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中国全科医学 ›› 2022, Vol. 25 ›› Issue (11): 1340-1345.DOI: 10.12114/j.issn.1007-9572.2022.01.603

所属专题： 睡眠研究最新文章合集； 阿尔茨海默病最新文章合集； 睡眠问题专题研究

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阻塞性睡眠呼吸暂停低通气综合征患者认知功能与情绪及睡眠结构的关系研究

刘奕姝1，谭慧文2，曾尹3，肖莉1，3*   

  1. 1.110004 辽宁省沈阳市，中国医科大学附属盛京医院睡眠医学中心　2.637003 四川省南充市中心医院呼吸与危重症医学科　
    3.110004 辽宁省沈阳市，中国医科大学附属盛京医院呼吸与危重症医学科
    * 通信作者：肖莉，主任医师，硕士研究生导师；E-mail：xiaolisy@163.com
  • 出版日期:2022-04-15 发布日期:2022-03-28
  • 基金资助:
    辽宁省重点研发指导计划（2019JH8/10300006）

Relationship of Cognitive Function with Emotion and Sleep Architecture in Patients with OSAHS

LIU Yishu1，TAN#br# Huiwen2，ZENG Yin3，XIAO Li1，3*   

  1. 1.Sleep Medical Center，Shengjing Hospital of China Medical University，Shenyang 110004，China
    2.Department of Pulmonary and Critical Care Medicine，Nanchong Central Hospital，Nanchong 637003，China
    3.Department of Pulmonary and Critical Care Medicine，Shengjing Hospital of China Medical University，Shenyang 110004，
    China
    *Corresponding author：XIAO Li，Chief physician，Master supervisor；E-mail：xiaolisy@163.com
  • Published:2022-04-15 Online:2022-03-28

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摘要： 背景　阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种睡眠呼吸障碍疾病，患者长期出现夜间间 歇性低氧血症和睡眠片段化，影响睡眠质量及情绪调节，这与患者认知功能有密切关联。目的　探讨OSAHS 患者认 知功能与情绪和睡眠结构的关系。方法　回顾性分析2019 年9 月至2020 年12 月在中国医科大学附属盛京医院睡 眠医学中心经多导睡眠监测诊断为OSAHS 的116 例患者的临床资料，获得患者多导睡眠监测的数据、睡眠监测前填 写的调查表〔包括焦虑筛查量表（GAD-7）、抑郁症筛查量表（PHQ-9）、蒙特利尔认知评估量表（MoCA）、记忆 与执行筛查量表（MES）、失眠严重指数量表（ISI）、Epworth 嗜睡量表（ESS）〕资料。根据MoCA 总分将OSAHS 患者分为认知正常组（MoCA 总分≥ 26 分，n=79）和认知异常组（MoCA 总分<26 分，n=37），应用Pearson 相关分 析及Spearman 秩相关分析探究认知功能与各指标间的相关性，采用多元线性回归分析探究OSAHS 患者认知功能的影 响因素。结果　认知正常组与认知异常组GAD-7、PHQ-9 评分比较，差异无统计学意义（P>0.05），两组年龄、性别、 MES 总分、微觉醒总次数、非快眼动睡眠（NREM）期微觉醒总次数、快眼动睡眠（REM）期微觉醒总次数、总睡眠 时间（TST）、睡眠后觉醒时间（WASO）、睡眠效率、N3 期占总睡眠时间的百分比（N3/TST%）和REM 期占总睡眠 时间的百分比（REM/TST%）比较，差异有统计学意义（P<0.05）。Person 相关分析/Spearman 秩相关分析结果显示， MoCA 总分与年龄、呼吸暂停低通气指数（AHI）、WASO 呈负相关（P<0.05），与TST、睡眠效率、REM/TST%，微 觉醒总次数和REM 期微觉醒总次数呈正相关（P<0.05）；MoCA 中延迟回忆得分与年龄、WASO 呈负相关（P<0.05）， 与睡眠效率、REM/TST%、微觉醒总次数和REM 期微觉醒总次数呈正相关（P<0.05）；MES 总分与年龄呈负相关（P<0.05）， 与REM/TST%、微觉醒总次数、NREM 期和REM 期微觉醒总次数呈正相关（P<0.05）。多元线性回归结果显示，年龄， AHI 和REM/TST% 为MoCA 总分的影响因素（P<0.05），年龄是延迟回忆得分及MES 总分的影响因素（P<0.05）。再 通过逐步多元线性回归法得出最终的回归模型，发现MoCA 总分与年龄和REM/TST% 相关性更强，MoCA 总分与年龄 呈负相关（P<0.05），与REM/TST% 呈正相关（P<0.05）。结论　OSAHS 患者认知功能下降与REM 期减少相关，未 发现OSAHS 合并认知障碍患者的情绪有明显异常。未来可进一步明确OSAHS 患者认知功能与睡眠结构之间的关系。

