Hoch C C, Reynolds C F, Nebes R D, Kupfer D J, Berman S R, Campbell D
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pennsylvania 15213.
J Am Geriatr Soc. 1989 Feb;37(2):138-44. doi: 10.1111/j.1532-5415.1989.tb05872.x.
In a study of 15 probable Alzheimer's patients and 12 healthy elderly control subjects, Alzheimer's patients had a significantly higher apnea index (patients versus controls, mean +/- SD: 6.3 +/- 6.6 vs 1.8 +/- 2.7, P less than .05) and greater maximal duration of apnea (patients versus controls, median: 50.0 vs 28.5 seconds, P less than .001), but no significant increase in oxyhemoglobin desaturation compared with controls. (The accepted normal threshold for abnormality is an apnea index more than 5.) Although three of seven psychometric tests (odd-even, category retrieval, face-hand test) showed diurnal effects on one or more of their subscores, with Alzheimer's patients having significantly poorer scores at the AM than at PM testing, overnight change scores in the psychometric tests were not significantly correlated with severity of sleep-disordered breathing. Further, only 18.1% of the disruptive (ie, requiring intervention) nocturnal behaviors of the Alzheimer's patients were temporally linked to sleep-disordered breathing. The current data suggest that sleep-disordered breathing in nonmedicated Alzheimer's patients is relatively mild and is not a predictor of either overnight mental status changes, of disruptive nocturnal behaviors, or of daytime behavioral fluctuations. Additional studies of more severely demented patients and possibly of sleeping pill effects would be useful in further evaluating the role of sleep apnea in Alzheimer behavioral changes.
在一项针对15名疑似阿尔茨海默病患者和12名健康老年对照受试者的研究中，阿尔茨海默病患者的呼吸暂停指数显著更高（患者与对照组，均值±标准差：6.3±6.6 vs 1.8±2.7，P<0.05），且呼吸暂停的最大持续时间更长（患者与对照组，中位数：50.0 vs 28.5秒，P<0.001），但与对照组相比，氧合血红蛋白去饱和没有显著增加。（公认的异常正常阈值是呼吸暂停指数大于5。）尽管七项心理测量测试中的三项（奇偶、类别检索、面手测试）在其一个或多个子分数上显示出昼夜效应，阿尔茨海默病患者上午测试的分数明显低于下午测试，但心理测量测试中的夜间变化分数与睡眠呼吸障碍的严重程度没有显著相关性。此外，阿尔茨海默病患者夜间干扰性（即需要干预）行为中只有18.1%与睡眠呼吸障碍在时间上相关。目前的数据表明，未用药的阿尔茨海默病患者的睡眠呼吸障碍相对较轻，不是夜间精神状态变化、夜间干扰性行为或白天行为波动的预测因素。对更严重痴呆患者以及可能的安眠药效果进行更多研究，将有助于进一步评估睡眠呼吸暂停在阿尔茨海默病行为变化中的作用。
