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

doi:10.6040/j.issn.1673-3770.0.2025.266

摘要/Abstract

摘要： 目的系统评估持续正压通气(continuous positive airway pressure, CPAP)治疗对中-重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)患者嗅觉及认知功能的纵向改善作用。方法纳入90例中-重度OSAHS患者,接受为期6个月的标准化CPAP治疗。分别在基线、治疗3个月和6个月时,采用Sniffin' Sticks嗅觉测试评估嗅觉阈值、辨别力、识别力及总分(threshold-discrimination-identification, TDI),采用蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)评估认知功能。采用Pearson相关分析评估基线睡眠呼吸暂停低通气指数(apnea-hypopnea index, AHI)与嗅觉、认知功能改善程度(Δ)的相关性,以及嗅觉功能改善与认知功能改善的相关性。结果疗后,患者嗅觉总分从(19.81±2.88)分提高至(26.49±2.56)分(P<0.05),MoCA总分从(19.52±2.48)分提高至(22.58±1.87)分(P<0.05)。嗅觉各维度呈现差异化恢复轨迹:阈值和识别力在治疗3个月时即改善(P<0.05),辨别力至治疗6个月时方显改善(P<0.05);认知功能中视空间与执行功能、注意力、记忆力在治疗3个月时改善(P<0.05)。嗅觉阈值改善与基线AHI呈正相关(r=0.41, P<0.05),嗅觉总分改善与认知总分改善亦呈正相关(r=0.46, P<0.05)。亚组分析显示,非肥胖、年龄≤50岁及女性患者的嗅觉改善更为明显(P<0.05)。结论 CPAP治疗可有效改善中-重度OSAHS患者的嗅觉与认知功能,功能恢复呈现时程差异与人群异质性,嗅觉与认知改善存在正相关关系。

关键词: 睡眠呼吸暂停, 阻塞性, 嗅觉功能, 认知功能, 持续气道正压通气

Abstract: Objective To longitudinally evaluate the effects of continuous positive airway pressure(CPAP)on olfactory and cognitive functions in patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods Ninety patients with moderate-to-severe OSAHS received standardized CPAP therapy for 6 months. Olfactory function, including threshold, discrimination, identification, and the total threshold-discrimination-identification(TDI)score, was assessed using the Sniffin' Sticks test at baseline, 3 months, and 6 months. Cognitive function was evaluated with the Montreal Cognitive Assessment(MoCA)at the same time points. Pearson correlation analysis was used to assess the relationships between baseline apnea-hypopnea index(AHI)and improvements(Δ)in olfactory and cognitive functions, as well as the correlation between olfactory and cognitive improvements. Results After treatment, the total olfactory score increased from 19.81±2.88 to 26.49±2.56(P<0.05), and the total MoCA score increased from 19.52±2.48 to 22.58±1.87(P<0.05). Olfactory subdomains showed differential recovery trajectories: threshold and identification improved significantly at 3 months(P<0.05), while discrimination improved only at 6 months(P<0.05). Among cognitive subdomains, visuospatial/executive function, attention, and memory showed significant improvement at 3 months(P<0.05). Improvement in olfactory threshold was positively correlated with baseline AHI(r=0.41, P<0.05), and improvement in total olfactory score was positively correlated with improvement in total cognitive score(r=0.46, P<0.05). Subgroup analysis revealed that non-obese patients, those aged ≤50 years, and females exhibited greater olfactory improvement(P<0.05). Conclusion CPAP therapy effectively improves olfactory and cognitive functions in patients with moderate to severe OSAHS, with functional recovery demonstrating temporal differences and population heterogeneity. Olfactory improvement is positively correlated with cognitive improvement.

Key words: Sleep apnea, Obstructive, Olfactory function, Cognitive function, Continuous positive airway pressure

中图分类号:

R749

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.

ZHAO Chunrong, YANG Sen, LI Chunyan, WANG Donghai, YANG Yu, YANG Xiaoying. Effects of continuous positive airway pressure on olfactory and cognitive functions in patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2026, 40(3): 68-73.

