The Clinical And Electroencephalogram Activity Features Of Patients With Obstructive Sleep Apnea Hypopnea Syndrome Complicated With Mood Disorders

Part Ⅰ The clinical features of patients with obstructive sleep apnea hypopnea syndrome complicated with mood disordersObjective Obstructive sleep apnea hypopnea syndrome(OSAHS)can not only lead to organic damage to patients,but also cause mood disorders,which seriously affect the quality of life and compliance with treatment of patients.To explore the clinical features of OSAHS with mood disorders,and correlation analyses were performed to investigate the association of mood disorders with cognitive function scores,sleep architecture,and nocturnal hypoxia parameters of OSAHS.Methods We prospectively recruited 105 patients with snoring or OSAHS at the Sleep Center of the Second Affiliated Hospital of Soochow University from June 2020 to January 2022,who were divided into primary snoring(n=15),mild-moderate OSAHS(n=43),and severe OSAHS group(n=47).We collected patient general information,PSG parameters,self-rating depresion scale(SDS),self-rating anxiety scale(SAS),epworth sleepiness score(ESS),logical memory test(LMT)immediate and delayed and digit span test(DST)forward and backward scales,and three sub-items data in cambridge neuropsychological test automatic battery(CANTAB),including pattern recognition memory(PRM),spatial recognition memory(SRM)and spatial working memory(SWM).We compared demographic data,PSG parameters,cognitive function and mood scores among the three groups of OSAHS patients.And correlation analyses were performed to investigate the association of mood disorders with cognitive function scores,sleep architecture,and nocturnal hypoxia parameters of OSAHS.Results 1.Comparison of demographic and general data:the patients tend to be older,with higher BMI in the severe OSAHS group than in the other two groups.2.Comparison of PSG parameter:increasing OSAHS severity is associated with higher NREM 1%,percent of total time with oxygen saturation level<90%(TS90%),arousal frequency,oxygen desaturation index(ODI)and longest time of apnea,lower NREM 3%,and lowest arterial oxygen saturation(LSaO2).3.Comparison of daytime sleepiness,mood disorders and cognitive function:the proportions of depressive mood and anxious mood in OSAHS patients were 34.4%and 13.3%,respectively,and the proportion of depressive mood in mild-moderate OSAHS was higher than that in severe OSAHS(37%vs 32%).The SDS and SAS scores of the patients with severe OSAHS were lower than the simple snoring group and mild-moderate OSAHS(both p<0.05).The patients tend to have more difficulty concentrating,and spatial recognition memory was stronger in the mild to moderate OSAHS group than in primary snoring group and severe OSAHS group.And there was no statistical difference in daytime sleepiness scores among the three groups.4.Correlation analysis:SDS score was shown to be negatively correlated with years of schooling(r=-0.31),NREM 2%(r=-0.21),LMT immediate(r=-0.49)and delay(r=-0.48),DST inversion(r=-0.22);SAS was shown to be negatively correlated with TST(r=-0.20),LMT immediate(r=-0.29)and delay(r=-0.27).And positively correlated with ESS(r=0.23).Conclusion OSAHS patients are combined with cognitive impairment and mood disorder,and the two affect each other.The mood disorder of OSAHS patients is mainly manifested in depressive mood,and depressive mood in OSAHS patients mainly impair the logical memory,verbal working memory and aspects of attention.Part Ⅱ EEG power spectrum analysis of patients with obstructive sleep apnea hypopnea syndrome complicated with depressive moodObjective Patients with OSAHS are complicated with mood disorders,especially in depressive mood.In this part,the EEG power spectrum characteristics in different frequency bands of the frontal lobe of the brain and the power spectrum change patterns before and after positive and negative emotional stimulation were observed in OSAHS with depressive mood patients,and the neural mechanism of OSAHS with depressive mood was explored.Methods We selected 86 OSAHS patients who met the inclusion and exclusion criteria among the recruited subjects and divided OSAHS into two groups according to SDS score:OSAHS without depressive mood group(n=56)and OSAHS with depressive mood group(n=30).According to AHI,OSAHS without depressive mood group was divided into two subgroups,that is,mild and moderate OSAHS did not with depressive mood group(n=27),severe OSAHS without depressive mood group(n=29),mild and moderate OSAHS with depressive mood group(n=16)and severe OSAHS with depressive mood group(n=14).15 positive pictures and 15 negative pictures in Chinese Emotional Photo Chinese affective picture system(CAPS)were selected,and the subjects were subjected to positive and negative emotional stimulation for 60s respectively.32-lead EEG data,including 3 minutes before the stimulation,5-8 minutes after positive emotional stimulation and 0-3 minutes after negative stimulation negative emotional stimulation,were collected,besides patient general data,questionnaire,PSG parameters and CANTAB data were collected.We compared the differences EEG power spectrum between and within the OSAHS with depressive mood patients and the power spectrum changes in each frequency band before and after the positive and negative stimulation in frontal lobe by using Matlab software.And we further analyzed the correlation of EEG power spectrum with clinical indicators.Results 1.Comparison of demographic and clinical characteristics between and within the two patient groups:OSAHS patients with depressive mood were less educated and more nighttime urination than OSA without depressive mood.In the unincorporated depressive mood group,the severe OSAHS group was more likely to have combined hypertension.No statistical differences were seen in the two subgroups in OSAHS with depressive mood.2.Comparison of PSG parameters between and within the two patient groups:OS AHS patients with depressive mood had a shorter REM latency period than