The Study Of Cognitive Fuction, Sleep Structure And Diurnal Blood Pressure In Stoke Combined With Obstructive Sleep Apneah Hypopnea Syndrome

Objective:To investigate the the related risk factors and cognitive dysfunction,analyze the characteristic of sleep structure, observe blood pressure variability of patients with cerebral infarction combined with obstructive sleep apnea hypopnea syndrom (CI-OSAHS) through registration of the patients'risk factors, cognitive function assessment,blood pressure measurement and polysomnography. This will facilitate the early diagnosis, intervention and treatment of patients with (CI-OSAHS) and improve the prognosis of stroke.Methods:Collect 188 patients(man 162, woman 26) with cerebral infarction, OSAHS or normal people in Department of Neurology and Breathing sleep monitoring room of tian jin medical university general hospital from December 2009 till march 2011. All the patients completed image examinations (CTandMRI) and the basic information and related risk factors had been registered. We evaluated the cognitive function by MMSE and MoCA.We also recorded their scores of Hachinski,NIHSS and HAMD and underwent polysomnography.We divided all the patients into 4 groups based on polysomnography. These 4 groups are combined group 79 persons(CI-OSAHS),cerebral infarction group 50 persons (CI), OSAHS group 39 persons (OSAHS) and normal group 20 persons(normal people). We compared and analyzed the related factors and the differences of the total scores of cognitive function and scores of cognitive every field.Collect 20 patients from CI-OSAHS as combined group,20 patients from OSAHS as OSAHS group,20 patients from nomal people as nomal group. Patients and their families gave written informed consent,all patients underwent polysomnography in breathing sleep monitoring room.All the patients completed image examination (CTandMRI)and the basic information and medical histories had been inquired. We evaluated the cognitive function by MMSE and MoCA.We also recorded their scores of Hachinski,NIHSS and HAMD. We analyzed and compared the changes of sleep structure, the correlation among scores of cognitive function,sleep-related breathing parameters and sleep structure.Collect 272 patients(man 222, woman 50) with cerebral infarction, OSAHS or normal people in Department of Neurology and Breathing sleep monitoring room of tian jin medical university general hospital from December 2009 till march 2011.All the patients completed image examinations(CTandMRI) and cerebral infarction and hypertension histories and the basic information has been registered.The patients and their families agreed to stop taking antihypertensive drug two weeks and monitor blood pressure by themselves.After two weeks,all the patients underwented polysomnography and before and after wake up the pressures were monitored. We divided all the patients into 4 groups based on polysomnography. These 4 groups are combined group 65 persons (CI-OSAHS),cerebral infarction group 51 persons (CI), OSAHS group 80 persons (OSAHS) and normal group 76 persons(normal people). We compared and analyzed the differences of the rate complicated with hypertension,blood pressure level and circadian of blood pressure.Results:1.AHI,ODI and the time of blood oxygen less than 90% of combined group and OSAHS group are higher than the cerebral infarction group and normal group (P< 0.05). nocturnal average hypoxemia and minimum hypoxemia are lower than the cerebral infarction group and normal group (P<0.05)2.The rates of the 3 groups complicated with hypertension are higher than the normal group (P<0.05). The rates of the combined group complicated with hypertension are higher than the Cerebral infarction group and normal group (P<0.05). The rates of the combined group and OSAHS group complicated with drinking and BMI are higher than the normal group (P<0.05).The rates of the combined group complicated with diabetes is higher than the normal group (P<0.05). The rates of the combined group complicated with hyperlipemia are higher than the Cerebral infarction group and normal group (P<0.05).The rates of the OSAHS group complicated with smoking are higher than the Cerebral infarction group and normal group (P<0.05).There are no differences in statistics in the rates of the 4 groups complicated with coronary heart disease (P>0.05)3.The total scores of MMSE and MoCA in combined group are lower than cerebral infarction group, OSAHS group and normal group (P<0.05). The total scores of MMSE and MoCA in cerebral infarction group and OSAHS group are lower than normal group (P<0.05)4.In addition to orientation,the score of cognitive every field (the executive function, naming, attention and calculation, language ability, abstract ability and delayed memory) in CI group are lower than the normal group (P<0.05). Apart from naming and orientation, the scores of cognitive every field in the OSAHS group are lower than the normal group (P<0.05). The scores of cognitive every field in the combined group are lower than the normal group (P<0.05). Besides abstract ability and orientation,the scores of cognitive every field in the combined group are lower than the CI group (P<0.05). Except for naming and abstract ability, the scores of cognitive every field in