阻塞性睡眠呼吸暂停低通气综合征对急性脑梗死患者认知功能的影响
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摘要
背景与目的:阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea-hypopnea Syndrome, OSAHS)是一种临床常见的睡眠呼吸障碍疾病,以睡眠中上气道的反复间歇性塌陷或阻塞,导致低氧血症为特征,主要表现为夜间睡眠紊乱,白天嗜睡和神经认知功能减退[1]。近年来,研究发现随病程延长,OSAHS可成为引起成人痴呆的主要病因之一[2]。OSAHS是卒中的独立危险因素,可影响卒中的康复和转归[3]。而卒中后高达64%的患者存在不同程度的认知障碍,其中1/3会发展为明显痴呆[4]。血管性认知功能障碍(Vascular Cognitive Impairment,VCI)有可能成为老年人慢性进行性认知障碍的最常见形式[5]但OSAHS对卒中患者认知功能的影响尚不明确,国内外相关研究不多。众所周知,OSAHS是可干预的危险因素,故对于这一领域的研究有助于脑卒中及血管性认知障碍的防治。本研究采用前瞻性的研究方法探讨OASHS对首次急性缺血性脑卒中患者认知功能的影响,为缺血性脑卒中的认知障碍的早期防治提供依据。
方法:连续收集2008年1月至2008年12月在我院神经内科住院部的首次急性脑梗死患者,经临床痴呆评定量表筛查,排除卒中前认知障碍者。所有患者行多导睡眠图(PSG)检测;认知功能量表评定:简易智能筛查(MMSE)、画钟试验(CDT)、词语流畅试验(VFT);认知电位:听觉事件相关电位(P300)检测(并纳入15名年龄相匹配的健康志愿者行P300检测,以作正常对照组)。所有患者依呼吸暂停低通气指数(AHI)分为OSAHS组和非OSAHS组。比较两组MMSE、CDT、VFT分值及病例组和对照组P300的潜伏期和波幅,并进行亚组分析比较。
结果:41例患者完成所有检查。依PSG检查结果呼吸暂停低通气指数(AHI)分为OSAHS组(21例),非OSAHS组(20例)。以MMSE评分计41例患者中有认知功能障碍者8例(19.51%),OSAHS组5例(23.81%),非OSAHS组3例(15%)。两组认知障碍者MMSE得分分别为21.63±4.08,23.47±2.26, OSAHS组低于非OSAHS组,但差异无统计学意义(P>0.05)。OSAHS组MMSE总分、CDT分值低于非OSAHS组,VFT分值高于非OSAHS组,两组比较差异无显著性(P>0.05);亚组分析显示中-重度OSAHS组MMSE、CDT得分为23.67±5.12,2.67±1.53,非OSAHS组为24.85±3.15,3.1±1.2,两组比较差异有显著性(P<0.05)。P300检查显示OSAHS组FZ、CZ、PZ潜伏期依次为393.05±60.82ms,379.50±56.67ms,384.40±52.61ms;非OSAHS组依次为359.85±26.81ms,346.00±37.06ms,356.90±38.36ms;健康对照组依次为352.27±34.64ms,349.47±29.01ms,328.33±18.78ms;OSAHS组P300潜伏期较非OSAHS组及健康对照组均延长,差异有统计学意义(P<0.05).亚组分析显示中重度OSAHS组较非OSAHS组的P300潜伏期显著延长(P<0.05)。各组P300的波幅差异无显著性(P>0.05)。
结论:OSAHS可加重急性脑梗死者的认知功能障碍,且与OSAHS的严重程度相关。P300检查对认知功能损害的检测可能较MMSE、CDT更敏感。
Background and Purpose: Obstructive Sleep Apnea-hypopnea Syndrome (OSAHS) is a highly prevalent sleep respiratory disorder, characterized by repetitive episodes of complete or partial obstruction of the upper airway during sleep, resulting in oxygen desaturation. Its clinical manifestations include nocturnal sleep disorder, daytime somnolence and neuropsychological cognitive hypofunction. Recent years, studies show that OSAHS may be a main cause of adult dementia with the prolongation of the course. OSAHS has been suggested to be a independent risk factor for stroke. It can affect the rehabilitation and prognosis of stroke. Sixty-four percent patients suffer from cognitive disfunction of different degree after stroke, 1/3 of whom would develop into obvious dementia. Vascular Cognitive Impairment (VCI)could be the most common pattern of elders’chronical progressive cognitive impairment. But till now, there has been no final conclusion in the influence of OSAHS on cognition of patients with ischemic stroke. It is well-known that OSAHS can be interventionable by respiratory machine or surgery, therefore, studies in this field will contribute to preventing and curing for stroke and VCI. This research adopted prospective study methods to investigate the influence of OSAHS on cognition of patients with acute ischemic stroke and to provide evidence for earlier prevention of VCI.
