山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (4): 155-161.doi: 10.6040/j.issn.1673-3770.0.2018.561

• 综述 • 上一篇    下一篇

成人阻塞性睡眠呼吸暂停综合征患者认知功能障碍的诊断及治疗研究进展

闫志刚,张慧慧,于丹,刘岩,文连姬,王迪   

  1. 吉林大学第二医院耳鼻咽喉头颈外科, 吉林 长春 130041
  • 出版日期:2019-07-20 发布日期:2019-07-22

Diagnosis and treatment of cognitive deficits in adult patients with obstructive sleep apnea hypopnea syndrome

YAN Zhigang, ZHANG Huihui, YU Dan, LIU Yan, WEN Lianji, WANG Di   

  1. Department of Otolaryngology and Head and Neck Surgery, The Second Hospital of JiLIin University, Changchun 130041, Jilin, China
  • Online:2019-07-20 Published:2019-07-22

摘要: 阻塞性睡眠呼吸暂停综合征(OSAS)是一种发病率较高的睡眠及呼吸障碍性疾病,可对全身多系统及器官产生损害。近年研究发现,OSAS可导致认知功能障碍,但其具体发病机制尚不明确,可能与慢性间歇低氧、睡眠结构紊乱等有关。认知功能障碍对OSAS患者的生活及工作产生了诸多不利影响。对OSAS伴发的认知功能障碍进行早期诊断及治疗对认知功能障碍的改善具有积极意义。

关键词: 阻塞性睡眠呼吸暂停综合征, 认知功能障碍, 诊断, 治疗

Abstract: Sleep apnea hypopnea syndrome(OSAS)is a sleep and respiratory disorder with high incidence, which can cause damage to multiple systems and organs. Several studies have shown that OSAS mainly leads to cognitive impairment; however, the specific mechanism is not clear. Cognitive impairment may be because of chronic intermittent hypoxia, sleep disorders, etc.; this can seriously affect the quality of life. Early diagnosis and treatment of OSAS significantly improves the cognitive impairment in patients with OSAS and cognitive deficits.

Key words: Obstructive sleep apnea hypopnea syndrome, Cognitive deficits, Diagnosis and treatment

中图分类号: 

