阻塞性睡眠呼吸暂停低通气综合征患者日间脑功能状态与血清标志物和认知功能的相关性  

Correlation of daytime brain function status with serum markers and cognitive function in patients with obstructive sleep apnea-hypopnea syndrome

作　　者：刘毅[1] 肖冰 高丽[1] 常朕阁 付娜 宋思瑶 张远 LIU Yi;XIAO Bing;GAO Li;CHANG Zhenge;FU Na;SONG Siyao;ZHANG Yuan(Civil Aviation Medicine Center(Civil Aviation General Hospital)of CAAC,Beijing 100123,China;College of Electronic and Information Engineering,Southwest University,Chongqing 400715,China)

机构地区：[1]中国民用航空局民用航空医学中心(民航总医院),北京100123 [2]西南大学电子信息工程学院,重庆400715

出　　处：《医学研究与战创伤救治》2023年第4期350-356,共7页Journal of Medical Research & Combat Trauma Care

基　　金：国家自然科学基金(62172340);首都卫生发展科研专项项目(2018-4-6031)。

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者日间脑功能状态改变及其与OSAHS严重程度和睡眠结构破坏和认知功能改变的相关性。方法选择2018年3月至2020年3月因打鼾在民航总医院睡眠中心就诊OSAHS患者95例,其中重度OSAHS患者41例,轻中度OSAHS患者25例,单纯鼾症患者29例。所有受试者均完成多导睡眠呼吸监测和日间脑功能状态定量测量。比较3组受试者多导睡眠监测(PSG)监测数据、日间脑功能状态指标、蒙特利尔认知功能(MoCA)、晚期氧化蛋白产物(AOPP)差异;并分析脑功能状态指标与OSAHS严重程度及睡眠结构破坏、MoCA、AOPP的相关性。结果各组患者体重指数(BMI)和Epworth嗜睡量表(ESS)评分差异均有统计学意义(P<0.05)。重度OSAHS患者MoCA低于轻中度OSAHS及单纯鼾症组[(25.51±1.57)分vs(27.35±1.35)分vs(28.03±1.32)分,P<0.001],差异均有统计学意义。重度OSAHS组患者AOPP高于轻中度OSAHS组及单纯鼾症组[(113.82±21.04)μmol/L vs(99.36±17.91)μmol/L vs(80.82±16.74)μmol/L,P<0.001],差异均有统计学意义。各组间N3期睡眠比率、最长呼吸暂停时间(LAT)、最低血氧饱和度(LSaO 2)、血氧<90%的时间占总监测时间百分比(TS90%)以及清醒时平均血氧饱和度等参数比较差异均有统计学意义(P<0.05)。重度OSAHS、轻中度OSAHS及单纯鼾症患者的外专注指数[15(9,23)vs 10(6,18)vs 8(6,12),P=0.004]、脑内敛指数[31(19,40)vs 37(28,47)vs 42(31,52),P=0.004]、记忆加工指数[3(0,8)vs 6(1,11)vs 9(4,13),P=0.008]、反应速度指数[6(4,10)vs 8(4,14)vs 11(5,15),P=0.022]及脑惰性指数[142(122,181)vs 150(116,178)vs 116(105,146),P=0.040]比较差异均有统计学意义。外专注指数与快速动眼期(rREM)期睡眠比率、LSaO 2、MoCA呈负相关,与睡眠呼吸暂停低通气指数(AHI)、LAT时间、TS90%、AOPP呈正相关;脑内敛指数、记忆加工指数、反应速度指数与LSaO 2、清醒时平均SaO 2、MoCA呈正相关,与AHI、TS90Objective To investigate the daytime brain function changes in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)and its correlation with the severity of OSAHS and the destruction of sleep structure.Methods A total of 95 patients were selected from March 2018 to March 2020 in the sleep center of Civil Aviation General Hospital due to snoring,including 41 patients with severe OSAHS,25 patients with mild to moderate OSAHS,and 29 patients with simple snoring.All subjects completed polysomnographic respiratory monitoring and quantitative measurement of brain function during the day.The differences in polysomnography(PSG)monitoring data,daytime brain functional status indicators,Montreal Cognitive Assessment(MoCA),and advanced oxidation protein products(AOPP)among the three groups of subjects were compared.The correlation between brain functional status indicators and the severity of OSAHS,the destruction of sleep structure,MoCA,and AOPP was analyzed.Results There were statistically significant differences in BMI(kg/m2)(11.402,P=0.003)and EES score(6.937,P=0.002)among the three groups.The MoCA of patients with severe OSAHS was lower than those with mild to moderate OSAHS and simple snoring(25.51±1.57 vs 27.35±1.35 and 28.03±1.32,P<0.001).The differences were statistically significant.The AOPP of patients with severe OSAHS was higher than that of patients with mild to moderate OSAHS and simple snoring(113.82±21.04 vs 99.36±17.91 and 80.82±16.74μmol/l,P<0.001)。The differences were statistically significant.There were statistically significant differences in N3 sleep ratio,LAT,LSaO2;TS90 and wake average SaO2 among the three groups.There were statistical differences in the external focus index[15(9,23),10(6,18)and 8(6,12);P=0.004],brain introversion index[31(19,40),37(28,47)and 42(31,52);P=0.004],memory processing index[3(0,8),6(1,11)and 9(4,13);P=0.008],reaction speedindex[6(4,10),8(4,14)and 11(5,15),P=0.022];brain inertia index[142(122,181),150(116,178)and 116(105,146);P=0.040]among the severe OSAH

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 多导睡眠图 睡眠结构 脑功能 蒙特利尔认知功能 晚期氧化蛋白产物 

分 类 号：R749[医药卫生—神经病学与精神病学]