阿尔茨海默病患者睡眠特征及其与认知障碍的相关性  

The relationship between sleep characteristics and cognitive impairment in patients with Alzheimer’s disease

作　　者：郭鹏[1] 连腾宏 何明月 张伟娇 罗冬梅 关惠盈 李晶卉 张唯佳 张文静[2] 齐婧 岳好 刘湛 郑紫静 张巍[1] Guo Peng;Lian Tenghong;He Mingyue;Zhang Weijiao;Luo Dongmei;Guan Huiying;Li Jinghui;Zhang Weijia;Zhang Wenjing;Qi Jing;Yue Hao;Liu Zhan;Zheng Zijing;Zhang Wei(Department of Neurology,Center for Cognitive Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,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认知障碍性疾病科,北京100070 [2]首都医科大学附属北京天坛医院神经病学中心,北京100070

出　　处：《中国医学前沿杂志（电子版）》2022年第7期1-7,共7页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：国家重点研发计划-欧盟地平线2020计划合作项目(2017YFE0118800-779238);国家重点研发计划重点专项(2016YFC1306300,2016YFC1306000);国家自然科学基金面上项目(81970992,81571229,81071015,30770745);首都卫生发展科研专项(首发2022-2-2048);首都临床特色应用研究(Z12110700100000);北京市自然科学基金面上项目(7082032);北京市中医药科技发展资金项目(JJ2018-48)。

摘　　要：目的探讨阿尔茨海默病(Alzheimer’s disease,AD)患者伴发睡眠障碍(sleep disorders,SD)的特征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2022年4月就诊于首都医科大学附属北京天坛医院的460例AD患者。收集人口学资料,包括性别、年龄、发病年龄、病程、受教育年限和体质指数。采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)量表评价总体睡眠状况,PSQI≥7分为AD伴发SD(AD-SD)组,PSQI<7分为AD不伴发SD(AD-n SD)组。采用简易精神状态检查量表(Mini-Mental State Examination,MMSE)和蒙特利尔认知评估量表(Montreal Cognitive Assessment,Mo CA)评价总体认知功能,采用听觉词语学习测验(Auditory Verbal Learning Test,AVLT)-即刻回忆、AVLT-延迟回忆及复杂图形测验(Complex Figure Test,CFT)-延迟回忆量表评价记忆功能,采用Boston命名测验(Boston Naming Test,BNT)量表评价语言功能,采用CFT-即刻回忆量表评价视觉空间功能,采用Stroop颜色词测试(Stroop-A试验、Stroop-B试验及Stroop-C试验)量表评价执行功能,采用连线测验A(Trail Making Test A,TMT-A)、连线测验B(Trail Making Test B,TMT-B)及符号数字转换测验(Symbol Digit Modality Test,SDMT)量表评价注意力。比较AD-SD组与AD-n SD组睡眠状况与认知功能的情况。结果460例AD患者中173例(37.61%)存在SD。AD-SD组和AD-n SD组的性别、年龄、起病年龄、病程、受教育年限及体质指数均无明显差异(P>0.05)。AD-SD组和AD-n SD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-n SD组相比,AD-SD组MMSE、Mo CA、听觉词语学习测验-即刻回忆评分及复杂图形-即刻回忆量表评分均明显降低(P<0.01,P<0.01,P<0.01,P<0.05)。AD-SD组主观睡眠质量与MMSE、Mo CA、AVLT-即刻回忆及CFT-即刻回忆量表评分均呈负相关(r=-0.277,P<0.001Objective To investigate the clinical characteristics of sleep disorders(SD)in patients with Alzheimer’s disease(AD)and their relationship with cognitive impairment.Method According to the inclusion and exclusion criteria of AD,460 AD patients presented to Beijing Tiantan Hospital from January 2016 to April 2022.Demographic data,including gender,age,age of onset,duration of disease,years of education and body mass index were collected.The Pittsburgh Sleep Quality Index(PSQI)scale was used to evaluate the overall sleep status.PSQI≥7 was classified as AD with SD(AD-SD)and PSQI<7 was classified as AD without SD(AD-n SD).The overall cognitive function of AD patients was evaluated by the scales of MiniMental State Examination(MMSE)and Montreal Cognitive Assessment(Mo CA),memory function was evaluated by the Auditory Verbal Learning Test(AVLT)-immediate recall,AVLT-delayed recall and Complex Figure Test(CFT)-delayed memory scales,the language was evaluated by Boston Naming Test(BNT)BNT scale,visuospatial ability was evaluated by CFT-imitation,executive function was evaluated by Stroop-A,Stroop-B and Stroop-C scales,attention was evaluated by Trail Making Test A(TMT-A),Trail Making Test B(TMT-B),and Symbol Digit Modality Test(SDMT)scales.The sleep status and congnitive function of AD-SD group and AD-n SD group were compared.Result Among the 460 AD patients,173 cases(37.61%)had SD.There was no significant difference in gender,age,age of onset,duration of disease,years of education and body mass index(BMI)between AD-SD and AD-n SD groups(P>0.05).The factors with significant difference in PSQI scale between AD-SD and AD-n SD groups included sleep quality,sleep latency,sleep duration,sleep efficiency,sleep disturbance,use of sleeping medication and daytime dysfunction(P<0.05).Compared with AD-n SD group,the total scores of MMSE,Mo CA,AVLT-immediate recall and CFT-imitation scales in AD-SD group were significantly lower(P<0.01,P<0.01,P<0.01,P<0.05).In AD-SD group,subjective sleep quality was significantly and negatively

关 键 词：北京天坛医院 阿尔茨海默病 睡眠时间 复杂图形 体质指数 数字转换 睡眠障碍 认知障碍 

分 类 号：R749.16[医药卫生—神经病学与精神病学]