画钟试验在OSAHS患者认知功能障碍评估中的作用及影响因素  

Application of clock drawing test in evaluation of cognitive impairment in OSASH patients

作　　者：庞帅 朱毅 蔡晓婷[1] 邵榴兰 周丽娜[1] 程齐俭[1] 李庆云[1] PANG Shuai;ZHU Yi;CAI Xiao-ting;SHAO Liu-lan;ZHOU Li-na;CHENG Qi-jian;LI Qing-yun(Department of Pulmonary and Critical Care Medicine,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai200025,China;Department of Pulmonary Medicine,Shanghai Jiading Hospital of Traditional Chinese Medicine,Shanghai 201800,China)

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸与危重症医学科,上海200025 [2]上海市嘉定区中医医院肺病科,上海201800

出　　处：《临床肺科杂志》2022年第10期1495-1500,共6页Journal of Clinical Pulmonary Medicine

基　　金：国家自然科学基金青年项目资助(No.82000091)。

摘　　要：目的 :通过画钟试验(clock drawing test, CDT)评估OSAHS患者认知功能障碍及影响因素。方法 对84例患者记录一般资料、Stop-bang评分、ESS评分与画钟试验,并进行多导睡眠监测。根据AHI指标将人群分为正常组、轻度OSAHS组、中度OSAHS组及重度OSAHS组,分析不同组人群画钟试验评分情况及其影响因素。结果 重度OSAHS患者CDT评分较轻度组(13.66±6.33 vs18.31±6.38,P=0.001)、中度组(13.66±6.33 vs16.63±6.23,P=0.027)显著减低;CDT评分随Stop-bang评分(r=-0.341)、AHI(r=-0.347)、氧减指数(r=-0.402)、最低氧饱和度(r=-0.369)升高而显著降低(P<0.05),与年龄(r=-0.238)、ESS评分(r=-0.298)、OAI(r=-0.258)、最长呼吸暂停时间(r=-0.296)、最长氧减时间(r=-0.217)、STI90(r=-0.294)呈弱负相关,与平均氧合(r=0.292)呈弱正相关,且均具有统计学意义(P<0.05)。通过线性回归分析,在男性患者中,AHI、最长呼吸暂停时间对CDT评分影响显著(P<0.05),可纳入模型,线性回归方程为Y=21.073-0.075X-0.033X。结论:CDT评分在重度OSAHS人群显著降低,与OSAHS疾病严重度显著相关。其中,AHI、最长呼吸暂停时间对男性OSAHS患者CDT评分影响显著。因此,CDT适用于筛查OSAHS患者认知功能障碍。Objective To explore the cognitive impairment in patients with OSAHS evaluated by clock drawing test(CDT) and its influencing factors. Methods The demographic characteristics of 84 patients were recorded. They were asked to complete stop Bang and ESS questionnaires and undergo standard whole-night polysomonography monitoring. According to the AHI index, the population was divided into the normal group, the mild OSAHS group, the moderate OSAHS group and the severe OSAHS group. The clock drawing test scores of different groups and their influencing factors were analyzed. Results The CDT scores of the severe OSAHS group were significantly lower than those of the mild group(13.66±6.33 vs 18.31±6.38, P=0.001) and the moderate group(13.66±6.33 vs 16.63±6.23, P=0.027). CDT score decreased significantly with the increase of stop Bang score(r=-0.341), AHI(r=-0.347), oxygen reduction index(r=-0.402) and the lowest oxygen saturation(r=-0.369). It was weakly negatively correlated with age(r=-0.238), ESS score(r=-0.298), OAI(r=-0.258), the longest apnea time(r=-0.296), the longest oxygen reduction time(r=-0.217) and SIT90(r=-0.294), and weakly positively correlated with mean oxygenation(r=0.292), which were all statistically significant(P<0.05). For male patients, AHI and the longest apnea time had significant effect on CDT score according to linear regression analysis(P<0.05). The linear regression equation was Y=21.073-0.075 X-0.033 X. Conclusion CDT score decreases significantly in patients with severe OSAHS and is significantly correlated with the severity of OSAHS. AHI and the longest apnea time have significant effect on the CDT score of male OSAHS patients. Therefore, CDT is acceptable to screen cognitive impairment in patients with OSAHS.

关 键 词：画钟试验 阻塞性睡眠呼吸暂停低通气综合征 认知功能障碍 睡眠呼吸暂停低通气指数 

分 类 号：R766[医药卫生—耳鼻咽喉科]