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

doi:10.6040/j.issn.1673-3770.0.2017.427

摘要/Abstract

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

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.

WANG Hongmei, LI Lianhe. The evaluation on mild cognitive impairment in patients with moderate-severe obstructive sleep apnea and[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2018, 32(2): 56-61.

参考文献

[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.

相关文章 15

[1]	赵春蓉,杨森,李春燕,王东海,杨宇,杨晓英. 持续正压通气治疗对中-重度阻塞性睡眠呼吸暂停低通气综合征患者嗅觉及认知功能的影响[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 68-73.
[2]	张欣,刘雅洁,李飞,黄春梅,张卉新,朱家斌. 重度OSA患者眼动脉及视网膜中央动脉血流动力学参数与AHI、LSaQ₂的关联性[J]. 山东大学耳鼻喉眼学报, 2026, 40(2): 87-94.
[3]	熊琴, 张砚, 乌日娜, 李锋, 唐力行. 鼻用糖皮质激素在儿童中的应用[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 160-167.
[4]	李晗,乔晓峰. 嗅觉训练改善认知功能的研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 132-138.
[5]	卫志成,彭裕,沈力,李莉琳,沈杭东,李馨仪,许华俊,关建. 犬尿氨酸介导阻塞性睡眠呼吸暂停所致肝功能损伤:一项横断面研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 38-44.
[6]	马馨,董凌康,吴红敏,易红良,邹建银. 外展悬吊缝合技术在阻塞性睡眠呼吸暂停治疗中的改良及应用进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 81-88.
[7]	李莉琳,李馨仪,关建. 阻塞性睡眠呼吸暂停与抑郁症共病机制的研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 89-96.
[8]	王小清,王钰彧,仇金玮,许金侠,朱梅. 口面肌功能训练对鼾声患者鼾声指标及睡眠质量的影响[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 101-107.
[9]	刘莲莲,李进让. 阻塞性睡眠呼吸暂停与咽喉反流[J]. 山东大学耳鼻喉眼学报, 2024, 38(6): 15-22.
[10]	罗露,周恩,肖旭平,林志强,方志杰,吕晓虹. 等离子点状激发技术在儿童OSA扁桃体腺样体切除术联合围手术期快速康复中的应用[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 26-30.
[11]	赵云,滕支盼,李琦,沈小飞. 儿童腺样体扁桃体切除后圆枕增生26例[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 43-48.
[12]	王桂芳,李仁高,马青. H-UPPP联合低温等离子舌根射频消融术对OSAHS患者血氧饱和度及动脉血氧分压的影响[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 49-54.
[13]	任晓勇. 阻塞性睡眠呼吸暂停合并症的研究现状和未来展望[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 1-5.
[14]	李彦如,施云瀚,曹莉莉,廖建宏,亢丹,费南希,韩德民. 前伸下颌动作与口腔矫治器对上气道形态影响的一致性分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 6-14.
[15]	郭瑞祥,王岩. 肠道菌群在阻塞性睡眠呼吸暂停相关认知功能障碍中的研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 15-23.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed