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摘要: 目的 探讨重度阻塞性睡眠呼吸暂停(OSA)患者与无到中度OSA患者间认知功能的差异。方法 使用MoCA量表评估196例接受PSG监测的受试者的整体认知功能及各子项功能; 并使用数字符号转换测验(SDMT)和连线测试A(TMT-A)量表评估其中161例患者的注意力和信息处理速度, 评估后搜集临床信息、体测数据、相关PSG监测数据。根据AHI是否>30将受试者分为重度OSA组和无到中度OSA组, 矫正混杂因素前后分别比较两组间各项认知量表评估指标的差异。使用线性回归明确各项认知功能的独立影响因素, 明确重度OSA是否与各项认知能力独立相关。结果 矫正多因素后, 重度OSA组MoCA量表延迟回忆得分和总分以及SDMT正确数显著低于无到中度OSA组(P < 0.05)。线性回归分析显示重度OSA与MoCA量表中延迟回忆得分和总分以及SDMT正确数独立负相关(P < 0.05)。结论 与无到中度OSA相比, 重度OSA患者整体认知、延迟回忆、注意力和处理速度表现更差。重度OSA可能是整体认知、延迟回忆、注意力和处理速度的独立影响因素。
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关键词:
- 睡眠呼吸暂停, 阻塞性 /
- 认知功能 /
- MoCA量表
Abstract: Objective To explore the differences in cognitive function between patients with severe OSA and non-moderate OSA.Methods The MoCA scale was used to evaluate the overall cognitive function and sub-items in 196 subjects who received polysomnography; and the SDMT and TMT-A scales were used to evaluate the performance in test of attention and information processing speed in 161 patients. The clinical information, physical examination data and related polysomnography data were collected. According to AHI, subjects were divided into two groups: severe OSA and non-to-moderate OSA. Before and after correction of confounding factors, the differences in cognitive scale evaluation indicators were compared between the two groups. We used linear regression analysis to clarify the independent influencing factors of cognitive functions, and to determine whether severe OSA is independently related to cognitive abilities.Results After correcting for multiple factors, the delayed recall score and total score of the MoCA scale and the correct number of SDMT in the severe OSA group were significantly lower than those in the non-to-moderate OSA group(P < 0.05). Linear regression analysis showed that severe OSA was independently negatively correlated with the delayed recall score, total score and SDMT correct number in the MoCA scale(P < 0.05).Conclusion Compared with non-to-moderate OSA, subjects with severe OSA have significant decline in overall cognition, delayed recall, attention and processing speed. Severe OSA may be an independent influencing factor of overall cognition, delayed recall, attention and processing speed.-
Key words:
- sleep apnea, obstructive /
- cognitive function /
- MoCA scale
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表 1 无到中度OSA组和重度OSA组基线特征、PSG指标及MoCA评分比较
指标 无到中度OSA组(n=77) 重度OSA组(n=119) P P1 男/女 65/12 108/11 0.178 - 年龄/岁 41.36±13.27 43.72±11.07 0.164 - 腰围/cm 92.34±9.33 99.24±11.31 0.000 - 腹型肥胖/例(%) 56(72.7) 100(84.0) 0.055 - 高血压/例(%) 23(29.9) 32(26.9) 0.650 - 糖尿病/例(%) 3(3.9) 4(3.4) 1.000 - 吸烟/例(%) 32(41.6) 61(51.3) 0.184 - 饮酒/例(%) 32(41.6) 64(53.8) 0.095 - 教育年限/年 11.38±3.97 11.12±3.52 0.609 - ESS评分 8.23±5.22 11.65±4.74 0.000 - PSG指标 AHI 13.31±9.24 59.58±17.87 0.000 - ODI 11.56±9.54 59.70±22.58 0.000 - LSaO2 85.47±7.51 68.33±11.73 0.000 - MoCA评分 视空间与执行能力 4.12±0.90 3.87±1.03 0.119 0.265 命名 2.95±0.22 2.90±0.35 0.383 0.355 注意力 5.95±0.22 5.83±0.64 0.464 0.298 语言 2.18±0.74 2.01±0.67 0.081 0.506 抽象 1.61±0.63 1.46±0.75 0.201 0.278 延迟回忆 2.88±1.34 2.31±1.46 0.007 0.012 定向 5.87±0.38 5.86±0.40 0.844 0.965 总分 25.56±2.38 24.24±2.69 0.002 0.002 P：基线特征、PSG指标、MoCA评分比较未矫正任何因素；P1：MoCA各项及总评分比较矫正了性别、年龄、教育年限、ESS、腹型肥胖、吸烟和饮酒因素。 
