失眠伴阻塞性睡眠呼吸暂停患者睡眠监测指标和脑电功率频谱与认知功能损害的相关性

Correlations between sleep monitoring indicators and EEG power spectra and cognitive impairment in patients with insomnia and obstructive sleep apnea

目的 探讨失眠伴阻塞性睡眠呼吸暂停(OSA)患者睡眠监测指标和脑电功率频谱与认知功能损害的相关性。方法 收集失眠患者74例,根据是否合并OSA将患者分为失眠组和失眠伴OSA组。采用多导睡眠监测仪监测两组睡眠指标,使用脑电功率频谱分析软件分析睡眠脑电功率频谱;采用蒙特利尔认知评估量表(MoCA)、记忆与执行筛查量表(MES)评估认知功能;采用Pearson相关法分析失眠伴OSA患者睡眠指标、脑电功率频谱与认知功能的相关性。结果 与失眠组比较,失眠伴OSA组睡眠呼吸暂停低通气指数(AHI)、氧减指数(ODI)升高,最低氧饱和度(LSPO_(2))降低,总睡眠时间(TST)及NREM2期睡眠减少(P<0.05或<0.01)。与失眠组比较,失眠伴OSA组清醒期beta、delta脑电功率频谱降低;NREM1期delta脑电功率频谱升高;NREM2期delta、beta脑电功率频谱升高,theta、sigma脑电功率频谱降低;REM期delta、beta、sigma脑电功率频谱升高(P<0.05或<0.01)。失眠伴OSA组MES总分、MoCA总分及其视空间与执行、抽象、延迟回忆等子项目评分低于失眠组(P<0.05或<0.01)。REM期睡眠与MoCA中延迟回忆评分呈正相关(r=0.331,P<0.05),NREM2期睡眠与MES总分呈正相关(r=0.352,P<0.01),AHI与MES总分呈负相关(r=-0.335,P<0.05),入睡后觉醒时间与MoCA中命名、定向评分呈正相关(r=0.445,P<0.05;r=0.452,P<0.05),入睡潜伏期和AHI与MoCA中命名评分呈负相关(r=-0.415,P<0.05;r=-0.360,P<0.05)。NREM2期theta脑电功率频谱与MES总分呈正相关(r=0.334,P<0.05),NREM1期alpha脑电功率频谱与MoCA中注意评分呈负相关(r=-0.679,P<0.05),NREM1期beta脑电功率频谱与MoCA中抽象评分呈负相关(r=-0.585,P<0.05)。结论 失眠伴OSA患者的睡眠监测指标和脑电功率频谱表现为NREM2期睡眠减少,睡眠中与缺氧相关的指标增加,NREM2期theta脑电功率频谱减少,NREM1期theta、alpha脑电功率频谱减少,这种睡眠的改变可损害其认知功能。

Objective To investigate the correlations between sleep monitoring indicators and electroencephalographic(EEG)power spectra and cognitive impairment in patients with insomnia and obstructive sleep apnea.Methods Seventy-four cases of insomnia patients were collected,and the patients were divided into the insomnia group and insomnia with OSA group according to whether they had OSA or not.Polysomnography was used to monitor the sleep indicators of the two groups,and sleep EEG power spectrum was analyzed by sleep EEG processing software.Cognitive function was assessed using the Montreal Cognitive Assessment Scale,and the Memory and Executive Screening Scale(MES).Pearson's correlation was used to analyze the correlations between sleep indicators and EEG power spectra and cognitive impairment in patients with insomnia and OSA.Results Compared with the insomnia group,the insomnia with OSA group had elevated AHI and ODI,decreased LSPO_(2),and reduced total sleep time(TST)and sleep in the NREM2 period(P<0.05 or P<0.01).Compared with the insomnia group,the insomnia with OSA group had reduced beta and delta EEG power spectra in the wakefulness period;had increased delta EEG power spectra in the NREM1 period;increased delta and beta EEG power spectra,and reduced theta and sigma EEG power spectra in the NREM2 period;and increased delta,beta,and sigma EEG power spectra in the REM period(P<0.05 or P<0.01).The MES total score,MoCA total score,and MoCA subfactors including overall cognitive function,visuospatial and executive,abstraction,delayed recall,and MES total score were lower in the insomnia with OSA group than in the insomnia group(P<0.05 or P<0.01).REM stage sleep was positively correlated with delayed recall(r=0.331,P<0.05),the sleep in the NREM2 period was positively correlated with total MES score(r=0.352,P<0.01),AHI was negatively correlated with total MES score(r=–0.335,P<0.05),WASO was positively correlated with naming function and orientation(r=0.445,P<0.05;r=0.452,P<0.05),and sleep latency and AHI were negatively correlated with naming function(r=–0.415,P<0.05;r=–0.360,P<0.05).The theta EEG power spectra in the NREM2 period were positively correlated with total MES score(r=0.334,P<0.05),alpha EEG power spectra in the NREM1 period were negatively correlated with MoCA attention scores(r=–0.679,P<0.05),and beta EEG power spectra in the NREM1 period were negatively correlated with MoCA abstraction score(r=–0.585,P<0.05).Conclusion Sleep monitoring indicators and EEG power spectra in insomnia with OSA patients showed decreased sleep in NREM2 stage,increased hypoxia-related indices in sleep,decreased theta power spectra in NREM2 period,and decreased theta,alpha power spectra in NREM1 period,and this alteration of the sleep structure damaged their level of cognitive function.