Analysis Of Related Factors Of Cognitive Impairment In Patients With Chronic Insomnia

Part?Effect of chronic insomnia on cognitive function of patientsObjective:To study the relationship between sleep quality,anxiety,depression and cognitive function in patients with chronic insomnia,so as to find the characteristics of cognitive impairment in patients with ch ronic insomnia and to find the related factors of cognitive impairment i n patients with chronic insomnia?Methods:A total of 193 patients with chronic insomnia were colle cted from the second Department of Neurology,The First Hospital of H ebei Medical University from October 2018 to October 2019.Collect pa tients'general information,including age,sex,education level,ask about the course of insomnia,difficulty in falling asleep,early awakening,fr equent awakening,daytime function,memory and other cognitive proble ms,anxiety and depression and other symptoms.The neuropsychological scale was evaluated by professionals,including Pittsburgh Sleep quality Index?PSQI?,Hamilton anxiety scale(HAMA₁₄),Hamilton Depression scale(HAMD₂₄),Montreal Cognitive Assessmen scale?Mo CA?,Mini-m ental State Examination?MMSE?.According to PSQI,patients with chron ic insomnia were divided into mild sleep impairment group?8?PSQI<14?and moderate and severe sleep impairment group?PSQI?14?.The patie nts with chronic insomnia were divided into no and mild anxiety state group(HAMA₁₄<17),moderate and severe anxiety state group(HAMA₁₄?17),depression group based on the median HAMD₂₄score of 15,and chronic insomnia patients were divided into no and mild depression gr oup(HAMD₂₄<15)and moderate to severe depression group(HAMD₂₄?15).The patients with chronic insomnia were divided into two groups:no and mild depression(HAMD₂₄<15)and moderate to severe depressio n(HAMD₂₄?15).SPSS25.0 software was used to analyze the data.Whe n the data obey normal distribution,the mean±standard deviation?±SD?was used for statistical description,and Mann-Whitney U test was used to analyze and compare the sleep quality,emotion and cognition amon g different groups.Spearman correlation analysis was used to analyze th e correlation between HAMA₁₄,HAMD₂₄,PSQI,MMSE and Mo CA.Th e difference was statistically significant?P<0.05??Results:1. General data of patients:among the 193 patients with chronic insomnia:There were 56 males?29.02%?and 137 females?70.98%?.The ratio of males to females was 2.45.The average age of the patients was 54.32±14.41 years,and the average course of insomnia was 6.36±9.21 years.The average score of MMSE is 26.16±4.52,The average score of Mo CA is 22.35±5.11,The average score of Naming is 2.45±0.80,The average score of Attention is 5.48±1.10,The average score of Delayed recollection is 2.16±1.69,The average score of Visual space and executive function is 3.41±1.17,The average score of Language function is 1.79±0.84,The average score of Abstract ability is 0.88±0.74,The average score of Orientation function is5.47±0.93.The average score of PSQI was 15.31±3.26.There were 114cases with mild sleep quality impairment?59.07%?,79 cases with moderate and severe sleep quality impairment?40.93%?.The average score of HAMA₁₄was 15.24±5.33,94 cases?48.70%?had no and mild anxiety,99 cases?51.30%?had moderate and severe anxiety,94 cases?48.70%?had no and mild anxiety,and 99 cases?51.3%?had moderate and severe anxiety.The average score of HAMD₂₄ was 17.47±6.19.There were 91 cases with no and mild depression?47.15%?and 102 cases with moderate and severe depression?52.85%?.Anxiety and depression comorbidities(HAMA₁₄<7,HAMD₂₄<8)were found in 181cases?93.78%?,only anxiety(HAMA ₁₄?7,HAMD₂₄<8)in 5 cases?2.60%?,and only depression in 5 cases(HAMA₁₄<7,HAMD₂₄?8)?2.60%?.2. The effects of chronic insomnia on cognitive function of patients:191cases?98.96%?with multiple cognitive domains??3?,17 cases?8.80%?with 4cognitive domains,36 cases?18.65%?with 5 cognitive domains,79 cases?40.93%?with 6 cognitive domains,78 cases?40.41%?with all cognitive domains.There were 192 cases with abnormal naming?99.3%?,192 cases with abnormal attention?99.3%?,177 cases with abnormal delayed memory?91.7%?,162 cases with abnormal visual space and executive function?83.4%?,155 cases with abnormal language function?80.3%?,151 cases with abnormal abstract thinking ability?78.2%?and 