老年人脑小血管病相关认知障碍与睡眠障碍的相关性研究

Study on the correlation between sleep disturbances and cognitive impairment-associated cerebral small vasculardiseaseinelderlypeople

目的探讨老年脑小血管病相关认知障碍(CSVD-CI)患者睡眠障碍(SD)的临床特点及其相关性。方法横断面研究, 连续纳入2019年12月至2021年12月就诊于天津医科大学第二医院神经内科的老年CSVD-CI患者261例。采用匹兹堡睡眠指数量表(PSQI)评价总体睡眠状况, PSQI≥7分为CSVD-CI伴SD(CSVD-CI-SD)组111例(42.5%), PSQI<7分为CSVD-CI不伴SD(CSVD-CI-NSD)组150例。采用蒙特利尔认知评估(MoCA)量表评价CSVD-CI患者的认知功能, 比较CSVD-CI-SD组与CSVD-CI-NSD组总体认知功能及各认知领域的情况。结果 CSVD-CI-SD组和CSVD-CI-NSD组患者性别、年龄、受教育水平、伴发疾病等比较, 差异无统计学意义(均P>0.05)。CSVD-CI-SD组较CSVD-CI-NSD组患者入睡时间更久、睡眠效率更差、睡眠时间更短、夜间SD更明显、睡眠质量更差、催眠药物使用更多、日间功能障碍更明显(均P<0.05)。与CSVD-CI-NSD组比较, CSVD-CI-SD组患者MoCA量表总评分、注意力、定向评分降低(均P<0.01)。相关性分析结果显示, CSVD-CI-SD组患者MoCA总分、注意力与夜间SD呈负相关(r值分别为-0.198、-0.115, 均P<0.05), 定向与睡眠质量呈负相关(r=-0.170, 均P<0.05)。结论 CSVD-CI患者SD发生率高, MoCA、注意力、定向损害更明显, 且MoCA总评分、注意力与夜间SD呈负相关, 定向与睡眠质量呈负相关。

Objective To investigate the clinical characteristics and correlation of sleep disturbances(SD)with cognitive impairment-associated cerebral small vascular disease(CSVD-CI)in elderly patients.Methods In this cross-sectional study,261 elderly CSVD-CI patients admitted to the Department of Neurology,Second Hospital of Tianjin Medical University between December 2o19 and December 2021 were continuously enrolled.The Pittsburgh Sleep Index Scale(PSQI)was used to evaluate the overall sleep quality.Those with a PSQI score≥7 was assigned to the CSVD-CI with sleep disturbances(CSVD-CI-SD)group,while those with a PSQI score<7 was assigned to the CSVDCI without SD(CSVD-CI-NSD)group.The Montreal Cognitive Assessment(MoCA)was used to evaluate the cognitive function of patients with CSVD-CI,and scores on the overall cognitive function and various cognitive domains were compared between the CSVD-CI-SD group and the CSVD-CI-NSD group.ResultsTThere were no significant differences between the CSVD-CI-SD group and the CSVD-CI-NSD group in sex ratio,age,education level and comorbidities(P>0.05).Compared with the CSVD-CI-NSD group.patients in the CSVD-CI-SD group took longer to fall asleep,had worse sleep efficiency,a shorter sleep duration,more obvious SD at night,worse sleep quality,more use of sleeping drugs,and more obvious daytime dysfunction(all P<0.05).Compared with the CSVD-CI-NSD group.the total MoCA score,attention score and orientation score in the CSVD-CI-SDgroupwere significantly decreased(P<0.O1).Correlation analysis results showed that the total MoCA score and attention in the CSVD-CI-SD group were negatively correlated with SD at night(r=-0.198,r=-0.115,P<0.05 for both),and orientation was negatively correlated with sleep quality(r=-0.170,P<0.05).Conclusions The prevalence of SD is high in CSVD-CI patients,with CSVD-CI-SD patients showing more obvious overall cognitive,attention and orientation impairment in MoCA.Additionally,the total MoCA score and attention are negatively correlated with nighttime SD,and orientation is negatively correlated with sleep quality in CSVD-CI-SD patients.