住院中年阻塞性睡眠呼吸暂停低通气综合征患者认知功能特点及影响因素分析
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摘要
目的探讨住院中年阻塞性睡眠呼吸暂停低通气综合征患者的认知功能特点及其影响因素。方法运用便利抽样法,选取348例住院中年阻塞性睡眠呼吸暂停低通气综合征患者为研究对象。采用蒙特利尔认知评估量表对其认知功能进行评估,根据得分分为认知功能正常组与认知功能障碍组,对比分析中年阻塞性睡眠呼吸暂停低通气综合征患者的认知功能特点,并应用多因素Logistic回归法分析其影响因素。结果住院中年阻塞性睡眠呼吸暂停低通气综合征患者认知功能障碍发生率为39.66%,认知功能障碍组延迟记忆、注意力与认知功能正常组比较,差异有统计学意义(均P<0.01)。Logistic回归分析结果显示,年龄、学历、体育锻炼频次、平均血氧饱和度是患者发生认知功能障碍的影响因素(均P<0.01)。结论住院中年阻塞性睡眠呼吸暂停低通气综合征患者存在较严重的认知功能损伤,其中以延迟记忆及注意力领域受损为主;认知功能障碍的发生与年龄偏大、学历偏低、体育锻炼不足、血氧饱和度偏低有关。
Objective To explore the characteristics and influencing factors of cognitive function among middle-aged inpatients with Obstructive Sleep Apnea-hypopnea Syndrome(OSAHS). Methods Totally 348 middle-aged OSAHS inpatients were recruited using convenience sampling, then Montreal Cognitive Assessment Scale(MoCA) was utilized to assess their cognitive function, and the patients were divided into a cognitive normal group and a cognitive impairment group according to their MoCA score, the characteristics of cognitive function among middle-aged OSAHS inpatients were analyzed comparatively, and its influencing factors were determined using multivariate logistic regression analysis. Results The incidence of cognitive impairment was 39.66% in middle-aged OSAHS inpatients. There were significant differences in delayed recall and attention between the two groups(P<0.01 for both). Logistic regression analysis revealed that, age, educational background, frequency of physical exercise and mean oxygen saturation were the influencing factors of cognitive impairment in middle-aged OSAHS inpatients(P<0.01 for all). Conclusion Cognitive impairment is serious in middle-aged OSAHS inpatients, especially in the area of delayed recall and attention. And cognitive impairment has something to do with patients′ older age, lower educational background, inadequate physical exercise and low oxygen saturation.
Objective To explore the characteristics and influencing factors of cognitive function among middle-aged inpatients with Obstructive Sleep Apnea-hypopnea Syndrome(OSAHS). Methods Totally 348 middle-aged OSAHS inpatients were recruited using convenience sampling, then Montreal Cognitive Assessment Scale(MoCA) was utilized to assess their cognitive function, and the patients were divided into a cognitive normal group and a cognitive impairment group according to their MoCA score, the characteristics of cognitive function among middle-aged OSAHS inpatients were analyzed comparatively, and its influencing factors were determined using multivariate logistic regression analysis. Results The incidence of cognitive impairment was 39.66% in middle-aged OSAHS inpatients. There were significant differences in delayed recall and attention between the two groups(P<0.01 for both). Logistic regression analysis revealed that, age, educational background, frequency of physical exercise and mean oxygen saturation were the influencing factors of cognitive impairment in middle-aged OSAHS inpatients(P<0.01 for all). Conclusion Cognitive impairment is serious in middle-aged OSAHS inpatients, especially in the area of delayed recall and attention. And cognitive impairment has something to do with patients′ older age, lower educational background, inadequate physical exercise and low oxygen saturation.
引文
[1] 何权瀛,王莞尔.阻塞性睡眠呼吸暂停低通气综合征诊治指南(基层版)[J].中国呼吸与危重监护杂志,2015,14(4):398-405.
[2] Bucks R S,Olaithe M,Rosenzweig I,et al.Reviewing the relationship between OSA and cognition:where do we go from here?[J].Respirology,2017,22(7):1253-1261.
[3] Young T,Palta M,Demppsey J,et al.The occurrence of sleep-disordered breathing among middle-aged adults[J].N Engl J Med,1993,328(17):1230-1235.
