The Clinical Study On Cognitive Impairment In OSAHS Patients

Objective:The Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)were performed on patients with Obstructive Sleep Apnea Hypopnea Syndrome(OSAHS)in adults.,to assess the cognitive impairment in adult OSAHS patients,and to investigate the relationship between nocturnal intermittent hypoxic ventilation and Apnea Hypopnea Index(AHI)and cognitive impairment in OSAHS patients.By measuring serum concentrations of highly sensitive C-reactive protein(CRPH,Hs-CRP)and serum homocysteine(HCY)in the study subjects,to explore the relationship between serum Hs-CRP and HCY levels and cognitive impairment in OSAHS patients,in order to explore the possible pathophysiological mechanisms of impaired cognitive function in OSAHS patients.Methods:Randomly selected inpatients who were consecutively admitted to the Department of Neurology of the Second Affiliated Hospital of Kunming Medical University from March 2017 to January 2018,they met the inclusion criteria and informed consent to participate in the study.All patients were monitored with a polysomnography monitor for 7 hours.The main test indicators were AHI and minimal arterial oxygen saturation(LSa02).Among them,40 were OSAHS patients and 37 were non-OSAHS patients,mainly based on AHI(times/h).OSAHS patients were divided into mild(5 to 15),moderate(>15 to 30)and severe(5 to 15>30)OSAHS groups;general information and previous medical history was obtained and recorded;Serum Hs-CRP,HCY,TCHOL,TG,HDL-C,LDL-C,NONHDL,APOA1,APOB,UA,etc.were detected after admission;Patients were assessed for cognitive function using the MMSE and MoCA scales.SPSS24.0 statistical analysis software was used for statistical analysis of all data.The main methods included exploratory analysis,one-way analysis of variance,t-test,chi-square test(?2 test),Pearson linear correlation,partial correlation analysis,multiple linear regression analysis,and two-class unconditional Logistic regression analysis.Results:1.Compared with the general condition of OSAHS group and non-OSAHS group,the two groups had statistically significant differences in age,LDL-C,NONHDL,APOB,UA,hypertension,and diabetes(P<0.05).The age,LDL-C,NONHDL,APOB,and UA of the OSAHS group were higher than those of the non-OSAHS group.The number of OSAHS combined hypertension and diabetes was higher than that of the non-OSAHS group.2.The total score of MoCA was less than 26(ie,cognitive impairment)in 28 cases,accounting for 70.0%.In the non-OSAHS group,the total score of MoCA was<26 points in 12 cases,accounting for 32.4%.The incidence of cognitive impairment in the OSAHS group was higher than that in the non-OSAHS group(?2=10.867,P=0.001).In the OSAHS group,the MMSE total score was less than 27 points(ie,cognitive impairment)in 14 cases,accounting for 35.0%.In the non-OSAHS group,there were 4 cases of MMSE total score<27 points,accounting for 10.8%.The incidence of cognitive impairment in the OSAHS group was also higher than in the non-OSAHS group(?2=6.279,P=0.012).The scores of MMSE,MoCA,visual space and executive function,attention,delayed recall,language and orientation in OSAHS group were lower than those in non-OSAHS group.3.In the OSAHS group,the cognitive function MMSE and MoCA scores were significantly negatively correlated with age and AHI,positively correlated with education years,and had no correlation with gender,BMI,and LSa02.In the scores of various areas of cognition,visual space/executive function,attention,abstraction,delayed recall,language and AHI are negatively correlated,visual space/executive function,attention,and delayed recall are inversely related to age,and attention is positively related to the number of years of schooling.After controlling education years,AHI and BMI,age was negatively correlated with MMSE score and MoCA score.After controlling education age,age and BMI,AHI was significantly negatively correlated with cognitive function MMSE scores and MoCA scores.4.Comparison of cognitive function scores in mild,moderate,and severe OSAHS patients.In 40 patients with OSAHS,There were 7 patients with mild OSAHS,20 patients with moderate OSAHS,and 13 patients with severe OSAHS.The number and incidence of MMSE scores<27 in mild,moderate,and severe OSAHS patients were 1(14.3%),12(20.0%),and 8(61.5%),respectively.The number and incidence of MoCA score<26 in mild,moderate,and severe OSAHS patients were 3(42.9%),12(66.7%),and 13(100.0%),respectively.The incidence of impaired cognitive function was significantly different between severe OSAHS patients and moderate and mild OSAHS patients(P<0.05).That is,the incidence of impaired cognitive function among patients with severe OSAHS is higher than moderate and mild.The MMSE scores of mild,moderate,and severe OSAHS patients were mild(28.85±1.57),moderate(28.05±1.79),and severe(25.6± 1.60).After one-way analysis of variance,the difference in scores was statistically significant(F=10.623,P=0.000).The MoCA scores of mild,moderate,and severe OSAHS patients were mild(25.71 ±2.75),moderate(24.00±3.12),and severe(19.23±3.16).After one-way analysis of