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

doi:10.6040/j.issn.1673-3770.0.2016.026

摘要/Abstract

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

朱越,黄志纯,杨明,朱新. 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[J]. 山东大学耳鼻喉眼学报, 2016, 30(5): 68-74.

ZHU Yue, HUANG Zhichun, YANG Ming, ZHU Xin. The study of cognitive disorderin patients with obstructive sleep apnea hypopnea syndrome.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(5): 68-74.

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