【摘要】：研究目的:阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive sleep apnea-hypopnea syndrome,OSAHS)可致使全身多系統(tǒng)受損,當(dāng)神經(jīng)系統(tǒng)受損時(shí),患者主要表現(xiàn)為認(rèn)知功能障礙。本研究通過(guò)蒙特利爾認(rèn)知評(píng)估量表(Montreal Cognitive Assessment,MoCA)評(píng)估OSAHS患者的認(rèn)知功能損害程度,探討OSAHS引起認(rèn)知功能障礙的影響因素及其病情程度與認(rèn)知功能障礙的關(guān)聯(lián),從而幫助臨床工作者早期發(fā)現(xiàn)和干預(yù)OSAHS患者受損的認(rèn)知能力,以減少相關(guān)并發(fā)癥的發(fā)生率及病死率,提高患者的生活質(zhì)量。方法:選取2016年8月-2016年12月于南昌大學(xué)第二附屬醫(yī)院呼吸內(nèi)科門診或病房中主訴睡眠時(shí)打鼾、白天嗜睡的首診患者128例,行多導(dǎo)睡眠監(jiān)測(cè)(polysomnography,PSG)后將受試者分為病例組及對(duì)照組,其中病例組又分為OSAHS輕、中、重度三組,每組人數(shù)均為32例,PSG主要監(jiān)測(cè)指標(biāo)包括呼吸暫停低通氣指數(shù)(apnea-hypopnea index,AHI)、氧減指數(shù)(oxygen desaturation index,ODI)及最低血氧飽和度(lowest arterial oxygen saturation,LSaO2);并納入患者年齡、受教育年限及體重指數(shù)(body mass index,BMI)。同時(shí)采用MoCA量表來(lái)評(píng)估病例組及對(duì)照組的認(rèn)知能力。收集整合實(shí)驗(yàn)資料,并運(yùn)用SPSS20.0統(tǒng)計(jì)軟件分析,主要統(tǒng)計(jì)方法包括x2檢驗(yàn)、Pearson相關(guān)分析、描述性分析、單因素方差分析、多因素Logistic回歸分析。結(jié)果:1、病例組中輕、中、重度OSAHS患者的平均年齡分別為(51.88±10.59)、(51.56±10.99)、(43.34±9.63);高中文化程度分別有15人(46.9%)、16人(50%)、12人(37.5%),大專以上文化程度分別有17人(53.1%)、16人(50%)、20人(62.5%),平均受教育年限分別為(13.84±1.85)、(13.72±1.78)、(14.16±1.74);體重指數(shù)分別為(27.60±4.61)Kg/m2、(27.40±3.13)Kg/m2、(29.12±3.66)Kg/m2。對(duì)照組中平均年齡為(45.78±10.96);高中文化程度有11人(34.4%),大專以上文化程度有21人(65.6%),平均受教育年限為(14.25±1.76);體重指數(shù)分別為(26.13±3.99)Kg/m2。各組別比較,受教育年限指數(shù)方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.593)。年齡、BMI差異有統(tǒng)計(jì)學(xué)意義。其中,年齡指數(shù)兩兩比較,對(duì)照組與病例組無(wú)差異有統(tǒng)計(jì)學(xué)意義(P0.05),OSAHS重度與OSAHS中度差異有統(tǒng)計(jì)學(xué)意義(P0.05);與OSAHS輕度差異有統(tǒng)計(jì)學(xué)意義(P0.01)。BMI指數(shù)兩兩比較,對(duì)照組與OSAHS重度差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2、病例組與對(duì)照組認(rèn)知功能障礙的發(fā)生率:96例OSAHS患者中有65例出現(xiàn)認(rèn)知受損,即MoCA評(píng)分26分,占68%;其中OSAHS輕度組中有11例,占34%;中度組中有25例,占78%;重度組中有29例,占90%;32例對(duì)照組中有1例出現(xiàn)認(rèn)知受損,占3%;OSAHS輕度、中度、重度與對(duì)照組認(rèn)知功能障礙發(fā)生率具有統(tǒng)計(jì)學(xué)差異(?2=62.436,P=0.000),OSAHS人群比非OSAHS人群更易出現(xiàn)認(rèn)知受損。3、在輕、中、重不同程度OSAHS患者中與對(duì)照組中,MoCA得分從高至低依次為對(duì)照組(27.72±1.30)分、輕度(26.03±2.39)分、中度(24.63±1.90)分、重度(21.56±3.23)分,其得分差異有統(tǒng)計(jì)學(xué)意義(F=40.609,P=0.000);MoCA兩兩比較,對(duì)照組與OSAHS輕度、OSAHS中度差異有統(tǒng)計(jì)學(xué)意義(P≤0.01);重度組與OSAHS輕度、OSAHS中度差異有統(tǒng)計(jì)學(xué)意義(P0.01),即OSAHS患者病情越重,MoCA的分值越低。將對(duì)照組與輕、中、重度OSAHS患者M(jìn)oCA的各項(xiàng)分值進(jìn)行比較,其中視空間(4.75±0.44 VS 4.38±0.98 VS4.56±0.76VS3.72±1.17,F=40.609,P=0.000)、注意力(5.75±0.44 VS5.5±0.57 VS4.81±0.74VS4.66±1.07,F=16.252,P=0.000)、語(yǔ)言(2.09±0.64VS 2.06±0.76 VS1.41±0.5VS1.5±0.62,F=10.398,P=0.000)、延遲回憶(4.00±0.149 VS3.28±0.239 VS3.09±0.231VS1.44±0.25,F=24.119,P=0.000)、定向力(5.97±0.18 VS5.81±0.4 VS5.53±0.72VS5.38±0.71,F=7.650,P=0.000)。