阻塞性睡眠呼吸暂停综合征患者的脑结构网络改变及其与认知障碍的相关性研究

Structural Network Changes in Patients with Obstructive Sleep Apnea and Their Association with Cognitive Impairment

目的 探究阻塞性睡眠呼吸暂停综合征(OSA)患者的结构网络改变及其与认知障碍的相关性。方法 搜集20例OSA患者以及22名与之年龄、性别相匹配的健康对照者作为研究对象。采用睡眠呼吸紊乱指数(AHI)和血氧饱和度≤90%时间占总监测时间的百分比(SIT90)评估受试者的睡眠情况。采用中文版简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)以及听觉词语学习测试(AVLT)评估受试者的认知状况。基于Pearson相关分析探究受试者的脑结构网络改变与认知和睡眠质量的关联。基于Logistic回归模型探究脑结构网络属性对OSA的鉴别效能。结果 与健康对照者相比,OSA患者表现出富人俱乐部、全局效率、局部效率以及相应节点效率降低(均P<0.05)。相关分析显示OSA患者富人俱乐部连接强度与其MMSE评分(r=0.589,P=0.006)、AVLT延迟评分(r=0.543,P=0.013)以及AHI评分显著相关(r=-0.483,P=0.031)。Logistic回归模型显示富人俱乐部连接对于OSA具有良好的鉴别效能(OR=0.59,敏感度80%,特异度86.4%,AUC=0.893,P<0.001)。结论 OSA患者未治疗前已经存在特征性结构网络改变,其中富人俱乐部连接与其认知和睡眠状况紧密相关,该指标有望成为新的疾病标志物和临床早期干预靶点。

Objective To investigate the structural network alterations and their correlation with cognitive impairment in patients with obstructive sleep apnea(OSA)syndrome.Methods Twenty patients with OSA and 22 age⁃and gender⁃matched healthy controls were collected as study subjects.Apnea⁃hypopnea index(AHI)and saturation impair time below 90%during total sleep(SIT90)were used to assess the subjects'sleep.Mini mental state examination(MMSE),montreal cognitive assessment(MoCA),and auditory verbal learning test(AVLT)were used to assess the subjects'cognitive status.Pearson's correlation analysis was used to investigate the associations between alterations in brain structural networks and cognition and sleep quality.Logistic regression was used to investigate the efficacy of brain structural network properties in i⁃dentifying OSA.Results Compared with healthy controls,OSA patients exhibited reduced rich⁃club connections,global efficiency,local efficiency,and nodal efficiency(all P<0.05).Correlation analysis showed that the rich⁃club connections of OSA patients was significantly correlated with MMSE score(r=0.589,P=0.006),AVLT latency score(r=0.543,P=0.013),and AHI score(r=-0.483,P=0.031).Logistic regression showed that rich⁃club connections had good discrimi⁃native efficacy(OR=0.031)in OSA(OR=0.59,sensitivity=80%,specificity=86.4%,AUC=0.893,P<0.001).Conclusion OSA patients have characteristic structural network changes before treatment,and the rich⁃club connection are closely related to their cognitive and sleep status,which is expected to become a new disease marker and a target for early clinical intervention.