  • R714.253
[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暂停低通气综合征患者轻度认知功能障碍的评价[J]. 山东大学耳鼻喉眼学报,2018, 32(2): 56-61. doi:10.6040/j.issn.1673-3770.0.2017.427. WANG Hongmei, LI Lianhe. The evaluation on mild cognitive impairment in patients with moderate-severe obstructive sleep apnea and hypopnea syndrome using neuropsychological scales and event related potential[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(2): 56-61. doi:10.6040/j.issn.1673-3770.0.2017.427.
[2] Bucks RS, Olaithe M, Rosenzweig I, et al. Reviewing the relationship between OSA and cognition: Where do we go from here?[J]. Respirology, 2017, 22(7): 1253-1261. doi:10.1111/resp.13140.
[3] D'Rozario AL, Cross NE, Vakulin A, et al. Quantitative electroencephalogram measures in adult obstructive sleep apnea-potential biomarkers of neurobehavioural functioning[J]. Sleep Medicine Reviews, 2017, 36: 29-42. doi:10.1016/j.smrv.2016.10.003.
[4] Zhou L, Chen P, Peng YT, et al. Role of oxidative stress in the neurocognitive dysfunction of obstructive sleep apnea syndrome[J]. Oxidative Medicine and Cellular Longevity, 2016, 2016: 1-15. doi:10.1155/2016/9626831.
[5] Polsek D, Gildeh N, Cash D, et al. Obstructive sleep apnoea and Alzheimer's disease: in search of shared pathomechanisms[J]. Neuroscience & Biobehavioral Reviews, 2018, 86: 142-149. doi:10.1016/j.neubiorev.2017.12.004.
[6] 吴宏赟, 齐向华. 功能磁共振在睡眠障碍中的应用进展[J]. 中国医药导报, 2014, 11(6): 159-161,166. WU Hongyun, QI Xianghua. Research application of functional magnetic resonance image in the sleep disorders[J]. China Medical Herald, 2014, 11(6): 159-161,166.
[7] Van Eldik LJ, Wainwright MS. The Janus face of glial-derived S100B: beneficial and detrimental functions in the brain. Restor Neurol Neurosci, 2003, 21(3-4): 97-108.
[8] Wang WH, He GP, Xiao XP, et al. Relationship between brain-derived neurotrophic factor and cognitive function of obstructive sleep apnea/hypopnea syndrome patients[J]. Asian Pacific Journal of Tropical Medicine, 2012, 5(11): 906-910. doi:10.1016/s1995-7645(12)60169-2.
[9] Nasreddine ZS, Phillips NA, Bédirian V,et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment[J]. Am Geriatr Soc,2005,53(4):695-699. doi:10.1111/j.1532-5415.2005.53221.x.
[10] O'Driscoll C, Shaikh M. Cross-cultural applicability of the montreal cognitive assessment(MoCA): a systematic review[J]. JAD, 2017, 58(3): 789-801. doi:10.3233/jad-161042.
[11] Yang LX, Tang X, Zhou N, et al. Application and reliability verification of Beijing-based cognitive assessment scale of montreal in cognitive function of adult OSAHS[J]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2018, 32(1): 58-64.
[12] Popovic IM, Lovrencic-Huzjan A, Simundic AM, et al. Cognitive performance in asymptomatic patients with advanced carotid disease[J]. Cognitive And Behavioral Neurology, 2011, 24(3): 145-151. doi:10.1097/wnn.0b013e3182313020.
[13] 穆新暖, 王滨, 王晓芝, 等. 呼吸睡眠暂停低通气患者脑功能的功能性MRI诊断[J]. 放射学实践, 2017, 32(1): 16-20. doi:10.13609/j.cnki.1000-0313.2017.01.004. MU Xinnuan, WANG Bin, WANG Xiaozhi, et al. Functional magnetic resonance imaging in obstructive sleep apnea hypopnea syndrome patients before and after continuous positive airway pressure treatment[J]. Radiologic Practice, 2017, 32(1): 16-20. doi:10.13609/j.cnki.1000-0313.2017.01.004.
[14] Pereira AC, Mao XL, Jiang CS, et al. Dorsolateral prefrontal cortex GABA deficit in older adults with sleep-disordered breathing[J]. Proc Natl Acad Sci USA, 2017, 114(38): 10250-10255. doi:10.1073/pnas.1700177114.
[15] Tummala S, Palomares J, Kang DW, et al. Global and regional brain non-gaussian diffusion changes in newly diagnosed patients with obstructive sleep apnea[J]. Sleep, 2016, 39(1): 51-57. doi:10.5665/sleep.5316.
[16] Inoue Y, Nanba K, Kojima K, et al. P300 abnormalities in patients with severe sleep apnea syndrome[J]. Psychiatry and Clinical Neurosciences, 2001, 55(3): 247-248. doi:10.1046/j.1440-1819.2001.00844.x.
[17] Puskás S, Kozák N, Sulina D, et al. Quantitative EEG in obstructive sleep apnea syndrome: a review of the literature[J]. Reviews in the Neurosciences, 2017, 28(3): 265-270. doi:10.1515/revneuro-2016-0064.
