葛敏,王增成,朱祥,王军
GE Min,WANG Zengcheng,ZHU Xiang,WANG Jun

• 1:上海交通大学医学院苏州九龙医院呼吸与危重症医学科
• 2:上海交通大学医学院苏州九龙医院儿科

摘要(Abstract)：

目的 探讨老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者夜间呼吸暂停情况与认知障碍的关系。方法 85例OSAHS老年患者根据蒙特利尔认知评估量表(MoCA)的评分结果分为正常组(n=52)和障碍组(n=33),比较2组患者的认知功能特征，通过多导睡眠监测记录2组患者夜间呼吸暂停低通气指数(AHI)、微觉醒指数(RI)、睡眠效率(SE)、最低血氧饱和度(LSPO_2)、平均血氧饱和度(MaSO_2)、夜间呼吸暂停次数、平均呼吸暂停持续时间及最长呼吸暂停持续时间，测定患者治疗前的血清胰岛素样生长因子1(IGF-1)、单核细胞趋化蛋白1(MCP-1)及半胱氨酸天冬氨酸蛋白酶(Caspase)-3含量；采用Pearson相关分析夜间呼吸暂停情况与血清指标的相关性、患者夜间呼吸暂停情况与认知功能障碍的相关性，采用多元线性回归模型分析患者发生认知障碍的危险因素。结果 障碍组在视空间与执行、命名、注意力、语言、抽象、延迟记忆和定向等认知功能特征的评分均低于正常组(P<0.05),年龄、病程、呼吸暂停次数、平均呼吸暂停持续时间、最长呼吸暂停持续时间、AHI、RI、MCP-1及Caspase-3水平高于正常组，SE、LSPO_2、MaSO_2、IGF-1低于正常组(P<0.05);患者夜间呼吸暂停次数和时长与IGF-1呈负相关，但与MCP-1、Caspase-3呈正相关(P<0.05),患者的MoCA评分与年龄、病程、AH、IRI、呼吸暂停次数、平均呼吸暂停持续时长、最长呼吸暂停时长以及MCP-1和Caspase-3水平呈负相关，和SE、LSPO_2、MaSO_2以及IGF-1水平为正相关性(P<0.05);夜间呼吸暂停次数、平均呼吸暂停持续时间及最长呼吸暂停持续时间是患者发生认知障碍的危险因素(P<0.05)。结论 老年OSAHS患者夜间呼吸暂停次数和暂停时间均与认知障碍程度呈正相关，呼吸暂停会增加患者出现认知障碍的风险。
Objective To investigate the relationship between nocturnal apnea events and cognitive impairment in elderly patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods A total of 85 elderly OSAHS patients were selected as the normal group(n=52) and obstructive group(n=33) based on the Montreal Cognitive Assessment(MoCA) scores. Cognitive function characteristics between the two groups were compared. Multichannel sleep monitoring was used to record following data of both groups: the apnea-hypopnea index(AHI), respiratory disturbance index(RDI), sleep efficiency(SE), lowest oxygen saturation(LSPO_2), mean oxygen saturation(MaSO_2), as well as the number of nocturnal apnea events, average duration of apnea events, and the longest duration of apnea events. Levels of insulin-like growth factor 1(IGF-1), monocyte chemoattractant protein-1(MCP-1), and Caspase-3 were also measured before treatment. Pearson was adopted to analyze correlation between nocturnal apnea condition and serum index, as well as the correlation between nocturnal apnea events and cognitive impairment. Multiple linear regression model was adopted to analyze the risk factors of cognitive impairment in patients. Results The obstructive group showed significantly lower scores than normal group in visuospatial and executive functions, naming, attention, language, abstraction, delayed memory, and orientation(P<0.05). Obstructive group showed higher record than normal group in terms of age, disease duration, number of apnea events, average duration of apnea events, longest duration of apnea events, AHI, RDI, MCP-1, and Caspase-3 levels, while SE, LSPO_2, MaSO_2, and IGF-1 of obstructive group were significantly lower than normal group(P<0.05). Number of nocturnal apnea and duration were negatively correlated with IGF-1, but positively correlated with MCP-1 and Caspase-3 levels(P<0.05). MoCA scores of patients were negatively correlated with age, disease duration, AH, IRI, number of apnea events, average duration of apnea events, longest duration of apnea events, MCP-1, and Caspase-3 levels, while the scores were positively correlated with SE, LSPO_2, MaSO_2, and IGF-1 levels(P<0.05). Multivariate linear regression analysis revealed number of apnea events, average duration of apnea events, longest duration of apnea events were risk factors of cognitive impairment for patients(P<0.05). Conclusion The number and duration of nocturnal apnea events in elderly OSAHS patients are positively correlated with the degree of cognitive impairment. Apnea events increase the risk of cognitive impairment in patients.

关键词(KeyWords)： 阻塞性睡眠呼吸暂停低通气综合征;夜间呼吸暂停;呼吸暂停低通气指数;认知障碍;相关性分析
obstructive sleep apnea hypopnea syndrome;nocturnal apnea;apnea-hypopnea index;cognitive impairment;correlation analysis

Abstract:

Keywords:

基金项目(Foundation): 江苏省自然科学基金面上项目(BK20191447)

作者(Author): 葛敏,王增成,朱祥,王军
GE Min,WANG Zengcheng,ZHU Xiang,WANG Jun

DOI: 10.19367/j.cnki.2096-8388.2024.02.020

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