中青年男性阻塞性睡眠呼吸暂停患者脑白质高信号的特征及其对认知功能的影响  

Characteristics of white matter hyperintensities in young and middle-aged male patients with obstructive sleep apnea and its impact on cognitive function

作　　者：丁啸 王婧[1] 伋立荣 王智君 李志强 吴慧 陈锐[1] Ding Xiao;Wang Jing;Ji Lirong;Wang Zhijun;Li Zhiqiang;Wu Hui;Chen Rui(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Medical Imaging,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Respiratory and Critical Care Medicine,Wuxi Fifth People's Hospital,Wuxi 214000,China)

机构地区：[1]苏州大学附属第二医院呼吸与危重症科,苏州215004 [2]苏州大学附属第二医院影像科,苏州215004 [3]无锡市第五人民医院呼吸与危重症科,无锡214000

出　　处：《中华结核和呼吸杂志》2025年第4期350-357,共8页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金项目(82070095,82470094);苏州市科技发展计划新型临床诊疗技术(编号:SKY2023054);苏州市科教兴卫青年项目(KJXW2021016)。

摘　　要：目的:探讨无心脑血管疾病的中青年男性阻塞性睡眠呼吸暂停(OSA)患者脑白质高信号(WMH)的特征及其对认知功能的影响。方法:横断面研究。前瞻性选取2021年6月至2023年6月在苏州大学附属第二医院睡眠中心因打鼾就诊的患者,符合入排标准的患者均行多导睡眠监测(PSG),使用蒙特利尔认知评估量表(MoCA)和剑桥神经心理自动化成套测试(CANTAB)评估认知功能,采集头颅MRI数据,使用Fazekas视觉评分法评价WMH的严重程度。根据呼吸暂停低通气指数(AHI)将受试者分为对照组(AHI≤15次/h)和OSA组(AHI>15次/h),比较上述指标在两组间的差异。采用Spearman相关分析探讨WMH与认知功能之间的关系,logistic回归模型分析WMH发生的危险因素。结果:纳入受试者共104例,均为男性,其中对照组48例,OSA组56例。PSG参数比较显示:OSA组的AHI、非快动眼睡眠1期加2期占总睡眠时间的比例(N1%+N2%)、氧减指数(ODI)、脉搏血氧饱和度低于90%时间所占比(TS90)更高(均 P<0.05),非快动眼睡眠3期占总睡眠时间的比例(N3%)、快速动眼睡眠占总睡眠时间的比例(REM%)、最低脉搏血氧饱和度(MinSpO 2)更低(均 P<0.05)。认知测试比较显示:与对照组相比,OSA组的MoCA总分以及子项目视空间与执行、延迟回忆分数更低;CANTAB测试中的运动筛查任务(MOT)平均反应时间、图形视觉记忆(PRM)延迟识别反应时间和空间工作记忆(SWM)完成总时间更长(均 P<0.05)。MRI成像显示:OSA组脑WMH发生率及Fazekas分级高于对照组( P<0.05),且深部脑白质高信号(DWMH)最常发生在额叶。受试者的Fazekas分级与MOT反应时间呈正相关( r=0.25, P=0.026),与PRM即刻识别正确率呈负相关( r=-0.36, P=0.002)。回归结果提示年龄增加是中青年OSA患者WMH发生的独立危险因素( OR=1.120,95% CI:1.038~1.210, P=0.004),而REM%增加是保护因素( OR=0.882,95% CI:0.801~0.901, P=0.011)。 结论:中青年男性OSA患者合并WMH的比�Objective:To explore the characteristics of white matter hyperintensities(WMH)in young and middle-aged male patients with obstructive sleep apnea(OSA)who did not have cardiovascular and cerebrovascular diseases,and its impact on cognitive function.Methods:This was a cross-sectional study.Patients who visited the sleep center of the Second Affiliated Hospital of Soochow University due to snoring between June 2021 and June 2023 were prospectively selected.All patients meeting the inclusion criteria underwent polysomnography(PSG)monitoring,while cognitive function was evaluated using the Montreal Cognitive Assessment(MoCA)and the Cambridge Neuropsychological Test Automated Battery(CANTAB).All subjects underwent Brain magnetic resonance imaging(MRI),and the Fazekas visual rating scale was used to assess the severity of WMH.Subjects were divided into a control group(AHI≤15/h)and an OSA group(AHI>15/h)based on the apnea-hypopnea index(AHI),and the above indicators were compared between the two groups.Spearman correlation analysis was conducted to investigate the relationship between WMH and cognitive function.A logistic regression model was used to analyze the risk factors associated with WMH occurrence.Results:A total of 104 subjects were enrolled,all male,48 in the control group and 56 in the OSA group.Comparisons of PSG parameters indicated that the OSA group had a higher AHI,percentage of non-rapid eye movement sleep stage 1 and 2 in total sleep time(N1%+N2%),oxygen desaturation index(ODI),and percentage of total sleep time with pulse oxygen saturation below 90%(TS90)(all P<0.05).In contrast,the percentage of Non-Rapid Eye Movement Sleep Stage 3 in total sleep time(N3%)and the percentage of Rapid Eye Movement Sleep in total sleep time(REM%),and the Minimum pulse oxygen saturation(MinSpO?)were lower(all P<0.05).Cognitive test comparisons indicated that the OSA group had lower total MoCA scores,and lower scores on sub-items such as visuospatial,executive function and delayed recall compared to the control group.In

关 键 词：睡眠呼吸暂停 阻塞性 磁共振成像 脑白质高信号 Fazekas评分 

分 类 号：R766[医药卫生—耳鼻咽喉科]