阻塞性睡眠呼吸暂停与老年人 5 年认知能力下降。
Obstructive sleep apnoea and 5-year cognitive decline in the elderly.
机构信息
Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
出版信息
Eur Respir J. 2023 Apr 27;61(4). doi: 10.1183/13993003.01621-2022. Print 2023 Apr.
BACKGROUND
The relationship between obstructive sleep apnoea (OSA) and cognitive decline remains controversial, especially in the elderly population. We used data from the HypnoLaus study to assess associations between OSA and longitudinal cognitive changes in a sample of community-dwelling elderly individuals.
METHODS
We studied associations between polysomnographic OSA parameters (of breathing/hypoxaemia and sleep fragmentation) and cognitive changes over a 5-year period, after adjustment for potential confounders. The primary outcome was the annual change in cognitive scores. The moderating effects of age, sex and apolipoprotein E4 (ApoE4) status were also examined.
RESULTS
358 elderly individuals without dementia were included (mean±sd age 71.0±4.2 years; 42.5% males). A lower mean peripheral oxygen saturation ( ) during sleep was associated with a steeper decline in Mini-Mental State Examination (= -0.12, p=0.004), Stroop test condition 1 (=0.53, p=0.002) and Free and Cued Selective Reminding Test delayed free recall (= -0.05, p=0.008). A longer time spent asleep with <90% was associated with a steeper decline in Stroop test condition 1 (=0.47, p=0.006). Moderation analysis showed that apnoea-hypopnoea index and oxygen desaturation index were associated with a steeper decline in global cognitive function, processing speed and executive function only in older participants, men and ApoE4 carriers.
CONCLUSIONS
Our results provide evidence of the contribution of OSA and nocturnal hypoxaemia to cognitive decline in the elderly population.
背景
阻塞性睡眠呼吸暂停（OSA）与认知能力下降之间的关系仍存在争议，尤其是在老年人群中。我们使用 HypnoLaus 研究的数据，评估了 OSA 与社区居住的老年个体样本中纵向认知变化之间的关系。
方法
我们研究了多导睡眠图 OSA 参数（呼吸/低氧血症和睡眠碎片化）与 5 年内认知变化之间的关系，调整了潜在混杂因素。主要结果是认知评分的年变化率。还检查了年龄、性别和载脂蛋白 E4（ApoE4）状态的调节作用。
结果
共纳入 358 名无痴呆的老年个体（平均年龄 71.0±4.2 岁；42.5%为男性）。睡眠期间平均外周血氧饱和度（ ）较低与简易精神状态检查（Mini-Mental State Examination，MMSE）得分下降速度加快（ =−0.12，p=0.004）、Stroop 测试条件 1（ =0.53，p=0.002）和自由和线索选择性记忆测试延迟自由回忆（ =−0.05，p=0.008）有关。睡眠时间中 ＜90%的时间与 Stroop 测试条件 1 得分下降速度加快有关（ =0.47，p=0.006）。调节分析表明，呼吸暂停-低通气指数和氧减指数与全球认知功能、处理速度和执行功能的下降速度加快有关，仅在年龄较大的参与者、男性和 ApoE4 携带者中。
结论
我们的研究结果提供了证据表明 OSA 和夜间低氧血症对老年人群认知能力下降的影响。
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