Clinical characteristics of mild cognitive impairment in patients with hypertension and obstructive sleep apnea syndrome
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摘要:
目的 探讨高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者轻度认知功能障碍(MCI)的临床特点及相关风险因素。 方法 连续选取2021年4—10月在新疆维吾尔自治区人民医院高血压专科住院患者120例，所有患者均完善整夜多导睡眠监测、24小时动态血压及蒙特利尔认知评估量表(MoCA)，MoCA评分 < 26定义为MCI。比较认知正常组(39例)与MCI组(81例)睡眠参数、动态血压水平等特点，并探讨MCI相关风险因素。 结果 总体人群中MCI检出率为67.5%(81/120)；与认知功能正常组相比，MCI组夜间最低氧饱和度[81.0(77.0，85.0)% vs. 86.0(79.0，88.0)%]下降，呼吸暂停低通气指数[20.1(15.3，31.6)次/h vs. 6.7(2.6，26.1)次/h]、血氧饱和度 < 90%的时间[27.2(5.3，80.4) min vs. 6.9(0.4，79.1)min]升高，在视空间/执行功能[3(2, 3)分vs. 4(3, 5)分]、注意力[5(5, 6)分vs. 6(6, 6)分]、延迟回忆[2(1, 3)分vs. 3(3, 4)分]、抽象思维[1(0, 1)分vs. 2(1, 2)分]认知领域明显减低(均P < 0.05)。多元logistic回归显示，夜间最低氧饱和度是影响该人群发生MCI的独立危险因素。 结论 高血压合并OSAS患者MCI检出率高，夜间最低氧饱和度低是该人群MCI患病率高的危险因素。 -
关键词:
- 高血压 /
- 阻塞性睡眠呼吸暂停综合征 /
- 轻度认知障碍
Abstract:Objective To investigate the clinical features and associated risk factors of mild cognitive impairment (MCI) in patients with hypertension and obstructive sleep apnea syndrome (OSAS). Methods A total of 120 patients with hypertension who were hospitalized in the People' s Hospital of Xinjiang Uygur Autonomous Region from April to October 2021 and completed overnight polysomnographic monitoring or diagnosis of OSAS were consecutively selected. All patients were evaluated by 24-hour ambulatory blood pressure and Montreal cognitive assessment scale (MoCA), and MoCA score < 26 was defined as MCI. The characteristics of sleep parameters and ambulatory blood pressure were compared between the cognitively normal group (39 cases) and the MCI group (81 cases), and associated risk factors were discussed. Results The detection rate of MCI in the general population was 67.5%(81/120); Compared with the normal cognitive function group, the nighttime minimum oxygen saturation[81.0(77.0, 85.0)% vs.86.0(79.0, 88.0)%] decreased in the MCI group, while AHI[20.1(15.3, 31.6) times/h vs. 6.7(2.6, 26.1) times/h], T90[27.2(5.3, 80.4) min vs. 6.9(0.4, 79.1) min], in visual space/execution function[3(2, 3) points vs. (4(3, 5) points], attention [5(5, 6) points vs. 6(6, 6) points], delay recall [2(1, 3) points vs.3(3, 4) points], abstract thinking [1(0, 1) points vs.2(1, 2) points], cognitive domains were significantly reduced (all P < 0.05). Multivariate logistic regression showed that the lowest oxygen saturation at night was independent risk factor for MCI in this population. Conclusion The high prevalence of MCI in hypertensive patients with OSAS, short education and low nocturnal minimum oxygen saturation are the risk factors for the high prevalence of MCI in this population. -
表 1 认知正常组和MCI组患者一般临床资料比较
Table 1. Comparison of general clinical data between the cognitively normal group and the MCI group
