日间高碳酸血症对阻塞性睡眠呼吸暂停低通气综合征患者逻辑记忆和工作记忆的影响  

Effects of daytime hypercapnia on logical memory and working memory in patients with obstructive sleep apnea hypopnea syndrome

作　　者：吴华蔓 王智君 程超虹 王婧[1] 王巧军 陈锐[1] Wu Huaman;Wang Zhijun;Cheng Chaohong;Wang Jing;Wang Qiaojun;Chen Rui(Department of Respiratory and Critical Care Medicine,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科与危重症医学科,215004

出　　处：《中华结核和呼吸杂志》2021年第10期873-879,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金(81770085,82070095);苏州大学附属第二医院科技创新团队托举项目(XKTJ-TD202003)。

摘　　要：目的探讨日间高碳酸血症对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者逻辑记忆和工作记忆的影响。方法前瞻性收集2020年1—11月因打鼾于苏州大学附属第二医院睡眠中心就诊确诊为OSAHS的患者,收集所有患者的基本信息、一般临床资料,进行记忆功能评分,检测日间经皮二氧化碳分压(PtcCO_(2)),以及夜间多导睡眠监测(PSG)。逻辑记忆评分采用逻辑记忆测试(LMT),工作记忆评分采用数字广度测试(DST)和剑桥神经心理自动化成套测试中的图形再认记忆(PRM)、空间广度(SSP)、空间工作记忆(SWM)。根据日间PtcCO_(2)将所有患者分成正常碳酸血症组和高碳酸血症组,比较上述指标在两组之间的差异,并通过二元Logistic逐步回归分析探讨OSAHS患者各项记忆评分的影响因素。结果共纳入OSAHS患者123例,其中正常碳酸血症组79例,高碳酸血症组44例。两组一般临床资料均差异无统计学意义(P>0.05),高碳酸血症组打鼾年限比正常碳酸血症组长(P<0.05)。与正常碳酸血症组相比,高碳酸血症组呼吸暂停低通气指数(AHI)、氧减指数(ODI)、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),而其他PSG参数差异均无统计学意义(均P>0.05);两组的即时逻辑记忆、PRM即刻正确率差异无统计学意义(均P>0.05),但延迟逻辑记忆、言语和空间工作记忆、执行功能更差,表现为LMT延迟、DST倒背、SSP得分均更低(均P<0.05),SWM组间错误和策略分均更高(均P<0.01)。经二元Logistic逐步回归分析显示,PtcCO_(2)≥45 mmHg(1 mmHg=0.133 kPa,OR=3.055,95%CI 1.359~6.868,P=0.007)和更高的BMI(OR=1.132,95%CI 1.005~1.275,P=0.041)为DST倒背表现差的影响因素;PtcCO_(2)≥45 mmHg为LMT延迟、SSP、SWM组间错误和策略分表现差的独立影响因素,OR=3.109、3.941、3.238、2.785(均P<0.05)。结论高碳酸血症对OSAHS患者的逻辑记忆和工作记忆产生影响,表现在延迟逻辑记忆、言语�Objective To investigate the effects of daytime hypercapnia on logical memory and working memory in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods This prospective study recruited patients complaining of snoring and diagnosed with OSAHS at the Sleep Center of the Second Affiliated Hospital of Soochow University from January to November 2020.Patients were assessed clinically and scored for their memory function.All patients underwent daytime transcutaneous carbon dioxide(PtcCO_(2))test,and overnight polysomnography(PSG).Logical memory was scored using the Logical Memory Test(LMT),while working memory was evaluated by Digit Span Test(DST)and Cambridge Neuropsychological Test Automated Battery(CANTAB)which included Pattern Recognition Memory(PRM),Spatial Span(SSP),and Spatial Working Memory(SWM).Patients were divided into the normocapnic group and the hypercapnic group using the daytime PtcCO_(2) test.The clinical and PSG parameters and the memory test scores between the two groups were compared.Binary logistic stepwise regression was conducted to identify risk factors of memory impairment in OSAHS patients.Results Among the 123 enrolled OSAHS patients,79 were normocapnic and 44 were hypercapnic.There was no significant difference in the general clinical parameters between the two groups.The snoring history in years in the hypercapnic group was longer than that in the normocapnic group(P<0.05).Compared with the normocapnic group,the apnea-hyponea index(AHI),oxygen desaturation index(ODI)and percentage of total sleep time with oxygen saturation level<90%(TS90)of the hypercapnic group were higher(all P<0.05),while other PSG parameters exhibited no statistically significant differences.There was no statistically significant difference in the immediate logical memory and PRM immediate accuracy rate between the two groups,while the delayed logical memory,verbal and spatial working memory,and executive function were worse in the hypercapnic group,as shown by lower total LMT scores,lower DST,lower S

关 键 词：睡眠呼吸暂停 阻塞性 高碳酸血症 逻辑记忆 工作记忆 

分 类 号：R766[医药卫生—耳鼻咽喉科]