Methods: Totally 41 consecutive first-ever stroke patients and fifteen healthy volunteers were included in this research from January 2008 to November 2008. All patients were administered Polysomnogram (PSG), Mini-Mental State Examination (MMSE), Clock Drawing Task (CDT), Verbal Fluency Test (VFT) and P300 test. Fifteen age-matched healthy volunteers participated in the P300 test study as a normal control group.These stroke patients were divided into OSAHS group and non-OSAHS group by Apnea Hyponea Index(AHI).The scores of MMSE、CDT and VFT between two groups were analyzed. Latencies and amplitudes from FZ, CZ, PZ electrode positions were compared between patients and controls. Results: Forty-one patients with first stroke were divided into the OSAHS group (n=21) and the non-OSAHS group (n=21) by the results of PSG,Eight of whom were found cognitive impairment (19.51%) depending on MMSE: five in the OSAHS group(23.81%), three in the non-OSAHS group(15%). The scores of MMSE and CDT in the OSAHS group were less than those in non-OSAHS group. No significant differences were observed in the scores of MMSE, CDT and VFT between the two groups (p>0.05). The scores of MMSE and CDT in moderate- severe degree OSAHS group were 23.67±5.12,2.67±1.53 respectively, differing from those in non-OSAHS groups(p<0.05), which were 24.85±3.15,3.1±1.2 respectively. P300 latencies from FZ, CZ and PZ electrode positions in the OSAHS group were 393.05±60.82ms, 379.50±56.67ms, 384.40±52.61ms, respectively;in the non-OSAHS group were 359.85±26.81ms, 346.00±37.06ms, 356.90±38.36ms respectively; in the normal control group were 352.27±34.64ms, 349.47±29.01ms, 328.33±18.78ms respectively. P300 latency in the OSAHS group was significantly longer than that in the other two group (p<0.05). P300 latency in moderate-severe degree OSAHS group was longer than that of non-OSAHS group (p<0.05). P300 amplitude in every group showed no significant difference.
Conclusion: OSAHS can aggravate cognitive impairment of patients with acute ischemic stroke . No doubt that cognitive impairment in the patients can get worse with the degree of OSAHS. P300 test may be more sensitive than MMSE and CDT to detection of cognitive impairment.
方法:连续收集2008年1月至2008年12月在我院神经内科住院部的首次急性脑梗死患者,经临床痴呆评定量表筛查,排除卒中前认知障碍者。所有患者行多导睡眠图(PSG)检测;认知功能量表评定:简易智能筛查(MMSE)、画钟试验(CDT)、词语流畅试验(VFT);认知电位:听觉事件相关电位(P300)检测(并纳入15名年龄相匹配的健康志愿者行P300检测,以作正常对照组)。所有患者依呼吸暂停低通气指数(AHI)分为OSAHS组和非OSAHS组。比较两组MMSE、CDT、VFT分值及病例组和对照组P300的潜伏期和波幅,并进行亚组分析比较。
结果:41例患者完成所有检查。依PSG检查结果呼吸暂停低通气指数(AHI)分为OSAHS组(21例),非OSAHS组(20例)。以MMSE评分计41例患者中有认知功能障碍者8例(19.51%),OSAHS组5例(23.81%),非OSAHS组3例(15%)。两组认知障碍者MMSE得分分别为21.63±4.08,23.47±2.26, OSAHS组低于非OSAHS组,但差异无统计学意义(P>0.05)。OSAHS组MMSE总分、CDT分值低于非OSAHS组,VFT分值高于非OSAHS组,两组比较差异无显著性(P>0.05);亚组分析显示中-重度OSAHS组MMSE、CDT得分为23.67±5.12,2.67±1.53,非OSAHS组为24.85±3.15,3.1±1.2,两组比较差异有显著性(P<0.05)。P300检查显示OSAHS组FZ、CZ、PZ潜伏期依次为393.05±60.82ms,379.50±56.67ms,384.40±52.61ms;非OSAHS组依次为359.85±26.81ms,346.00±37.06ms,356.90±38.36ms;健康对照组依次为352.27±34.64ms,349.47±29.01ms,328.33±18.78ms;OSAHS组P300潜伏期较非OSAHS组及健康对照组均延长,差异有统计学意义(P<0.05).亚组分析显示中重度OSAHS组较非OSAHS组的P300潜伏期显著延长(P<0.05)。各组P300的波幅差异无显著性(P>0.05)。
结论:OSAHS可加重急性脑梗死者的认知功能障碍,且与OSAHS的严重程度相关。P300检查对认知功能损害的检测可能较MMSE、CDT更敏感。