[18] Puche JE,Mu(~overn)oz U, García-Magari(~overn)o M,et al. Partial IGF-1 deficiency induces brain oxidative damage and edema, which are ameliorated by replacement therapy[J]. Biofactors,2016,42(1):60-79.doi:10.1002/biof.1255.
[19] Izumi S, Ribeiro-Filho FF, Carneiro G, et al. IGF-1 levels are inversely associated with metabolic syndrome in obstructive sleep apnea[J]. JCSM, 2016, 12(4): 487-493. doi:10.5664/jcsm.5672.
[20] Mysliwiec V, Gill J, Matsangas P, et al. IGF-1: a potential biomarker for efficacy of sleep improvement with automatic airway pressure therapy for obstructive sleep apnea[J]. Sleep Breath, 2015, 19(4): 1221-1228. doi:10.1007/s11325-015-1142-x.
[21] Kanbay A, Demir NC, Tutar N, et al. The effect of CPAP therapy on insulin-like growth factor and cognitive functions in obstructive sleep apnea patients[J]. The Clinical Respiratory Journal, 2017, 11(4): 506-513. doi:10.1111/crj.12365.
[22] Hoyos CM, Killick R, Keenan DM, et al. Continuous positive airway pressure increases pulsatile growth hormone secretion and circulating insulin-like growth factor-1 in a time-dependent manner in men with obstructive sleep apnea: a randomized sham-controlled study[J]. Sleep, 2014, 37(4): 733-741. doi:10.5665/sleep.3580.
[23] 李洁,冯明亮.阻塞性睡眠呼吸暂停低通气综合征患者血清S-100β、神经元特异性烯醇化酶水平变化及其与认知功能的相关性[J].实用心脑血管肺病杂志, 2017,25(4):162-164. doi:10.3969/j.issn.1008-5971.2017.04.047. LI Jie,FENG Mingliang.Change of serum levels of S-100β and NSE in patients with obstructive sleep apnea hypopnea syndrom and the correlation with cognitive function [J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2017, 25(4):162-164.doi:10.3969/j.issn.1008-5971.2017.04.047.
[24] JIANG Qingsong, LIANG Ziliang, WU Minjie, et al. Reduced brain-derived neurotrophic factor expression in cortex and hippocampus involved in the learning and memory deficit in molarless SAMP8 mice[J]. Chinese Medical Journal, 2011, 124(10): 1540-1544. doi:10.3760/cma.j.issn.0366-6999.2011.10.019.
[25] Giacobbo BL, Corrêa MS, Vedovelli K, et al. Could BDNF be involved in compensatory mechanisms to maintain cognitive performance despite acute sleep deprivation? An exploratory study[J]. International Journal of Psychophysiology, 2016, 99: 96-102. doi:10.1016/j.ijpsycho.2015.11.008.
[26] 梁春荣, 刘雨辉, 王叶冉, 等. 阿尔茨海默病患者外周血炎症因子水平与认知功能的相关性研究[J]. 解放军医学杂志, 2014, 39(2): 133-137. doi:10.11855/j.issn.0577-7402.2014.02.11. LIANG Chunrong, LIU Yuhui, WANG Yeran, et al. Correlation between serum inflammatory factor levels and cognitive function in patients with Alzheimer's disease[J]. Medical Journal of Chinese People's Liberation Army, 2014, 39(2): 133-137. doi:10.11855/j.issn.0577-7402.2014.02.11.
[27] Hansson O, Zetterberg H, Buchhave P, et al. Association between CSF biomarkers and incipient Alzheimer's disease in patients with mild cognitive impairment: a follow-up study[J]. The Lancet Neurology, 2006, 5(3): 228-234. doi:10.1016/s1474-4422(06)70355-6.
[28] 谭曦舒,李立群,胡玲玲,等.OSAHS患者HCY、SAA水平与认知功能的关系研究[J].中国现代医学杂志,2017,27(1): 82-85. doi:10.3969/j.issn.1005-8982.2017.01.016. TAN Xishu, LI Liqun,HU Lingling,et al. Correlations of serum homocysteine and amyloid protein A levels with cognitive function in patients with obstructive sleep apnea hypopnea syndrome[J].China Journal of Modern Medicine, 2017, 27(1):82-85.doi:10.3969/j.issn.1005-8982.2017.01.016.
[29] Canessa N,Castronovo V,Cappa SF,et al.Obstructive sleep apnea: Brain structural changes and neurocognitive function before and after treatment.Am J Respir Crit Care Med, 2011, 183(10):1419-1426. doi:10.1164/rccm.201005-0693OC.
[30] Dalmases M, Solé-Padullés C, Torres M, et al. Effect of CPAP on cognition, brain function, and structure among elderly patients with OSA[J]. Chest, 2015, 148(5): 1214-1223. doi:10.1378/chest.15-0171.
[31] Engleman HM, Martin SE, Deary IJ, et al. Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome[J]. Thorax, 1997, 52(2): 114-119. doi:10.1136/thx.52.2.114.
