事件相关电位对阻塞性睡眠呼吸暂停低通气综合征患者轻度认知功能障碍及行为改变的评价

目的 通过事件相关电位中的P300检测并结合神经心理测试量表评价OSAHS患者的轻度认知功能障碍（MCI）及行为改变.方法 前瞻性观察多导睡眠图确诊的10例中度OSAHS患者、26例重度OSAHS患者及17例正常对照,以蒙特利尔认知评估量表（MoCA）评分判断参加者是否存在MCI,并行Epworth嗜睡量表（ESS）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、症状自评量表及P300检测.分别比较中、重度OSAHS患者组与正常对照组的认知功能及行为改变.相关分析和多元线性回归分析MoCA评分、P300相关参数及ESS评分的相关性及相关程度.结果 与正常对照组比较,中、重度OSAHS患者在Cz,C3,C4点P300潜伏期明显延长（F分别为4.164,4.018,3.960;P ＜0.05）;重度组MoCA评分明显延长（25.42±2.76 vs 27.41±1.80,F=3.954,P＜0.01）,MoCA亚项分析重度组记忆/延迟回忆评分（2.81±0.98 vs4.06±0.97,Z＝13.075,P＜0.01）明显降低;中、重度组HAMA评分及重度组HAMD评分明显增加（F分别为3.576,3.487;P＜0.05）.Fz,Cz,Pz,C3,C4点P300潜伏期分别与MoCA评分呈负相关（r分别为-0.422,-0.410,-0.374,-0.424,-0.442;P值均＜0.01）.Fz点P300波幅与MoCA评分呈负相关（r＝-0.346,P=0.013） ;ESS评分与睡眠呼吸暂停低通气指数、最长呼吸暂停时间呈正相关（r分别为0.409,0.342;P值均＜0.05）,与平均手指脉搏血氧饱和度（MSPO2）呈负相关（r＝-0.342,P=0.041）,记忆/延迟回忆与最低SPO2（LSPO2）呈正相关（r=0.355,P=0.041）.Pz点P300潜伏期及Fz点P300波幅对MoCA评分影响较大.结论 ①中、重度OSAHS患者存在MCI;②中、重度OSAHS患者存在焦虑症状,重度OSAHS患者存在抑郁症状;③P300检测可作为评价OSAHS患者认知功能障碍的电生理指标之一,能早期发现OSAHS患者的认知功能障碍,结合MoCA评分可为临床早期干预提供依据.

The evaluation on mild cognitive dysfunction and behavior change in patients with obstructive sleep apnea hypopnea syndrome based on event related potential

Objective To investigate the mild cognitive impairment and behavior changes measured by neuropsychological test scale evaluation and the P300 of ERP in the patients with obstructive sleep apnea hypopnea syndrome （OSAHS）.Methods A prospective study with 10 moderate to 26 severe OSAHS patients and 17 controls were carried out to determine whether the participants have mild cognitive impairment （MCI） by Montreal cognitive assessment scale （MoCA）.Parallel Epworth sleepiness scale （ESS）,Hamilton Anxiety Scale （HAMA）,Hamilton Depression Scale （HAMD）,symptom checklist 90 and P300,respectively,in patients with moderate,severe OSAHS group and normal control group to compare their cognitive function and behavior change.Correlation and multiple linear regression analysis between MoCA score,P300 parameters and the correlation with ESS score.Results In moderate to severe OSAHS patients in Cz,C3,C4,P300 latency was significantly prolonged compared with normal control group （F =4.164,4.018,3.960,P 〈0.05） ;MoCA score of severe OSAHS group （25.42±2.76） was significantly prolonged （F =3.954,P 〈0.01） than that of the normal control group （27.41±1.80）.The MoCA analysis showed that memory/delayed recall score of the severe group （2.81 ± 0.98） was significantly decreased than the normal control group （4.06 ± 0.97,Z =13.075,P 〈0.01）.The HAMA scores of the moderate and severe group were significantly higher than the normal group （F =3.576,P 〈0.05）.The HAMD scores of the severe group were also significantly higher than the normal group （F =3.487,P 〈0.05）.Correlation analysis showed that Fz,Cz,Pz,C3,C4,P300 latency and MoCA score was negatively correlated （r =-0.422,-0.410,-0.374,-0.424,-0.442,P 〈0.01） ;Fz P300 amplitude was negatively related to MoCA score （r =-0.346,P =0.013）,ESS score and sleep apnea hypopnea index （AHI）,the longest apnea time were positively correlated （r =0.409,0.342,P 〈 0.05）,and the average finger pulse oximetry （MSPO2） we