山东大学耳鼻喉眼学报 ›› 2018, Vol. 32 ›› Issue (2): 56-61.doi: 10.6040/j.issn.1673-3770.0.2017.427

• ·论著· • 上一篇    下一篇

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

王红梅,李连贺   

  1. 朝阳市中心医院耳鼻喉科, 辽宁 朝阳 122000
  • 收稿日期:2017-10-15 出版日期:2018-03-20 发布日期:2018-03-20
  • 通讯作者: 李连贺. E-mail:llh186@163.com

The evaluation on mild cognitive impairment in patients with moderate-severe obstructive sleep apnea and

WANG Hongmei, LI Lianhe   

  1. Department of Otolaryngology, The Central Hospital Of Liaoning Province Chaoyang City, Chaoyang 122000, Liaoning, China
  • Received:2017-10-15 Online:2018-03-20 Published:2018-03-20

HTML

PDF (PC)

395

摘要： 目的 通过神经心理量表和事件相关电位中的P300检测评价中、重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的轻度认知功能障碍(MCI)。 方法 对多导睡眠呼吸监测(PSG)确诊的中重度OSAHS患者30例(患者组)、志愿者20例(对照组),分别以蒙特利尔认知评估量表(MoCA)评分判断参加者是否存在MCI,并行Epworth嗜睡量表(ESS)和事件相关电位中的P300检测,PSG检查记录呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(LSaO2)、夜间平均血氧饱和度(MSaO2)和血氧饱和度低于90%的时间占整个睡眠时间的百分比(CT90%)、氧减指数(ODI)、呼吸性微觉醒指数(RMI)和睡眠结构。分别比较患者组与对照组的各项指标,相关分析MoCA评分与各项指标和P300相关参数的相关性。 结果 与对照组比较,中、重度OSAHS患者年龄和受教育年限差异无统计学意义,BMI和ESS评分明显增加,MoCA总评分明显降低,MoCA亚项分析中记忆/延迟回忆评分明显降低,AHI明显增加,LSaO2和MSaO2明显降低,CT90%增加,ODI和RMI指数明显增加,浅睡眠(S1、S2期)延长、深睡眠(S3、S4期)及快动眼睡眠期(REM)减少;在P300检测中,Cz、C3、C4、Pz点P300潜伏期明显延长,直线相关分析MoCA亚项中记忆/延迟回忆评分与ESS、AHI、MSaO2、Cz、C3、C4点潜伏期无相关性,与LSaO2正相关,与RMI、ODI、CT90%与Pz点潜伏期和Fz点波幅负相关,Pz点P300潜伏期及Fz点P300波幅对MoCA评分影响较大。 结论 中、重度OSAHS患者存在MCI,OSAHS患者的记忆功能变化是由夜间微觉醒所致。P300检测可作为评价OSAHS患者认知功能障碍的电生理指标之一,结合MoCA评分能对OSAHS患者认知能力及时测评。

关键词: 认知功能, 阻塞性, 事件相关电位P300, 蒙特利尔认知评估量表, 神经心理学测试, 睡眠呼吸暂停

Abstract: Objective To investigate the mild cognitive impairment measured by necropsy ecological scales and the P300 of ERP in the patients with moderate-severe obstructive sleep apnea and hypopnea syndrome(OSAHS). Methods A total of 30 patients(patients group)who were monitored by Polysomnography(PSG)and 20 volunteers(controls groups)were enrolled, the 30 patients were carried out to determine whether the participants have mild Cognitive Impairment(MCI)by Montréal cognitive assessment scale(MoCA).Parallel Epworth sleepiness scale(ESS)and P300.All of them were monitored for apnea/hyponea index(AHI)、lowest oxygen saturation(LSaO2)、mean oxygen saturation(MSaO2)during sleep and the total sleep time of SaO2<90%(CT90), the oxygen saturation index(ODI)、the respiratory micro arousal(RMI)and sleep structure. And compare the parameter one by one. Compare the various indicators and correlation the MoCA score, P300 parameters and the PSG parameters. Results Compared with the control group, the moderate-severe OSAHS patients, there was no significant statistically different in age and educational level. The BMI and ESS increased,the score of MoCA in OSAHS group strikingly lower than that of the control group, the MoCA analysis showed that memory/delayed recall score was significantly decreased, the AHI increased.the score of LSaO2 and MSaO2 decreased, CT90% increased, ODI and RMI increased significantly, the S1 and S2 prolonged, the S3、S4 and REM shortened, the Cz,C3,C4,Pz P300 latency was significantly prolonged in P300. Correlation analysis showed that the MoCA memory/delayed not associated with ESS, AHI, MSaO2, CT90%, Cz, C3, C4, and was positively related to LSaO2, and was negatively the RMI, ODI, CT90%, the latent period of Pz, the amplitude of Fz, Pz P300 latency and Fz P300 amplitude had significant influence on the MoCA. Conclusion Moderate-severe OSAHS patients existing MCI, the memory function of patients with OSAHS was significantly associated with the RMI which caused by the sleep structure disorder, P300 detection can be used as electric physiological indicator of cognitive dysfunction in OSAHS patients, combined the MoCA score can promptly evaluate the cognitive dysfunction in OSAHS patients, and promptly make a diagnosis and give treatment according to the evaluation result.