視空間指數(shù)兩兩比較,OSAHS重度與對(duì)照組、OSAHS中度差異有統(tǒng)計(jì)學(xué)意義(P≤0.01)。注意力兩兩比較,對(duì)照組與OSAHS中度組、OSAHS重度組差異有統(tǒng)計(jì)學(xué)意義(P≤0.01);OSAHS輕度組與OSAHS中度組、OSAHS重度組差異有統(tǒng)計(jì)學(xué)意義(P0.01)。語(yǔ)言指數(shù)兩兩比較,對(duì)照組與OSAHS中度組、OSAHS重度組差異有統(tǒng)計(jì)學(xué)意義(P≤0.01);OSAHS輕度組與OSAHS中度組、OSAHS重度組差異有統(tǒng)計(jì)學(xué)意義(P0.01)。延遲回憶指數(shù)兩兩比較,對(duì)照組與OSAHS中度組、OSAHS重度組差異有統(tǒng)計(jì)學(xué)意義(P≤0.01);OSAHS重度組與OSAHS輕度組、OSAHS中度組差異有統(tǒng)計(jì)學(xué)意義(P0.01)。定向力指數(shù)兩兩比較,對(duì)照組與OSAHS中度組、OSAHS重度組差異有統(tǒng)計(jì)學(xué)意義(P≤0.01);OSAHS重度組與OSAHS輕度組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4、認(rèn)知功能與年齡、BMI、受教育年限的關(guān)系、AHI、LSa O2、ODI的相關(guān)性:OSAHS患者M(jìn)oCA總分與年齡(r=-0.244,P=0.017)顯著負(fù)相關(guān),與BMI顯著負(fù)相關(guān)(r=-0.314,P=0.002),與受教育年限顯著正相關(guān)(r=0.205,P=0.045);與AHI(r=-0.653,P=0.000)、ODI(r=-0.630,P=0.000)顯著負(fù)相關(guān),與LSaO2顯著正相關(guān)(r=0.653,P=0.000)。5、對(duì)OSAHS患者認(rèn)知功能的影響的多因素Logistic回歸分析結(jié)果,進(jìn)入回歸方程的因素只有3個(gè):LSaO2、BMI及AHI。其中LSaO2的OR值與95%CI均1,是OSAHS患者發(fā)生認(rèn)知功能障礙的保護(hù)性因素;BMI與AHI的OR值與95%CI均1,是OSAHS患者發(fā)生認(rèn)知功能障礙的危險(xiǎn)因素。隨著LSa O2的升高,OSAHS患者發(fā)生認(rèn)知功能障礙的風(fēng)險(xiǎn)性降低,其OR值為0.897(95%CI:0.815,0.987)。而B(niǎo)MI異常級(jí)別的增高的同時(shí),也提高了OSAHS患者發(fā)生認(rèn)知功能障礙的風(fēng)險(xiǎn)性,其OR值為2.133(95%CI:1.047,4.346)。同樣的,AHI異常級(jí)別的增高的同時(shí),也提高了OSAHS患者發(fā)生認(rèn)知功能障礙的風(fēng)險(xiǎn)性,其OR值為3.415(95%CI:1.695,6.882)。Logistic回歸方程為:logitP=-0.109X1+0.758X2+1.228X3。結(jié)論:本研究中約有68%的OSAHS患者發(fā)生認(rèn)知功能障礙,且認(rèn)知功能障礙的發(fā)生率與OSAHS的病情呈正相關(guān)。OSAHS患者的認(rèn)知功能障礙與年齡、肥胖、受教育年限以及夜間間斷低氧/低通氣有關(guān)。OSAHS患者的認(rèn)知功能障礙的嚴(yán)重程度與年齡、肥胖呈正相關(guān)性,與受教育程度呈負(fù)相關(guān)性。同時(shí),OSAHS患者的低通氣與夜間呼吸停頓的次數(shù)愈多,夜間最低血氧飽和度愈低,其認(rèn)知功能受損愈嚴(yán)重,著重表現(xiàn)在記憶力、注意力及語(yǔ)言方面。
[Abstract]:OBJECTIVE: Obstructive sleep apnea-hypopnea syndrome (OSAHS) can lead to systemic multi-system impairment. When the nervous system is damaged, patients mainly show cognitive impairment. This study assessed OSAHS by Montreal Cognitive Assessment (MoCA). Objective:To investigate the degree of cognitive impairment in patients with OSAHS and the relationship between cognitive impairment and the influencing factors of cognitive impairment caused by OSAHS. From August 2016 to December 2016, 128 patients who complained of snoring during sleep and were asleep during daytime were enrolled in the respiratory department or ward of the Second Affiliated Hospital of Nanchang University. In 32 cases, the main monitoring indices of PSG included apnea-hypopnea index (AHI), oxygen desaturation index (ODI) and lowest arterial oxygen saturation (LSaO2), and included age, length of education and body mass index (BMI). Cognitive ability of case group and control group was assessed. The