[4] 上海市医学会呼吸病学分会睡眠呼吸疾病学组.上海市30岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查[J].中华结核和呼吸杂志,2003,26(5):15-19.
[5] 王玲,孔辉,苏英峰.176例多导睡眠呼吸监测结果及临床分析[J].大连医科大学学报,2012,34(2):153-165.
[6] Feliciano A,Torres V M,Vaz F,et al.Overview of proteomics studies in obstructive sleep apnea[J].Sleep Med,2015,16(4):437-445.
[7] 赵海源,于荣焕,刘辉,等.中年阻塞性睡眠呼吸暂停低通气综合征对认知功能及记忆的影响[J].中国实用神经疾病杂志,2012,15(16):5-7.
[8] 王炜,王鲁宁.“蒙特利尔认知评估量表”在轻度认知损伤患者筛查中的应用[J].中华内科杂志,2007,46(5):414-416.
[9] Chen X,Zhang R,Xiao Y,et al.Reliability and validity of the Beijing version of the Montreal Cognitive Assessment in the evaluation of cognitive function of adult patients with OSAHS[J].PLoS One,2015,10(7):1-12.
[10] 高金颖,沈扬,樊东升,等.伴轻度认知损害的青中年阻塞性睡眠呼吸暂停综合征患者认知损伤特点[J].实用医学杂志,2008,24(20):3494-3496.
[11] Yaffe K,Laffan A M,Harrison S L,et al.Sleep-disordered breathing,hypoxia,and risk of mild cognitive impairment and dementia in older women[J].JAMA,2011,306(6):613-619.
[12] Wallace A,Bucks R S.Memory and obstructive sleep apnea:a meta-analysis[J].Sleep,2013,36(2):203-220.
[13] 张永林,张媛媛,任寿安,等.中青年阻塞性睡眠呼吸暂停低通气综合征患者认知功能障碍特点及相关因素分析[J].山西医科大学学报,2017,48(6):578-582.
[14] Khazaie H,Maroufi A.Obstructive sleep apnea syndrome;a neglected cause of traffic collision among Iranian public transport drivers[J].J Inj Violence Res,2014,6(2):99-99.
[15] Li Y,Veasey S C.Neurobiology and neuropathophysiology of obstructive sleep apnea[J].Neuromolecular Med,2012,14(3):168-179.
[16] 谭亚洲.阻塞性睡眠呼吸暂停低通气综合征患者认知功能障碍及影响因素[D].芜湖:皖南医学院,2015.
[17] Lavie P,Lavie L.Unexpected survival advantage in el-derly people with moderate sleep apnea[J].J Sleep Res,2009,18(4):397-403.
[18] 叶志英,杨莹,肖强,等.社区高知老年人认知功能与社会支持关系的研究[J].护理学杂志,2018,33(1):94-96.
[19] 方柳絮,沈勤.社区老人智力活动与认知功能状况研究[J].护理学杂志,2017,32(13):84-86.
[20] 张连成,高淑青.身体锻炼对认知老化的延迟作用:来自脑科学的证据[J].天津体育学院学报,2014,29(4):309-312.
[21] Erickson K I,Voss M W,Prakash R S,et al.Exercise training increases size of hippocampus and improves memory[J].Proc Natl Acad Sci USA,2011,108(7):3017-3022.
[22] Rosano C,Venkatraman V K,Guralnik J,et al.Psychomotor speed and functional brain MRI 2 years after completing a physical activity treatment[J].J Gerontol A Biol Sci Med Sci,2010,65(6):639-647.
[23] Yang X H,Liu H G,Liu X,et al.Thioredoxin and impaired spatial learning and memory in the rats exposed to intermittent hypoxia[J].Chin Med J,2012,125(17):3074-3080.
[24] 陈燕,赵春玲,张春来,等.慢性间断性低氧大鼠认知功能和脑胆碱能神经元的进行性变化[J].中国应用生理学杂志,2011,27(2):192-195.
[25] Hoth K F,Zimmerman M E,Meschede K A,et al.Obstructive sleep apnea:impact of hypoxemia on memory[J].Sleep Breath,2013,17(2):811-817.
[2] Bucks R S,Olaithe M,Rosenzweig I,et al.Reviewing the relationship between OSA and cognition:where do we go from here?[J].Respirology,2017,22(7):1253-1261.
