持续气道正压通气治疗对中重度阻塞性睡眠呼吸暂停低通气综合征患者认知功能的影响

Effect of Continuous Positive Airway Pressure Treament on Cognitive Function in Patients with Moderate to Severe Obstructive Sleep Apnea Hypopnea Syndrome

目的:观察持续气道正压通气(CPAP)治疗对中重度阻塞性睡眠呼吸暂停低通气综合征患者认知功能的影响,并探讨其与生长激素(GH)、胰岛素样生长因子1(IGF-1)的关系。方法:中重度OSAHS患者39例为OSAHS组,根据治疗方法分为CPAP治疗亚组20例和保守治疗亚组19例。另选取同期健康体检者20例为对照组,治疗3月。治疗前后所有受试者经多导睡眠监测(PSG)、认知功能评估、GH/IGF-1水平测定。结果:与对照组相比,OSAHS组的AHI、TS90%、(N1+N2)%明显升高,LSaO2、N3%、REM%、睡眠潜伏期明显降低,MoCA总分、视空间及执行功能、注意力、延迟回忆评分、IGF-1及GH水平明显降低(均P<0.01)。Pearson相关分析显示,OSAHS组的MOCA评分与ESS评分、AHI、(NI+N2)%、TS90%呈负相关,与LSaO2、N3及REM%、IGF-1水平呈正相关。治疗3月后,CPAP亚组与治疗前及保守治疗亚组相比,AHI、TS90%、(N1+N2)%明显降低,LSaO2、N3%、REM%、MoCA总分、视空间及执行功能、注意力、延迟回忆分数、IGF-1及GH水平均明显升高(均P<0.05)。结论:CPAP治疗可改善中重度OSAHS患者的睡眠呼吸参数及认知功能,提高GH、IGF-1水平。

Objective:To observe the effect of continuous positive airway pressure(CPAP)on cognitive function and its relationship with growth hormone(GH)and insulin growth factor-1(IGF-1)in patients with moderate to severe obstructive sleep apnea syndrome(OSAS).Methods:Total 39 patients with moderate or severe OSAHS were assigned to the OSAHS group and further divided them based on treatment type to into the CPAP treatment(20 cases)and conservative treatment(19 cases)subgroups.During the same period,20 healthy physical examinees were recruited to control group.The treatment duration was 3 months.Polysomnography(PSG)data,cognitive function,and GH/IGF-1 level of all subjects were assessed before and after treatment.Results:Compared to the control group,the OSAHS group showed increased AHI,TS90%,and(N1+N2)%;decreased LSaO2,N3%,REM%,and sleep latency;and decreased MOCA total score,visuospatial and executive function,attention,delayed recall score,and IGF-1 and GH levels(all P<0.05).Pearson correlation analysis showed that,for the OSAHA group,MOCA score was negatively correlated with ESS score,AHI,(N1+N2)%,and TS90%and positively correlated with LSaO2,N3,REM ratio,and IGF-1 levels.After 3 months of treatment,the CPAP subgroup showed decreased AHI,TS90%,and(N1+N2)%and increased LSaO2,N3%,REM%,MOCA total score,visuospatial and executive function,attention,delayed recall score,and IGF-1 and GH levels compared to before treatment and to the conservative treatment subgroup after treatment(all P<0.05).Conclusion:CPAP treatment can improve the sleep respiratory parameters and cognitive function of patients with moderate and severe OSAHS and increase the levels of GH and IGF-1.