Zhang Yan, Wang Wanhua, Cai Sijie, Sheng Qi, Pan Shenggui, Shen Fang, Tang Qing, Liu Yang
Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, 215300 Kunshan, China; Department of Neurology, The First People's Hospital of Kunshan, 215300 Kunshan, China.
Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, 215300 Kunshan, China; Department of Neurology, The First People's Hospital of Kunshan, 215300 Kunshan, China.
Sleep Med. 2017 May;33:183-190. doi: 10.1016/j.sleep.2016.11.028. Epub 2017 Feb 4.
Obstructive sleep apnea (OSA) is very common in stroke survivors. It potentially worsens the cognitive dysfunction and inhibits their functional recovery. However, whether OSA independently damages the cognitive function in stroke patients is unclear. A simple method for evaluating OSA-induced cognitive impairment is also missing.
Forty-four stroke patients six weeks after onset and 24 non-stroke patients with snoring were recruited for the polysomnographic study of OSA and sleep architecture. Their cognitive status was evaluated with a validated Chinese version of Cambridge Prospective Memory Test. The relationship between memory deficits and respiratory, sleeping, and dementia-related clinical variables were analyzed with correlation and multiple linear regression tests.
OSA significantly and independently damaged time- and event-based prospective memory in stroke patients, although it had less power than the stroke itself. The impairment of prospective memory was correlated with increased apnea-hypopnea index, decreased minimal and mean levels of peripheral oxygen saturation, and disrupted sleeping continuity (reduced sleep efficiency and increased microarousal index). The further regression analysis identified minimal levels of peripheral oxygen saturation and sleep efficiency to be the two most important predictors for the decreased time-based prospective memory in stroke patients.
OSA independently contributes to the cognitive dysfunction in stroke patients, potentially through OSA-caused hypoxemia and sleeping discontinuity. The prospective memory test is a simple but sensitive method to detect OSA-induced cognitive impairment in stroke patients. Proper therapies of OSA might improve the cognitive function and increase the life quality of stroke patients.
阻塞性睡眠呼吸暂停（OSA）在中风幸存者中非常常见。它可能会使认知功能障碍恶化，并抑制其功能恢复。然而，OSA是否独立损害中风患者的认知功能尚不清楚。目前也缺乏一种评估OSA所致认知障碍的简单方法。
招募了44名发病六周后的中风患者和24名有打鼾症状的非中风患者，进行OSA和睡眠结构的多导睡眠图研究。使用经过验证的中文版剑桥前瞻性记忆测试评估他们的认知状态。通过相关性和多元线性回归测试分析记忆缺陷与呼吸、睡眠及痴呆相关临床变量之间的关系。
OSA显著且独立地损害了中风患者基于时间和事件的前瞻性记忆，尽管其影响程度小于中风本身。前瞻性记忆损害与呼吸暂停低通气指数增加、外周血氧饱和度最低值和平均值降低以及睡眠连续性中断（睡眠效率降低和微觉醒指数增加）相关。进一步的回归分析确定外周血氧饱和度最低值和睡眠效率是中风患者基于时间的前瞻性记忆下降的两个最重要预测因素。
OSA可能通过导致低氧血症和睡眠中断独立导致中风患者的认知功能障碍。前瞻性记忆测试是检测中风患者OSA所致认知障碍的一种简单而敏感的方法。对OSA进行适当治疗可能会改善中风患者的认知功能并提高其生活质量。
