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Title: [The characteristics and determining factors of attention and short-term memory impairment in young patients with obstructive sleep apnea-hypopnea syndrome].
Author: Li Q, Li NZ, Li TT, Sun YQ, Wang J, Chen R.
Journal: Zhonghua Jie He He Hu Xi Za Zhi; 2019 Jun 12; 42(6):419-425. PubMed ID: 31189227.
Abstract:
Objective: To explore the characteristics and determining factors of attention and short-term memory impairment in young patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: A total of 203 eligible patients with snoring were recruited for the study at Sleep Center, Second Affiliated Hospital of Soochow University from July 2016 to July 2017, and they were all monitored with overnight polysomnography(PSG), recording sleep parameters [NREM (Ⅰ+Ⅱ) sleep ratio, NREM Ⅲ sleep ratio, REM sleep ratio] and respiratory parameters (AHI, ODI, LSaO(2), TS90%, RRMAI). Based on apnea/hypopnea index(AHI), the patients were categorized into non-OSAHS group (0<AHI≤5/h), mild and moderate OSAHS group (5<AHI≤30/h), and severe OSAHS group (AHI>30/h). All patients were assessed for sleepiness and the Motreal Cognitive Assessment (MoCA) questionnaires, Mini-mental State Examination (MMSE), Epworth Sleepiness Scale(ESS), attention and short-term memory assessment which included Trail Marking Test(TMT), digit span test(DST), and Complex Figure Test(CFT). The PSG parameters, ESS scores, total MoCA scores, attention and short-term memory were compared among groups, and a multivariate logistic regression analysis was conducted to investigate the characteristics of attention and short-term memory impairment in young patients with OSAHS and their determining factors. Results: In the overall cognitive function assessment, severe OSAHS patients's MoCA scores were lower than those of the other two groups [27.0 (25.0, 28.0) vs 27.0 (26.0, 28.0) , 27.0 (26.0, 27.0) , P<0.01]. In the sleepiness self-assessment, severe OSAHS patients's ESS scores were significantly higher than those of the other groups (11.4±5.4 vs 5.3±4.5, 8.0±5.0, P<0.01) . In the attention tests, scores on the DST-D (8.1±1.1 vs 8.8±0.9, 8.5±1.0) and DST-B[5.5 (4.0, 7.0) vs 6.0 (5.0, 7.0) , 6.0 (5.0, 7.0) ] were significantly lower in severe OSAHS patients than in the other two groups (P<0.01) . In the memory tests, the re-drawing scores of severe OSAHS patients were significantly lower than those of the other two groups [23.0 (16.0, 27.0) vs 26.0 (24.0, 28.0) , 24.0 (20.0, 28.0) , P<0.01]. In the executive function tests, severe OSAHS patients spent much longer on both TMT-A (46.7±19.0 vs 40.2±17.4, 34.6±17.2) and TMT-B (76.9±32.6 vs 67.2±21.2, 58.6±27.5) than the other two groups (P<0.01). Multivariate logistic stepwise regression analysis showed that, AHI, ODI and NREM (Ⅰ+Ⅱ) sleep ratios were the independent determining factors. Conclusion: Attention and short-term memory functions of young patients with OSAHS were impaired. The severity of apnea and hypoxia, NREM (Ⅰ+Ⅱ) ratio were all determining factors. 目的： 探索中青年阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者注意力及短期记忆损害特征及影响因素。 方法： 选择2016年7月至2017年7月于苏州大学附属第二医院睡眠门诊因打鼾而就诊的中青年患者，纳入OSAHS患者151例和非OSAHS者52例，对所有203例受试者行多导睡眠图（PSG）监测，记录睡眠参数及呼吸参数。据睡眠呼吸暂停低通气指数（AHI）将患者分为3组：非OSAHS组（0次/h<AHI≤5次/h）、轻中度OSAHS组（5次/h<AHI≤30次/h）及重度OSAHS组（AHI>30次/h），行嗜睡、总体认知评估及注意力、短期记忆检测（连线测试、数字广度测试、复杂图形测试）。比较3组患者PSG参数、总体认知功能及注意力、短期记忆之间的差异，并探讨中青年OSAHS患者注意力、短期记忆损伤的特点及影响因素。 结果： （1）总体认知功能评估：重度组OSAHS患者MoCA评分为27.0（25.0, 28.0），低于非OSAHS组[27.0（26.0, 28.0）]与轻中度OSAHS组[27.0（26.0, 27.0）]，差异有统计学意义（P<0.01）；（2）主观嗜睡程度评估：重度组OSAHS患者ESS得分（11.4±5.4）高于非OSAHS组（5.3±4.5）与轻中度OSAHS组（8.0±5.0），差异有统计学意义（P<0.01）；（3）注意力比较：重度OSAHS组、非OSAHS组和轻中度OSAHS组数字广度测试顺背得分（分别为8.1±1.1、8.8±0.9和8.5±1.0）、倒背得分[分别为5.5（4.0, 7.0）、6.0（5.0, 7.0）和6.0（5.0, 7.0）]，差异均有统计学意义（P<0.01）；（4）记忆力比较：重度OSAHS组、非OSAHS组和轻中度OSAHS组复杂图形再绘得分分别为23.0（16.0, 27.0）、26.0（24.0, 28.0）和24.0（20.0, 28.0），差异有统计学意义（P<0.01）；（5）执行功能比较：重度OSAHS组、非OSAHS组和轻中度OSAHS组连线测试A使用时间分别为46.7±19.0、40.2±17.4和34.6±17.2、B使用时间分别为76.9±32.6、67.2±21.2和58.6±27.5，差异均有统计学意义（P<0.01）。经多元Logistic逐步回归分析得出，AHI、ODI、NREM（Ⅰ+Ⅱ）期比率是影响OSAHS患者注意力及短期记忆的独立因素。 结论： 中青年OSAHS患者注意力、短期记忆受损,呼吸暂停、夜间低氧的严重程度及NREM（Ⅰ+Ⅱ）期比率均为影响因素。.

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