Key words: Sleep apnea, obstructive, Neuropsychological test, Cognitive function, Eventrelated potential P300, The Montreal cognitive assessment scale

中图分类号: 

  • R766.7
[1] Harsch IA, Schahin SP, Radespiel—Trger M, et al. Continuous positive airway pressure treatment rapidly ireproves insulin sensitivily in patients with obstructive sleep apnea syndrome[J].Am J Respir Crit Care Med, 2009, 169(5):156-162.
[2] 中华医学会呼吸病学分会睡眠呼吸疾病学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案)[J].中华结核和呼吸杂志,2002,25(4):195-198.
[3] Yaffe K, Laffan AM, Harrison SL, et al. Sleep disordered breathing,hypoxia and risk of mild cognitive impairment and dementia in older women[J]. JAMA, 2001, 306(6):613-619.
[4] 高金颖,沈扬,樊东升,等.伴轻度认知损害的青中年阻塞性睡眠呼吸暂停综合征患者认知损伤特点[J].实用医学杂志,2008,24(20):3494-3495. GAO Jinying, SHEN Yang, FAN Dongsheng, et al. The features of mild cognitive impairment in young and middle-aged patients with obstructive sleep apnea syndrome[J]. The Journal of Practical Medicine, 2008, 24(20):3494-3495.
[5] Saunamaki T, Jehkonen M. A review of executive functions in obstructive sleep apnea syndrome[J]. Acta Neurol Scand, 2007, 115(1):1-11.
[6] Decary A, Rouleau I, Montplaisir J. Cognitive deficits associated with sleep apnea syndrome: a proposed neuropsycAological test baltery[J]. Sleep, 2000, 23(3):369-381.
[7] 彭斌,李舜伟.睡眠呼吸暂停综合征患者的认知功能障碍[J]. 中国临床神经科学,2000, 8(1):65-66. PENG Bin, LI Shunwei. The cognitive function obstruction in patients with obstructive sleep apnea syndrome[J].Chinese Journal of Clinical Neurosciences, 2000, 8(1):65-66.
[8] Hono T, Miyata Y. The scoring of satge Wake during a noctunal sleep in human: a comparison between the scoring with Rechtschaffen & Kales and the awareness of awakening from sleep with a butten-pressing[J]. Kawasaki Medical Welfare Journal, 1992, 2:199-203.
[9] 张雪晴,曾慧. 北京版蒙特利尔量表测试内容调整对测试结果的影响[J]. 护理研究,2013,27(13):1268-1269. ZHANG Xueqing, ZENG Hui. Influence of adjustment of test items of beijing version of Montreal Scale on test effect[J]. Chinese Nursing Research, 2013, 27(13):1268-1269.
[10] Sleep apnea hypopnea syndrome: a critical review[J]. J Int Neurop Sycholsoc, 2004, 10(5):772-785.
[11] Ihara M, Okamoto Y, Takahashi R. Suitability of the montreal cognitive assessment versus the mini-mental state examination in detecting vascular cognitive impairment[J]. J stroke cerebrovasc Dis, 2013, 22(6):737-741.
[12] Popovic IM, Lovrencic-Huzjan A, Simundic AM, et al. Cognitive performance in asymptomatic patients with advanced carotid disease[J]. Cogn behav Neurol, 2011, 24(3):145-151.
[13] Martins CH, Castro Junior Nd, Costa Ficho OA, et al. Obstructive sleep apnea and P300 evoked auditory potential.[J]. Braz J Otorhinolaryngol, 2011, 77(6):700-705.
[14] 孔德磊,康健,王玮,等.不同性别睡眠呼吸暂停低通气综合征患者日间嗜睡与睡眠质量分析研究[J].中国全科医学,2010,13(22):2464-2466. KONG Delei, KANG Jian, WANG Wei, et al. Daytime sleepiness and sleep quality in patients of different genders with obstructive sleep apnea syndrome[J]. Chin Gen Med, 2010, 13(22):2464-2466.
[15] 王赞峰,康健,冯学威.间断低氧对大鼠脑内诱导型一氧化氮合酶表达与神经细胞凋亡的影响[J].中华结核和呼吸杂志,2006,29(12):847-848. WANG Zanfeng, KANG Jian, FENG Xuewei. The expression of inducible nitric oxide synthase and the effect of nerve cell apoptosis in rat brain with the intermittent hypoxia.Chin J Tubere Respir Dis, 2006, 29(12):847-848.
