阻塞性睡眠呼吸暂停综合征对精神分裂症患者睡眠及认知功能的影响研究

doi:10.12114/j.issn.1007-9572.2021.01.220

摘要/Abstract

摘要： 背景　认知功能的损害是精神分裂症的重要特征，阻塞性睡眠呼吸暂停综合征（OSAS）不仅影响睡眠质量，同时对其认知功能也有损害，但目前关于精神分裂症伴发OSAS患者的睡眠和认知功能损害的研究鲜有报道。目的　比较伴OSAS和不伴OSAS的精神分裂症患者睡眠及认知功能情况，探讨OSAS对精神分裂症患者的睡眠及认知功能的影响。方法　选取2018年3月至2019年12月在安徽医科大学附属巢湖医院精神科住院的精神分裂症患者为研究对象（80例），选取同期在安徽医科大学附属巢湖医院体检中心体检的健康人群作为对照组（31例）。采用自制一般人口学资料调查表收集入组研究对象的性别、年龄、受教育年限、吸烟情况、体质量、身高信息，并计算体质指数（BMI）。采用重复性成套神经心理状态测验（RBANS，即刻记忆、视觉广度、言语功能、注意力、延时记忆）评定入组对象认知功能，采用阳性和阴性综合征量表（PANSS）评估患者的临床精神症状，中文版Epworth嗜睡量表（ESS）评估患者的主观嗜睡倾向。通过心肺耦合分析（CPC）技术记录患者睡眠情况，睡眠参数包括睡眠总时间、熟睡时间、浅睡时间、快速眼球运动（REM）睡眠时间、觉醒时间、初入熟睡时间、睡眠效率及睡眠呼吸暂停指数（AHI），以AHI≥5次/h为标准，将80例精神分裂症患者分为伴OSAS组（35例）和不伴OSAS组（45例）。各变量间的相互关系采用Spearman秩相关分析，认知功能影响因素分析采用多元线性回归分析。结果　3组研究对象即刻记忆得分、视觉广度得分、言语功能得分、注意力得分、延时记忆得分、RBANS总分比较，差异均有统计学意义（P<0.05）。伴OSAS组患者熟睡时间短于不伴OSAS组（P<0.05），浅睡时间、觉醒时间长于不伴OSAS组（P<0.05），AHI、阴性症状得分、PANSS总分高于不伴OSAS组（P<0.05），即刻记忆得分、视觉广度得分、言语功能得分、注意力得分、延时记忆得分、RBANS总分低于不伴OSAS组（P<0.05）。精神分裂症患者中，即刻记忆得分、视觉广度得分与病程、阴性症状得分、AHI呈负相关（P<0.05），言语功能得分与年龄、病程、一般精神病理症状得分、浅睡时间、觉醒时间、AHI呈负相关（P<0.05），注意力得分与年龄、病程、阴性症状得分、AHI呈负相关（P<0.05），延迟记忆得分与阴性症状得分、AHI呈负相关（P<0.05），RBANS总分与病程、阴性症状得分、潜睡时间、觉醒时间、AHI呈负相关（P<0.05）。多元线性回归分析结果显示，阴性症状得分、受教育年限是即刻记忆得分的影响因素（P<0.05），AHI、病程是视觉广度得分、言语功能得分的影响因素（P<0.05），病程是注意力得分的影响因素（P<0.05），受教育年限、AHI是延迟记忆得分的影响因素（P<0.05），受教育年限、病程、AHI是RBANS总分的影响因素（P<0.05）。结论　伴OSAS的精神分裂症患者睡眠和认知功能损害程度较不伴OSAS的精神分裂症患者严重；浅睡时间、觉醒时间等睡眠指标与精神分裂症患者的认知功能呈负相关，受教育年限、病程、AHI可能是精神分裂症患者认知功能的影响因素。如果能够早期对精神分裂症患者进行CPC检查，并及时干预，可能减少OSAS导致的睡眠和认知损害。

