| Background: Obstructive sleep apnea syndrome, OSAS, can cause the sufferer's cognition obstruction. According to the studies, it will occur mainly because of the mess of the sleeping structure and chronic, repeated and reversible hypoxia at night, while the pathophysiological changes in the oxygen sensitive area of the brain might be the pathological basis of the cognition obstruction. The study showed that the cognition obstruction of the patients with OSAS will generate an exhaustive damage in their cognitive function, and to some extent, there is a relation with senile dementia, SD. A new clinical evaluation system with high specificity and operability is strongly expected to update the assessment tools of cognitive function, although the using of some inspection methods such as neuroimaging techniques has already worked quite well. Alzheimer-associated neuronalthread protein, AD7c-NTP, belongs to the big neurofilament family and is expressed in neurons, exists in the axons of developing nerve cells. The levels of AD7c-NTP in the cortical neuron, brain tissue and cerebrospinal fluid extract rise, and there is a positive correlation between the level of AD7c-NTP and the patients'dementia severity extent. Foreign relevant researches found that the detection of AD7c - NTP in the urine of patients with SD can achieve the same effect as what in their cerebrospinal fluid. Urine-determination of AD7c-NTP is easier to be received by patients and will be a better clinical promotion as a noninvasive inspection method. Serum amyloid A protein, SAA, one of the acute phase proteins in one's body, is positively regulated by inflammatory cytokines such as IL-1 and IL-6. SAA is mainly synthesized by liver and secreted as one of main ingredients of apolipoprotein particles. SAA can be accumulated in the patient's brains of Alzheimer. This might be related with chronic brain inflammation and could lead to loss of neurons and white matter lesions. The higer level of SAA explained the increased incidence of cardiovascular disease and dementia in patients with OSAS. Mini-Mentalstat Examination, MMSE, which was commonly used in cognitive checking can do some simple mental state examinations and therapeutic evaluation. It could evaluate participants'direction location, executive ability, short-term memory, visual spatial cognition, structure imitation and language retell ability. MMSE includes:①Directional ability: Time directional ability(5 points) and Site directional ability(5 points);②Memory: Immediate memory(3points); Delayed memory(3 points);③Language ability: nomenclature(2 points); retell ability(1 points); Writing ability(1 points);④Visual space ability(1 points);⑤Executive ability(4 points);〤omputational ability (5 points). MMSE have 30 points totally.Methods: According to the 2009 otolaryngology & head and neck surgery magazine editorial committee, Chinese medical association otolaryngology head and neck surgery branch, the diagnostic basis about obstructive sleep apnea syndrome, had chosen outpatients and inpatients diagnosed as obstructive sleep apnea syndrome by PSG in the second hospital of Shandong university. Based on apnea hypopnea index (AHI) measured by polysomnography,52 patients with OSAS only were divided into mild OSAS group (n= 11), moderate OSAS group (n= 12) and severe OSAS group (n= 29). Eighteen healthy subjects with matched age and BMI were recruited as control group. AD7c-NTP and SAA specific monoclonal ELISA method was used to measure and contrast morning AD7c-NTP in urine and SAA concentrations in serum among different groups. In addition, correlation of AD7c-NTP and SAA with AHI and minimal pulse oxygen saturation (miniSaO2) was analyzed in OSAS patients. MMSE was used to measure the differences between control group and patient group, and to compare the curative effect of the patients treated with continuous positive airway pressure (CPAP) treatment for three months. Statistical analysis was performed using SPSS 13.0. Results:Age, body mass index have no statistical differences in each group, but polysomnography monitoring index AHI, LSaO2 has obvious significance differences between two groups(P<0.01), and positively correlated with the degrees of OSAS. Analyzing on AD7c-NTP and SAA concentrations demonstrated that compared with control group, AD7c-NTP (1.56±0.67) n g/ml,SAA (6.22±2.63 ug/ml), AD7c-NTP and SAA levels were significantly higher in mild OSAS group AD7c-NTP(1.63±0.87ng/ml, P=0.4),SAA (11.13±3.41μg/ml, P<0.05), in moderate OSAS group AD7c-NTP (2.06±0.64 n g/ml, P<0.05),SAA (18.37±1.17μg/ml, P< 0.01), and in severe OSAS group AD7c-NTP (2.20±0.83 n g/ml, P<0.005)^ SAA (23.76±2.94μg/ml, P<0.01). There was a significant difference in AD7c-NTP and SAA levels among different groups. As the degrees of OSAS become more severe, AD7c-NTP and SAA level became higher. Analysis indicated that AD7c-NTP and SAA was positively correlated with AHI, AD7c-NTP (r= 0.48,P< 0.05,SAA (r=0.90,P< 0.001), but negatively correlated with LSaO2, AD7c-NTP (r =-0.56,P<0.05),SAA (r=-0.85,P< 0.001). Time directional force and site directional force, immediate memory and delayed recall force, naming, repeat, writing, visual space ability, executive ability; calculation force have no significant difference between the control group and patient group, and to compare the curative effect of the patients treated with continuous positive airway pressure treatment for three months, P>0.05。Conclusions:AD7c-NTP and SAA levels were significantly higher in OSAS patients and they were positively correlated with the severe extent of OSAS. Elevated AD7c-NTP and SAA levels may contribute to some increased risks for Alzheimer disease in OSAS patients. Intelligent and mental state have no significance difference between the control group and patient group, and between before and after the therapy of the patients treated with continuous positive airway pressure treatment for three months. It may be caused by the too short time of illness and treatment, and also, MMSE as a follow-up tool of impaired cognition function is less sensitive. |
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