慢性失眠合并阻塞性睡眠呼吸暂停患者睡眠结构和自主神经功能特征及其与神经心理特征相关分析  

Sleep structure and autonomic nervous function in patients with chronic insomnia combined with obstructive sleep apnea and their correlation with neuropsychological characteristics

作　　者：万亚会 吕梦頔 李征 周凯丽 高海静 薛蓉[4] WAN Ya-hui;LÜMeng-di;LI Zheng;ZHOU Kai-li;GAO Hai-jing;XUE Rong(Department of Neurology,Tianjin Medical University General Hospital Airport Hospital,Tianjin 300308,China;Department of Neurology,Tianjin First Central Hospital,Tianjin 300192,China;Department of Neurology,Tianjin Fifth Central Hospital,Tianjin 300450,China;Department of Neurology,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院空港医院神经内科,300308 [2]天津市第一中心医院神经内科,300192 [3]天津市第五中心医院神经内科,300450 [4]天津医科大学总医院神经内科,300052

出　　处：《中国现代神经疾病杂志》2023年第8期693-708,共16页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：天津市科技计划项目(项目编号:17ZXMFSY00180);天津市滨海新区卫生健康委员会一般扶持项目(项目编号:2019BWKY015);天津市医学重点学科(专科)建设项目(项目编号:TJYXZDXK-004A)。

摘　　要：目的探讨慢性失眠合并阻塞性睡眠呼吸暂停患者睡眠结构和自主神经功能特征及其与神经心理特征的相关性。方法纳入2019年9月至2021年6月天津医科大学总医院和空港医院收治的91例慢性失眠患者,根据是否合并阻塞性睡眠呼吸暂停分为单纯慢性失眠组(失眠组,46例)和慢性失眠合并阻塞性睡眠呼吸暂停组(共病组,45例),同时招募性别、年龄、受教育程度相匹配的22例对照者,采用PSM-100A睡眠呼吸监测设备分析睡眠结构和自主神经功能特征,匹兹堡睡眠质量指数、Epworth嗜睡量表和失眠严重程度指数评价主观睡眠质量,并行神经心理学测验。结果(1)睡眠结构:共病组总睡眠时间(P=0.003,0.002)、睡眠效率(P=0.000,0.019)、快速眼动睡眠期(REM)占比(P=0.000,0.015)、平均动脉血氧饱和度(SaO_(2);P=0.000,0.000)、最低SaO(2P=0.000,0.000)低于对照组和失眠组,觉醒次数(P=0.028,0.033)和睡眠呼吸暂停低通气指数(AHI;P=0.000,0.000)高于对照组和失眠组。(2)自主神经功能:共病组和失眠组低频耦合(LFC;P=0.000,0.006)和LFC/高频耦合(HFC)比值(P=0.000,0.009)高于对照组,HFC(P=0.000,0.006)和PNN50(P=0.000,0.047)低于对照组。(3)神经心理学测验:整体认知功能方面,共病组简易智能状态检查量表(MMSE)评分低于对照组(P=0.000)和失眠组(P=0.002),失眠组MMSE评分低于对照组(P=0.008)。记忆力方面,共病组听觉词语学习测验(AVLT)-短延迟回忆、长延迟回忆、再认评分低于对照组(P=0.004,0.000,0.000)和失眠组(P=0.017,0.000,0.000),共病组AVLT-即刻回忆评分低于对照组(P=0.000),失眠组AVLT-即刻回忆、长延迟回忆、再认评分低于对照组(P=0.035,0.005,0.020)。视空间能力方面,共病组本顿线方向测验(JLO)正确个数少于对照组(P=0.000)和失眠组(P=0.000),失眠组JLO正确个数少于对照组(P=0.017)。注意力方面,共病组数字广度测验(DST)顺背和倒背、符号数字转换测验(SDMT)正确�Objective:To investigate the sleep structure and autonomic nervous function of patients with chronic insomnia combined with obstructive sleep apnea(OSA)and analyze their correlation with neuropsychological characteristics.Methods:A total of 91 patients with chronic insomnia admitted to Tianjin Medical University General Hospital and Airpot Hospital from September 2019 to June 2021 were included.They were divided into simple chronic insomnia group(insomnia group,n=46)and chronic insomnia combined with OSA group(comorbidity group,n=45)according to whether combined with OSA.And 22 volunteers matched in sex,age and education were recruited as the control group.Sleep structure and autonomic nervous function were analyzed by PSM-100A sleep breathing monitoring.Subjective sleep quality was assessed by Pittsburgh Sleep Quality Index(PSQI),Epworth Sleepiness Scale(ESS)and Insomnia Severity Index(ISI).Meanwhile,neuropsychological tests were performed.Results:1)Sleep structure:total sleep time(TST;P=0.003,0.002),sleep efficiency(P=0.000,0.019),proportion of rapid eye movement(REM;P=0.000,0.015),mean arterial oxygen saturation(SaO_(2);P=0.000,0.000),minimum SaO_(2)(P=0.000,0.019)in the comorbidity group were lower than those in control group and insomnia group;while the wake times(P=0.028,0.033)and sleep apnea hypopnea index(AHI;P=0.000,0.000)were higher than those in control group and insomnia group.2)Autonomic nervous function:the low frequency coupling(LFC;P=0.000,0.006)and LFC/high frequency coupling(HFC)ratio(P=0.000,0.009)in comorbidity group and insomnia group were higher than those in control group,while HFC(P=0.000,0.006)and PNN50(P=0.000,0.047)were lower than those in control group.3)Neuropsychological test:the comorbidity group had a lower Mini-Mental State Examination(MMSE)score than the control group(P=0.000)and insomnia group(P=0.002),and the insomnia group had a lower MMSE score than the control group(P=0.008).In terms of memory,Auditory Verbal Learning Test(AVLT)-short delayed recall,long delayed recall and r

关 键 词：入睡和睡眠障碍 睡眠呼吸暂停 阻塞性 共病现象 认知障碍 神经心理学测验 

分 类 号：R740[医药卫生—神经病学与精神病学] R766[医药卫生—临床医学]