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表 2 无到中度OSA组和重度OSA组基线特征、PSG指标、SDMT和TMT-A指标比较
指标 无到中度OSA组(n=63) 重度OSA组(n=98) P P1 男/女 53/10 88/10 0.287 - 年龄/岁 41.19±13.91 43.91±11.51 0.160 - 腰围/cm 91.87±10.21 98.37±11.45 0.001 - 腹型肥胖/例(%) 45(71.4) 81(82.7) 0.092 - 高血压/例(%) 11(17.5) 20(20.4) 0.643 - 糖尿病/例(%) 1(1.6) 1(1.0) 1.000 - 吸烟/例(%) 29(46.0) 57(58.2) 0.132 - 饮酒/例(%) 20(31.7) 50(51.0) 0.056 - 教育年限/年 10.06±3.49 10.53±3.38 0.384 - ESS评分 8.78±4.94 11.44±4.42 0.001 - PSG指标 AHI 12.59±9.08 60.12±18.38 0.000 - ODI 10.53±9.55 60.05±24.31 0.000 - LSaO2 86.59±6.25 68.12±11.1 0.000 - 注意力和信息处理速度 SDMT正确数 48.33±15.87 44.08±13.85 0.154 0.019 TMT-A耗时数 47.06±18.76 47.98±21.34 0.981 0.480 P：基线特征、PSG指标、SDMT、TMT-A评估指标比较未矫正任何因素；P1：SDMT、TMT-A评估指标比较矫正了性别、年龄、教育年限、ESS、腹型肥胖、吸烟和饮酒因素。
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表 3 重度OSA、腹型肥胖、性别、年龄、ESS、吸烟、饮酒和教育年限与MoCA评分线性回归分析
指标 重度OSA 腹型肥胖 性别 年龄 ESS 吸烟 饮酒 教育年限 视空间与执行能力 Beta -0.070 -0.159 -0.032 -0.063 -0.029 0.014 -0.003 0.523 P 0.265 0.008 0.618 0.305 0.643 0.837 0.962 < 0.001 命名 Beta -0.070 0.072 -0.182 -0.065 -0.043 -0.086 -0.025 0.110 P 0.355 0.322 0.021 0.384 0.579 0.306 0.760 0.173 注意力 Beta -0.080 0.028 0.007 -0.158 -0.056 0.102 -0.078 -0.018 P 0.298 0.698 0.932 0.037 0.468 0.234 0.352 0.827 语言 Beta -0.048 -0.201 -0.092 -0.141 -0.092 -0.004 -0.050 0.140 P 0.506 0.004 0.223 0.051 0.213 0.961 0.526 0.071 抽象 Beta -0.079 -0.005 -0.074 -0.107 -0.050 0.017 0.031 0.284 P 0.278 0.947 0.328 0.136 0.498 0.837 0.694 < 0.001 延迟回忆 Beta -0.178 0.101 0.012 -0.209 0.038 -0.117 -0.019 0.247 P 0.012 0.136 0.869 0.003 0.592 0.137 0.804 0.001 定向 Beta 0.003 -0.032 -0.027 -0.132 0.002 -0.015 -0.031 0.021 P 0.965 0.667 0.739 0.085 0.981 0.866 0.712 0.802 MoCA总分 Beta -0.180 -0.050 -0.073 -0.261 -0.044 -0.047 -0.040 0.454 P 0.002 0.374 0.225 < 0.001 0.462 0.471 0.537 < 0.001
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表 4 重度OSA、性别、年龄、ESS、吸烟、饮酒和教育年限与SDMT、TMT-A线性回归分析
指标 重度OSA 性别 年龄 ESS 吸烟 饮酒 教育年限 SDMT Beta -0.123 0.025 -0.574 0.064 -0.013 0.012 0.397 P 0.019 0.634 < 0.001 0.217 0.828 0.839 < 0.001 TMT-A Beta 0.046 0.031 0.434 -0.084 -0.008 -0.148 -0.334 P 0.480 0.645 < 0.001 0.193 0.911 0.048 < 0.001
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| 引用本文: |
樊欣, 宋建雄, 谢飞, 等. 重度阻塞性睡眠呼吸暂停对认知功能的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(6): 511-516. doi: 10.13201/j.issn.2096-7993.2021.06.006
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| Citation: |
FAN Xin, SONG Jianxiong, XIE Fei, et al. Influences of severe obstructive sleep apnea on cognitive function[J]. J Clin Otorhinolaryngol Head Neck Surg, 2021, 35(6): 511-516. doi: 10.13201/j.issn.2096-7993.2021.06.006
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