Background and Purpose: Obstructive Sleep Apnea-hypopnea Syndrome (OSAHS) is a highly prevalent sleep respiratory disorder, characterized by repetitive episodes of complete or partial obstruction of the upper airway during sleep, resulting in oxygen desaturation. Its clinical manifestations include nocturnal sleep disorder, daytime somnolence and neuropsychological cognitive hypofunction. Recent years, studies show that OSAHS may be a main cause of adult dementia with the prolongation of the course. OSAHS has been suggested to be a independent risk factor for stroke. It can affect the rehabilitation and prognosis of stroke. Sixty-four percent patients suffer from cognitive disfunction of different degree after stroke, 1/3 of whom would develop into obvious dementia. Vascular Cognitive Impairment (VCI)could be the most common pattern of elders’chronical progressive cognitive impairment. But till now, there has been no final conclusion in the influence of OSAHS on cognition of patients with ischemic stroke. It is well-known that OSAHS can be interventionable by respiratory machine or surgery, therefore, studies in this field will contribute to preventing and curing for stroke and VCI. This research adopted prospective study methods to investigate the influence of OSAHS on cognition of patients with acute ischemic stroke and to provide evidence for earlier prevention of VCI.
Methods: Totally 41 consecutive first-ever stroke patients and fifteen healthy volunteers were included in this research from January 2008 to November 2008. All patients were administered Polysomnogram (PSG), Mini-Mental State Examination (MMSE), Clock Drawing Task (CDT), Verbal Fluency Test (VFT) and P300 test. Fifteen age-matched healthy volunteers participated in the P300 test study as a normal control group.These stroke patients were divided into OSAHS group and non-OSAHS group by Apnea Hyponea Index(AHI).The scores of MMSE、CDT and VFT between two groups were analyzed. Latencies and amplitudes from FZ, CZ, PZ electrode positions were compared between patients and controls. Results: Forty-one patients with first stroke were divided into the OSAHS group (n=21) and the non-OSAHS group (n=21) by the results of PSG,Eight of whom were found cognitive impairment (19.51%) depending on MMSE: five in the OSAHS group(23.81%), three in the non-OSAHS group(15%). The scores of MMSE and CDT in the OSAHS group were less than those in non-OSAHS group. No significant differences were observed in the scores of MMSE, CDT and VFT between the two groups (p>0.05). The scores of MMSE and CDT in moderate- severe degree OSAHS group were 23.67±5.12,2.67±1.53 respectively, differing from those in non-OSAHS groups(p<0.05), which were 24.85±3.15,3.1±1.2 respectively. P300 latencies from FZ, CZ and PZ electrode positions in the OSAHS group were 393.05±60.82ms, 379.50±56.67ms, 384.40±52.61ms, respectively;in the non-OSAHS group were 359.85±26.81ms, 346.00±37.06ms, 356.90±38.36ms respectively; in the normal control group were 352.27±34.64ms, 349.47±29.01ms, 328.33±18.78ms respectively. P300 latency in the OSAHS group was significantly longer than that in the other two group (p<0.05). P300 latency in moderate-severe degree OSAHS group was longer than that of non-OSAHS group (p<0.05). P300 amplitude in every group showed no significant difference.
Conclusion: OSAHS can aggravate cognitive impairment of patients with acute ischemic stroke . No doubt that cognitive impairment in the patients can get worse with the degree of OSAHS. P300 test may be more sensitive than MMSE and CDT to detection of cognitive impairment.
引文
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[1]Banno K,Kryger MH.Sleep apnea:clinical investigations in humans.Sleep Medicine, 2007,8(4): 400-426
[2]Mattei A,Tabbia G,Baldi S.Diagnosis of sleep apnea.Minerva Med ,2004,95(3):213-31.
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