| Objective:Obstructive sleep apnea hypopnea syndrome(OSAHS)can cause multiple system damage in the whole body,including cognitive dysfunction.This study assessed the degree of cognitive impairment in patients with OSAHS by the Montreal Cognitive Assessment(MoCA),to explore the related factors and the correlation between the effect of cognitive impairment severity and cognitive dysfunction in OSAHS patients,and help clinical workers found earlier and intervene cognitive dysfunction in patients with OSAHS,in order to reduce the incidence of related complications and mortality,and to improve patient the quality of life.Methods:A total of 128 patients with snoring and daytime sleepiness in the outpatient department or ward of the Second Affiliated Hospital of Nanchang University from August 2016 to December 2016 were selected to monitor with polysomnography(PSG)during the whole night,and the subjects were divided into two groups: case group and matched group,and the case group was divided into three groups of mild,moderate and severe,with each group having a total of 32 cases.The main monitoring parameters of PSG included apnea hypopnea index(AHI),oxygen desaturation index(ODI)and the lowest oxygen saturation(LSaO2).Moreover,the factors of age,education and body mass index(BMI)were collected.The Montreal cognitive assessment scale was used to evaluate the cognitive function of the case group and the control group.All data were collected and analyzed by SPSS20.0 statistical software.The main statistical methods included x2 test,descriptive analysis,Pearson correlation analysis,one-way ANOVA,multivariate Logistic regression analysis.All data were collected and analyzed by SPSS20.0 statistical software.The main statistical methods included Chi-square test,descriptive analysis,Pearson correlation coefficient analysis,analysis of variance(ANOVA),multiple Logistic analysis.Results:1.Comparison of general data between the case group and the control group:The average age of the case group was(51.88±10.59),(51.56±10.99),(43.34±9.63);and people with high school education were 15(46.9%),16(50%),12(37.5%),with college degree or above were 17(53.1%)and,16(50%),20(62.5%),the average length of schooling was(13.84±1.85),(13.72±1.78),(14.16±1.74);the score of body mass index was(27.60±4.61)Kg/m2,(27.40±3.13)Kg/m2,(29.12±3.66)Kg/m2.The average age in the control group was(45.78±10.96);the people with high school education were 11(34.4%)and 21(65.6%)with college degree or above,the average length of schooling was(14.25±1.76);the score of body mass index was(26.13±3.99)Kg/m2.There was no significant difference between the groups in length of schooling(P=0.593).While the difference in the age and BMI was statistically significant(P<0.05).The difference between the control group with mild,moderate groups was statistically significant(P<0.05),and the difference between the severe group with mild,moderate groups was statistically significant(P<0.05).There was significant difference between the control group and the OSAHS group(P<0.05)in BMI.In the comparison of age index,there was no significant difference between the control group and the case group(P>0.05),while the difference between the severe group with the moderate group was statistically significant(P<0.05);and there was significant difference in mild OSAHS(P<0.01).Compared with the BMI index the difference between the control group and the severe group was statistically significant(P<0.05).2.Comparison of the incidence of cognitive dysfunction between the case group and the control group:the patients with cognitive dysfunction(the total score of MoCA< 26)was 65 in case group(68%);the mild group was 11(34%);the moderate group was 25(78%);the severe group was 29(90%);the patients with cognitive dysfunction was 1 in control group(3%);there was statistically significant difference between the case group and the control group in the incidence of cognitive dysfunction(2=62.436,P=0.000),the incidence of cognitive dysfunction in patients with OSAHS was significantly higher than that in the people without OSAHS.3.Characteristics of cognitive dysfunction in case group and control group:In the case group and the control group,MoCA score from high to low is the controlgroup(27.72±1.30),mild(26.03±2.39),moderate(24.63±1.90),severe(21.56±3.23),there was a statistically significant difference(score F=40.609,P=0.000);the more severe OSAHS patients were,the lower the MoCA score was in the patients.Comparing the control group with the case group,the visual space(4.75±0.44 VS 4.38±0.98 VS 4.56±0.76 VS 3.72±1.17,F=40.609,P=0.000),concentration(5.75±0.44 VS 5.5±0.57 VS 4.81±0.74 VS 4.66±1.07,F=16.252,P=0),language(2.09±0.64 VS 2.06±0.76 VS 1.41±0.5 VS 1.5±0.62,F=10.398,P=0.000),delayed recall(4.00±0.149 VS 3.28±0.239 VS 3.09±0.231 VS 1.44±0.25,F=24.119,P=0.000)and orientation(5.97±0.18 VS 5.81±0.4 VS 5.53±0.72 VS 5.38±0.71,F=7.650,P=0.000).There was statistical difference between the severe group with the control group,the mild group and the moderate group in visual space(P?0.01),and there was statistical difference between the control group with the mild group and the severe group in concentration(P ? 0.01).In the language,there was statistical difference between the control group with the mild group and the severe group(P?0.01),while it is the same between the mild group with the moderate group and the severe group(P<0.01).In the comparison of orientation index,there were statistically significant differences between the control group with the moderate group and the severe group(P ? 0.01);there were statistically significant differences between the severe group with the mild group(P< 0.05).4.The correlation between cognitive function with age,education level,body mass index,apnea hypopnea index,the lowest oxygen saturation and oxygen desaturation index:there was a negative correlation between age(r=-0.244,P=0.017),BMI(r=-0.314,P=0.002),AHI(r=-0.653,P=0.000)and oxygen index(r=-0.630,P=0.000);and there was a positive correlation in education(r=0.205,P=0.045)and lowest arterial oxygen saturation.5.There were 3 factors influencing the cognitive function of patients with OSAHS,including the lowest oxygen saturation,body mass index(BMI)and AHI by multivariate Logistic regression analysis.The lowest arterial oxygen saturation was a protective factor(OR<1;95%CI<1).BMI and AHI were risk factors(OR>1;95%CI>1).The risk of cognitive impairment in patients with OSAHS decreased with the increase of the lowest oxygen saturation(OR:0.897;95%CI:0.815,0.987).With theincrease of BMI,the risk of cognitive dysfunction in patients with OSAHS also increased(OR :2.133;95%CI:1.047,4.346).It is the same with AHI(OR:3.415;95%CI:1.695,6.882).Logistic regression equation is: logitP=-0.109X1+0.758X2+1.228X3.Conclusion:In this study,about 68% in experimental group had cognitive dysfunction,and the incidence of cognitive dysfunction was positively correlated with OSAHS.Cognitive impairment in patients with OSAHS was related to age,obesity,educational attainment,and nocturnal intermittent hypoxia / hypoventilation.The severity of cognitive impairment in OSAHS patients was positively correlated with age and obesity,and negatively correlated with the level of education.At the same time,the number of OSAHS patients with nocturnal respiratory pause and the number of low frequency of ventilation,the lower the nighttime minimum oxygen saturation,the more serious cognitive impairment,especially in memory,attention and language. |
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