中青年男性睡眠呼吸暂停低通气综合征患者警觉性和任务处理速度损害状况及其相关因素分析  

Alertness and task processing speed impairment status and influencing factors of young-middle aged men with obstructive sleep apnea hypopnea syndrome

作　　者：程超虹 苏桐 王婧[1] 朱麒霖 吴华蔓 王智君 韩菲[1] 陈锐[1] Cheng Chaohong;Su Tong;Wang Jing;Zhu Qilin;Wu Huaman;Wang Zhijun;Han Fei;Chen Rui(Department of Respiratory and Critical Care Medicine/Sleep Center,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院呼吸与危重症医学科睡眠中心,苏州215004

出　　处：《中华医学杂志》2023年第22期1685-1691,共7页National Medical Journal of China

基　　金：国家自然科学基金(81770085,82070095)

摘　　要：目的探讨中青年男性睡眠呼吸暂停低通气综合征(OSAHS)患者早期警觉性及任务处理速度等认知领域的损害状况,并进一步分析其相关因素。方法前瞻性纳入2020年7月至2021年9月在苏州大学附属第二医院睡眠中心行多导睡眠监测(PSG)的打鼾患者251例,年龄(38.9±7.6)岁(18~59岁),收集患者一般资料、Epworth嗜睡量表(ESS)、PSG参数,进行认知功能测试。采用蒙特利尔认知评估量表(MoCA)、简易精神状态量表(MMSE)及计算机化认知测试软件(CANTAB)评估OSAHS患者多维度的认知功能,包括运动筛查任务(MOT)反应时间评估警觉性,图形视觉记忆(PRM)、空间广度(SSP)、空间工作记忆(SWM)反应时间评估任务处理速度。根据呼吸暂停低通气指数(AHI)三分位数将所有患者分为3组:AHI<15次/h(Q1组)79例,15次/h≤AHI<45次/h(Q2组)88例,AHI≥45次/h(Q3组)84例,比较3组一般资料、ESS、PSG参数、认知不同领域损伤的差异,并采用多重线性回归分析探讨认知损害的相关因素。结果3组年龄、受教育年限、吸烟饮酒史及既往疾病史(除高血压患病率)差异均无统计学意义(P>0.05)。3组体质指数(BMI)、ESS、高血压患病率、主诉日间嗜睡的比例差异有均统计学意义(均P<0.05)。与Q1、Q2组相比,Q3组觉醒指数(ArI)、氧减指数(ODI)、非快速眼动睡眠1期+2期(N1+N2)比例、血氧饱和度<90%时间占总睡眠时间百分比(TS90)均更高(均P<0.05)。认知功能评估中,各组间MoCA总分及单项得分、MMSE量表得分差异均无统计学意义(均P>0.05);与Q1组相比,Q3组的任务处理速度及警觉性表现更差,表现为PRM即刻反应时间、PRM延迟反应时间、SSP反应时间和MOT反应时间更慢(均P<0.05);Q2组SWM总时间较Q1组更慢(P<0.05)。多重线性回归分析显示,教育年限(β=-40.182,95%CI:-69.847~-10.517)、ODI(β=3.539,95%CI:0.600~6.478)为PRM即刻反应时间的影响因素,年龄(β=13.303,95%CI:2.487~24.119)、教育年限(β=-Objective To investigate the alertness and task processing speed impairment status in young-mild aged men with obstructive sleep apnea hypopnea syndrome(OSAHS),and analyze its influencing factors.Methods This prospective study recruited 251 snoring patients aged 18 to 59(38.9±7.6)years in the Sleep Center of the Second Affiliated Hospital of Soochow University from July 2020 to September 2021 and all patients were diagnosed by polysomnography(PSG).Clinical information,Epworth Sleepiness Scale(ESS)and PSG date were collected.All patients were assessed with the Montreal Cognitive Assessment(MoCA)questionnaires,Mini-mental State Examination(MMSE)and Computerized Neurocognitive Assessment System which includes the reaction time of Motor Screening Task(MOT)for alertness,the reaction time of pattern recognition memory(PRM),spatial span(SSP)and spatial working memory(SWM)for task processing speed.Based on AHI tertiles,all patients were divided into Q1 group(AHI<15 times/h,n=79),Q2 group(15 times/h≤AHI<45 times/h,n=88),and Q3 group(AHI≥45 times/h,n=84).The characteristics of clinical information,ESS,PSG parameters and cognitive scores among three groups were compared.Multiple linear stepwise regression was conducted to analyze the influencing factors of cognitive impairment.Results There were no statistically significant differences in age,years of education,history of smoking and drinking,and past disease history(except for the prevalence of hypertension)among the 3 groups(P>0.05).There were statistically significant among-group differences in the body mass index(BMI),ESS,prevalence of hypertension and complaints of daytime sleepiness(P<0.05).Compared with Q1 and Q2 group,the arousal index(ArI),oxygen desaturation index(ODI),the proportion of non-rapid eye movement phase 1 and 2(N1+N2)and percentage of total sleep time with oxygen saturation level<90%(TS90)of Q3 group were higher(all P<0.05).In the cognitive assessment,there was no statistically significant difference in the MoCA total and individual scores and MMS

关 键 词：睡眠呼吸暂停综合征 缺氧 任务处理速度 警觉性 横断面研究 

分 类 号：R766[医药卫生—耳鼻咽喉科]