项目 总人数(n=120) 认知正常组(n=39) MCI组(n=81) 统计量 P值 性别(男性/女性，例) 83/37 27/12 56/25 < 0.001a 0.992 年龄(x±s，岁) 49.5±11.1 45.0±8.8 51.7±11.4 3.191b 0.002 受教育年限[M(P25, P75)，年] 12(12，16) 16(12，16) 15(9，15) -3.118c 0.002 人体学测量 BMI(x±s) 26.8±3.3 26.3±3.6 27.0±3.2 0.986b 0.326 颈围(x±s，cm) 39.5±4.0 38.9±3.8 39.8±4.0 1.156b 0.250 腹围(x±s，cm) 95.8±9.9 94.1±11.1 96.7±9.2 1.369b 0.174 甘油三酯(x±s，mmol/L) 1.7(1.3，16) 1.5(1.1，2.2) 1.82(1.4，2.5) -2.049c 0.040 总胆固醇(x±s，mmol/L) 4.6±1.2 4.7±1.0 4.5±1.3 -0.929b 0.355 空腹血糖(x±s，mmol/L) 4.8(4.4，5.4) 4.9(4.4，5.4) 4.8(4.3，5.3) -0.609c 0.540 全天收缩压平均值 133.5(126.0, 142.0) 132.0(125. 0, 137.0) 136.0(126.0, 144.5) -1.343c 0.179 全天舒张压平均值 88.5±11.0 88.5±9.2 88.6±11.8 0.055b 0.956 PSG参数 最低氧饱和度[M(P25, P75)，%] 82.0(77.0，86.0) 86.0(79.0，88.0) 81.0(77.0，85.0) -2.714c 0.007 AHI[M(P25, P75)，次/h] 18.3(10.3，28.9) 6.7(2.6，26.1) 20.1(15.3，31.6) -3.432c 0.001 T90[M(P25, P75)，min] 19.3(3.6，79.3) 6.9(0.4，79.1) 27.2(5.3，80.4) -2.393c 0.017 N1%[M(P25, P75)] 6.2(4.6，9.4) 5.2(3.7，7.8) 7.8(5.5，9.5) -3.234c 0.001 N2%(x±s) 68.9±8.8 70.5±8.1 68.1±9.0 -1.420b 0.159 N3%[M(P25, P75)] 6.5(1.9，3.7) 6.7(2.5，10.9) 7.0(1.2，13.7) -0.009c 0.993 总睡眠时间(x±s, min) 374.2±82.9 404.5±72.3 359.7±84.1 -2.858b 0.005 睡眠效率(x±s, %) 69.2±15.1 74.4±14.7 66.6±14.6 -2.670b 0.009 注：N1%为1期睡眠，N2%为2期睡眠，N3%为3期睡眠；a为χ2值，b为t值，c为Z值。 
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表 2 2组研究对象认知功能MoCA量表评分比较[M(P25, P75)，分]
Table 2. Comparison of MoCA scores of cognitive function between two groups [M(P25, P75), points]
组别 例数 视空间/执行功能 命名 注意力 语言 抽象思维 延迟回忆 定向力 总分 认知正常组 39 4(3, 5) 3(3, 3) 6(6, 6) 3(2, 3) 2(1, 2) 3(3, 4) 6(6, 6) 27(26, 27) MCI组 81 3(2, 3) 3(3, 3) 5(5, 6) 2(2, 3) 1(0, 1) 2(1, 3) 6(6, 6) 23(21, 24) Z值 -5.598 -0.531 -3.840 -1.949 -4.944 -5.194 -1.441 -8.908 P值 < 0.001 0.596 < 0.001 0.051 < 0.001 < 0.001 0.150 < 0.001
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表 3 不同亚组人群MCI的检出率比较
Table 3. Comparison of MCI detection rate in different subgroups
项目 例数 认知障碍(例) MCI检出率(%) χ2值 P值 年龄 < 44岁 40 22 55.0a 10.556 0.005 45~59岁 64 43 67.1a ≥60岁 16 16 100.0 受教育年限 6~11年 26 21 80.7b 11.128 0.004 12~15年 54 41 75.9b ≥16年 40 19 47.5 最低血氧饱和度 ≥85% 43 21 48.8 11.755 0.003 80%~84% 37 31 83.7c < 80% 40 29 72.5 注：与年龄≥60岁比较, aP < 0.05;与受教育年限≥16年比较, bP < 0.05;与最低血氧饱和度≥85%比较, cP < 0.05。
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表 4 高血压与OSAS交互作用及与MoCA评分的相关性(x±s)
Table 4. The interaction between hypertension and OSAS and its correlation with MoCA score(x±s)
AHI(次/h) 24 h MSBP < 135 mmHg 24 h MSBP≥135 mmHg < 15 25.6±1.9a 24.5±2.9a ≥15 23.9±2.9ab 22.5±2.5 注：与24 h MSBP≥135 mmHg合并AHI≥15次/h比较，aP < 0.05；与24 h MSBP < 135 mmHg合并AHI < 15次/h比较，bP < 0.05。
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表 5 影响高血压合并OSAS患者发生MCI的多因素logistic回归分析
Table 5. Multivariate Logistic Regression Analysis of MCI in Hypertensive Patients with OSAS
变量 B SE Wald χ2 P值 OR值 95% CI 年龄 -0.035 0.026 1.765 0.184 0.966 0.918~1.017 受教育年限(12~15年) -0.823 0.742 1.230 0.267 0.439 0.103~1.880 受教育年限(≥16年) -1.202 0.558 4.649 0.031 0.300 0.101~0.896 夜间最低氧饱和度(80%~84%) 1.286 0.613 4.400 0.036 3.619 1.088~12.037 夜间最低氧饱和度(< 80%) -0.927 0.685 1.830 0.176 0.396 0.103~1.516 N1% -0.154 0.074 4.291 0.038 0.857 0.741~0.992 睡眠效率% -0.005 0.031 0.023 0.881 0.995 0.937~1.058 总睡眠时间 0.012 0.006 3.675 0.055 1.012 0.937~1.058
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