The Study Of The Dynamic Cerebral Autoregulation In Patients With Narcolepsy And OSAHS

Objective:To study the dynamic cerebral autoregulation(d CA)changes in patients with narcolepsy and obstructive sleep apnea hypopnea syndrome(OSAHS)and to discuss the possible pathophysiological mechanisms.Methods:In this study,we selected patients from neurological out patients and hospitalizations from March 2017 to March 2019 in the First Hospital of Jilin University.20 cases with the narcolepsy and 60 cases with OSAHS(including 20 patients with mild,moderateand severe OSAHS)and 20 healthy controls.The Epworth sleepiness scale(ESS)was used to evaluate the subjective sleepiness.STOP-BANG scale(SBQ)was used to assess the risk of OSAHS risk.TCD and continuous fingertip blood pressure monitorwere used to record thebilateralmiddle cerebralarterial blood flow velocity and arterial blood pressuresynchronously.Transfer function analyses(TFA)were used to analyze the autoregulatory parameters:phase difference and gain.Statistical analysis was performed on the obtained data to evaluate changes in d CA.The ESS and d CA were reviewed after standardized treatment for 1 month and compared with pre-treatment.The ESS,AHI and d CA were reviewed after effective CPAP for 1 month and compared with pre-treatment.Result:1.ESS and SBQ score results of different groups of subjects :(1)ESS score results:narcolepsy,mild OSAHS group,moderate OSAHS group and severe OSAHS group were higher than control group(P<0.05).The scores of ESS in narcolepsy group were higher than those in OSAHS group(P<0.05).(2)SBQ score results: The percentage of SBQ scores ≥3 in the mild OSAHS group,moderate OSAHS group and severe OSAHS group increased compared with the control group(P<0.05).The percentage of SBQ scores ≥3 in the moderate and severe OSAHS group was higher than that in narcolepsy(P<0.05),The percentage of SBQ scores ≥3 in the moderate and severe OSAHS group was higher than that in mild OSAHS group(P<0.05).2.The structure of PSG:The SL in the group narcolepsy were lower than control group(P<0.05).SE in the narcolepsy group,mild,moderate,and severe OSAHS group were lower than control group(P<0.05).N1% in the narcolepsy group,mild,moderate,and severe OSAHS groups were higher than control group(P<0.05).N3% in the narcolepsy group,mild,moderate,and severe OSAHS groups were lower than control group(P<0.05).Ar I in the narcolepsy group,mild,moderate,and severe OSAHS group were higher than control group(P<0.05).Ar I in the moderate and severe OSAHS group were higher than mild OSAHS group and narcolepsy group(P<0.05).The narcolepsy group combined with RBD were higher than OSAHS group and control group(P<0.05).The ESS score was linearly correlated with the arousal index(P<0.05).The SBQ score was linearly correlated with AHI in OSAHS patients(P<0.05).3.Comparison of d CA parameters in narcolepsy group and ESS and d CA parameters before and after treatment:The bilateral PD in the narcolepsy group were lower than that in control group(P<0.05).There was no significant difference between the bilateral gain and the control group(P>0.05).After treatment,the ESS score was lower than that before treatment(P<0.05).The bilateral PD after treatment was higher than that before treatment(P<0.05).There was no significant difference between the bilateral gain and the treatment before treatment(P>0.05).4.Comparison of ESS,AHI and d CA parameters before and after treatment in the d CA parameters of the OSAHS group and the moderate to severe OSAHS group:The bilateral PD of the moderate and severe OSAHS group was lower than that in control group(P<0.05).The bilateral PD of the moderate and severe OSAHS group was lower than mild OSAHS group(P<0.05).There was no significant difference in gain between OSAHS group and control group(P>0.05).The ESS scores of the moderate and severe OSAHS group were lower than those before treatment(P<0.05).The AHI after treatment was lower than that before treatment(P<0.05).There was no significant difference in the d CA parameters after treatment(P>0.05).5.The bilatera PD were associated with arousal index(P<0.001),AHI(P<0.001),average Sp O2(P<0.001),lowest Sp O2(P<0.001),and <90% oxygen(P<0.001).The AHI(P=0.005,P=0.007)was an independent risk factor for impaired d CA.Conclusion:1.ESS scores in patients with central hypersomia increased,ESS scores in patients with narcolepsy were higher than OSAHS group;2.Changes in sleep structure of PSG:The arousal index of moderate to severe OSAHS was higher than narcolepsy;compared with OSAHS,narcolepsy was easy to be combined with RBD;ESS score was linearly positively correlated with arousal index;SBQ score was linearly positively correlated with AHI in OSAHS;3.The d CA dyfunction was happened in patients with narcolepsy.The ESS score and d CA were improved in patients with narcolepsy after 1 month of drug treatment;4.The d CA dyfunction was happened in patients with moderate and severe OSAHS.HI,mean Sa O2,minimum Sa O2,< 90% oxygen reduction percentage were associated with impaired d CA function in OSAHS patients,and AHI was an independent risk factor for impaired d CA function in OSAHS patients;5.The ESS score and AHI of patients with moderate to severe OSAHS decreased,but the d CA did not improve significantly after 1 month of effective CPAP treatment.