山东大学耳鼻喉眼学报 ›› 2016, Vol. 30 ›› Issue (5): 68-74.doi: 10.6040/j.issn.1673-3770.0.2016.026

• 睡眠呼吸障碍性疾病 • 上一篇    下一篇

阻塞性睡眠呼吸暂停低通气综合征患者认知功能损害的研究

朱越1,黄志纯1,杨明2,朱新1   

  1. 1.东南大学附属中大医院耳鼻咽喉头颈外科, 江苏 南京 210009;
    2.南京医科大学附属南京儿童医院放射科, 江苏 南京 210008
  • 收稿日期:2016-01-20 出版日期:2016-10-20 发布日期:2016-10-20
  • 通讯作者: 黄志纯. E-mail:huang1963618@sohu.com E-mail:503708814@qq.co
  • 作者简介:朱越. E-mail:503708814@qq.co

The study of cognitive disorderin patients with obstructive sleep apnea hypopnea syndrome.

ZHU Yue1, HUANG Zhichun1, YANG Ming2, ZHU Xin   

  1. 1. Department of Otolaryngology &Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210009, Jiangsu, China;2. Department of Radiation and Imaging, Nanjing Childrens Hospital, Nanjing Medical University, Nanjing 210008, Jiangsu, China
  • Received:2016-01-20 Online:2016-10-20 Published:2016-10-20

摘要: 目的 通过高级神经认知功能量表评估阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的认知功能损害程度,并根据多导睡眠图(PSG)的监测结果分析OSAHS患者认知功能的受损情况。 方法 通过纳入55例OSAHS患者和27例正常对照组的PSG结果,并采集认知功能相关量表,以评估OSAHS患者认知受损情况及其与PSG相关参数之间的相关性,并分析与认知功能受损有关的PSG参数的最佳界值。 结果 (1)两组之间性别、年龄及受教育程度差异无明显统计学意义(P>0.05);(2)两组间呼吸暂停低通气指数(AHI)、呼吸暂停指数、最长呼吸暂停时间、低通气指数、氧减指数(ODI)、夜间平均动脉血氧饱和度(MSaO2)、夜间最低血氧饱和度(LSaO2)、睡眠期间血氧饱和度低于90%的时间占总睡眠时间的百分比(TST<0.9)的差异均有统计学意义(均P<0.05);(3)两组睡眠结构结果对照,可见总睡眠时间及睡眠结构的差异无统计学意义(P>0.05);(4)两组简易精神状态量表(MMSE)结果可见两组MMSE评分,及其中定向力的差异有统计学意义(P<0.05);(5)两组高级神经功能量表结果对照,可见两组间Epworth嗜睡量表(ESS)、STOP Bang、逻辑记忆测验(LMT)及延迟回忆(LMT DR)差异有统计学意义(P<0.05);(6)高级神经认知功能量表与PSG有关参数的相关性结果显示AHI及呼吸暂停指数这两个参数与各高级神经功能量表间相关性最强;最长呼吸暂停时间、低通气指数、ODI、TST<0.9、MSaO2和LSaO2与各量表存在一定的相关性,而觉醒次数及鼾声指数则无明显相关性;(7)MMSE的筛查效度比较,结果显示ROC曲线下面积(AUC)为0.664,在界值为29.5时,约登指数最高,为0.32,此时MMSE量表灵敏度为76.4%,特异度为55.6%;(8)PSG参数的效度筛查结果显示,呼吸暂停指数的最佳界值为5.15,最长呼吸暂停时间的最佳界值为105 s,低通气指数的最佳界值为0.55,ODI的最佳界值为3.1,TST<0.9的最佳界值为0.27%,MSaO2的最佳界值为96.5%,LSaO2的最佳界值为81.5%。 结论 (1)OSAHS患者夜间存在反复呼吸暂停及低通气,引起低氧血症,进而导致认知功能障碍的发生;(2)OSAHS患者夜间总睡眠时间无明显减少,睡眠结构未见明显紊乱;(3)OSAHS患者认知功能存在不同程度的受损,且与疾病严重程度密切相关;(4)OSAHS患者认知功能中定向力、逻辑记忆及回忆能力方面受损明显;(5)呼吸暂停指数>5.15,和(或)最长呼吸暂停时间>105 s,和(或)低通气指数>0.55,和(或)ODI>3.1、和(或)TST<0.9>0.27%、和(或)MSaO2<96.5%,和(或)LSaO2<81.5%时,可以快速提示临床医生OSAHS患者可能存在的认知功能受损。

