OSAHS患者合并认知功能障碍的危险因素分析及防控建议-现代医学

OSAHS患者合并认知功能障碍的危险因素分析及防控建议

单位：1. 徐州市中心医院耳鼻喉科, 江苏徐州 221000;
2. 徐州医科大学徐州临床学院, 江苏徐州 221000

分类号：R563.8

出版年·卷·期（页码）：2021·49·第八期（950-959）

摘要：

目的：分析阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者合并认知功能障碍的危险因素，并指出防控建议。方法：对本院2017年10月—2019年10月收治的118例OSAHS患者的临床资料进行回顾性分析，分析患者病情严重程度与蒙特利尔认知评估量表（MoCA）评分的关系；另统计认知功能障碍的发生情况，分析其危险因素。结果：中度、重度OSAHS患者MoCA评分均低于轻度患者，重度患者MoCA评分低于轻度患者，差异均有统计学意义（P<0.05）；经Spearman相关分析，OSAHS病情等级与MoCA评分呈负相关（P<0.05）；OSAHS患者中认知功能障碍发生率为58.47%，且认知功能障碍组年龄≥60岁、肥胖、高脂血症、2型糖尿病、高血压、高同型半胱氨酸血症、高尿酸血症、冠心病、心衰、房颤、吸烟史、饮酒史、中度OSAHS、重度OSAHS、最低血氧饱和度≤90%、氧减指数>10次·h^-1、微觉醒指数>30次·h^-1、快速动眼睡眠（REM）期比例<20%、焦虑、抑郁占比均高于认知功能正常组，合理膳食占比低于认知功能正常组，对比差异均有统计学意义（P<0.05）；经Spearman相关分析显示，认知功能障碍严重程度与年龄、肥胖、高脂血症、2型糖尿病、高血压、高同型半胱氨酸血症、高尿酸血症、冠心病、心衰、房颤、吸烟史、饮酒史、OSAHS程度、最低血氧饱和度、氧减指数、微觉醒指数、REM期比例、焦虑、抑郁均呈正相关性（P<0.05），与合理膳食呈负相关性（P<0.05），且经Logistic多元回归分析证实以上指标均是OSAHS患者合并认知功能障碍的影响因素（P<0.05）。结论：OSAHS患者合并认知功能障碍风险高，且病情越重，MoCA评分越低，另年龄≥60岁、肥胖、高脂血症、2型糖尿病、高血压、高同型半胱氨酸血症、高尿酸血症、冠心病、心衰、房颤、吸烟史、饮酒史、中度OSAHS、重度OSAHS、最低血氧饱和度≤90%、氧减指数>10次·h^-1、微觉醒指数>30次·h^-1、REM期比例<20%、焦虑、抑郁均为其危险因素，合理膳食是其保护因素，临床需加强对此类患者的监督管理，以便及时发现异常并给予对症干预，以降低认知功能障碍发生率。

Objective: To analyze the risk factors of cognitive impairment in patients with OSAHS, and to point out the prevention and control suggestions.Methods: The clinical data of 118 patients with OSAHS admitted to our hospital from October 2017to October 2019 were retrospectively analyzed, and the relationship between the severity of patients' condition and the score of montreal cognitive assessment scale (MoCA) was analyzed. The incidence of cognitive impairment was counted and the risk factors were analyzed.Results: The MoCA scores of moderate and severe OSAHS patients were lower than thatof mildpatients, and the MoCA score ofseverepatients was lower than that of moderate patients, withstatistically significant differences(P<0.05). Spearman correlation analysis showed that the disease gradeof OSAHS was negatively correlated with MoCA score(P<0.05). The incidence of cognitive impairment in OSAHS patients was 58.47%, and the cognitive impairment group of age ≥ 60 years old, obesity, hyperlipidemia, type 2 diabetes, hypertension, hyperhomocysteinemia, hyperuricemia, coronary heart disease, previous ischemic stroke, heart failure, atrial fibrillation, smoking history, drinking history, moderate OSAHS, severe OSAHS, minimum blood oxygen saturation ≤ 90%, oxygen depletion index>10 times·h^-1, micro arousal index>30 times·h^-1, rapid eye movement sleep(REM) period proportion<20%, anxiety and depression were higher than those of normal cognitive function group(P<0.05), but the proportion of reasonable diet was lower than that of normal cognitive function group(P<0.05). Spearman correlation analysis showed that the severity of cognitive impairment was positively correlated with age, obesity, hyperlipidemia, type 2 diabetes, hypertension, hyperhomocysteinemia, hyperuricemia, coronary heart disease, atrial fibrillation, smoking history, drinking history, OSAHS level, minimum blood oxygen saturation, oxygen reduction index, arousal index, REM phase ratio, anxiety and depression(P<0.05), and it was negatively correlated with reasonable diet(P<0.05).Logistic multiple regression analysis confirmed that the above indexes were the influencing factors ofcognitive impairment(P<0.05). Conclusion: The risk of cognitive impairment in patients with OSAHS is high, and the more serious of the disease, the lower of the MoCA score, and the old age ≥ 60 years, obesity, hyperlipidemia, type 2 diabetes, hypertension, hyperhomocysteinemia, hyperuricemia, coronary heart disease, heart failure, atrial fibrillation, smoking history, drinking history, moderate OSAHS, severe OSAHS, minimum blood oxygen saturation ≤ 90%, oxygen depletion index>10 times·h^-1, micro arousal index>30 times·h^-1, REM period proportion<20%, anxiety and depression are the risk factors, but reasonable diet is aprotective factor, which is necessary to strengthen the supervision and management of such patients in clinic, so as to find out the abnormality in time and give symptomatic intervention to reduce the incidence rate of cognitive impairment.

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