成人OSAHS患者认知功能障碍影响因素及海马区磁共振波谱成像临床价值研究

目的研究成人阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者认知功能障碍及影响因素,分析海马区磁共振波谱成像对OSAHS患者认知功能障碍的临床价值。方法纳入71例成年人,根据多导睡眠监测结果分为OSAHS组和非OSAHS组,比较两组基线资料、多导睡眠监测值、蒙特利尔认知评估(montreal cognitive assessment,MoCA)值、海马区磁共振波谱(magnetic resonance spectroscopy,MRS)值;对OSAHS组进行二元Logistic回归分析及MoCA总分与海马区MRS线性回归分析。结果 OSAHS组血红蛋白比非OSAHS组高(P0.05);OSAHS组在视空间与执行、延迟记忆、注意力、MoCA总分均低于非OSAHS组(P0.05);OSAHS组在呼吸暂停低通气指数(apnea-hypopnea index,AHI)、最长暂停时间、平均暂停时间均高于非OSAHS组,而最低血氧饱和度(SaO_2)、平均血氧饱和度(SaO_2)均低于非OSAHS组(P0.05);最低SaO_2可能是认知功能障碍的独立保护因素(P0.05);OSAHS组海马区MRS中N-乙酰天门冬氨酸/肌酸(NAA/Cr)、胆碱/肌酸(Cho/Cr)、N-乙酰天门冬氨酸/胆碱(NAA/Cho)均下降(P0.05);MoCA总分和NAA/Cr呈正相关(调整R2=0.63,P0.05)。结论 OSAHS认知功能障碍主要在视空间与执行、延迟记忆、注意力等方面;最低SaO_2可能是认知功能障碍的独立保护因素;OSAHS组NAA/Cr降低、Cho/Cr、NAA/Cho降低且NAA/Cr值随着MoCA总分降低而降低,说明MRS对客观评估OSAHS患者认知障碍及海马代谢变化方面具有重要的临床价值。

Influence of cognitive dysfunction in adult patients with obstructive sleep apnea-hypopneasyndrome and clinical value study of magnetic resonance spectroscopy of hippocampus region

Objective To explore the characteristics and influence factors of cognitive dysfunction in adult patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) ,and analyze the value of magnetic resonance spectrum of hipp-ocampal region on cognitive dysfunction .Methods Basing on result of multi guide sleep monitoring ,71 adults were divided into OSAHS group and no-OSAHS group .Baseline data for both groups ,multi guide sleep monitoring value ,Montreal cogni-tive assessment ( MoCA) scale and magnetic resonance spectrum ( MRS) of hippocampal region were compared .Binary Lo-gistic regression analysis was performed for cognitive dysfunction group and relationship between MoCA total score and MRS of hippocampal with linear regression was analyzed .Results Compared with the non-OSAHS group,hemoglobin value were higher(P<0.05).The OSAHS group had lower scores than ,the cognitive normal group in visual space and execution de-layed memory,attention and MoCA value.Cognitive dysfunction in apnea-hypopnea hypoventilation index (AHI),the longest pause time,average pause time were higher than cognitive normal group, while the minimum blood oxygen saturation ( SaO2 ) was lower than cognitive normal group (P<0.05).Minimum SaO2 may be independent protective factors for cognitive dys-function.The N-acetylasparagine/Creatine(NAA/Cr),Choline/Creatine(Cho/Cr),N-acetylasparagine/Choline(NAA/Cho) went down in MRS of hippocampus region of cognitive dysfunction group (P<0.05).The total score of MoCA was positively correlated with the NAA/Cr (adjusted R2=0.63,P<0.05).Conclusion The cognitive dysfunction of OSAHS mainly included visual space ,execution and delayed memory and attention ,minimum SaO2 may be independent protective factors for cognitive dysfunction ,NAA/Cr value was decreased with MoCA total score .It was shown that MRS may have im-portant clinical value in evaluating the cognitive impairment and metabolic changes of hippocampus in OSAHS patients .