[3] Young T,Palta M,Demppsey J,et al.The occurrence of sleep-disordered breathing among middle-aged adults[J].N Engl J Med,1993,328(17):1230-1235.
[4] 上海市医学会呼吸病学分会睡眠呼吸疾病学组.上海市30岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查[J].中华结核和呼吸杂志,2003,26(5):15-19.
[5] 王玲,孔辉,苏英峰.176例多导睡眠呼吸监测结果及临床分析[J].大连医科大学学报,2012,34(2):153-165.
[6] Feliciano A,Torres V M,Vaz F,et al.Overview of proteomics studies in obstructive sleep apnea[J].Sleep Med,2015,16(4):437-445.
[7] 赵海源,于荣焕,刘辉,等.中年阻塞性睡眠呼吸暂停低通气综合征对认知功能及记忆的影响[J].中国实用神经疾病杂志,2012,15(16):5-7.
[8] 王炜,王鲁宁.“蒙特利尔认知评估量表”在轻度认知损伤患者筛查中的应用[J].中华内科杂志,2007,46(5):414-416.
[9] Chen X,Zhang R,Xiao Y,et al.Reliability and validity of the Beijing version of the Montreal Cognitive Assessment in the evaluation of cognitive function of adult patients with OSAHS[J].PLoS One,2015,10(7):1-12.
[10] 高金颖,沈扬,樊东升,等.伴轻度认知损害的青中年阻塞性睡眠呼吸暂停综合征患者认知损伤特点[J].实用医学杂志,2008,24(20):3494-3496.
[11] Yaffe K,Laffan A M,Harrison S L,et al.Sleep-disordered breathing,hypoxia,and risk of mild cognitive impairment and dementia in older women[J].JAMA,2011,306(6):613-619.
[12] Wallace A,Bucks R S.Memory and obstructive sleep apnea:a meta-analysis[J].Sleep,2013,36(2):203-220.
[13] 张永林,张媛媛,任寿安,等.中青年阻塞性睡眠呼吸暂停低通气综合征患者认知功能障碍特点及相关因素分析[J].山西医科大学学报,2017,48(6):578-582.
[14] Khazaie H,Maroufi A.Obstructive sleep apnea syndrome;a neglected cause of traffic collision among Iranian public transport drivers[J].J Inj Violence Res,2014,6(2):99-99.
[15] Li Y,Veasey S C.Neurobiology and neuropathophysiology of obstructive sleep apnea[J].Neuromolecular Med,2012,14(3):168-179.
[16] 谭亚洲.阻塞性睡眠呼吸暂停低通气综合征患者认知功能障碍及影响因素[D].芜湖:皖南医学院,2015.
[17] Lavie P,Lavie L.Unexpected survival advantage in el-derly people with moderate sleep apnea[J].J Sleep Res,2009,18(4):397-403.
[18] 叶志英,杨莹,肖强,等.社区高知老年人认知功能与社会支持关系的研究[J].护理学杂志,2018,33(1):94-96.
[19] 方柳絮,沈勤.社区老人智力活动与认知功能状况研究[J].护理学杂志,2017,32(13):84-86.
[20] 张连成,高淑青.身体锻炼对认知老化的延迟作用:来自脑科学的证据[J].天津体育学院学报,2014,29(4):309-312.
[21] Erickson K I,Voss M W,Prakash R S,et al.Exercise training increases size of hippocampus and improves memory[J].Proc Natl Acad Sci USA,2011,108(7):3017-3022.
[22] Rosano C,Venkatraman V K,Guralnik J,et al.Psychomotor speed and functional brain MRI 2 years after completing a physical activity treatment[J].J Gerontol A Biol Sci Med Sci,2010,65(6):639-647.
[23] Yang X H,Liu H G,Liu X,et al.Thioredoxin and impaired spatial learning and memory in the rats exposed to intermittent hypoxia[J].Chin Med J,2012,125(17):3074-3080.
[24] 陈燕,赵春玲,张春来,等.慢性间断性低氧大鼠认知功能和脑胆碱能神经元的进行性变化[J].中国应用生理学杂志,2011,27(2):192-195.
[25] Hoth K F,Zimmerman M E,Meschede K A,et al.Obstructive sleep apnea:impact of hypoxemia on memory[J].Sleep Breath,2013,17(2):811-817.