OSA without depressive mood.In the unincorporated depressive mood group,increasing OSAHS severity is associated with higher NREM 1%,ODI,TS90%,arousal frequency and longest time of apnea,lower NREM 3%,and LSaO2.Increasing OSAHS severity is associated with higher NREM 1%,ODI,TS90%,arousal frequency and longest time of apnea,lower LSaO2 in OSAHS without depressive mood patients.3.Comparison of daytime sleepiness,mood disorders and cognitive function between and within the two patient groups:OSAHS patients with depressive mood were more prone to anxious mood and more daytime sleepiness,OSAHS patients with depressive mood had worse logical memory,attention and verbal working memory than OSA without depressive mood.In the unincorporated depressive mood group,patients with severe OSAHS are more likely to have daytime sleepiness and experience inattention,smaller visual working memory capacity,visual recognition memory,and impaired spatial recognition memory.No statistical differences were seen in the two subgroups in OSAHS with depressive mood.4.Comparison of power spectrum in frontal lobe between and within the two patient groups:OSAHS patients with depressive mood had higher alpha power and gamma power than OSA without depressive mood.In the unincorporated depressive mood group,patients with severe OSAHS had a lower alpha power than mild-moderate OSAHS group.No statistical differences were seen in the two subgroups in OSAHS with depressive mood.5.The frequency band power spectrum changes in the frontal lobe before and after positive and negative stimulation:OSAHS patients without depressive mood had higher delta power,theta power,beta power and gamma power after positive and negative stimulation;In OSAHS patients with depressive mood,delta power and theta power were increased compared with baseline values.In OSAHS patients with depressed mood,delta power,theta power and gamma power were increased compared with baseline values.And the severity of OSAHS can affect the EEG power of the frontal lobe before and after emotional stimulation in different frequency bands.6.Correlation of power spectrum with clinical and PSG indexes:alpha power was shown to be positively correlated with LSaO2(r=0.38)and negatively correlated with AHI,ODI,TS90%(r=-0.47,-0.43,-0.33).Mean reaction time of the PRM was shown to be negatively correlated with delta power,theta,power and gamma power(r=-0.24,-0.24,0.25).Conclusion 1.Alpha power can be used as an early biomarker to judge the brain damage caused by chronic hypoxia at night in OSAHS.2.The increase of alpha power and gamma power leads to the pathological inhibition of the cerebral motor cortex in OSAHS patients,and both are possible neural mechanisms underlying depressive mood in OSAHS.Part Ⅲ EEG functional connectivity analysis of patients with mild-moderate obstructive sleep apnea hypopnea syndrome complicated with depressive mood Objective Patients with OSAHS are complicated with depressed mood,especially in mild-moderate OSAHS patients.In this part,we study functional connectivity patterns in patients with mild to moderate OSAHS with depressive mood,and find the common brain network in which OSAHS cognitive impairment and mood disorders affect each other,as well as the neural mechanisms and emotional circuits of OSAHS with depressive mood.Methods We selected mild-moderate OSAHS patients who met the inclusion and exclusion criteria and divided into two groups according to SDS score:mild-moderate OSAHS without depressive mood(n=27)and mild-moderate OSAHS with depressive mood(n=29).We collected 32-lead resting-state EEG data of 3 minutes with eyes open and 3 minutes with eyes closed for mild-moderate OSAHS while collecting patient’s general information,questionnaire,PSG parameters and CANTAB data.We explored the delta,theta,alpha,beta and gamma bands functional connectivity in attentional network(AN),frontal network(FN),and default mode network(DMN)in patients mild-moderate OSAHS with depressive mood based on cortical traceability using eLORETA,and the correlation of functional connectivity indicators and clinical indicators was also analyzed.Results 1.Comparison of demographic and general data:No statistical differences were observed in the demographic and general data between the two groups.2.Comparison of PSG parameter:No statistical differences were observed in the PSG parameters between the two groups.3.Comparison of daytime sleepiness,mood disorders and cognitive function:Mildmoderate OSAHS patients with depressed mood were more prone to anxiety and daytime sleepiness and more likely to have logical memory impairment,attention and verbal working memory impairment compared to control patients.4.Comparison of functional connectivity:Mild-moderate OSAHS patients with depressive mood were more decreased alpha-band functional connectivity and more enhanced gamma-band functional connectivity in attentional network compared to control patients.And mild-moderate OSAHS patients with depressive mood were more enhanced gamma-band functional connectivity in default mode network and frontal network compared to control patients.5.Correlation of functional connectivity with clinical and PSG indexes:Gamma-band functional connectivity in attentional network was shown to be negatively correlated with NREM 3%(r=-0.34,p<0.05),similar change trends were also observed in default mode network and frontal network.In addition,gamma-band functional connectivity in the attention network,default mode network and frontal network were negatively associated with the LMT immediate score(r=-0.35,p<0.05).Conclusion 1.Alpha-band sparse connectivity in attentional network and gamma-band close network connectivity in the attention network,default mode network and frontal network are a possible neural network mechanism for OSAHS prone to depressive mood disorders.2.The functional reorganization of attention network,default mode network and frontal network is a common pathological basis for the mutual influence of cognitive disorders and mood disorders in OSAHS patients.