total score of CSVD patients group was correlated with both CTT-A(β= 3. 62,95% CI: 1.20 - 6.05) and CTT-B(β= 5.35,95% CI:- 0.63 - 11.34), while this correlation was not found in normal controls group ( CTT-A:β=- 0.27,95%CI:- 1.71 - 1.18;CTT-B:β=- 1.36,95%CI:- 4.63 - 1. 91;interaction all P < 0. 05).Further analysis found that CSVD patients group's daytime function was significantly correlated with several cognitive functions ( all P < 0. 05 ),but there is no correlation in the normal controls group.Conclusion Impaired daytime function may be the cause of impaired sleep function in CSVD patients,and is related to cognitive function to some degree.