Study On The Distribution Of TCM Syndrome Types Of OSAHS Patients With Mild Cognitive Impairment Combined With Lethargy Or Insomnia

ObjectiveThis study aimed to explore the distribution characteristics of TCM symptom type in patients with mild cognitive impairment obstructive sleep apnea hypopnea syndrome(OSAHS)complicated with drowsiness or insomnia through cluster analysis,and to study different TCM symptom type and polysomnography(PSG)parameters,Montreal Cognitive Assessment Scale(MOCA),Epworth Sleepiness Scale(ESS),Pittsburgh Sleep Quality Index Scale(PSQI),Hamilton Anxiety Scale(HAMA),The correlation and regularity of Hamilton Depression Scale(HAMD)scores provide a theoretical reference for the TCM differential treatment of patients with mild cognitive impairment OSAHS complicated with drowsiness or insomnia.MethodsSelect OSAHS patients with mild cognitive impairment who met the inclusion criteria and signed the informed consent form of the research project from November 2021 to January2023 at the Sleep Medical Center of the First People’s Hospital of Yunnan Province,and analyze the clinical data of these patients,regardless of gender(age ≥ 18 years),and divide them into three groups.Among them,60 OSAHS patients with mild cognitive impairment and daytime sleepiness(MoCA<26 points;Epworth score>11 points;PSQI score<6 points)served as sleepiness group;60 patients with OSAHS complicated with mild cognitive impairment,accompanied by insomnia at night and not accompanied by daytime sleepiness(MoCA<26points;Epworth score<6 points;PSQI score>16 points)were regarded as insomnia group;60OSAHS patients with mild cognitive impairment,neither daytime sleepiness nor nighttime insomnia(MoCA<26 points;Epworth score<6 points;PSQI score<6 points)served as the control group(simple OSAHS combined with mild cognitive impairment group).By collecting and sorting out the general data,PSG monitoring results,ESS score,HAMD score,HAMA score,PSQI score,MoCA score and other clinical data of the selected patients,and according to the results of relevant literature research and consultation with experts,complete the collection of the four diagnostic information of traditional Chinese medicine,such as clinical symptoms,tongue and pulse,and establish the corresponding database,and use SPSS26.0 to statistically analyze the data.Observe and compare the distribution of TCM syndrome types of patients in the control group and the observation group,explore the distribution characteristics of TCM syndrome types of OSAHS patients with mild cognitive impairment combined with lethargy or insomnia,and analyze the correlation and regularity between different TCM syndrome types and various indicators of the three groups of patients.Results1.A total of 180 OSAHS patients with mild cognitive impairment were included in this study,with an average age of 46.49 ± 11.29 years and an average BMI of 30.30 ± 6.79 Kg/m2.Among them,106 were male(58.9%)and 74 were female(41.1%).According to the ESS and PSQI scores,60 patients were divided into the group with narcolepsy,the group with insomnia,and the group with OSAHS only with cognitive impairment.2.Through cluster analysis of the TCM symptoms and signs of 180 OSAHS patients with mild cognitive impairment,the TCM syndrome types were identified as three syndrome types: phlegm and blood stasis syndrome,spleen and kidney deficiency syndrome and phlegm-heat accumulation syndrome,with phlegm and blood stasis syndrome(78.7%)>spleen and kidney deficiency syndrome(16.8%)>phlegm-heat accumulation syndrome(4.5%).Among them,there were 49 cases(81.7%)of phlegm-stasis syndrome in lethargy group,44cases(77.2%)in insomnia group and 29 cases(76.3%)in control group;Spleen and kidney deficiency syndrome was found in 10 cases(16.7%)in lethargy group,7 cases(12.3%)in insomnia group and 9 cases(23.7%)in control group;The syndrome of phlegm-heat accumulation was found in 1 case(1.7%)in the sleepiness group,6 cases(10.5%)in the insomnia group,and 0 case(0%)in the control group;There was no significant difference in the distribution of each syndrome type among the three groups(P>0.05).3.The complications of 180 patients were mainly hypertension,hyperuricemia,fatty liver,hyperlipidemia and diabetes.The proportion of hyperuricemia,hyperlipidemia and fatty liver in insomnia group was lower than that in sleepiness group and control group(P < 0.05).The proportion of secondary polycythemia in sleepiness group was higher than that in insomnia group and control group(P < 0.05).4.BMI,AHI,TSP 90%,mean blood oxygen saturation,minimum blood oxygen saturation,and longest apnea time were positively correlated with ESS score and PSQI score(P<0.05).There was a positive correlation between HAMD score and PSQI score(P<0.05).5.Neck circumference and AHI were the influencing factors of ESS score;Age,mean blood oxygen saturation and HAMD score are the influencing factors of PSQI score.Conlusion1.Cluster analysis shows that OSAHS patients with mild cognitive impairment have three TCM syndrome types: phlegm and blood stasis syndrome,spleen and kidney deficiency syndrome,and phlegm and heat accumulation syndrome,of which phlegm and blood stasis syndrome is the main syndrome type.2.Phlegm heat accumulation syndrome is mainly seen in OSAHS patients with mild cognitive impairment combined with insomnia.3.There was no significant difference in PSG parameters and clinical complications among OSAHS patients with mild cognitive impairment in different TCM syndromes.4.Neck circumference and AHI were the influencing factors of ESS score in OSAHS patients with mild cognitive impairment;Age,mean blood oxygen saturation and HAMD score are the influencing factors of PSQI score.