data were collected and analyzed by SPSS20.0. The main statistical methods included x2 test, Pearson correlation analysis, descriptive analysis, one-way ANOVA and multivariate logistic regression analysis. Results: 1. The average ages of patients with moderate, moderate and severe OSAHS were 51.88. There were 15 (46.9%), 16 (50%) and 12 (37.5%) high school educated students, 17 (53.1%), 16 (50%) college educated students, 20 (62.5%) high school educated students, with an average length of education of (13.84 +1.85), (13.72 +1.78), (14.16 +1.74), and body mass index of (27.60 +4.61) Kg/m2, (27.40 +3.13) Kg/m2, respectively. The average age of the control group was (45.78 65507 There was no significant difference in age index between the control group and the case group (P 0.05). There was significant difference in OSAHS severity and OSAHS moderate (P 0.05). There was significant difference in OSAHS mild (P 0.01). BMI index was significantly different between the control group and OSAHS severity (P 0.05). 2. The incidence of cognitive impairment in case group and control group: 65 of 96 patients with OSAHS had cognitive impairment, that is, 26 points of MoCA score, accounting for 68%; 11 of them had mild OSAHS, accounting for 34%; 25 of them had moderate OSAHS, accounting for 78%; 29 of them had severe OSAHS, accounting for 90%; 1 of 32 patients had cognitive impairment, accounting for 3%; OSAHS had mild, moderate, severe and severe OSAHS. The incidence of cognitive impairment in the control group was significantly different (? 2 = 62.436, P = 0.000). The patients with OSAHS were more likely to suffer from cognitive impairment than those without OSAHS. In the patients with mild, moderate and severe OSAHS and the control group, the MoCA scores were 27.72 (+ 1.30), 26.03 (+ 2.39), 24.63 (+ 1.90), and 2.63 (+ 1.90), respectively. The score of MoCA was statistically significant (F = 40.609, P = 0.000); there was a significant difference between the control group and OSAHS mild, OSAHS moderate (P < 0.01); the severe group and OSAHS mild, OSAHS moderate difference was statistically significant (P 0.01), that is, the more serious the OSAHS patients were, the lower the score of MoCA. The scores of MoCA in AHS patients were compared, including visual space (4.75 + 0.44 VS 4.38 + 0.48 VS 4.38 + 0.98 VS 4.38 + 0.98 VS 4.56 + 0.76VS 3.72 + 1.17, F = 40.609, P = 0.000, F = 40.609, P = 40.609, P = 0.000), attention (5.75 + 0.75 + 0.44 VS 5.5.5.5.5.5.5.5 + 0.44 VS 5.5.5.5.5.5 + 0.57 VS 4.81 + 0.81 + 0.74 VS 4.66 + 1.07, F = 16.252.38 + 0.98 VS 4.38, P = 0.98 62, F = 10.398, P = 0.000, delayed recall (4.00 + 0.149 V) OSAHS severity and OSAHS moderate difference (P < 0.01) between the