背景:呼吸暂停低通气指数(AHI)是当前用于诊断和估计阻塞性睡眠呼吸暂停(OSA)严重程度的诊断参数。是的,然而,与OSA的主要临床症状相关性较差,白天过度嗜睡,以及OSA患者中经常出现的认知能力下降。为了更好地评估OSA严重程度,引入了新的低氧负荷参数,这些参数考虑了与呼吸暂停或呼吸不足相关的氧饱和度下降的持续时间和深度。本文的目的是比较新型低氧负荷参数和传统OSA参数与OSA患者的言语记忆和执行功能。
方法:共有207名成年人在睡眠实验室完成了一晚上的多导睡眠图和两项神经心理学评估,Rey听觉语言学习测试和Stroop测试。
结果:使用简单线性回归分析来评估每个OSA参数与认知表现之间的独立关联。发现了即时回忆和唤醒指数之间的关联,缺氧<90%,睡眠期间的平均SpO2,和DesSev100+RevSev100。总召回与所有OSA参数相关,没有发现与Stroop测试有关联。随后,性别,年龄,在每个OSA参数和认知表现的多元线性回归分析中,将教育作为协变量纳入.该研究的主要发现是,睡眠期间的平均SpO2是总回忆的重要预测因子(p<.007,β=-.188),回归模型解释了21.2%的表现变化。睡眠期间的平均SpO2也是即时回忆的重要预测因子(p<.022,β=-.171),回归模型解释了11.4%的表现变化。传统的OSA参数和新的低氧负荷参数都不能预测性别调整后的认知表现,年龄,和教育。
结论:研究结果证实,AHI并不是OSA认知表现的有效指标,并且表明睡眠期间的平均血氧饱和度可能是OSA认知下降的最强PSG预测因子。结果还强调了在选择神经认知测试时考虑年龄的重要性,每个认知领域包括多个测试的重要性,因为大多数测试不是单一认知因素的纯粹衡量标准,以及将涵盖所有认知领域的测试纳入OSA的重要性可能会产生弥漫性认知效应。
BACKGROUND: The apnea-hypopnea index (AHI) is the current diagnostic parameter for diagnosing and estimating the severity of obstructive sleep apnea (OSA). It is, however, poorly associated with the main clinical symptom of OSA, excessive daytime sleepiness, and with the often-seen cognitive decline among OSA patients. To better evaluate OSA severity, novel hypoxic load parameters have been introduced that consider the duration and depth of oxygen saturation drops associated with apneas or hypopneas. The aim of this paper was to compare novel hypoxic load parameters and traditional OSA parameters to verbal memory and executive function in OSA patients.
METHODS: A total of 207 adults completed a one-night polysomnography at sleep laboratory and two neuropsychological assessments, the Rey Auditory Verbal Learning Test and Stroop test.
RESULTS: Simple linear regression analyses were used to evaluate independent associations between each OSA parameter and cognitive performance. Associations were found between immediate recall and arousal index, hypoxia <90 %, average SpO2 during sleep, and DesSev100+RevSev100. Total recall was associated with all OSA parameters, and no associations were found with the Stroop test. Subsequently, sex, age, and education were included as covariates in multiple linear regression analyses for each OSA parameter and cognitive performance. The main findings of the study were that average SpO2 during sleep was a significant predictor of total recall (p < .007, β = -.188) with the regression model explaining 21.2 % of performance variation. Average SpO2 during sleep was also a significant predictor of immediate recall (p < .022, β = -.171) with the regression model explaining 11.4 % of performance variation. Neither traditional OSA parameters nor novel hypoxic load parameters predicted cognitive performance after adjustment for sex, age, and education.
CONCLUSIONS: The findings validate that the AHI is not an effective indicator of cognitive performance in OSA and suggest that average oxygen saturation during sleep may be the strongest PSG predictor of cognitive decline seen in OSA. The results also underline the importance of considering age when choosing neurocognitive tests, the importance of including more than one test for each cognitive domain as most tests are not pure measures of a single cognitive factor, and the importance of including tests that cover all cognitive domains as OSA is likely to have diffuse cognitive effects.