64 cases with abnormal orientation?33.2%?.3. Comparison of sleep,emotion and cognitive function between different genders:There were significant differences in years of education?10.43±1.71vs9.81±1.22,Z=-2.835,P=0.017?,HAMA₁₄?13.55±5.29vs15.93±5.21,Z=-2.762,P=0.006?,MMSE?27.71±2.38vs25.52±5.02,Z=-2.877,P=0.004?,visual space and executive function?3.83±1.06vs2.24±1.17,Z=-3.419,P=0.011?,naming?2.86±0.35vs2.28±0.87,Z=-4.675,P=0.000?,and abstract thinking ability?1.12±0.76vs0.77±0.70,Z=-2.934,P=0.003?between different genders.There was no significant difference in PSQI,age,HAMD₂₄,Mo CA,attention,language,delayed recall and orientation.4. The relationship between sleep quality and cognitive impairment:There were significant differences in naming?2.62±0.71vs2.38±0.83,Z=-2.118,P=0.034?and abstract ability?1.06±0.77vs0.81±0.72,P=0.041?between mild sleep impairment group and moderate and severe sleep impairment group.There was a significant negative correlation between PSQI and Mo CA?r=-0.123,P=0.044?,attention?r=-0.084,P=0.047?,abstraction?r=-0.186,P=0.005?,orientation?r=0.139,P=0.027?.5. The relationship between anxiety,depression and sleep quality:The total score of PSQI in patients with moderate and severe anxiety was significantly higher than that in patients with no and mild anxiety?15.98±3.20vs14.60±3.19,P<0.05?.The total score of PSQI in patients with moderate and severe depression was significantly higher than that in patients with no and mild depression?16.11±3.07vs14.41±3.26,P<0.05?.There was a positive correlation between PSQI and HAMA₁₄?r=0.018,P<0.05?and HAMD₂₄?r=0.216,P<0.05?.6. The relationship between anxiety,depression and cognitive function in patients with chronic insomnia:There was no significant difference in the total scores of MMSE and Mo CA between patients with no and mild anxiety and patients with moderate and severe anxiety?26.85±4.17vs25.72±4.69,P=0.119;23.47±3.55vs21.65±5.78,P=0.296?.The total score of MMSE in patients with moderate and severe depression was significantly lower than that in patients with no and mild depression?25.71±4.89vs26.63±4.07,P=0.018?.There was no significant difference in the total score of Mo CA between the two groups?22.77±4.60vs21.66±4.52,Z=-1.948,P=0.051?.Conclusions:1.Cognitive impairment is common in patients with chronic insomnia,and the vast majority of patients have multiple cognitive domain impairment,of which at least 90%of patients have cognitive domain impairment of naming,attention,and delayed recall.2.The study found that the prevalence rate of chronic insomnia in women is higher than that in men,and the damage degree of women is more severe than that of men in MMSE,visual space executive ability,naming and abstract functional cognitive domain.3.Patients with poor sleep quality are more likely to have abnormal naming and abstract function.Sleep quality was negatively correlated with overall cognitive function,attention,abstract thinking and oriented cognitive function.It is suggested that sleep quality does affect the cognitive function of patients,especially in attention,abstract thinking and orientation.4.Anxiety and depression are common in patients with chronic insomnia,and the worse the sleep quality is in patients with serious anxiety and depression.5.In patients with chronic insomnia,the heavier the anxiety,the worse the orientation and attention,the more serious the depression,the worse the visual space,executive function and orientation.Part ? Relationship between cytokines and cognitive function in patients with chronic insomniaObjective: To study the levels of serum IL-4 and IFN-? in patients with chronic insomnia with mild cognitive impairment?MCI?,and to f urther explore the relationship between cognitive function and IL-4 and IFN-? in patients with chronic insomnia?Methods: In addition to the above neuropsychological scale,serum cytokines IL-4 and IFN-? were detected in 62 patients with chronic insomnia.The subjects collected fasting blood in the early morning,and avoiding strenuous activity and mental stimulation before blood collection.Within 4 hours after blood collection,high-speed centrifugation for 20 minutes,serum 0.5ml were taken,and IL-4 and IFN-? were detected by flow fluorimetry.According to the scores of Mo CA,MMSE and the chief complaints of cognitive impairment,the