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阻塞性睡眠呼吸暂停低通气综合征患者注意网络的研究
胡颖
裴翀
刘菲菲
沈莉
胡盼盼
汪凯
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1001-0939.2015.09.008
A study of attention networks in patients with obstructive sleep apnea-hypopnea syndrome
Hu Ying
Pei Chong
Liu Feifei
Shen Li
Hu Panpan
Wang Kai
Authors Info & Affiliations
Hu Ying
Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
Pei Chong
Liu Feifei
Shen Li
Hu Panpan
Wang Kai
·
DOI： 10.3760/cma.j.issn.1001-0939.2015.09.008
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摘要

目的研究OSAHS患者的注意网络及相关认知，探讨其可能的影响因素。

方法经神经心理学测试筛查选取2013年6月至2014年3月在合肥市第一人民医院呼吸内科睡眠监测室多导睡眠监测确诊的OSAHS患者50例，其中男43例，女7例，年龄23～60岁，平均(43±10)岁，同期纳入40名健康对照者，其中男35名，女5名，年龄24～60岁，平均(44±10)岁，对所有患者进行注意网络测试并与对照组比较。

结果OSAHS组的执行控制网络时间[(138±58)ms]较对照组[(104±37)ms]明显延长，与对照组比较差异有统计学意义( P<0.01)。OSAHS组在神经心理学背景测试MoCA评分(25.1±2.9)、stroop效应(16±11)、词汇流畅性(18±4)、数字广度测试(7.3±1.4、5.1±1.6)、HAMA焦虑(4.5±4.0)、贝克抑郁评分(4.8±3.3)与健康对照组相比较差，差异有统计学意义(均 P<0.05)，而警觉、定向网络、反应时间及正确率两组差异均无统计学意义(均 P>0.05)。OSAHS组的执行网络与夜间最长呼吸暂停时间呈显著正相关( r＝0.620, P<0.01)，与平均氧饱和度、最低氧饱和度呈负相关( r＝–0.869, –0.577，均 P<0.05)。

结论OSAHS患者存在一定程度的注意力缺损，以执行控制网络损伤尤为明显，夜间缺氧和通气不足可能是影响其注意力和执行功能的重要因素。

认知;睡眠呼吸暂停综合征，阻塞性;注意网络;执行功能
ABSTRACT

ObjectiveTo explore the different aspects of attention function in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and further to investigate the factors related to the impairments.

MethodsAfter one night polysomnography (PSG) monitoring, a total of 50 patients with OSAHS and 40 demographic-matched healthy controls received basic cognitive assessment with a neuropsychological battery and then performed the attention networks test (ANT) was performed.

ResultsCompared with healthy controls, patients with OSAHS performed significantly worse on cognitive tests and emotion evaluation including Montreal Cognitive Assessment (MoCA), stroop, verbal fluency, digital span, Hamilton anxiety scale (HAMA) and Beck depression inventory (BDI). With regard to ANT, significant group differences were found in executive control network [(138±58) ms vs (104±37)ms, P=0.003], but not in alertness [(33±36)ms vs (33±18)ms, P=0.975] or orientation [(48±30)ms vs (51±22)ms, P=0.674]. Correlation analysis indicated that the scores of the executive control network was positively correlated with the longest apnea time during the night ( r=0.620, P=0.006), but was negatively correlated with the average oxygen saturation( r=-0.869, P=0.000) and the lowest oxygen saturation( r=-0.577, P=0.019).

ConclusionsPatients with OSAHS were associated with impaired attention function, especially in the executive control network efficiency. Chronic hypoxia and apnea during the sleep may be the key factors that could diminish their attention and executive function.

Cognition;Sleep apnea, obstructive;Attention networks;Executive function
Wang Kai, Email: mocdef.6ab214691iakgnaw

Hu Ying and Pei Chong are the first authors who contributed equally to the article

Copyright by Chinese Medical Association
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All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.
引用本文

胡颖,裴翀,刘菲菲,等. 阻塞性睡眠呼吸暂停低通气综合征患者注意网络的研究[J]. 中华结核和呼吸杂志,2015,38(9)：659-663.

DOI:10.3760/cma.j.issn.1001-0939.2015.09.008

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OSAHS是一种严重的睡眠呼吸疾病，以睡眠期间反复发生的气道狭窄阻塞和呼吸暂停为主要临床特征，从而引发夜间低氧血症和睡眠结构紊乱，并会导致患者白天过度嗜睡且伴有不同程度的神经认知功能障碍 [ 1 ]。尽管有关OSAHS患者的注意、执行功能、记忆等认知成分近年来愈发受到关注，其具体机制尚未明确 [ 2 ]。反复发生的夜间缺氧和呼吸暂停是导致其认知能力下降的主要因素 [ 3 ]，夜间低通气指数的增高同时也会增加痴呆和轻度认知障碍的患病风险 [ 4 ]。注意力是认知功能的重要范畴，指心理活动对一定信息或对象的指向与集中过程。Posner等 [ 5 ]提出注意网络可分为警觉、定向和执行控制3个部分，各部分有其特定的神经解剖和生化机制。最近的研究结果表明注意力缺乏在OSAHS患者的所有认知损害中扮演重要角色，注意力损害导致其不仅在日常生活中难以保持清醒，且在面对刺激环境和应激状态时反应降低 [ 6 ]。现利用注意网络测试(attention networks test，ANT)研究OSAHS患者的注意网络损害情况，并探讨相关影响因素。
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备注信息
A
汪凯，Email： mocdef.6ab214691iakgnaw
B

胡颖与裴翀对本文有同等贡献

C
国家自然科学基金 (91232717，31300925)
国家"973"项目 (2011CB707805)
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