variance,the difference in scores was statistically significant(F=13.347,P=0.000).By using the Bonferroni method,the comparison among the three is shown:there were significant differences in cognitive function MMSE and MoCA scores between severe OSAHS patients and mild and moderate OSAHS patients(P<0.01).But,there was no significant difference in cognitive function MMSE and MoCA scores between mild and moderate OSAHS patients(P>0.05).To compare the sub-values of MoCA in patients with mild,moderate and severe OSAHS,compared with the corresponding mild group,the scores of visual space/executive function,attention,language and delayed recall in severe OSAHS patients were statistically significant(P<0.05).5.In multivariate logistic regression analysis of cognitive impairment in patients with OSAHS,four possible risk factors for age,years of education,BMI,and AHI were used as independent variables.There were two risk factors that eventually entered the model:age(XI)and AHI(X4).Both the OR and the 95%CI range of the OR were>1.It is suggested that both age and AHI are risk factors for cognitive impairment in patients with OSAHS.6.The serum HCY concentrations in the OSAHS group and non-OSAHS group were(16.84 ± 6.59)umol/L and(12.99 ±3.33)umol/L,respectively.The difference was statistically significant(P<0.01).The serum CRPH concentrations in the OSAHS group and non-OSAHS group were(3.96±3.23)mg/L and(1.99 ±1.45)mg/L,respectively.The difference in mean serum CRPH concentrations between the two groups was statistically significant(P<0.05).The serum HCY concentrations in the cognitive impairment group and normal cognitive function group were(17.27± 6.43)umol/L and(12.52 ± 3.02)umol/L,respectively.The difference was statistically significant(P<0.01).The levels of serum Hs-CRP in the cognitive impairment group and the normal cognitive function group were(3.85±3.20)mg/L and(2.63 ±2.39)mg/L,respectively.There was no significant difference in the serum Hs-CRP by the rank sum test(P ? 0.05).The average MoCA score in the OSAHS group was lower than that in the normal cognitive function group and non-OSAHS group combined with cognitive impairment(P<0.05).The levels of serum HCY in OSAHS and non-OSAHS patients with cognitive impairment were significantly higher than those in normal cognitive function(P<0.05).Serum HCY levels in OSAHS patients with combined cognitive impairment were higher than non-OSAHS combined and cognitive impairment groups(P<0.05).There was no significant difference in serum Hs-CRP level between OSAHS combined with cognitive impairment and non-OSAHS combined with cognitive impairment(P?0.05).In the OSAHS group,there was no significant difference in serum Hs-CRP levels between cognitive impairment and normal cognitive function(P ? 0.05).7.The serum HCY concentration of the study was positively correlated with age and AHI,negatively correlated with LSa02,and not related to BMI.The serum Hs-CRP concentration of the study subjects was positively correlated with AHI,negatively correlated with LSaO2,and had no correlation with age and BMI.After controlling AHI and BMI,there was no correlation between age and HCY concentration.After controlling age and BMI,AHI and HCY concentrations were significantly positively correlated.After controlling for age and AHI,there was no correlation between BMI and HCY concentrations.Subject's age,BMI,AHI,TCHOL,TG,and LDL-C were used as independent variables.Take HCY,Hs-CRP as the strains Y1,Y2 respectively.Set up multiple linear regression equations for HCY,Hs-CRP,and.multiple independent variables(?in=0.10,?out=0.15).There was a linear regression relationship between HCY and AHI(b=0.182,P=0.000),BMI(b=-0.324,P=0.033).There was a linear regression relationship between Hs-CRP and AHI(b=0.082,P=0.007).8.Serum HCY concentrations in study subjects were negatively correlated with MMSE,MoCA,visual space/executive function,attention,delayed recall,and language,but not with abstraction and orientation.Serum Hs-CRP concentrations in study subjects were negatively correlated with MoCA,attention,delayed recall,language,abstraction and orientation,and were not related to MMSE and visual space/execution function.After controlling for age and culture,there was a significant negative correlation between serum HCY concentration and MMSE or MoCA.The serum Hs-CRP concentration of the study subjects was negatively correlated with MoCA and not with MMSE.Conclusions:1.About 70.0%of OSAHS patients suffer from varying degrees of cognitive impairment.The higher the severity of OSAHS,the greater the proportion of patients with impaired cognitive function.Impaired cognitive function in patients with OSAHS is associated with intermittent hypoxia.The more frequency of night apnea hypoventilation index,the more severe cognitive impairment.2.Serum HCY and serum Hs-CRP levels are higher in OSAHS patients than non-OSAHS patients.The impaired cognitive function is related to serum HCY levels and OSAHS.3.In the cognitive assessment of OSAHS patients,the detection rate of cognitive impairment in OSAHS was higher in the MoCA scale than in the MMSE scale.