阻塞性睡眠呼吸暂停低通气综合征患者与认知功能障碍的相关影响因素的研究
发布时间：2018-08-20 16:28
【摘要】：研究目的:阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea-hypopnea syndrome,OSAHS)可致使全身多系统受损,当神经系统受损时,患者主要表现为认知功能障碍。本研究通过蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评估OSAHS患者的认知功能损害程度,探讨OSAHS引起认知功能障碍的影响因素及其病情程度与认知功能障碍的关联,从而帮助临床工作者早期发现和干预OSAHS患者受损的认知能力,以减少相关并发症的发生率及病死率,提高患者的生活质量。方法:选取2016年8月-2016年12月于南昌大学第二附属医院呼吸内科门诊或病房中主诉睡眠时打鼾、白天嗜睡的首诊患者128例,行多导睡眠监测(polysomnography,PSG)后将受试者分为病例组及对照组,其中病例组又分为OSAHS轻、中、重度三组,每组人数均为32例,PSG主要监测指标包括呼吸暂停低通气指数(apnea-hypopnea index,AHI)、氧减指数(oxygen desaturation index,ODI)及最低血氧饱和度(lowest arterial oxygen saturation,LSaO2);并纳入患者年龄、受教育年限及体重指数(body mass index,BMI)。同时采用MoCA量表来评估病例组及对照组的认知能力。收集整合实验资料,并运用SPSS20.0统计软件分析,主要统计方法包括x2检验、Pearson相关分析、描述性分析、单因素方差分析、多因素Logistic回归分析。结果:1、病例组中轻、中、重度OSAHS患者的平均年龄分别为(51.88±10.59)、(51.56±10.99)、(43.34±9.63);高中文化程度分别有15人(46.9%)、16人(50%)、12人(37.5%),大专以上文化程度分别有17人(53.1%)、16人(50%)、20人(62.5%),平均受教育年限分别为(13.84±1.85)、(13.72±1.78)、(14.16±1.74);体重指数分别为(27.60±4.61)Kg/m2、(27.40±3.13)Kg/m2、(29.12±3.66)Kg/m2。对照组中平均年龄为(45.78±10.96);高中文化程度有11人(34.4%),大专以上文化程度有21人(65.6%),平均受教育年限为(14.25±1.76);体重指数分别为(26.13±3.99)Kg/m2。各组别比较,受教育年限指数方面差异无统计学意义(P=0.593)。年龄、BMI差异有统计学意义。其中,年龄指数两两比较,对照组与病例组无差异有统计学意义(P0.05),OSAHS重度与OSAHS中度差异有统计学意义(P0.05);与OSAHS轻度差异有统计学意义(P0.01)。BMI指数两两比较,对照组与OSAHS重度差异有统计学意义(P0.05)。2、病例组与对照组认知功能障碍的发生率:96例OSAHS患者中有65例出现认知受损,即MoCA评分26分,占68%;其中OSAHS轻度组中有11例,占34%;中度组中有25例,占78%;重度组中有29例,占90%;32例对照组中有1例出现认知受损,占3%;OSAHS轻度、中度、重度与对照组认知功能障碍发生率具有统计学差异(?2=62.436,P=0.000),OSAHS人群比非OSAHS人群更易出现认知受损。3、在轻、中、重不同程度OSAHS患者中与对照组中,MoCA得分从高至低依次为对照组(27.72±1.30)分、轻度(26.03±2.39)分、中度(24.63±1.90)分、重度(21.56±3.23)分,其得分差异有统计学意义(F=40.609,P=0.000);MoCA两两比较,对照组与OSAHS轻度、OSAHS中度差异有统计学意义(P≤0.01);重度组与OSAHS轻度、OSAHS中度差异有统计学意义(P0.01),即OSAHS患者病情越重,MoCA的分值越低。将对照组与轻、中、重度OSAHS患者MoCA的各项分值进行比较,其中视空间(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)、语言(2.09±0.64VS 2.06±0.76 VS1.41±0.5VS1.5±0.62,F=10.398,P=0.000)、延迟回忆(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)。视空间指数两两比较,OSAHS重度与对照组、OSAHS中度差异有统计学意义(P≤0.01)。注意力两两比较,对照组与OSAHS中度组、OSAHS重度组差异有统计学意义(P≤0.01);OSAHS轻度组与OSAHS中度组、OSAHS重度组差异有统计学意义(P0.01)。语言指数两两比较,对照组与OSAHS中度组、OSAHS重度组差异有统计学意义(P≤0.01);OSAHS轻度组与OSAHS中度组、OSAHS重度组差异有统计学意义(P0.01)。延迟回忆指数两两比较,对照组与OSAHS中度组、OSAHS重度组差异有统计学意义(P≤0.01);OSAHS重度组与OSAHS轻度组、OSAHS中度组差异有统计学意义(P0.01)。定向力指数两两比较,对照组与OSAHS中度组、OSAHS重度组差异有统计学意义(P≤0.01);OSAHS重度组与OSAHS轻度组差异有统计学意义(P0.05)。4、认知功能与年龄、BMI、受教育年限的关系、AHI、LSa O2、ODI的相关性:OSAHS患者MoCA总分与年龄(r=-0.244,P=0.017)显著负相关,与BMI显著负相关(r=-0.314,P=0.002),与受教育年限显著正相关(r=0.205,P=0.045);与AHI(r=-0.653,P=0.000)、ODI(r=-0.630,P=0.000)显著负相关,与LSaO2显著正相关(r=0.653,P=0.000)。5、对OSAHS患者认知功能的影响的多因素Logistic回归分析结果,进入回归方程的因素只有3个:LSaO2、BMI及AHI。其中LSaO2的OR值与95%CI均1,是OSAHS患者发生认知功能障碍的保护性因素;BMI与AHI的OR值与95%CI均1,是OSAHS患者发生认知功能障碍的危险因素。随着LSa O2的升高,OSAHS患者发生认知功能障碍的风险性降低,其OR值为0.897(95%CI:0.815,0.987)。而BMI异常级别的增高的同时,也提高了OSAHS患者发生认知功能障碍的风险性,其OR值为2.133(95%CI:1.047,4.346)。同样的,AHI异常级别的增高的同时,也提高了OSAHS患者发生认知功能障碍的风险性,其OR值为3.415(95%CI:1.695,6.882)。Logistic回归方程为:logitP=-0.109X1+0.758X2+1.228X3。结论:本研究中约有68%的OSAHS患者发生认知功能障碍,且认知功能障碍的发生率与OSAHS的病情呈正相关。OSAHS患者的认知功能障碍与年龄、肥胖、受教育年限以及夜间间断低氧/低通气有关。OSAHS患者的认知功能障碍的严重程度与年龄、肥胖呈正相关性,与受教育程度呈负相关性。同时,OSAHS患者的低通气与夜间呼吸停顿的次数愈多,夜间最低血氧饱和度愈低,其认知功能受损愈严重,着重表现在记忆力、注意力及语言方面。
[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.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766
本文编号：2194271
[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.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766
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