| Objective:Through Cardiopulmonary coupling analysis(CPC)、neuropsychological and sleep scale,1、Analyze the incidence of OSAHS in patients with chronic insomnia,and to explore the effects of OSAHS on anxiety and depression,cognitive function and objective sleep structure in patients with chronic insomnia.;2、Analysis of cognitive impairment and objective sleep structure disorder in patients with chronic insomnia;3、Compare the effects of insomnia and depression severity on cognitive function and sleep structure,and the changes of sleep structure in patients with chronic insomnia under different cognitive function levels;4、Investigate the correlation between cognitive function and CPC sleep structure in patients with chronic insomnia.Method:Collected patients with insomnia and without snoring complaintin the neurology clinic of Tianjin medical university general hospital and Kong Gang hospital from October 2017 to April 2018,choose the DSM-V as the diagnostic criteria of 100 cases of chronic insomnia patients.Thirty patients with physical and mental disorders,such as cerebral infarction,epilepsy,thyroid disease,dementia,anxiety disorder,depression,were excluded,and 70 patients in the case group were selected,Registration the basic information of the patients.Then using the(Pittsburgh Sleep Quality Index,(PSQI),Insomnia Severity Index(ISI)to evaluate the subjective Sleep condition,use the Epworth Sleepiness Scale(ESS)to evaluate the Daytime sleepiness,use the Hamilton Anxiety Scale(HAMA)and Hamilton depression rating Scale(HAMD)to evaluate the level of neuropsychological condition,use Montreal Cognitive function scale(MOCA)to assess the level of patient’s Cognitive function.Use CPC to evaluate nocturnal sleep structure and apnea hyponea index.According to the AHI > 5 times / h,screening the incidence rate of OSAHS in chronic insomnia without snoring patients,and 70 patients with chronic insomnia were divided into chronic insomnia with OSAHS group(n = 27)and chronic insomnia without OSAHS group(n = 43).Compare the anxiety,depression,cognitive function and objective sleep structure between the two groups;explore the effects of OSAHS on anxiety and depression,cognitive function and objective sleep structure in patients with chronic insomnia;2、After the 70 patients with chronic insomnia were excluded from OSAHS,43 patients were selected and 15 matched healthy volunteers were recruited as the normal control group.use the basic scale,Sleep Assessment scale(PSQI、ISI),the Depression Scale(HAMD),the cognitive scale(Mo CA),and the CPC to estimate the basic information,the subjective sleep,the degree of depression,the cognitive function,the night sleep structure and apnea hyponea index of the subjects.The research subgroups were:.(1): According to ISI ≥ 15,patients with chronic insomnia were divided into moderate and severe chronic insomnia group and mild chronic insomnia group;(2): according to the degree of depression(HAMD ≥ 7),Chronic insomniacs were divided into chronic insomnia with depression group and chronic insomnia without depression group;(3)according to the Montreal Cognitive Assessment scale(Mo CA ≥ 26),Patients with chronic insomnia were divided into two groups: chronic insomnia with cognitive decline group and chronic insomnia with cognitive normal group.Compare the effects of insomnia and depression severity on cognitive function and sleep structure,and the changes of sleep structure in patients with chronic insomnia under different cognitive function levels;Investigate the correlation between cognitive function and CPC sleep structure in patients with chronic insomnia.Result:1.In this study,70 patients met the inclusion criteria.And there are 27 patients with the AHI index > 5,the incidence rate of OSA was 38.57%.There were 18 mild OSA patients,the incidence ratewas 25.71%;5 patients with moderate OSA,the incidence rate was 7.14%,4 patients with severe OSA.The incidence rate was 5.71%.2、Compared with chronic insomnia without OSAHS group,the score of HAMA and HAMD in chronic insomnia with OSAHS group had a increasing tendency,but there was no statistical difference between the two groups(P > 0.05).3、The scores of visual space and executive function in chronic insomnia with OSAHS group were significantly lower than those in chronic insomnia without OSAHS group(P < 0.05),but the score of Mo CA,naming,delayed recall,attention,language,abstraction were no different between the two groups.There was no statistical difference in orientation score(P > 0.05).4、Compared with simple chronic insomnia group,the high frequency coupling ratio in decreased and the low frequency coupling ratio increased in objective sleep structure of chronic insomnia with OSAHS group,the difference between the two groups was statistically significant(P < 0.05),and there was no significant difference in the extremely low frequency coupling ratio between the two groups(P > 0.05).5、Compared with the control group,the score of Mo CA,visual space and execution,attention score,high frequency coupling ratio were decreased and low frequency coupling