patients were divided into two groups: MCI group and non-MCI group.PSQI,HAMA14 and HAMD24 were evaluated.Serum IL-4 and IFN-? were detected by flow fluorescence,and the data werestatistically analyzed by SPSS 25.0 software.When the data obeys the normal distribution,the mean±standard deviation?SD?is used for statistical description.The comparison of IL-4,IFN-?,PSQI,HAMA14 and HAMD24 between MCI group and non-MCI group was analyzed by Mann-Whitney U test.The correlation between IL-4,IFN-? and Mo CA and its subitems was studied by Spearman correlation analysis,Partial correlation analysis and binary Logistic regression analysis.The comparison of IL-4 and IFN-? among different sleep quality impairment groups was analyzed by Mann Whitney U test,and the correlation between PSQI and IL-4,IFN-? was studied by Spearman correlation analysis.The difference was statistically significant?P < 0.05?.The relationship between different levels of Serum IL-4,IFN-? and MCI in patients with chronic insomnia was analyzed by chi-square test.Results: 1.Levels of Serum IL-4 and IFN-? in 62 patients with chronic insomnia :The level of Serum IL-4 was lower than the normal range in 52 cases?83.87%?,and the level of Serum IFN-? was lower than the normal range in 48 cases?77.42%?.2.The relationship between sleep quality and IL-4 and IFN-? levels: There was no significant difference in the levels of IL-4 and IFN-? between mild sleep quality impairment group and moderate and severe sleep quality impairment group?1.46 ±1.32vs1.48 ±1.07,P > 0.05;1.36 ±1.16vs1.53 ±1.36 P > 0.05?.There was no correlation between the total score of PSQI and thelevels of IL-4 and IFN-?.3.Levels of Serum IL-4 and IFN-? in patients with chronic insomnia with MCI : In 30 patients with chronic insomnia with MCI,the level of Serum IL-4 was lower than the normal range in 28 cases?93.33%?,and the level of IFN-? was lower than the normal range in 25 cases?83.33%?.The levels of Serum IL-4 and IFN-? in MCI group were significantly lower than those in MCI group?0.97±0.86vs1.94±1.29,P<0.05;1.59±1.07vs1.72±1.52,P< 0.05?.In chronic insomnia with MCI group,Serum IFN-?/IL-4 > 1 was found in 15 cases?50%?,and Serum IFN-?/IL-4 > 1 was found in 9 cases?28.13%?in non-MCI group.There was no significant difference in the value of Serum IFN-?/IL-4,PSQI,HAMA14 and the total score of HAMD24 between the MCI group and the group without MCI.4.The relationship between the levels of Serum IL-4,IFN-? and cognitive function in patients with chronic insomnia:The levels of Serum IL-4 and IFN-? in patients with chronic insomnia were positively correlated with the total scores of MMSE,Mo CA,Naming,Delayed recall and Orientation,and the levels of Serum IFN-? were also positively correlated with visual space and executive function.Furthermore,on the basis of controlling age,sex,education level,PSQI,HAMA14 and HAMD24,the results of partial correlation analysis showed that only Serum IL-4 was positively correlated with Mo CA total score,Naming and Delayed recall.The results of multivariate regression analysis showed that only age,sex,education level and IL-4 had significant influence on MCI in patients with chronic insomnia,while IFN-? had no significant effect on MCI in patients with chronic insomnia.Conclusions: 1.The levels of Serum IL-4 and IFN-? in patients with chronic insomnia with MCI are often lower than normal.However,there was no correlation between sleep quality and Serum IL-4,IFN-?,and there was no significant difference between sleep quality impairment and Serum IL-4,IFN-?.2.There is a positive correlation between serum IL-4,IFN-? and cognitive function in patients with chronic insomnia.The levels of serum IL-4 and IFN-? in patients with chronic insomnia with MCI are significantly decreased,which suggests that serum IL-4 has a protective effect on cognitive function in patients with chronic insomnia and has a significant effect on the occurrence of MCI in patients with chronic insomnia.There was a positive correlation between Serum IFN-? and the total scores of MMSE and Mo CA in patients with chronic insomnia,but there was no regression relationship.Through the analysis of the ratio of Serum IFN-?/IL-4,it was found that the relationship of Th1/Th2 had no significant effect on the cognition of patients with chronic insomnia.