阻塞性睡眠呼吸暂停患者CPAP治疗前后客观嗜睡与认知功能的关系  

Associations between objective sleepiness and cognition function before and after CPAP in obstructive sleep apnea patients

作　　者：雷飞[1] 李桃美 谭路 任蓉[1] 唐向东[1] 杨玲慧[2] Lei Fei;Li Taomei;Tan Lu;Ren Rong;Tang Xiangdong;Yang Linghui(Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu 610041;Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041)

机构地区：[1]四川大学华西医院睡眠医学中心,成都610041 [2]四川大学华西医院麻醉与危重急救研究室转化神经科学中心,成都610041

出　　处：《中华医学杂志》2019年第28期2182-2186,共5页National Medical Journal of China

基　　金：国家自然科学基金(81530002,81629002,81770087).

摘　　要：目的探讨阻塞性睡眠呼吸暂停(OSA)患者持续气道正压通气(CPAP)治疗前后客观嗜睡与认知功能的关系。方法回顾性分析2018年2至12月因打鼾在四川大学华西医院睡眠中心就诊经整夜睡眠呼吸监测(PSG)确诊为中重度OSA[呼吸暂停低通气指数(AHI)≥15次/h]并接受首夜CPAP治疗的53例患者的临床资料。所有患者在基线时完成日间多次睡眠潜伏期测试(MSLT)、Epworth嗜睡量表(ESS)评分和精神运动警觉测试(PVT)。首夜CPAP治疗后完成MSLT和PVT测试。运用配对分析,比较CPAP前后嗜睡程度及PVT参数的差异。结果与基线相比,CPAP治疗后患者的呼吸暂停低通气指数下降[68.8(42.2,80.0)比7.4(3.1,11.1)次/h,P<0.05],非快速眼球运动(NREM)3期睡眠时间占比[0(0,0.5%)比4.4%(1.9%,11.3%),P<0.05]和快速眼球运动(REM)睡眠时间占比[18.6%(13.2%,22.7%)比25.4%(23.8%,30.3%),P<0.05]增加。治疗后,OSA患者反应时间[353.0(317.5,429.5)比333.6(309.7,381.4)ms,P<0.05]、10%最慢反应时间[602.9(473.2,841.3)比505.5(431.6,618.8)ms,P<0.05]和10%最快反应时间[260.8(236.6,300.6)比251.4(233.6,283.2)ms,P<0.05]缩短,脱漏次数[6.0(2.5,16.5)比3.0(1.0,8.5)次,P<0.05]减少,同时日间平均睡眠潜伏期(MSL)[5.8(3.4,8.3)比7.5(4.7,12.4)min,P<0.05]延长。CPAP治疗前后PVT参数的变化[Δ反应时间(r=0.20,P>0.05)、Δ10%最慢反应时间(r=0.15,P>0.05)、Δ10%最快反应时间(r=0.24,P>0.05)和Δ脱漏次数(r=0.15,P>0.05)]与ΔMSL不相关。仅在基线中发现10%最慢反应时间与ESS相关。结论OSA患者治疗前后客观嗜睡程度与PVT不相关,两者在本质上可能不同。Objective To examine the association between objective sleepiness and neurocognitive function before and after continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA) patients. Methods A total of 53 patients with overnight polysomnography (PSG) determined moderate-to-severe OSA (apnea hypopnea index (AHI)≥15 events/h) and with overnight CPAP therapy from West China Hospital, Sichuan University within the period from Feb 2018 to Dec 2018 were enrolled in the study. At the baseline, all patients underwent overnight PSG study, multiple sleep latency test (MSLT), psychomotor vigilance test (PVT), and Epworth sleepiness score (ESS). After CPAP therapy, all patients underwent MSLT and PVT. Paired nonparametric test or t test were used to compare the differences between daytime sleepiness and PVT performance before and after CPAP. Results Compared with baseline data, AHI [68.8(42.2, 80.0) vs 7.4(3.1, 11.1) events/h, P<0.05] decreased, the percentages of non-rapid eye movement stage 3 sleep time [0(0, 0.5%) vs 4.4%(1.9%, 11.3%), P<0.05] and the percentages of rapid eye movement sleep time [18.6%(13.2%, 22.7%) vs 25.4%(23.85, 30.3%), P<0.05] increased after CPAP therapy. The reaction time (RT)[353.0(317.5, 429.5) vs 333.6(309.7, 381.4) ms, P<0.05], the slowest 10% RT [602.9(473.2, 841.3) vs 505.5(431.6, 618.8) ms, P<0.05] and the fastest 10% RT [260.8(236.6, 300.6) vs 251.4(233.6, 283.2) ms, P<0.05] shortened, and the lapse [6.0(2.5, 16.5) vs 3.0(1.0, 8.5) events, P<0.05] decreased. The mean sleep latency (MSL)[5.8 (3.4, 8.3) vs 7.5(4.7, 12.4) min, P<0.05] increased. The changes in PVT parameters [ΔRT (r=0.20, P>0.05),Δslowest 10% RT (r=0.15, P>0.05),Δfastest 10% RT (r=0.24, P>0.05), and Δlapse (r=0.15, P>0.05)] were not correlated with the change in MSL. The significant association between the slowest 10% RT and ESS was found in baseline data. Conclusions The change in MSL is not associated with the change in PVT performance before and after CPAP therapy. MSLT and PVT may be different in nature.

关 键 词：睡眠呼吸暂停 阻塞性 连续气道正压通气 嗜睡 认知 

分 类 号：R766[医药卫生—耳鼻咽喉科]