the combined group are lower than the OSAHS group (P< 0.05). The naming in CI group are lower than the OSAHS group (P<0.05)5.The awake time, S1, S2 and NREM periods in combined group and OSAHS group are significantly longer, the S3+S4and REM periods are significantly shorter than the normal group (P<0.05). The NREM and S1 periods in combined group are longer,S3+S4 and REM periods are shorter than the OSAHS group (P<0.05).6.There is negative correlation between the total scores of MMSE andMoCA and AHI, OD1 (P<0.05) while,is positive correlation between them and nocturnal average hypoxemia and minimum hypoxemia in the OSAHS group. There is negative correlation between ODI, arousal index and the total scores of MoCA in the combined group (P<0.05). There is correlation between the total scores of MMSE and the other sleep parameters, but, there is no difference in statistics (P>0.05)7.There is negative correlation between the total scores of MMSE and the S1+S2 period (P<0.05) while, is positive correlation between it and the S3+S4 in the OSAHS group. There is positive correlation between the S3+S4 period and the total scores of MoCA (P<0.05) in the OSAHS group. There is correlation between the total scores of MMSE and the sleep structure, but, there is no difference in statistics (P>0.05). There is positive correlation between the REM period and the total scores of MoCA (P<0.05)8.The incidences of hypertension of the combined group, cerebral infarction group and OSAHS group are higher than the normal group (P<0.05).The incidences of systolic hypertension in cerebral infarction group is higher than other 3 group (P< 0.05). The incidences of diastolic hypertension in the combined group and OSAHS group are higher than the normal group (P<0.05)9.The incidences of night,morning and refractory hypertension in the combined group are higher than the normal group (P<0.05). The incidences of night and refractory hypertension in the cerebral infarction group are higher than the normal group (P< 0.05). The incidence of night hypertension in the OSAHS group is higher than the normal group (P<0.05) while,the incidence of morning hypertension is higher than the cerebral infarction group and normal group (P<0.05)10.The SBP in the 3 group are higher than the normal group (P<0.05). The DBP in the combined group and OSAHS group are higher than the cerebral infarction group and normal group (P<0.05)11.We find significant difference between pre-sleep and morning DBP in the combined group (P<0.05), rise 4.108mmHg. Morning SBP, DBP in the OSAHS group are significantly elevated as compared with their pre-sleep levels (P< 0.05),respectively rise 4.062 mmHg and 5.875 mmHg.Conclusion:1.Patients with CI-OSAHS and with OSAHS exist obvious hypopnea and sleep apnea.2.The rates of Smoking, obesity, alcohol increase significantly in Patients with CI-OSAHS and OSAHS.They will affect the relapse and prognosis of CI.OSAHS lead to high incidence of hypertension,diabetes and hyperlipidemia which are related risk factors of CI.3.Patients with CI and OSAHS may impaire cognitive function. The characteristics of cognitive dysfunction in patients with CI mainly manifest the damage of executive function, naming,attention and calculation, language ability, abstract ability and delayed memory.OSAHS lead to cognitive dysfunction,mainly manifest executive function,attention and calculation, language ability, abstract ability and delayed memory. OSAHS may aggravate the damage of executive function, attention and calculation, language ability and delayed memory of patients with CI. 4.Patients with CI-OSAHS and OSAHS exist obvious sleep structure disorder.The awake time and light sleep periods are significantly longer than the normal group, while,the deep sleep and REM periods are significantly shorter than the normal group.5.The higher the AHI, the lower the night blood oxygen is lower, the more obvious cognitive dysfunction. The longer the light sleep, the shorter the deep sleep and REM periods,the more serious cognitive dysfunction.6.Hypertension in CI-OSAHS and OSAHS group are higher than the normal group, We can find systolic hypertension in cerebral infarction group. OSAHS lead to high diastolic hypertension7.Cerebral infarction lead to the changes of blood pressure circadian rhythms, night blood pressure rises.OSAHS cause the change of blood pressure circadian rhythms, night blood pressure don't fall, since morning blood pressure increases, especially diastolic pressure increases. The disappearance of blood pressure circadian rhythms caused the occurrence of refractory hypertension and affect blood pressure control.To sum up, CI-OSAHS has a high incidence. Drinking and obesity increase the occurrence of OSAHS. OSAHS can cause intermittent hypoxia and sleep structure di-order. Hypertension, diabetes, high blood fat and other dangerous factors may com mon cause the occurrence of VCI. Cognitive dysfunction in CI-OSAHS mainlymarni-ifest the damage of executive function, attention and calculation, language ability and delayed memory. It appears more severe sleep structure disorder and the changes of blood pressure. The diagnosis and intervention of CI-OSAHS may prevent vascular cognitive dysfunction, adjust sleep structure and improve the quality of sleep.