阿尔茨海默病患者睡眠障碍及其与认知障碍关系的研究  

Relationship between sleep disorders and cognitive impairment in patients with Alzheimer's Disease

作　　者：郭鹏[1] 连腾宏 李丽霞[2] 丁杜宇 李丹凝 刘丽[2] 余秋瑾 金朝[1] 左丽君[1] 张巍[1,3,4,5,6] Guo Peng;Lian Tenghong;Li Lixia;Ding Duyu;Li Danning;Liu Li;Yu Qiujin;Jin Zhao;Zuo Lijun;Zhang Wei(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Internal Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Center for Cognitive Neurology,Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Key Laboratory for Neurodegenerative Disorders of the Ministry of Education,Capital Medical University,Beijing 100069,China;Center of Parkinson's Disease,Beijing Institute for Brain Disorders,Beijing 100053,China;Beijing Key Laboratory on Parkinson’s Disease,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,100070 [2]首都医科大学附属北京天坛医院综合内科,100070 [3]国家神经系统疾病临床医学研究中心,北京100070 [4]教育部神经变性疾病重点实验室,北京100069 [5]北京脑重大疾病研究院帕金森病研究所,100053 [6]帕金森病研究北京重点实验室,100053

出　　处：《中华老年医学杂志》2019年第11期1237-1241,共5页Chinese Journal of Geriatrics

基　　金：国家重点研发计划重点专项(2016YFC1306000,2016YFC1306300);国家自然科学基金项目(81571229);首都医科大学校自然科学基金(PYZ2018077)。

摘　　要：目的探讨阿尔茨海默病(AD)患者伴发睡眠障碍(SD)的临床特点及其与认知障碍的关系。方法按照AD的入组和排除标准,连续纳入2016年1月至2017年1月就诊于北京天坛医院的89例AD患者。采用匹兹堡睡眠指数量表(PSQI)评价总体睡眠状况,PSQI≥7分为AD伴发SD(AD-SD)组,PSQI<7分为AD不伴发SD(AD-NSD)组。采用蒙特利尔认知评估(MoCA)量表评价AD患者的认知功能,比较AD-SD组与AD-NSD组总体认知功能及各认知领域的情况。结果89例AD患者中71例(79.78%)存在SD。AD-SD组和AD-NSD组性别、年龄、起病年龄、受教育水平及病程等均无明显差异(P>0.05)。AD-SD组和AD-NSD组PSQI量表中具有显著差异的因子包括睡眠质量、睡眠潜伏期、睡眠时间、睡眠效率、夜间SD、使用睡眠药物及日间功能障碍(均P<0.05)。与AD-NSD组相比,AD-SD组MoCA量表总分明显降低(P<0.05),其中延迟回忆及语言评分明显降低(P<0.05)。AD-SD组入睡时间与MoCA量表总分及延迟回忆评分均呈负相关(r=-0.245,P=0.041;r=-0.249,P=0.039);夜间SD与MoCA量表总分及延迟回忆评分均呈负相关(r=-0.248,P=0.038;r=-0.283,P=0.018)。结论AD-SD的发生率高达79.78%;AD-SD患者的主观睡眠质量更差、入睡时间更长、睡眠时间更短、睡眠效率更低、夜间SD更重、使用睡眠药更多、日间功能障碍更明显;AD-SD患者总体认知功能、延迟回忆及语言损害更明显;AD-SD组入睡时间、夜间SD与总体认知功能及延迟回忆有关。Objective To investigate the clinical characteristics of sleep disorders(SD)in patients with Alzheimer's disease(AD),and the relationship between SD and cognitive impairment.Methods According to the inclusion and exclusion criteria of AD,89 consecutive AD patients admitted to Beijing Tiantan Hospital from January 2016 to January 2017 were included.The Pittsburgh sleep quality index(PSQI)scale was used to evaluate the overall sleep status.The patients were randomized into the AD with SD(AD-SD)group(PSQI>7)and the AD without SD(AD-NSD)group(PSQI<7).The cognitive function of AD patients was evaluated by the Montreal cognitive assessment(MoCA)scale,and the overall cognitive function and cognitive domains were compared between the AD-SD and AD-NSD groups.Results Of the 89 AD patients,71 cases(79.78%)had SD.There was no significant difference in gender,age,age of onset,education level and disease duration between the AD-SD and AD-NSD groups(P>0.05).The factors in the PSQI scale had significant differences between AD-SD和AD-NSD groups,including sleep quality,sleep latency,sleep duration,sleep efficiency,sleep disturbance,administration of sleeping medication and daytime dysfunction(P<0.05).Compared with the AD-NSD group,the AD-SD group showed that the total score of MoCA scale was significantly reduced(P<0.05),and the scores of delayed recall and language were significantly decreased(P<0.05).There was a negative correlation of the sleep time with the total score of MoCA scale and the score of delayed recall in the AD-SD group(r=-0.245 and-0.249,P=0.041 and 0.039).Night SD was negative correlated with the total score of MoCA scale and the score of delayed recall(r=-0.248 and-0.283,P=0.038 and 0.018).Conclusions The incidence of AD-SD is up to 79.78%.AD-SD patients have a worse subjective sleep quality,longer time to fall asleep,shorter sleep time,lower sleep efficiency,higher night SD,more use of sleep drugs and more daytime dysfunction.General cognitive dysfunction,delayed recall and language impairment are more obviou

关 键 词：阿尔茨海默病 睡眠障碍 认知障碍 

分 类 号：R74[医药卫生—神经病学与精神病学]