关键词: 精神分裂症；睡眠呼吸暂停, 阻塞性；心肺耦合分析；睡眠；认知功能；影响因素分析

Abstract: Background　Cognitive impairment is an important feature of schizophrenia. Obstructive sleep apnea syndrome（OSAS）not only affects sleep quality，but also has extensive cognitive impairment. However，there are few reports on the sleep and cognitive impairment of schizophrenia patients with OSAS. Objective　To compare the sleep situation and cognitive functions in schizophrenia patients with or without OSAS，in order to explore whether the sleep and cognitive function of patients with schizophrenia are affected by OSAS. Methods　Patients with schizophrenia hospitalized in the Department of Psychiatry，Chaohu Hospital of Anhui Medical University from March 2018 to December 2019 were selected as the study subjects（80 cases），and healthy population in the physical examination center of Chaohu Hospital Afiliated to Anhui Medical University during the same period were selected as the control group（31 cases）. The information of gender，age，years of education，smoking status，body mass and height of the enrolled subjects were collected by using the self-made questionnaire of general demographic data，and the body mass index（BMI）was calculated. Repetitive sets of neuropsychological status tests（RBANS，immediate memory，visual breadth，speech function，attention，delayed memory）were used to evaluate the cognitive function of the enrolled subjects，and the positive and negative syndrome scale（PANSS）was used to evaluate the clinical psychiatric symptoms，the Chinese version of Epworth Sleepiness Scale（ESS）were used to assess the patient's subjective drowsiness tendency.The sleep status of the patients was recorded through the cardiopulmonary coupling analysis（CPC）technology. The sleep parameters included total sleep time，deep sleep time，light sleep time，REM sleep time，awakening time，first falling asleep time，sleep efficiency and sleep apnea index（AHI）. Based on the standard of AHI≥5 times/h，80 patients with schizophrenia were divided into OSAS group（35 cases）and non-OSAS group（45 cases）. Pearson or Spearman rank correlation analysis was used for the correlation between the variables，and multiple linear regression analysis was used for the analysis of factors affecting cognitive function. Results　There were statistically significant differences in the instant memory scores，visual breadth scores，speech function scores，attention scores，delayed memory scores，and total RBANS scores among the three groups of study subjects（P<0.05）. Patients in the OSAS group had a shorter sleep time than the non-OSAS group（P<0.05），and the light sleep time and awakening time were longer than those in the non-OSAS group（P<0.05）. AHI，negative symptom scores，and PANSS total scores were higher than those in the non-OSAS group（P<0.05），the immediate memory score，visual breadth score，speech function score，attention score，delayed memory score，and RBANS total score were lower than those in the group without OSAS（P<0.05）. In patients with schizophrenia，immediate memory score，visual breadth score were negatively correlated with disease course，negative symptom score，and AHI（P<0.05）；The speech function score was negatively correlated with age，disease course，general psychopathological symptom score，light sleep time，wake time，and AHI（P<0.05）；Attention score was negatively correlated with age，disease course，negative symptom score and AHI（P<0.05）；Delayed memory score was negatively correlated with negative symptom score，AHI（P<0.05）；The total score of RBANS was negatively correlated with the course of disease，negative symptom score，sleep time，awakening time，and AHI（P<0.05）. The results of multiple regression analysis showed that negative symptom scores and years of education were the influencing factors of immediate memory score（P<0.05）. AHI and disease course were the influencing factors of visual breadth score and speech function score（P<0.05），and disease course was the influencing factors of the attention score（P<0.05）. The length of education，AHI were the influencing factors of the delayed memory score（P<0.05）. The length of education，the course of disease，and AHI were the influencing factors of the total score of RBANS（P<0.05）. Conclusion　The sleep and cognitive impairment of schizophrenia patients with OSAS are more severe than that of schizophrenia patients without OSAS；Sleep indicators such as light sleep time and awakening time are negatively correlated with cognitive function of schizophrenia patients；And years of education，disease course，AHI may be the influencing factors of cognitive function in patients with schizophrenia. Early CPC examination and timely intervention may reduce the sleep and cognitive impairment caused by OSAS.

Key words: Schizophrenia；Sleep apnea, obstructive；Cardiopulmonary coupling analysis；Sleep；Cognitive function；Root cause analysis

宋苏琪,张凯,周晓琴,等. 阻塞性睡眠呼吸暂停综合征对精神分裂症患者睡眠及认知功能的影响研究[J]. 中国全科医学, 2021, 24(32): 4110-4115. DOI: 10.12114/j.issn.1007-9572.2021.01.220.
SONG Suqi,ZHANG Kai,ZHOU Xiaoqin, et al. The Effects of Obstructive Sleep Apnea on Sleep and Cognitive Function in Patients with Schizophrenia　[J]. Chinese General Practice, 2021, 24(32): 4110-4115. DOI: 10.12114/j.issn.1007-9572.2021.01.220.

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