关键词: 睡眠呼吸暂停,阻塞性, 认知功能, 神经认知功能量表

Abstract: Objective Using Neurocognitive function scalesto evaluate the changes of cognitive function in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS). And analyzing the cognitive disorderin patients by the polysomnography(PSG). Methods A collection of 55 patients with OSAHS and 27 cases of normal control group, collecting their PSG results and related cognitive function to assess cognitive damage in patients with OSAHS. Analysisof the correlation between parameters associated with the PSG, and the parameters associated with impaired cognitive function best bound values. Results (1) There were no significant differences in gender, age and level of education(P>0.05); 山东大学耳鼻喉眼学报30卷5期 -朱越,等.阻塞性睡眠呼吸暂停低通气综合征患者认知功能损害的研究 \=-(2) There weresignificant differences in AHI, apnea index between the two groups, the longest time of apnea, low ventilation index, ODI, TST < 0.9, MSaO2, LSaO2(all P<0.05); (3) There were no significant differences in sleep structure comparison and total sleep time(P>0.05); (4) There were significant differences in MMSE scale results, including directional force(P<0.05); (5) There were significant differences in ESS, STOP Bang, LMT, LMT DR(P<0.05); (6) Neurocognitive function scale and PSG related parameters of the correlation of the results show that the AHI and apnea index are the strongest correlation between neurocognitive function scale; The longest time of apnea, low ventilation index, ODI, TST < 0.9, MSaO2 and LSaO2 has certain correlation with the scale, and number of awakening and snoring is no significant correlation; (7) MMSE standard for cognitive dysfunction screening validity comparison, results show that the AUC is 0.664. When the boundary value of 29.5, the Youden index is highest, about 0.32, and the sensitivity is 76.4%, while the specificity is 55.6%; (8) PSG validity screening, the best boundary value analysis of the parameters. The results showed that the best of apnea index value is 5.15, the longest apnea time the best value is 105 seconds, hypoventilation index the best value is 0.55, ODI the best value is3.1,TST < 0.9 the best value is 0.27%, MSaO2 the best value is 96.5%, and LSaO2 best value is 81.5%. Conclusions (1) Patients with OSAHS have low ventilation and apnea at night, leading to the occurrence of cognitive dysfunction; (2) There were no significant differences in sleep structure and total sleep time; (3) Cognitive function in patients with OSAHS exist different degree of damage, and is closely related to the severity of disease; (4) Directional force, logical memoryand memory ability in cognitive function in patients with OSAHS are impaired obviously; (5) Apnea index > 5.15, and(or)the longest apnea time > 105 seconds, and(or)apnea-hypopnea index > 0.55, and(or)ODI > 3.1, and(or)TST < 0.9 > 0.27%, and(or)MSaO2 < 96.5%, and(or)LSaO2 < 81.5%, can quickly promptclinical doctors OSAHS patients that may have impaired cognitive function.

Key words: Obstructive sleep apnea hypopnea syndrome, Cognitive function, Neurocognitive function scales

中图分类号: 