关键词: 睡眠呼吸暂停, 阻塞性；认知功能；情绪；睡眠结构；影响因素分析

Abstract: Background　Obstructive sleep apnea-hypopnea syndrome （OSAHS） is a sleep-related breathing
disease，which influences patients' sleep quality and emotion regulation due to long-term intermittent hypoxemia and sleep fragmentation. It has a close relationship with cognitive function. Objective　To explore the relationship of cognitive function
with emotion and sleep architecture in patients with OSAHS. Methods　A retrospective analysis was conducted. Participants
were 116 cases of OSAHS diagnosed by polysomnography（PSG） recruited from Sleep Medical Center，Shengjing Hospital of
China Medical University from September 2019 to December 2020. Clinical data were collected，including results of PSG and
questionnaires before PSG〔including Generalized Anxiety Disorder（GAD-7），Patient Health Questionnaire-9（PHQ-9），
Montreal Cognitive Assessment（MoCA），Mean Memory and Executive Screening（MES），Insomnia Severity Index（ISI），
Epworth Sleepiness Scale（ESS）〕. According to the total score of MoCA，participants were divided into normal cognition group
（≥ 26 points， n=79） and abnormal cognition group （<26 points， n=37）. Pearson and Spearman correlation analyses were
used to study the correlation of cognitive function with PSG indicators. Multiple linear regression analysisi was used to explore the
factors associated with cognitive function. Results　There were no significant differences in emotion functions between normal
cognition group and abnormal cognition group. Both groups had significant differences in mean age，sex ratio，MES score，total
arousals，arousals in non-rapid eye movement（NREM），arousals in rapid eye movement（REM），total sleep time（TST），
wake after sleep onset（WASO），sleep efficiency，percentage of stage N3 sleep（N3/TST%） and percentage of REM（REM/
TST%） （P<0.05）. Correlation analyses showed that MoCA score was negatively correlated with age，apnea hypopnea index
（AHI），and WASO（P<0.05），and positively correlated with TST，sleep efficiency，REM/TST%，total arousals and
arousals in REM（P<0.05）. The score of delayed recall in the MoCA scale was negatively correlated with age and WASO
（P<0.05），and positively correlated with sleep efficiency，REM/TST%，total arousals and arousals in REM（P<0.05）.The
total score of MES was negatively correlated with age（P<0.05），and positively correlated with REM/TST%，total arousals，
and arousals in NREM and REM（P<0.05）. Multiple linear regression analysis showed that age，AHI and REM/TST% were
associated with MoCA score（P<0.05），and age was associated with delayed recall score and MES score（P<0.05）. The final
regression model established using stepwise regression revealed that the MoCA score had a stronger correlation with age and REM/
TST%，and MoCA score was negatively correlated with age（P<0.05），and positively correlated with REM/TST%（P<0.05）.
Conclusion　The decline of cognitive function in OSAHS patients was significantly correlated with the reduction of REM. No
obvious abnormality in emotion was found in these patients with cognitive dysfunction. The relationship between cognitive function
and sleep architecture in OSAHS patients can be further clarified in future research.

Key words: Sleep apnea, obstructive；Cognitive function；Emotion；Sleep architecture；Root cause analysis

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