Abstract：
OBJECTIVE: Obstructive sleep apnea (OSA) increases the risk of cognitive impairment. Measures of sleep microarchitecture from EEG may help identify patients at risk of this complication.
METHODS: Participants with suspected OSA (n=1142) underwent in-laboratory polysomnography and completed sleep and medical history questionnaires, and tests of global cognition (Montreal Cognitive Assessment, MoCA), memory (Rey Auditory Verbal Learning Test, RAVLT) and information processing speed (Digit-Symbol Coding, DSC). Associations between cognitive scores and stage 2 NREM sleep spindle density, power, frequency and %-fast (12-16Hz), odds-ratio product (ORP), normalized EEG power (EEGNP) and the delta:alpha ratio were assessed using multivariable linear regression (MLR) adjusted for age, sex, education, and total sleep time. Mediation analyses were performed to determine if sleep microarchitecture indices mediate the negative effect of OSA on cognition.
RESULTS: All spindle characteristics were lower in participants with moderate and severe OSA (p≤0.001, versus no/mild OSA) and positively associated with MoCA, RAVLT and DSC scores (false discovery rate corrected p-value, q≤0.026), except spindle power which was not associated with RAVLT (q=0.185). ORP during NREM sleep (ORPNREM) was highest in severe OSA participants (p≤0.001) but neither ORPNREM (q≥0.230) nor the delta:alpha ratio were associated with cognitive scores in MLR analyses (q≥0.166). In mediation analyses, spindle density and EEGNP (p≥0.048) mediated moderate-to-severe OSA\'s negative effect on MoCA scores while ORPNREM, spindle power and %-fast spindles mediated OSA\'s negative effect on DSC scores (p≤0.018).
CONCLUSIONS: Altered spindle activity, ORP and normalized EEG power may be important contributors to cognitive deficits in patients with OSA.
METHODS: Participants with suspected OSA (n=1142) underwent in-laboratory polysomnography and completed sleep and medical history questionnaires, and tests of global cognition (Montreal Cognitive Assessment, MoCA), memory (Rey Auditory Verbal Learning Test, RAVLT) and information processing speed (Digit-Symbol Coding, DSC). Associations between cognitive scores and stage 2 NREM sleep spindle density, power, frequency and %-fast (12-16Hz), odds-ratio product (ORP), normalized EEG power (EEGNP) and the delta:alpha ratio were assessed using multivariable linear regression (MLR) adjusted for age, sex, education, and total sleep time. Mediation analyses were performed to determine if sleep microarchitecture indices mediate the negative effect of OSA on cognition.
RESULTS: All spindle characteristics were lower in participants with moderate and severe OSA (p≤0.001, versus no/mild OSA) and positively associated with MoCA, RAVLT and DSC scores (false discovery rate corrected p-value, q≤0.026), except spindle power which was not associated with RAVLT (q=0.185). ORP during NREM sleep (ORPNREM) was highest in severe OSA participants (p≤0.001) but neither ORPNREM (q≥0.230) nor the delta:alpha ratio were associated with cognitive scores in MLR analyses (q≥0.166). In mediation analyses, spindle density and EEGNP (p≥0.048) mediated moderate-to-severe OSA\'s negative effect on MoCA scores while ORPNREM, spindle power and %-fast spindles mediated OSA\'s negative effect on DSC scores (p≤0.018).
CONCLUSIONS: Altered spindle activity, ORP and normalized EEG power may be important contributors to cognitive deficits in patients with OSA.
摘要：
目的：阻塞性睡眠呼吸暂停（OSA）增加认知障碍的风险。从EEG测量睡眠微结构可能有助于识别有这种并发症风险的患者。
方法：疑似OSA（n=1142）的参与者接受实验室多导睡眠图和完成睡眠和病史问卷，和全球认知测试(蒙特利尔认知评估，MoCA），记忆(Rey听觉言语学习测试，RAVLT)和信息处理速度(数字符号编码，DSC）。认知得分与2期NREM睡眠纺锤密度之间的关系，电源,频率和％-快（12-16Hz），比值比乘积(ORP)，归一化EEG功率（EEGNP）和delta：alpha比率使用多变量线性回归（MLR）进行评估，性别,教育,和总睡眠时间。进行中介分析以确定睡眠微体系结构指数是否介导OSA对认知的负面影响。
结果：中度和重度OSA参与者的所有主轴特征均较低（p≤0.001，与无/轻度OSA相比），并且与MoCA呈正相关，RAVLT和DSC评分(错误发现率校正p值，q≤0.026),除了主轴功率与RAVLT无关（q=0.185）。NREM睡眠期间的ORP（ORPNREM）在重度OSA参与者中最高（p≤0.001），但ORPNREM（q≥0.230）和delta：alpha比值均与MLR分析中的认知评分（q≥0.166）无关。在调解分析中，纺锤体密度和EEGNP（p≥0.048）介导的中度至重度OSA对MoCA评分的负面影响，而ORPNREM，主轴功率和%-快速主轴介导OSA对DSC评分的负面影响(p≤0.018)。
结论：纺锤体活动改变，ORP和归一化EEG功率可能是OSA患者认知缺陷的重要原因。
方法：疑似OSA（n=1142）的参与者接受实验室多导睡眠图和完成睡眠和病史问卷，和全球认知测试(蒙特利尔认知评估，MoCA），记忆(Rey听觉言语学习测试，RAVLT)和信息处理速度(数字符号编码，DSC）。认知得分与2期NREM睡眠纺锤密度之间的关系，电源,频率和％-快（12-16Hz），比值比乘积(ORP)，归一化EEG功率（EEGNP）和delta：alpha比率使用多变量线性回归（MLR）进行评估，性别,教育,和总睡眠时间。进行中介分析以确定睡眠微体系结构指数是否介导OSA对认知的负面影响。
结果：中度和重度OSA参与者的所有主轴特征均较低（p≤0.001，与无/轻度OSA相比），并且与MoCA呈正相关，RAVLT和DSC评分(错误发现率校正p值，q≤0.026),除了主轴功率与RAVLT无关（q=0.185）。NREM睡眠期间的ORP（ORPNREM）在重度OSA参与者中最高（p≤0.001），但ORPNREM（q≥0.230）和delta：alpha比值均与MLR分析中的认知评分（q≥0.166）无关。在调解分析中，纺锤体密度和EEGNP（p≥0.048）介导的中度至重度OSA对MoCA评分的负面影响，而ORPNREM，主轴功率和%-快速主轴介导OSA对DSC评分的负面影响(p≤0.018)。
结论：纺锤体活动改变，ORP和归一化EEG功率可能是OSA患者认知缺陷的重要原因。