control group and the OSAHS moderate and severe group. There was statistical significance (P < 0.01); OSAHS mild group and OSAHS moderate group, OSAHS severe group had statistical significance (P 0.01). Language index two or two comparison, control group and OSAHS moderate group, OSAHS severe group had statistical significance (P < 0.01); OSAHS mild group and OSAHS moderate group, OSAHS severe group had statistical significance (P 0.01). The OSAHS severity group and OSAHS severity group had significant difference (P < 0.01); OSAHS severity group and OSAHS mild group, OSAHS moderate group had significant difference (P < 0.01). Orientation index had significant difference between the control group and OSAHS moderate group (P < 0.01); OSAHS severity group and OSAHS severity group had significant difference (P < 0.01). There was a significant negative correlation between MoCA score and age (r = - 0.244, P = 0.017) and BMI (r = - 0.314, P = 0.002), and a significant positive correlation between MoCA score and educational years (r = 0.205, P = 0.045); and AHI (r = - 0.653, P = 0.000) in OSAHS patients. ODI (r = - 0.630, P = 0.000) was significantly negatively correlated with LSaO2 (r = 0.653, P = 0.000). Multivariate logistic regression analysis showed that only three factors entered the regression equation: LSaO2, BMI and AHI. The OR value of LSaO2 and 95% CI were all 1, which were protective factors for cognitive impairment in OSAHS patients. The OR values of BMI and AHI were 1 and 95% CI, which were risk factors for cognitive impairment in OSAHS patients. With the increase of LSa O2, the risk of cognitive impairment in OSAHS patients decreased, and the OR values were 0.897 (95% CI: 0.815, 0.987). The increase of abnormal BMI levels also increased the risk of cognitive impairment in OSAHS patients. The OR value was 3.415 (95% CI: 1.695, 6.882). The logistic regression equation was: logitP = - 0.109X1 + 0.758X2 + 1.228X3. Conclusion: About 68% of OSAHS patients in this study had cognitive impairment, and about 68% of OSAHS patients had cognitive impairment. Cognitive dysfunction was positively correlated with OSAHS. Cognitive dysfunction was associated with age, obesity, years of education and intermittent nocturnal hypoxia/hypoventilation. The severity of cognitive dysfunction was positively correlated with age, obesity, and negatively correlated with education. The more frequent hypoventilation and nighttime breathing arrest, the lower the minimum oxygen saturation at night, the more serious the cognitive impairment, especially in memory, attention and language.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R766

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