阻塞性睡眠呼吸暂停患者的脑代谢损害：阻塞性睡眠呼吸暂停与白质改变的独立关联。
Cerebral metabolic impairment in patients with obstructive sleep apnoea: an independent association of obstructive sleep apnoea with white matter change.
作者信息
Kamba M, Inoue Y, Higami S, Suto Y, Ogawa T, Chen W
机构信息
Center for Magnetic Resonance Research, University of Minnesota Medical School, 2021 6th Street SE, Minneapolis, MN 55455, USA.
出版信息
J Neurol Neurosurg Psychiatry. 2001 Sep;71(3):334-9. doi: 10.1136/jnnp.71.3.334.
OBJECTIVES
To determine the relation between severity of obstructive sleep apnoea (OSA) and degree of cerebral metabolic impairment.
METHODS
Fifty five patients with habitual snoring and excessive daytime sleepiness underwent standard overnight polysomnography and magnetic resonance spectroscopy separately. Proton MR spectra were measured with two dimensional chemical shift imaging (repetition time; 1500 ms, echo time; 135 ms). Severity of cerebral metabolic impairment was assessed by the N-acetylaspartate (NAA)/choline ratios for the cerebral cortex and white matter. Severity of OSA was assessed by the apnoea-hypopnoea index (AHI) and the minimum value of peripheral oxyhaemoglobin saturation. All patients were evaluated for the presence or absence of comobidities including hypertension, cardiac disease, diabetes mellitus, and hyperlipidaemia. Univariate analysis of variance (ANOVA) and mulitple linear regression analysis were used for statistical analyses.
RESULTS
Univariate ANOVA disclosed significant effects of AHI, age, and the presence or absence of hypertension on the NAA/choline ratio for cerebral white matter (p=0.011, p=0.028, p=0.0496, respectively). The AHI had a significant negative association with the NAA/choline ratio for cerebral white matter, independent of age and the presence or absence of cardiac disease, in the final multivariate regression model (standardised partial regression coefficient=-0.417, p<0.001). No significant relation was found between severity of OSA and the NAA/choline ratio for the cerebral cortex. Age alone had a significant effect on the NAA/choline ratio for the cerebral cortex on univariate ANOVA (p<0.001) and a significant negative association with the NAA/choline ratio for the cerebral cortex in the regression model (r=-0.552, p<0.001).
CONCLUSIONS
A significant relation exists between AHI and the degree of metabolic impairment in cerebral white matter in patients with OSA.
目的
确定阻塞性睡眠呼吸暂停（OSA）的严重程度与脑代谢损害程度之间的关系。
方法
55例习惯性打鼾且白天过度嗜睡的患者分别接受了标准的夜间多导睡眠图检查和磁共振波谱分析。采用二维化学位移成像测量质子磁共振波谱（重复时间；1500毫秒，回波时间；135毫秒）。通过大脑皮质和白质的N-乙酰天门冬氨酸（NAA）/胆碱比值评估脑代谢损害的严重程度。通过呼吸暂停低通气指数（AHI）和外周氧合血红蛋白饱和度最小值评估OSA的严重程度。对所有患者评估是否存在包括高血压、心脏病、糖尿病和高脂血症在内的合并症。采用单因素方差分析（ANOVA）和多元线性回归分析进行统计分析。
结果
单因素方差分析显示，AHI、年龄以及是否存在高血压对脑白质的NAA/胆碱比值有显著影响（分别为p = 0.011、p = 0.028、p = 0.0496）。在最终的多变量回归模型中，AHI与脑白质的NAA/胆碱比值呈显著负相关，且独立于年龄以及是否存在心脏病（标准化偏回归系数 = -0.417，p < 0.001）。未发现OSA严重程度与大脑皮质的NAA/胆碱比值之间存在显著关系。仅年龄在单因素方差分析中对大脑皮质的NAA/胆碱比值有显著影响（p < 0.001），且在回归模型中与大脑皮质的NAA/胆碱比值呈显著负相关（r = -0.552，p < 0.001）。
结论
OSA患者的AHI与脑白质代谢损害程度之间存在显著关系。
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