中青年阻塞性睡眠呼吸暂停低通气综合征患者睡眠微结构与日间嗜睡和认知功能的相关性
首发时间:2019-04-04
摘要:目的:比较中青年不同严重程度的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠脑电微结构特征的差异,探讨其与认知功能及日间嗜睡的相关性。方法:筛选2017年7月至2019年1月于我院睡眠门诊就诊的疑似OSAHS的中青年打鼾患者,并分析睡眠宏观结构,包括NREM1(N1)、NREM2(N2)、NREM3(N3)和REM(R);睡眠微观结构,包括脑电觉醒指数、循环交替模式(CAP)参数(包括CAP时间、CAP率和CAP指数等)以及常规PSG参数。共纳入患者134例患者,均行整夜多导睡眠图监测(PSG),根据呼吸暂停低通气指数(AHI)分为:单纯鼾症组25例,轻度OSAHS组28例,中度OSAHS组26例和重度OSAHS组55例。利用蒙特利尔认知评估(MoCA)和Epworth嗜睡量表(ESS)评估患者认知功能和日间嗜睡状况。结果:随着OSAHS严重程度增加,MoCA评分逐渐减少,ESS评分逐渐增加。睡眠脑电宏观结构结果显示,与其他3组相比,仅重度OSAHS组的N1%,N2%和N3%有显着差异(均P <0.05)。睡眠脑电微观结构结果显示,与轻度OSAHS和单纯鼾症组相比,中度和重度OSAHS组在觉醒指数、呼吸相关觉醒指数、CAP时间、CAP率、A相指数(包括A1相指数A2相指数和A3相指数),CAP循环数和A相平均时间均有差异(均P <0.05或P <0.01)。逐步多元回归分析显示,A3相指数与MoCA评分呈负相关,与ESS评分正相关(均P <0.01)。结论:中青年OSAHS患者存在睡眠脑电微结构的紊乱,并与其认知功能损伤及日间嗜睡相关;CAP参数中的A3相指数是评价OSAHS患者睡眠微结构紊乱的敏感指标。
关键词: 循环交替模式 觉醒 阻塞性睡眠呼吸暂停低通气综合征 认知功能 日间嗜睡
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Correlation of Sleep Microstructure with Daytime Sleepiness and Cognitive Function in Young and Middle-aged Adults with Obstructive Sleep Apnea-Hypopnea Syndrome
Abstract:Purpose: To compare microstructural features of sleep in young and middle-aged adults with differing severities of obstructive sleep apnea-hypopnea syndrome (OSAHS), and to investigate the relationship between sleep microstructural fragmentation and cognitive impairment, as well as daytime sleepiness, in these patients. Methods: A total of 134 adults with snoring (mean age, 37.54±7.66 years) were classified into four groups based on apnea-hypopnea index: primary snorinCorrelation of Sleep Microstructure with Daytime Sleepiness and Cognitive Function in Young and Middle-aged Adults with Obstructive Sleep Apnea-Hypopnea Syndromeg, mild OSAHS, moderate OSAHS, and severe OSAHS. Overnight polysomnography was performed to assess respiratory, sleep macrostructure (N1, N2, N3, R), and sleep microstructure (arousal, cyclic alternating pattern [CAP]) parameters. Cognitive function and daytime sleepiness were assessed using Montreal Cognitive Assessment (MoCA) and Epworth Sleepiness Scale (ESS). Results: As OSAHS severity increased, MoCA gradually decreased and ESS gradually increased. N1%, N2%, and N3% sleep were significantly different between the severe OSAHS group and the primary snoring, mild OSAHS, and moderate OSAHS groups (all P<0.05). Overall arousal index, respiratory-related arousal index, CAP time, CAP rate, phase A index, number of CAP cycles, and phase A average time differed significantly in the moderate and severe OSAHS groups compared with the mild OSAHS and primary snoring groups (all P<0.05). The strongest correlations identified by stepwise multiple regression analysis were between phase A3 index and the MoCA and ESS scores. Conclusions: Sleep microstructure exhibited significant fragmentation in patients with moderate and severe OSAHS, which was associated with decreased MoCA and increased ESS scores. This suggests that phase A3 index is a sensitive indicator of sleep fragmentation in OSAHS.
Keywords: Cyclic alternating pattern Arousal Obstructive sleep apnea-hypopnea syndrome Cognitive function Daytime Sleepiness
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中青年阻塞性睡眠呼吸暂停低通气综合征患者睡眠微结构与日间嗜睡和认知功能的相关性
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