[16] Aloia MS, Llniczky N, Di Dio P, et al. Neuropsychological changes and treatment compiance in older adults with sleep apnea[J]. Psychosom Res, 2003, 54(1):71-76.
[17] 徐雁,李舜伟,黄席珍,等.阻塞性睡眠呼吸暂停综合征患者的认知障碍与胰岛素样生长因子-I间的关系[J].中华医学杂志,2002,82(20):1388-1390. XU Yan, LI Shunwei, HUANG Xizhen, et al. Insulin-like growth factor-1 and cognitive function in patients with obstructive sleep apnea syndrome[J]. Nat Med J of Chin, 2002, 1(7):426-436.
[18] Gaultier C. Obstructive sleep apnea syndrome and genetics[J].Rev Neurol(paris), 2003, 159(11 suppl):98-101.
[1] 刘大炜,张宇,李成林,陈秀梅,宋西成. 加速康复外科在儿童OSAS围手术期中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 19-22.
[2] 吕旭琴,万文锦. 阻塞性睡眠呼吸暂停低通气综合征合并高血糖患者的围手术期血糖管理[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 100-104.
[3] 刘大波. 重视儿童阻塞性睡眠呼吸暂停低通气综合征睡眠结构紊乱[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 6-8.
[4] 沈翎,林宗通,林兴,杨中婕. 儿童阻塞性睡眠呼吸暂停低通气综合征危险因素的[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 25-29.
[5] 李延忠,张泰. 关于儿童阻塞性睡眠呼吸暂停低通气综合征我们面临的问题[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 1-5.
[6] 张会芳,杨红珍. 经鼻持续气道正压通气对阻塞性睡眠呼吸暂停低通气[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 48-51.
[7] 许志飞,倪鑫. 重视阻塞性睡眠呼吸暂停低通气综合征儿童腺样体[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 9-13.
[8] 王岩,师晓丽. 变态反应与儿童OSAHS的关系[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 14-18.
[9] 杨微,郑莉,许志飞. 中重度阻塞性睡眠呼吸暂停低通气综合征儿童无创正压[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 19-24.
[10] 仇书要,刘大波,钟建文,杨李强. 儿童阻塞性睡眠呼吸暂停低通气综合征等离子[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 34-37.
[11] 钟建文,刘大波,罗向前,黄振云,仇书要,程超,杨李强,易新华,曾锦鸿. 可穿戴设备在儿童阻塞性睡眠呼吸暂停诊断中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 30-33.
[12] 李浩,李延忠,王岩. HIF-1α、VEGF在阻塞性睡眠呼吸暂停低通气综合征患者[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 43-47.
[13] 龚齐,张劼,赵屏屏. 鼻腔扩容术对慢性鼻-鼻窦炎伴睡眠呼吸暂停[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 52-55.
[14] 张剑伟,倪泽,唐东亮,徐金. OSAHS患者手术麻醉中应用纤维喉镜引导经鼻行气管插管[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 61-64.
[15] 任涛,唐以军,王梅芳,刘岩,钱鑫. 阻塞性睡眠呼吸暂停低通气综合征对血糖、血脂及C反应蛋白的影响[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 53-57.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 赵利敏，倪坤，吴佳丽，陈淑梅，李晓艳. 婴幼儿吸气性喉喘鸣病因分析与治疗[J]. 山东大学耳鼻喉眼学报, 2013, 27(2): 49 -51 .
[2] 史春生1，张庆泉2,王强2,孙岩2,葛长艺1. 软腭缺损修复组织瓣的特点[J]. 山东大学耳鼻喉眼学报, 2013, 27(2): 86 -88 .
[3] 张令1,孙传义1,许安廷2. 以耳聋就诊的岩尖胆脂瘤1例[J]. 山东大学耳鼻喉眼学报, 2013, 27(2): 93 -94 .
[4] 吴彦桥，邸斌，李军，高晓红 . 鼻内镜下难治性鼻出血出血点寻找及止血策略[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 1 -3 .
[5] 罗惠秀，范春涛，邓延华. 阻塞性睡眠呼吸暂停低通气综合征患儿扁桃体腺样体切除术临床疗效分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 17 -20 .
[6] 郝颖娟1，杨庆松2，周跃华2，易省平1，翟长斌2. 飞秒激光在薄瓣LASIK手术中制作的角膜瓣厚度形态观察[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 26 -31 .
[7] 闻华明1，李海祥2. 应用三角函数法估算LASIK术后人工晶状体度数[J]. 山东大学耳鼻喉眼学报, 2013, 27(5): 74 -76 .
[8] 朱见，贺青卿，郑鲁明，范子义，赵国伟，侯蕾，史后彬 . cN0甲状腺微小乳头状癌淋巴结转移高危因素及行预防性清扫临床分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 9 -12 .
[9] 李少华，孙一帆，卢标清. 双软组织血管瓣填塞乳突术腔的临床研究[J]. 山东大学耳鼻喉眼学报, 2014, 28(1): 6 -7 .
[10] 魏希建1，阴瑞兰2，郭星3. 增殖诱导配体在喉鳞状细胞癌中的表达[J]. 山东大学耳鼻喉眼学报, 2014, 28(1): 14 -16 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发