持续气道正压通气对早期阿尔茨海默病合并阻塞性睡眠呼吸暂停低通气综合征患者的睡眠障碍及神经心理状况的影响

Effect of continuous positive airway pressure on sleep disorder and neuropsychological characteristics in patients with early Alzheimer’s disease combined with obstructive sleep apnea hypopnea syndrome

目的探讨持续气道正压通气(CPAP)对早期阿尔茨海默病(AD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的睡眠障碍及神经心理的影响。方法纳入2019年5月至2020年12月诊断的早期AD合并OSAHS患者42例,随机分为CPAP联合治疗组(20例)和单纯药物治疗组(22例)。采用蒙特利尔认知功能评分量表(MoCA)、简易精神状态量表(MMSE)和霍普金斯词语学习测验(HVLT)评估神经认知功能变化;9条目患者健康问卷(PHQ9)评估抑郁情绪状态;多导睡眠图评价睡眠特征和呼吸参数;Epworth嗜睡量表(ESS)和匹茨堡睡眠质量指数(PSQI)评估患者的主观睡眠状况。分别比较使用CPAP治疗3个月后CPAP联合治疗组自身及其与单纯药物治疗组两组间的睡眠状况、认知功能及情绪的变化情况。结果治疗3个月后,CPAP联合治疗组的ESS、PSQI和PHQ9评分较治疗前明显降低,MoCA、MMSE、HVLT(总分和延迟回忆)较治疗前明显增高(均P<0.05),呼吸暂停低通气指数较治疗前明显降低(P<0.05),最低血氧饱和度明显升高(P<0.05),治疗前后的睡眠结构参数的差异无统计学意义(P>0.05)。治疗3个月后,CPAP联合治疗组患者的ESS、PSQI和PHQ9评分较单纯药物治疗组明显降低(均P<0.05),而两组认知评分差异无统计学意义(P>0.05)。结论CPAP连续治疗3个月可显著缓解早期AD合并OSAHS患者的低通气和缺氧程度,改善日间嗜睡及抑郁状态,认知功能有明显改善,而睡眠结构紊乱无明显变化。

Objective To investigate the effect of continuous positive airway pressure(CPAP)on sleep disorder and neuropsychological characteristics in patients with early Alzheimer’s disease(AD)combined with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods A total of forty-two early AD patients with OSAHS were randomly divided into a CPAP combined treatment group(20 cases)and a simple medicine treatment group(22 cases).The changes of neurocognitive function were assessed by Montreal Cognitive Assessment(MoCA),Mini-mental State Examination(MMSE)and Hopkins Verbal Learning Test-revised(HVLT).Patient Health Questionnaire-9(PHQ9)was used to evaluate the depression mood changes.The sleep characteristics and respiratory parameters were evaluated by polysomnography.The changes of the patients’sleep status were assessed by Epworth Sleepiness Scale(ESS)and Pittsburgh Sleep Quality Index(PSQI).The changes of sleep status,cognitive function and mood in the CPAP combined treatment group were compared before and three months after CPAP treatment,and with the simple medicine treatment group.Results After three months of CPAP treatment,the ESS,PSQI and PHQ9 scores in the CPAP combined treatment group were significantly decreased compared with those before treatment,whereas MoCA,MMSE and HVLT(total scores and recall)in the CPAP combined treatment group were increased compared with those before treatment(P<0.05).After CPAP treatment,the respiratory parameters apnea hypopnea index in the CPAP combined treatment group was significantly lower than that before treatment(P<0.05),and the minimum blood oxygen saturation was significantly higher than that before treatment(P<0.05).However,the sleep characteristics and parameters did not show statistically significant changes compared with those before treatment(P>0.05).The ESS,PSQI and PHQ9 scores were significantly reduced in the CPAP combined treatment group compared with the simple medicine treatment group(P<0.05),while there was no statistically significant changes of cognitive scores between the two groups(P>0.05).Conclusions The degree of low ventilation and hypoxia is alleviated,and the daytime sleepiness and depression is improved in early AD patients with OSAHS after three-month continuous CPAP treatment.Cognitive function is significantly improved,whereas there is no significant change in sleep structure disorder.