Braley Tiffany J, Kratz Anna L, Kaplish Neeraj, Chervin Ronald D
Department of Neurology, Multiple Sclerosis and Sleep Disorders Centers, University of Michigan, Ann Arbor, MI.
Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine and Rehabilitation, University of Michigan.
Sleep. 2016 Aug 1;39(8):1525-33. doi: 10.5665/sleep.6012.
To examine associations between cognitive performance and polysomnographic measures of obstructive sleep apnea in patients with multiple sclerosis (MS).
Participants underwent a comprehensive MS-specific cognitive testing battery (the Minimal Assessment of Cognitive Function in MS, or MACFIMS) and in-laboratory overnight PSG.
In adjusted linear regression models, the oxygen desaturation index (ODI) and minimum oxygen saturation (MinO2) were significantly associated with performance on multiple MACFIMS measures, including the Paced Auditory Serial Addition Test (PASAT; 2-sec and 3-sec versions), which assesses working memory, processing speed, and attention, and on the Brief Visuospatial Memory Test-Revised, a test of delayed visual memory. The respiratory disturbance index (RDI) was also significantly associated with PASAT-3 scores as well as the California Verbal Learning Test-II (CVLT-II) Discriminability Index, a test of verbal memory and response inhibition. Among these associations, apnea severity measures accounted for between 12% and 23% of the variance in cognitive test performance. Polysomnographic measures of sleep fragmentation (as reflected by the total arousal index) and total sleep time also showed significant associations with a component of the CVLT-II that assesses response inhibition, explaining 18% and 27% of the variance in performance.
Among patients with MS, obstructive sleep apnea and sleep disturbance are significantly associated with diminished visual memory, verbal memory, executive function (as reflected by response inhibition), attention, processing speed, and working memory. If sleep disorders degrade these cognitive functions, effective treatment could offer new opportunities to improve cognitive functioning in patients with MS.
A commentary on this article appears in this issue on page 1489.
探讨多发性硬化症（MS）患者认知表现与阻塞性睡眠呼吸暂停多导睡眠图测量指标之间的关联。
参与者接受了一套全面的针对MS的认知测试组合（MS认知功能最小评估，即MACFIMS）以及实验室过夜多导睡眠图监测。
在调整后的线性回归模型中，氧去饱和指数（ODI）和最低氧饱和度（MinO2）与多项MACFIMS测量指标的表现显著相关，包括评估工作记忆、处理速度和注意力的听觉序列加法测试（PASAT；2秒和3秒版本），以及修订后的简短视觉空间记忆测试，一项延迟视觉记忆测试。呼吸紊乱指数（RDI）也与PASAT - 3得分以及加利福尼亚言语学习测试 - II（CVLT - II）辨别指数显著相关，后者是一项言语记忆和反应抑制测试。在这些关联中，呼吸暂停严重程度指标占认知测试表现变异的12%至23%。睡眠片段化的多导睡眠图测量指标（以总觉醒指数反映）和总睡眠时间也与CVLT - II中评估反应抑制的一个成分显著相关，分别解释了表现变异的18%和27%。
在MS患者中，阻塞性睡眠呼吸暂停和睡眠障碍与视觉记忆、言语记忆、执行功能（以反应抑制反映）、注意力、处理速度和工作记忆的减退显著相关。如果睡眠障碍会损害这些认知功能，有效的治疗可能为改善MS患者的认知功能提供新机会。
关于本文的一篇评论发表在本期第1489页。
