正压无创呼吸机治疗对阻塞性睡眠呼吸暂停低通气综合征患者认知功能的影响  

Positive pressure non-invasive ventilator therapy for obstructive sleep apnea hypopnea syndrome patients with mild cognitive impairment

作　　者：刘志超[1] 姚涛[1] 彭勃[1] LIU Zhichao;YAO Tao;PENG Bo(Dept.of Neurology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院神经内科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2021年第2期302-306,共5页Medical Journal of Wuhan University

摘　　要：目的:研究正压无创呼吸机治疗对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者认知功能的影响。方法:选择2018年3月—2019年7月在武汉大学人民医院就诊的阻塞性睡眠呼吸暂停低通气综合征伴有轻度认知功能障碍(MCI)患者33例,将患者随机分为治疗组(n=17)和对照组(n=16),每个患者观察时间为6个月。治疗组睡眠过程中给予正压无创呼吸机治疗,同时要求患者每天进行半小时有氧运动锻炼,低盐低脂饮食,控制体重等。对照组不进行正压无创呼吸机治疗,只要求患者每天进行半小时有氧运动锻炼,低盐低脂饮食,控制体重等。所有患者在入组前进行颅脑磁共振(MRI)、血生化等检查,排除脑器质性病变和其他重要脏器功能障碍所导致的认知功能下降。在患者入组时、治疗后3个月、治疗后6个月分别检测简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA),并进行血总胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸检测。记录患者研究期间的不良反应。结果:治疗组和对照组患者治疗前的MMSE、MoCA评分比较差异无统计学意义(P>0.05)。治疗组患者治疗后3个月、6个月的MMSE、MoCA评分明显高于对照组,差异有统计学意义(P<0.05);治疗组患者治疗后3个月、6个月血总胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸与对照组比较均有统计学意义(P<0.05);治疗组不良反应的发生率与对照组比较无统计学意义(P>0.05)。结论:正压无创呼吸机治疗可以显著改善OSAHS患者的认知功能障碍,并且使患者的低密度脂蛋白胆固醇等卒中危险因素降低;未发生明显的不良反应。Objective: To study the effect of positive pressure non-invasive ventilator therapy on cognitive function in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) with mild cognitive impairment.Methods: From March 2018 to July 2019, 33 patients with OSAHS accompanied by mild cognitive impairment who were treated in the Renmin Hospital of Wuhan University were randomly divided into treatment groups(n=17) and control group(n=16). The patients in treatment group received positive pressure non-invasive ventilator treatment when sleeping, on the basis of conventional treatment such as regular exercise and diet control. The patients in control group only received conventional treatment. All patients underwent brain MRI and blood biochemical examination before enrollment, to exclude cognitive impairments caused by other brain organic diseases. At the time of enrollment, 3 months after treatment, and 6 months after treatment, the Mini Mental Scale(MMSE)and the Montreal Cognitive Assessment Scale(Mo CA) were tested, and the total blood cholesterol,low density lipoprotein cholesterol, and homocysteine were measured. The adverse reactions of the patient during the study were recorded.Results: There was no significant difference in MMSE and Mo CA scores between treatment group and control group before treatment(P>0. 05). The MMSE and Mo CA scores of the patients in treatment group at the end of 3 and 6 months after treatment were significantly higher than those in control group(P<0. 05). After 3 and 6 months after treatment respectively, the serum levels of total cholesterol, LDL cholesterol, and homocysteine in treatment group were significantly different from those in control group(P<0. 05). No difference in the incidence of adverse reactions between the two groups was found(P>0. 05).Conclusion: Positive pressure non-invasive ventilator treatment can significantly improve the cognitive impairment of patients with OSAHS. As a risk factor for stroke, the LDL cholesterol level are reduced after ventilator treatment,

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 正压无创呼吸机 轻度认知功能 脑卒中 

分 类 号：R747.9[医药卫生—神经病学与精神病学]