  • R766.7
[1] 戚颖,周旭.中重度阻塞性睡眠呼吸暂停低通气综合征患者经悬雍垂腭咽成形术治疗后的远期生活质量评价[J].中国临床医学,2014,21(5):558-560. QI Ying, ZHOU Xu. Evaluation on long-term life quality in patients with moderate to severe obstructive sleep apnea hypopnea syndrome after UPPP[J].Chin J Clin Med, 2014, 21(5):558-560.
[2] 王勇,朱源生,方翔,等.阻塞性睡眠呼吸暂停低通气综合征对高血压患者血栓前状态的影响[J].广东医学,2014,35(7):1048-1051. WANG Yong, ZHU Yuansheng, FANG Xiang, et al. Obstructive sleep apnea hypopnea syndrome thrombosis in patients with high blood pressure before the state proponents[J]. Guangdong Med J, 2014, 35(7):1048-1051.
[3] Bruin P F, Bagnato M C. Cognitive impairment in obstructive sleep apnea syndrome[J]. Bras Pneumol, 2010, 36(2):32-37.
[4] Bulcun E, Ekici A, Ekici M. Quality of life and metabolic disorders in patients with obstructive sleep apnea[J]. Clin Invest Med, 2012, 35(2):E105-113.
[5] Berry R B, Budhiraja R, Gottlieb D J, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine[J]. J Clin Sleep Med, 2012, 8(5):597-619.
[6] 中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志, 2012, 35(1):9-12. DOI: 10.3760/cma. j. issn. 1001-0939. 2012. 01. 007.
[7] 王卫红,OSAHS对认知功能的影响及相关机理研究[D].长沙:中南大学,2012.
[8] 周丽媛,王斌全,张岑娜.阻塞性睡眠呼吸暂停低通气综合征患者血清脂联素水平的研究[J].临床耳鼻咽喉头颈外科杂志, 2010, 24(6):264-265. ZHOU Liyuan, WANG Binquan, ZHANG Cenna. Study of the level of adiponectin in obstructive sleep apnea hypopnea syndrome patients[J]. J Clin Otorhinolaryngol Head Neck Surg, 2010, 24(6):264-265.
[9] 黄家军,刘畅,苏炳泽,等. 老年阻塞性睡眠呼吸暂停综合征多导睡眠图与认知功能的相关性[J]. 中国老年学杂志,2014,34(20):5700-5701. HUANG Jiajun, LIU Chang, SU Binze, et al. Elderly patients with obstructive sleep apnea syndrome more sleep figure and the correlation of cognitive function[J]. Chin J Gerontol, 2014, 34(20):5700-5701.
[10] 陈燕,赵春玲,张春来,等.慢性间断性低氧大鼠认知功能和脑胆碱能神经元的进行性变化[J].中国应用生理学杂志,2011,27(2):192-193. CHEN Yan, ZHAO Chunlin, ZHANG Chunlai, et al. The progressive effects of chronic intermittent hypoxia on cognitive function and the cholinergic neuron in rats[J]. Chin J App Physiol, 2011, 27(2):192-193.
[11] Xu M, Yang Y, Zhang J. Levels of neuroglobin in serum and neurocognitive impairments in Chinese patients with obstructive sleep apnea[J]. Sleep Breath, 2013, 17(2):573-582.
[12] Djonlagic I, Sahoisky J, Carusona A, et al. Increased sleep fragmentation leadsto impaired off-line consolidation of motor memories in humans[J]. PLoS One, 2012, 7(3):E34106.
[13] 何迎雪,丛琳,杜怡峰. 阿尔茨海默病患者睡眠障碍的临床特点及相关因素[J].山东大学耳鼻喉眼学报,2015,29(2):1-8. HE Yingxue, CONG Lin, DU Yifeng. Clinical investigation of sleep disorders and related factors in Alzheimes disease[J]. J Otolaryngol Ophthalmol Shandong Univ, 2015, 29(2):1-8.
[14] 卢俏丽,薛蓉,董丽霞,等.脑梗死伴阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构及认知功能分析[J].中华神经科杂志,2012,45(6):400-403. LU Qiaoli, XUE Rong, DONG Lixia, et al. Sleep structure and cognitive function in stoke combined with obstructive sleep apnea hypopnea syndrome[J]. Chin J Neurol, 2012, 45(6):400-403.
[15] Cesarovic N, Jirkof P, Rettich A, et al. Combining sevoflurane anesthesia with fentanyl-midazolam or s-ket-amine in laboratory mice[J]. J Am Assoc Lab AnimSci, 2012, 51(2):209-218.
[16] Guimaraes C, Martins M V, Vaz Rodrigues L, et al. Epworth Sleepiness Scale in obstructive sleep apnea syndrome-an underestimated subjective scale[J]. Rev Port Pneumol, 2012, 18(6):267-271.
[17] Naismith S, Winter V, Gotsopoulos H, et al. Neurobehavioral functioning in obstructive sleep apnea: differential effects of sleep quality, hypoxemia and subjective sleepiness[J]. J Clin Exp Neuropsychol, 2004, 26(1):43-54.
[18] Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea[J]. Canad J Anaesth, 2010, 57(5):423-438.
[1] 王红梅,李连贺. 神经心理量表联合事件相关电位对中、重度阻塞性睡眠呼吸[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 56-61.
[2] 耿聪,张丽伟,丁明. 全身麻醉对单纯鼾症患者术后认知功能的影响[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 85-88.
[3] 李小波,曹忠胜,辛洁,谢辰,陈锐. 罗格列酮对间歇性低氧小鼠氧化应激及认知功能的作用研究[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 45-49.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!