阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构、效率与认知功能的相关性研究  

Correlation study of sleep structure,sleep efficiency and cognitive function in patients with OSAHS

作　　者：苏艳娜[1] 黄诚文 刘美新 庞桂芬[1] SU Yanna;HUANG Chengwen;LIU Meixin;PANG Guifen(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Chengde Medical University,Chengde,Hebei 067000,China;Department of Respiratory,Chengde Central Hospital,Chengde,Hebei 067000,China)

机构地区：[1]承德医学院附属医院呼吸与危重症医学科,河北承德067000 [2]承德市中心医院呼吸内科,河北承德067000

出　　处：《临床肺科杂志》2024年第10期1479-1484,共6页Journal of Clinical Pulmonary Medicine

基　　金：承德市科技计划自筹经费项目(No.202109A062)。

摘　　要：目的探讨睡眠结构、效率对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的认知功能的影响。方法回顾性分析自2022年1月至2022年6月于承德医学院附属医院经多导睡眠监测(polysomnography,PSG)诊断为OSAHS共52例的临床资料,并选取同期于该中心行多导睡眠监测后除外OSAHS诊断的30例作为健康对照组。安排OSAHS患者及健康受试者在进行多导睡眠监测前填写蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)、Epworth嗜睡量表(Epworth sleepiness scale,ESS)。分析患者年龄、性别、微觉醒指数、睡眠后觉醒时间(Wake-time After Sleep Onset,WASO)、睡眠效率、N3期占总睡眠时间的百分比(N3/TST%)和REM期占总睡眠时间的百分比(REM/TST%)等指标与MoCA量表结果之间的相关性。以MoCA总分为因变量进行多因素逐步回归来分析认知功能下降的预测指标。结果1.OSAHS组患者与健康对照组相比,最低脉氧饱和度水平(LaSpO_(2))减低(Z=-7.290,P<0.001),AHI(Z=-7.394,P<0.001)、ESS评分(Z=-2.558,P<0.05)升高。2.与对照组相比,OSAHS患者在MoCA总分(Z=-4.405,P<0.001)、视空间与执行能力(Z=-2.818,P=0.005)、注意(Z=-2.695,P=0.007)、语言(Z=-2.476,P=0.013)、抽象(Z=-2.328,P=0.020)、延迟回忆能力(Z=-2.978,P=0.003)方面均有所下降,而命名(P=0.182)、定向能力(P=0.181)无统计学意义。3.MoCA总分与LaSpO_(2)(r=0.624,P<0.001)、N3/TST%(r=0.425,P<0.001)、REM/TST%(r=0.541,P<0.001)呈正相关,与AHI(r=-0.714,P<0.001)、微觉醒指数(r=-0.641,P<0.001)、ESS(r=-0.527,P<0.001)呈负相关。受试者的视空间与执行能力与AHI(r=-0.541,P<0.001)、ESS(r=-0.470,P<0.001)呈负相关,与LaSpO_(2)(r=0.403,P<0.001)、REM/TST%(r=0.468,P<0.001)呈正相关;注意能力与AHI(r=-0.459,P<0.001)、微觉醒指数(r=-0.562,P<0.001)呈负相关;抽象能力与REM/TST%(r=0.400,P<0.001)呈正相关;延迟回忆能力与AHI(r=-0.498,P<0.001)、ESS(r=-0.469,P<0.001)、微觉醒�ability was positively correlated with REM/TST%(r=0.400,P<0.001).Delayed recall ability was negatively correlated with AHI(r=-0.498,P<0.001),ESS(r=-0.469,P<0.001),and micro-arousal index(r=-0.483,P<0.001),and positively correlated with LaSpO_(2)(r=0.441,P<0.001).4.Through multiple stepwise regression analysis,taking MoCA total score as the dependent variable and BMI,AHI,longest apnea/hypopnea time,LaSpO_(2),ESS,sleep efficiency,micro arousal index,REM/TST%,N1/TST%,N3/TST%,and WASO as independent variables,AHI was found to be the independent variable for multiple stepwise regression analysis(β=-0.482,P<0.001),REM/TST%(β=0.441,P<0.001),the longest duration of apnea/hypopnea(β=0.328,P<0.001),and LaSpO_(2)(β=0.235,P=0.033)was an important predictive indicator of cognitive decline.Conclusion OSAHS patients are more likely to have abnormal cognitive function.The decline of cognitive function in OSAHS patients is related to hypoxia,the decreased REM sleep period and the increased micro-arousal index.The decreased sleep efficiency of OSAHS patients is associated with cognitive dysfunction.AHI,REM/TST%,the longest duration of apnea/hypopnea,and LaSpO_(2) are important predictive indicators of cognitive decline.

关 键 词：睡眠呼吸暂停 认知功能 睡眠结构 影响因素分析 

分 类 号：R766[医药卫生—耳鼻咽喉科]