ratio and very low frequency coupling ratio in patients with chronic insomnia were increased(P < 0.05),the difference was statistically significant(P < 0.05).There was no statistical difference in the scores of language,abstraction and orientation between the two groups(P > 0.05).6、Compared with the normal control group,the total score of Mo CA 、visual spatial and executive function、attention、the high frequency coupling ratio,was in decreased the moderate and severe chronic insomnia group;and the low frequency coupling and the extremely low frequency coupling ratio were increased.The difference was statistically significant(P<0.05).Compared with mild chronic insomnia group,the total score of Mo CA,visual space and execution,attention and language scores in moderate and severe chronic insomnia group decreased,and extremely low frequency coupling ratio increased(P < 0.05).7、.Compared with the normal control group,the total score of Mo CA,visual space and performance,attention score,high frequency coupling ratio were decreased,low frequency coupling ratio and very low frequency coupling ratio increased in insomnia with depression group(P < 0.05).Compared with insomnia without depression,the total score of Mo CA,visual space and execution,attention score decreased,and the coupling ratio of very low frequency increased in the group of insomnia with depression(P < 0.05).8、Compared with the normal control group,the visual space and executive performance,delayed recall,attentional and abstract scores,the proportion of high-frequency coupling of the cognitive impairment group of chronic insomnia were decreased,while the coupling ratio of low frequency coupling and extremely low frequency were increased.The difference was statistically significant(P<0.05).Compared with the normal cognitive group of chronic insomnia,there were significant differences in visual space and executive space,delayed recall,attention,abstract score,high frequency coupling ratio and low frequency coupling ratio in the patients with chronic insomnia cognitive decline(P <0.05).9、Total score of Mo CA,visual space and execution were positively correlated with high frequency coupling ratio,and were negatively correlated with very low frequency coupling ratio.Total score of Mo CA was negatively correlated with very low frequency coupling ratio.Attention was positively correlated with high frequency coupling ratio(P < 0.05).Conclusion: 1、Using cardiopulmonary coupling technique to screen OSAHS of chronic insomnia patients without snoring,it was found that the incidence rate of OSAHS in chronic insomnia patients was 38.57%,among which the incidence rate of mild OSAHS was higher,the cardiopulmonary coupling technique could be used as a simple and objective sleep evaluation tool to evaluate the sleep structure and Respiratory Disorder in patients with Insomnia and OSAHS;2、There was no significant increase in anxiety and depression in patients with chronic insomnia and OSAHS;3、OSAHS can aggravate cognitive impairment in patients with chronic insomnia,mainly in visual space and executive function.In addition,OSAHS can aggravate sleep structure disorder in patients with chronic insomnia,which is mainly manifested in increasing proportion of unstable sleep and decreasing proportion of stable sleep;4、Chronic insomnia patients have cognitive impairment,mainly manifested in visual space and execution,attention,and the heavier the degree of insomnia,the more serious the impairment of cognitive function,moderate and severe chronic insomnia patients with space and execution,attention,language function damage more serious;depression aggravates the chronic insomnia patients cognitive impairment,manifested in visual space and implementation,Attention.5、Objective sleep structure disorder was found in patients with chronic insomnia,such as decreasing stable sleep,increasing unstable sleep and awakening time / REM phase,increasing awakening time / REM phase when the degree of insomnia become higher.Depression exacerbates sleep disorder in patients with chronic insomnia,which is reflected in the increase of awakening time / REM phase;.6、The total score of Mo CA,visual space and execution in patients with chronic insomnia were positively correlated with stable sleep ratio,negatively correlated with awakening time / REM phase,The total score of Mo CA negatively correlated with unstable sleep ratio,attention positively correlated with stable sleep ratio,and considered that the cognitive function of patients was related to sleep disorder.7、The more severe the degree of insomnia in patients with chronic insomnia or insomnia with depression,can increase cognitive impairment and sleep structure disorder,we need to find early insomnia patients,identify insomnia patients with depression,targeted treatment;In addition,CPC can objectively evaluate the sleep status of patients with chronic insomnia,which is helpful to provide guidance for the standardized treatment of patients with chronic insomnia and is worth popularizing. |
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