参考文献

[1] Yuan FJ, Zhang SS, Liu X, et al. Correlation between obstructive sleep apnea hypopnea syndrome and hypertension: a systematic review and meta-analysis[J]. Ann Palliat Med, 2021, 10(12): 12251-12261. doi:10.21037/apm-21-3302
[2] Lyons MM, Bhatt NY, Pack AI, et al. Global burden of sleep-disordered breathing and its implications[J]. Respirology, 2020, 25(7): 690-702. doi:10.1111/resp.13838
[3] Tondo P, Fanfulla F, Sabato R, et al. Obstructive sleep apnoea-hypopnoea syndrome: state of the art[J]. Minerva Med, 2023, 114(1): 74-89. doi:10.23736/s0026-4806.22.08190-3
[4] Jonsson Fagerlund M, Franklin KA. Perioperative continuous positive airway pressure therapy: a review with the emphasis on randomized controlled trials and obstructive sleep apnea[J]. Anesth Analg, 2021, 132(5): 1306-1313. doi:10.1213/ane.0000000000005480
[5] Shieu MM, Zaheed AB, Shannon C, et al. Positive airway pressure and cognitive disorders in adults with obstructive sleep apnea: a systematic review of the literature[J]. Neurology, 2022, 99(4): e334-e346. doi:10.1212/wnl.0000000000200383
[6] Binar M, Gokgoz MC. Olfactory function in patients with obstructive sleep apnea and the effect of positive airway pressure treatment: a systematic review and meta-analysis[J]. Sleep Breath, 2021, 25(4): 1791-1802. doi:10.1007/s11325-021-02349-5
[7] Berry RB, Brooks R, Gamaldo CE, et al. The AASM manual for the scoring of sleep and associated events[J]. Rules, Terminology and Technical Specifications, Darien, Illinois, American Academy of Sleep Medicine, 2012, 176(2012): 1-7
[8] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组, 魏永祥. 嗅觉障碍诊断和治疗专家共识(2017年)[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(7): 484-494. doi:10.3760/cma.j.issn.1673-0860.2018.07.002
[9] 中华医学会神经病学分会痴呆与认知障碍学组写作组,中国阿尔茨海默病协会(ADC). 中国痴呆与认知障碍诊治指南:轻度认知障碍的诊断和治疗[J]. 中华医学杂志, 2010, 90(41): 2887-2893. doi:10.3760/cma.j.issn.0376-2491.2010.41.003
[10] Magliulo G, De Vincentiis M, Iannella G, et al. Olfactory evaluation in obstructive sleep apnoea patients[J]. Acta Otorhinolaryngol Ital, 2018, 38(4): 338-345. doi:10.14639/0392-100x-1981
[11] Boerner B, Tini GM, Fachinger P, et al. Significant improvement of olfactory performance in sleep apnea patients after three months of nasal CPAP therapy-Observational study and randomized trial[J]. PLoS One, 2017, 12(2): e0171087. doi:10.1371/journal.pone.0171087
[12] Gelardi M, Carbonara G, Maffezzoni E, et al. Regular CPAP utilization reduces nasal inflammation assessed by nasal cytology in obstructive sleep apnea syndrome[J]. Sleep Med, 2012, 13(7): 859-863. doi:10.1016/j.sleep.2012.04.004
[13] Osorio RS, Gumb T, Pirraglia E, et al. Sleep-disordered breathing advances cognitive decline in the elderly[J]. Neurology, 2015, 84(19): 1964-1971. doi:10.1212/wnl.0000000000001566
[14] 万晓勇, 赵文瑞, 吴欣然, 等. 阻塞性睡眠呼吸暂停的脑影像研究: 来自静息态脑电和功能磁共振的证据[J]. 生理学报, 2019, 71(5): 760-768. doi:10.13294/j.aps.2019.0049 WAN Xiaoyong, ZHAO Wenrui, WU Xinran, et al. The brain imaging studies of obstructive sleep apnea: evidence from resting-state EEG and fMRI[J]. Acta Physiologica Sinica, 2019, 71(5): 760-768. doi:10.13294/j.aps.2019.0049
[15] Daurat A, Foret J, Bret-Dibat JL, et al. Spatial and temporal memories are affected by sleep fragmentation in obstructive sleep apnea syndrome[J]. J Clin Exp Neuropsychol, 2008, 30(1): 91-101. doi:10.1080/13803390701236116
[16] Dintica CS, Marseglia A, Rizzuto D, et al. Impaired olfaction is associated with cognitive decline and neurodegeneration in the brain[J]. Neurology, 2019, 92(7): e700-e709. doi:10.1212/wnl.0000000000006919
[17] Altundag A, Salihoglu M, Tekeli H, et al. Lateralized differences in olfactory function and olfactory bulb volume relate to nasal septum deviation[J]. J Craniofac Surg, 2014, 25(2): 359-362. doi:10.1097/scs.0000000000000617
[18] Salihoglu M, Kendirli MT, Altundag A, et al. The effect of obstructive sleep apnea on olfactory functions[J]. Laryngoscope, 2014, 124(9): 2190-2194. doi:10.1002/lary.24565
[19] Loch D, Heidel C, Breer H, et al. Adiponectin enhances the responsiveness of the olfactory system[J]. PLoS One, 2013, 8(10): e75716. doi:10.1371/journal.pone.0075716
[20] Franco R, Garrigós C, Capó T, et al. Olfactory receptors in neural regeneration in the central nervous system[J]. Neural Regen Res, 2025, 20(9): 2480-2494. doi:10.4103/nrr.nrr-d-24-00495
[21] Xie YQ, Wang SL, Cha XD, et al. Aging and chronic inflammation: impacts on olfactory dysfunction-a comprehensive review[J]. Cell Mol Life Sci, 2025, 82(1): 199. doi:10.1007/s00018-025-05637-5
[22] Abaffy T, Lu HY, Matsunami H. Sex steroid hormone synthesis, metabolism, and the effects on the mammalian olfactory system[J]. Cell Tissue Res, 2023, 391(1): 19-42. doi:10.1007/s00441-022-03707

相关文章 15

[1]	冯思聪,于晓岚,娄丹. 基于囊泡组织Ki67、GM-CSF表达评估Messerklinger中鼻甲成形术对慢性鼻-鼻窦炎合并鼻息肉的效果[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 31-39.
[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