阻塞性睡眠呼吸暂停对急性脑梗死患者认知功能的影响

The effect of obstructive sleep apnea on cognitive function in patients with acute cerebral infarction

目的探讨阻塞性睡眠呼吸暂停(OAS)对急性缺血性脑梗死患者认知功能的影响,为早期防治OSA提供依据。方法收集2019年1月至12月缺血性脑梗死患者167例。通过多导睡眠监测(PSG)评估睡眠呼吸暂停,采用呼吸暂停-低通气指数(AHI)评估OSA严重程度。采用美国国立卫生研究院卒中量表(NIHSS)评价患者的神经系统功能,采用简易智力状态检查(MMSE)和蒙特利尔认知评估量表(MoCA)评估认知功能。结果167例急性缺血性脑梗死患者中,符合中重度OSA组(AHI≥15)标准50例,非中重度OSA组(AHI<15)117例。中重度OSA组患者高血压比例、NIHSS分值均明显高于非中重度OSA组。广义线性模型回归分析提示,中重度OSA组患者认知功能比非中重度OSA患者差,表现为MMSE[-2.89(-4.17,-1.61),P<0.001]和MoCA[-3.16(-4.62,-1.70),P<0.001]总分明显下降;中重度OSA组患者定向力、注意力、计算力、视空间与执行能力、语言功能、延迟回忆等均明显比非中重度组差。上述结果调整了高血压和NIHSS的影响。结论OSA是急性缺血性脑梗死患者认知功能障碍的独立危险因素;OSA早期诊治是改善急性缺血性脑梗死患者认知功能的有效方法。

Objective To explore the specific effect of obstructive sleep apnea(OSA)on the cognitive function of patients with acute cerebral infarction.Methods A total of 167 patients with ischemic stroke were enrolled from Department of Neurology,Sir Run Run Show Hospital,Zhejiang University School of Medicine from January 2018 to June 2019.OSA was diagnosed by polysomnography(PSG)and its severity was assessed using the apnea-hypopnea index(AHI).The National Institute of Health Stroke Scale(NIHSS)was used to evaluate patients'nervous system function.The Mini-mental State Examination(MMSE)and the Montreal Cognitive Assessment(MoCA)were used to assess cognitive function.Results Of the 167 patients with acute ischemic stroke,50 had moderate to severe OSA(AHI≥15)criteria and 117 had non-moderate and severe OSA(AHI<15).The proportion of hypertension and NIHSS scores in patients with moderate to severe OSA were significantly higher than those in non-moderate and severe OSA groups.Generalized linear regression analysis showed that patients with moderate to severe OSA had significantly worse cognitive function than patients with nonmoderate and severe OSA,with MMSE total score[-2.89(-4.17,-1.61),P<0.001]and MoCA[(-3.16(-4.62,-1.70),P<0.001]decreased significantly.The orientation,attention,computational power,visual space and executive ability,language aspect,and delayed recall of patients with moderate to severe OSA were significantly worse than those of the non-moderate and severe groups.The above results adjusted the effects of hypertension and NIHSS.Conclusion OSA is an independent risk factor for cognitive dysfunction in patients with acute ischemic cerebral infarction early diagnosis and treatment of OSA is an effective method to improve cognitive function in patients with acute ischemic cerebral infarction.