[32] Rosenzweig I, Glasser M, Crum WR, et al. Changes in neurocognitive architecture in patients with obstructive sleep apnea treated with continuous positive airway pressure[J]. EBio Medicine, 2016, 7: 221-229. doi:10.1016/j.ebiom.2016.03.020.
[33] Jurádo-Gámez B, Guglielmi O, Gude F, et al. Effects of continuous positive airway pressure treatment on cognitive functions in patients with severe obstructive sleep apnoea[J]. Neurología(English Edition), 2016, 31(5): 311-318. doi:10.1016/j.nrleng.2015.03.008.
[34] Bardwell WA, Ancoli-Israel S, Berry CC, et al. Neuropsychological effects of one-week continuous positive airway pressure treatment in patients with obstructive sleep apnea: a placebo-controlled study[J]. Psychosomatic Medicine, 2001, 63(4): 579-584. doi:10.1097/00006842-200107000-00010.
[35] Mulgrew AT, Lawati NA, Ayas NT, et al. Residual sleep apnea on polysomnography after 3 months of CPAP therapy: clinical implications, predictors and patterns[J]. Sleep Medicine, 2010, 11(2): 119-125. doi:10.1016/j.sleep.2009.05.017.
[36] Karimi M, Hedner J, Lombardi C, et al. Driving habits and risk factors for traffic accidents among sleep apnea patients-a European multi-centre cohort study[J]. J Sleep Res, 2014, 23(6): 689-699. doi:10.1111/jsr.12171.
[37] Avellar ABCC, Carvalho LBC, Prado GF, et al. Pharmacotherapy for residual excessive sleepiness and cognition in CPAP-treated patients with obstructive sleep apnea syndrome: a systematic review and meta-analysis[J]. Sleep Medicine Reviews, 2016, 30: 97-107. doi:10.1016/j.smrv.2015.10.005.
[38] 张盼盼, 汪彦辉, 韩晓庆, 等. 丁苯酞对老年OSAHS患者氧化应激及认知功能的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(18): 1422-1425. doi:10.13201/j.issn.1001-1781.2018.18.014. ZHANG Panpan, WANG Yanhui, HAN Xiaoqing, et al. Effect of butylphthalide on oxidative stress and cognitive function in old obstructive sleep apnea hypopnea syndrome patients[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(18): 1422-1425. doi:10.13201/j.issn.1001-1781.2018.18.014.
[39] Lal C, Siddiqi N, Kumbhare S, et al. Impact of medications on cognitive function in obstructive sleep apnea syndrome[J]. Sleep Breath, 2015, 19(3): 939-945. doi:10.1007/s11325-014-1105-7.
[40] Voss MW, Vivar C, Kramer AF, et al. Bridging animal and human models of exercise-induced brain plasticity[J]. Trends in Cognitive Sciences, 2013, 17(10): 525-544. doi:10.1016/j.tics.2013.08.001.
[1] 方璐, 雷玉丹, 王华. 环孢素滴眼液联合玻璃酸钠滴眼液治疗干眼临床效果的Meta分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(2): 65-73.
[2] 雷玉丹,方璐,陈健,彭昌福. 托珠单抗治疗激素抵抗或不耐受的中重度甲状腺相关性眼病临床疗效的Meta分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 54-67.
[3] 朱明琼,李征,刘茹,田涛,彭婧利,吕倩怡,谭华霞. 基于OCT/OCTA的AI筛查系统在抗VEGF治疗糖尿病性黄斑水肿患者效果评价中的应用[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 68-73.
[4] 卢朝阳, 翟兆雪, 王慧康, 邵丽婷, 张宇. 新冠肺炎治疗引发糖尿病酮症酸中毒合并鼻眶脑型毛霉菌病1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 90-94.
[5] 顾敏,陆美萍. 纳米药物输送系统在变应性鼻炎过敏原免疫治疗中的应用进展[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 106-111.
[6] 程卓, 梁辉, 邢鲁民. 深度学习技术在咽喉内镜应用中的研究进展及前景分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 112-119.
[7] 刘一洁,卢秀珍,吴秋欣. 外泌体在眼病发病机制和诊疗中的研究进展[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 135-141.
[8] 马孝宝,沈佳丽,杨军,陈建勇,朱颂欢. 水平半规管扫视波的临床意义探究[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 40-45.
[9] 刘梓琪,黄佳丽,汪李琴,陈曦,张立庆,周涵. 窄带成像内镜联合嗓音声学分析在声带白斑鉴别诊断中的价值[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 87-96.
[10] 刘玉柱,陈尧,苑铁君,李春森,李波. 喉纤维肉瘤1例并相关文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 133-137.
[11] 韩鑫宇,陈钢钢,李莹,周丽媛,杨捷,吴佳鑫,李育军. 双侧前庭病的非药物治疗研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 154-159.
[12] 王晓杰,张明君,宋哲莹,崔丽梅,宋西成. 山奈酚抗癌的作用机制及研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 168-178.
[13] 刘南仙,杨泽垠,韩琳,张爱英,赵宇亮,薛静,孙怡君,邵永良. 视频脑电图在儿童复发性眩晕诊断中的意义[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 20-25.
[14] 许雪萌,樊磊,喻望博,蒋芝月,潘晨,黄泳芹. 奥马珠单抗联合特异性免疫治疗变应性鼻炎疗效的Meta分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 26-33.
[15] 刘玉柱,苑铁君,李波. 会厌原发神经内分泌癌1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 97-100.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!