不同年龄阻塞性睡眠呼吸暂停患者睡眠结构参数差异及其与日间脑功能状态的关系

Differences in sleep structural parameters and their relationship with daytime brain function in patients with obstructive sleep apnea at different ages

目的探讨不同年龄阻塞性睡眠呼吸暂停(OSA)患者睡眠结构参数差异及其与日间脑功能状态的关系。方法选择2019年4月~2022年5月首都医科大学附属北京积水潭医院收治的200例OSA患者为研究对象,根据年龄将患者分为青年组(<40岁,n=67)、中年组(41~65岁,n=78)和老年组(>65岁,n=55),比较三组患者的临床资料。多导睡眠监测(PSG)睡眠结构参数,采用静息态脑电波测量日间脑功能状态定量,Logistic回归分析睡眠结构参数与日间脑功能状态之间的关系,受试者工作特征曲线分析各指标在不同年龄层对PSG结果及脑功能状态的诊断价值。结果中年组患者快波睡眠次数、N2期睡眠比率、快速眼动睡眠(rapid eye movement sleep,REM)期比率、脑混沌(brain chaos,BC)指数、外专注(external focus,EF)指数、内专注(internal focus,IF)指数均高于青年组和老年组;慢波睡眠次数、内源性焦虑(endogenous anxiety,EA)指数、反应速度(reaction speed,RS)指数较青年组低,差异均有统计学意义(P<0.05)。多因素结果显示慢波睡眠次数、快波睡眠次数、N2期睡眠比率及REM期比率是不同年龄OSA患者日间脑功能状态改变的独立危险因素。慢波睡眠次数与BC指数、RS指数、IF指数呈负相关;快波睡眠次数和N2期睡眠比率与BC指数、EF指数呈正相关;REM期比率与BC指数、EA指数、IF指数呈正比。在中年组中,当呼吸暂停低通气指数(AHI)≥5次/h、AHI≥15次/h及AHI≥30次/h时,快波睡眠次数、N2期睡眠比率及REM期比率对其诊断OSA及严重程度有高度预测价值;在青年组和老年组中,AHI≥30次/h时快波睡眠次数可高度预测青年组患者诊断中度、重度OSA价值,N2期睡眠比率和REM期比率可高度预测老年组患者诊断中度OSA价值。结论OSA患者睡眠及脑状态在不同年龄分层中有显著差异性,41~65岁患者睡眠质量最差且日间脑功能状态改变明显,患者睡眠结构慢波睡眠次数、快波睡眠次数、N2期睡眠比率、REM期比率紊乱对日间脑功能的诊断价值最高。

OBJECTIVE To explore the differences in sleep structure parameters and the relationship with brain functional status in patients with obstructive sleep apnea(OSA)at different ages.METHODS A total of 200 OSA patients admitted to our hospital from April 2019 to May 2022 were selected as the study objects,and the patients were divided into young group(<40 years old,n=67),middle-aged group(41-65 years old,n=78),and elderly group(>65 years old,n=55)according to age,and the clinical data of the three groups were compared.Sleep structure parameters were got from polysomnography(PSG);Resting state EEG(rs-EEG)was used to measure the daytime brain function.The relationship between sleep structure parameters and daytime brain function status was analyzed using Logistic regression.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of PSG results and brain function status in different age groups.RESULTS The frequency of fast wave sleep,N2 phase ratio,REM phase ratio,brain chaos index,external focus index and external focus index in the middle-aged group were higher than those in the young group and the old group.The number of slow wave sleep,endogenous anxiety index and reaction speed index in the middle-aged group were lower than those of young group,and the differences were statistically significant(P<0.05).Multi-factor results showed that the number of slow-wave sleep,the number of fast-wave sleep,the ratio of N2 phase sleep and the ratio of REM sleep were independent risk factors for the change of daytime brain function status in OSA patients of different ages.The number of slow wave sleep was negatively correlated with brain chaos index,reaction speed index and internal focus index.The frequency of fast wave sleep and the ratio of N2 phase sleep were positively correlated with brain chaos index and external focus index.The REM phase ratio was positively correlated with the brain chaos index,endogenous anxiety index and internal focus index.In the middle-aged group,when AHI≥5,≥15 and≥30 times/h,the frequency of fast wave sleep,N2 phase sleep ratio and REM phase ratio had highly predictive values for the diagnosis and evaluation of severity of OSA.In the young group and the elderly group,when AHI≥30 times/h,the frequency of fast wave sleep can highly predict the diagnostic value of moderate and severe OSA in the young group,and the N2 phase sleep ratio and REM phase ratio can highly predict the diagnostic value of moderate OSA in the elderly group.CONCLUSION The sleep and brain status of OSA patients showed significant differences among different age groups.Patients in middle age group had the worst sleep quality and significant changes in daytime brain function status.The number of Slow-wave sleep,N2 phase sleep ratio,and REM phase sleep ratio have the highest diagnostic values for daytime brain function.