失眠合并OSAS与急性脑梗死患者认知功能障碍的相关性研究

Study on the correlation between insomnia combined with OSAS and cognitive dysfunction in patients with acute cerebral infarction

目的探讨失眠合并阻塞性睡眠呼吸暂停综合征(OSAHS)与急性脑梗死患者认知功能障碍的相关性。方法选择急性脑梗死患者200例为研究对象,按照是否伴有失眠合并OSAHS分为单纯脑梗组和脑梗伴失眠及OSAHS组,比较2组一般资料(性别、年龄、NIHSS评分、吸烟史和饮酒史及伴随糖尿病、高血压、高血脂症比例)、蒙特利尔认知评估量表(MoCA)评分、事件相关电位P300、多导睡眠监测(PSG)参数,采用Pearson相关性分析P300、睡眠参数与MoCA量表总分的相关性,并采用多元Logistic回归方程分析患者认知功能障碍的相关因素。结果2组性别、年龄、NIHSS评分、吸烟史和饮酒史及伴随糖尿病、高血压、高血脂症比例比较差异均无统计学意义(P均>0.05);脑梗伴失眠及OSAHS组MoCA量表总分及命名能力、视空间和执行能力、注意力、延迟记忆、语言、注意力、定向力、抽象各维度评分均明显低于单纯脑梗组(P均<0.05);脑梗伴失眠及OSAHS组P300潜伏期较单纯脑梗组显著延长(P<0.05),而P300波幅较单纯脑梗组显著降低(P<0.05);脑梗伴失眠及OSAHS组总睡眠时间、睡眠效率、微觉醒指数、快速眼动睡眠(REM)比例、非快速眼动睡眠(NREM)Ⅲ期比例、最低血氧饱和度[S a(O 2)]、平均S a(O 2)均短于或低于单纯脑梗组(P均<0.05),入睡潜伏期、睡后觉醒时间、NREMⅠ期比例、NREMⅡ期比例、睡眠呼吸暂停低通气指数(AHI)均长于或高于单纯脑梗组(P均<0.05)。Pearson相关性分析显示,MoCA量表总评分与P300潜伏期、入睡潜伏期、睡后觉醒时间、NREMⅠ期比例、NREMⅡ期比例、AHI呈负相关(P<0.05),而与P300波幅、总睡眠时间、睡眠效率、微觉醒指数、REM期比例、NREMⅢ期比例、平均S a(O 2)、最低S a(O 2)呈正相关(P<0.05);多元Logistic回归方程分析显示,合并失眠和OSAHS是急性脑梗死患者认知功能障碍独立危险因素[OR=2.014,95%CI(1.320,3.540),P<0.05]。结论失眠合并OSAHS可能是急性脑梗死患者发生认知功能障碍的独立危险因素,且P300、睡眠连续性破坏与睡眠片段化、睡眠效率低下、机体缺氧状态与认知功能受损密切相关。

Objective It is to investigate the relationship between insomnia combined with obstructive sleep apnea syndrome(OSAHS) and cognitive dysfunction in patients with acute cerebral infarction. Methods A total of 200 patients with acute cerebral infarction were enrolled and divided into simple cerebral infarction group(group Ⅰ) and cerebral infarction with insomnia and OSAHS group(group Ⅱ) according to whether they complicated with insomnia combined with OSAHS. The general data(sex, age, NIHSS score, smoking history and drinking history and the proportion of diabetes, hypertension, hyperlipidemia), Montreal Cognitive Assessment Scale(MoCA) score, event-related potential P300, polysomnography(PSG) parameters were compared between the two groups. Pearson correlation analysis was used to analyzed the relationship between P300, sleep parameters and the total scores of the MoCA scale, and the multivariate logistic regression equation was used to analyze the factors related to cognitive dysfunction in these patients. Results There was no significant difference in gender, age, NIHSS score, smoking history, drinking history and the proportion of diabetes, hypertension and hyperlipidemia between the two groups(P>0.05). The total scores and scores of naming ability, visual space and executive ability, attention, delayed memory, language, attention, orientation, and abstract dimensions of MoCA scale of group Ⅱ were significantly lower than those of group Ⅰ(P<0.05). The latency of P300 was significantly longer while the amplitude of P300 was significantly lower in group Ⅱ than that of group Ⅰ(P<0.05). The total sleep time, sleep efficiency, arousal index, proportion of rapid eye movement sleep(REM), proportion of non-rapid eye movement sleep(NREM) at stage Ⅲ, minimum Sa(O2), mean Sa(O2) in group Ⅱ were lower or shorter while sleep latency, sleep awakening time, proportion of NREMI at stage Ⅰ and stage Ⅱ, apnea hypopnea index(AHI) were higher or longer than those of group Ⅰ(P<0.05). Pearson correlation analysis showed that the total score of MoCA scale was negatively correlated with P300 latency, sleep latency, sleep awakening time, proportion of NREMI at stage Ⅰ and stage Ⅱ, AHI(P<0.05), and were positively correlated with P300 amplitude, total sleep time, sleep efficiency, arousal index, REM phase ratio, proportion of NREM at stage Ⅲ, mean Sa(O2), and minimum Sa(O2)(P<0.05). Multivariate logistic regression equation analysis showed that insomnia with OSAHS is an independent risk factor of cognitive dysfunction in patients with acute cerebral infarction [OR=2.014, 95% CI(1.320, 3.540), P<0.05]. Conclusion Insomnia combined with OSAHS may be an independent risk factor for cognitive dysfunction in patients with acute cerebral infarction, and P300, sleep continuity destruction and sleep fragmentation, low sleep efficiency, and hypoxia are closely related to cognitive impairment.