日间过度嗜睡和主观睡眠质量下降对老年阻塞性睡眠呼吸暂停低通气综合征患者神经心理特征的影响

Effect of excessive daytime sleepiness and subjective sleep quality decline on neuropsychological characteristics in elderly patients with obstructive sleep apnea hypopnea syndrome

目的 分析日间过度嗜睡(EDS)和主观睡眠质量下降对老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者神经心理特征的影响。方法 经多导睡眠监测诊断为OSAHS的老年患者203例,根据爱泼沃斯嗜睡量表(ESS)评分将患者分为EDS组(有EDS且ESS评分>9分,70例)和非EDS组(无EDS且ESS评分≤9分,133例)。收集患者的临床资料,采用匹兹堡睡眠质量指数(PSQI)评定患者睡眠质量,采用失眠严重程度指数量表(ISI)评估失眠的严重程度,采用蒙特利尔认知评估量表(MoCA)评估神经认知功能的变化,采用焦虑自评量表(SAS)和贝克抑郁自评量表(BDI)分别评价患者焦虑和抑郁情绪状态。分析老年OSAHS患者MoCA评分、SAS评分和BDI评分的影响因素。结果 与非EDS组比较,EDS组睡眠中憋醒和睡眠间断评分、PSQI评分、ISI评分、SAS评分和BDI评分较高,MoCA评分较低(P<0.05)。与非EDS组比较,EDS组微觉醒指数(MAI)较高,夜间最低血氧饱和度(LSaO;)较低(P<0.01)。高ESS评分、高PSQI评分、高MAI及高ISI评分是老年OSAHS患者MoCA评分<26分的独立危险因素(P<0.01);高ESS评分、高PSQI评分及高ISI评分是老年OSAHS患者SAS评分>50分的独立危险因素(P<0.01);高ESS评分、高PSQI评分和高ISI评分是老年OSAHS患者BDI评分>20分的独立危险因素(P<0.01);而高夜间LSaO;是老年OSAHS患者MoCA评分<26分及BDI评分>20分的保护性因素(P<0.01)。结论 EDS和主观睡眠质量下降不仅会损害老年OSAHS患者的认知功能,还会加重老年患者的焦虑和抑郁情绪,且彼此相互影响。

Objective To investigate the effect of excessive daytime sleepiness(EDS) and subjective sleep quality decline on the neuropsychological characteristics in elderly patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods According to Epworth sleepiness scale(ESS) score, 203 elderly patients with OSAHS diagnosed by polysomnography were divided into two groups of A(with EDS,ESS score>9 points, 70 cases) and B(without EDS,ESS score≤9 points, 133 cases).The clinical data were collected.The sleep quality was assessed by Pittsburgh sleep quality index(PSQI).The severity of insomnia was evaluated by insomnia severity index(ISI).The change of neurocognitive function was analyzed by Montreal cognitive assessment(MoCA).The anxiety and depression emotional state were evaluated by self-rating anxiety scale(SAS) and Beck depression inventory(BDI).The influencing factors for MoCA score, SAS score and BDI score in elderly patients with OSAHS were analyzed.Results Compared to group B,the sleep suppression and sleep interruption score, PSQI score, ISI score, SAS score and BDI score were higher and MoCA score was lower in group A(P<0.05).The microarousal index(MAI) was higher and minimum oxygen saturation(LSaO;) at night was lower in group A than those in group B(P<0.01).The higher ESS score, PSQI score, MAI score and ISI score were the independent risk factors for MoCA score <26 points in elderly patients with OSAHS(P<0.01).The higher ESS score, PSQI score and ISI score were the independent risk factors for SAS score >50 points in elderly patients with OSAHS(P<0.01).The higher ESS score, PSQI score and ISI score were the independent risk factors for BDI score >20 points(P<0.01).The higher LSaO;at night was the protective factor for MoCA score <26 points and BDI score >20 points in elderly patients with OSAHS(P<0.01).Conclusion EDS and subjective sleep quality decline not only damage the cognitive function in elderly OSAHS patients, but also aggravate the anxiety and depression.EDS and subjective sleep quality decline effect with each other.