摘要【目的】探讨老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者记忆损伤及认知障碍情况。【方法】选取2017年1月至2019年12月在本院诊治96例老年OSAHS患者(OSAHS组),根据睡眠呼吸暂停低通气指数(AHI)次数分为轻中度OSAHS组( n =56,5次/小时<AHI≤30次/小时)和重度OSAHS组( n =40,>30次/小时);另外选取同期在本院行健康体检老年人40例作为对照组(0次/小时≤AHI≤5次/小时)。比较三组入选对象认知和记忆情况。【结果】氧减指数(Oxygen reduction index,ODI)、AHI、呼吸相关微觉醒指数(Respiratory Related Micro Awakening Index,RRMAI)、非快动眼睡眠(non-rapid eye movement slee, NREM)Ⅰ~Ⅱ期比例、重度OSAHS组认知功能障碍比例、使用连线测验(TMT) A使用时间、TMT B使用时间均显著高于对照组、轻中度OSAHS组( P <0.05);夜间最低脉氧(Nocturnal pulse oxygen,LSaO2)、NREM Ⅲ期比例、简易智能精神状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分、数字广度测试(DST)顺背、DST倒背、复杂图形测验(CFT)再绘评分低于轻中度OSAHS组及对照组( P <0.05);轻中度OSAHS组认知功能障碍比例、TMT A使用时间、TMT B使用时间均显著高于对照组( P <0.05),MMSE、MoCA评分、DST顺背、DST倒背、CFT再绘评分显著低于对照组( P <0.05)。相关性分析结果显示:AHI与TMT A使用时间、TMT B使用时间呈正相关( P <0.05),与DST顺背、DST倒背、CFT再绘、MMSE及MoCA呈负相关( P <0.05)。【结论】OSAHS存在认知障碍,表现为记忆损伤、注意力及执行能力降低,且随着病情加重,记忆损伤、认知障碍、注意力及执行能力降低程度加重,应引起临床重视。
Abstract：【Objective】To observe the memory and cognitive impairment in elderly patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). 【Methods】We selected 96 elderly OSAHS patients (OSAHS group) from January 2017 to December 2019 in our hospital, whose sleep apnea hypopnea index (AHI) times was more than 5 times/hour. In the same period, 40 elderly health checkups who participated this study were selected as the control group (SHIm: 0 times/h≤AHI≤5 times/h). Furthermore, the OSAHS Patients were divided into two groups according to the sleep apnea hypopnea index (AHI): the mild-moderate OSAHS group (56 patients, 5 times/h <AHI≤30 times/h) and the severe OSAHS group (40 patients, AHI> 30 times/h). The three groups of subjects received polysomnography (PSG), overall cognition, short-term memory, attention and executive ability tests'. Thus, the cognitive impairment and memory impairment were compared in the three groups. 【Results】The proportion of ODI (oxygen reduction index), AHI, RRMAI (respiratory related micro awakening index), NREM (non-rapid eye movement) sleep stage Ⅰ to Ⅱ ratio, severe cognitive dysfunction, TMT A use time, and TMT B use time in the severe OSAHS group were higher than those in the non-OSAHS group and mild-moderate OSAHS group ( P <0.05). LSaO2 (nocturnal pulse oxygen at night), NREM Ⅲ stage ratio, MMSE (simple mental state examination) scale score, MocA (Montreal cognitive assessment) scale score, DST (digital span test) forward, DST backward, CFT (complex graph test) redraw scores were lower than those in the mild to moderate OSAHS group and the non-OSAHS group ( P <0.05). The proportion of cognitive dysfunction, TMT A use time, and TMT B use time in the mild-to-moderate OSAHS group were higher than those in the non-OSAHS group ( P <0.05); and the MMSE, MoCA score, DST forward, DST reverse, and CFT redraw scores were lower than those in the non-OSAHS group ( P <0.05). Correlation analysis results showed that AHI was positively correlated with TMT A use time and TMT B use time ( P <0.05), and AHI was negatively correlated with DST forward, DST reverse, CFT redraw, MMSE, and MoCA ( P <0.05). 【Conclusion】OSAHS has memory impairment, cognitive impairment and decreased attention and execution ability. As the disease worsens, the degree of memory impairment and cognitive impairment plus the attention and execution ability decreases, which should draw important attention clinically.
2021, Vol. 38 
