睡眠结构、通气氧合水平与阻塞性睡眠呼吸暂停合并亚临床抑郁患者人际反应、快感及认知的关系

颜蓉; 潘友让

doi:10.16766/j.cnki.issn.1674-4152.003189

睡眠结构、通气氧合水平与阻塞性睡眠呼吸暂停合并亚临床抑郁患者人际反应、快感及认知的关系

doi: 10.16766/j.cnki.issn.1674-4152.003189

颜蓉^,,
潘友让

绍兴市第七人民医院精神科，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2023RC292

详细信息

通讯作者:
颜蓉，E-mail: 276903303@qq.com

中图分类号: R443.6 R766.3
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出版历程
- 收稿日期: 2023-05-29
- 网络出版日期: 2023-11-23

Relationship between sleep structure, ventilation oxygenation level and interpersonal response, pleasure and cognition in patients with obstructive sleep apnea complicated with subclinical depression

YAN Rong^,,
PAN Yourang

Department of Psychiatry, the Seventh People' s Hospital of Shaoxing, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的通过量表评估阻塞性睡眠呼吸暂停(OSA)合并亚临床抑郁(SD)患者睡眠结构、通气氧合水平、共情(人际反应)、快感和认知灵活性，探讨睡眠数据与人际反应、快感及认知灵活性的关系。方法选取绍兴市第七人民医院2022年5月—2023年5月门诊或住院确诊OSA合并SD患者37例作为OSA合并SD组，同期非SD的OSA患者65例作为OSA组。比较2组患者睡眠结构、睡眠通气氧合状态、共情、快感及认知灵活性等指标；并针对有差异的睡眠指标与情致认知指标间行Pearson(或Spearman)相关分析。结果 OSA合并SD患者睡眠效率(SE)与人际反应指标个人痛苦(r=-0.668)和共情关心(r=-0.579)呈负相关关系，与快感体验的抽象(r=0.664)、具体(r=0.597)预期快感和抽象完成快感(r=0.770)呈正相关关系，与认知灵活性中错误应答数(Re)、持续性错误数(Rpe)维度负向相关系数可达0.5以上。睡眠潜伏期(SL)主要与个人痛苦(r=0.546)和抽象完成快感(r=-0.574)具有一定的相关性。快速眼球运动睡眠百分比(REM%)与共情指标中的个人痛苦和大多数快感评估指标相关系数均在0.5以上，微觉醒指数则重点影响患者共情状态(均r＞0.5)。呼吸暂停低通气指数(AHI)与氧减指数(ODI)同患者情致、认知指标均具有一定的相关性(均|r|＞0.5)。结论 OSA合并SD患者睡眠结构、通气氧合状态对其人际反应、快感感受以及认知灵活性造成一定的影响，部分指标间存在显著相关关系。
- 阻塞性睡眠呼吸暂停 /
- 亚临床抑郁 /
- 睡眠结构 /
- 通气氧合状态 /
- 人际反应 /
- 快感 /
- 认知灵活性
Abstract: Objective The sleep structure, ventilation oxygenation level, empathy (interpersonal response), pleasure and cognitive flexibility of patients with obstructive sleep apnea (OSA) and subclinical depression (SD) were evaluated by the scale, and the relationship between sleep data and affective cognitive indicators was explored. Methods Thirty-seven patients with confirmed outpatient or inpatient diagnosis of OSA combined with SD in the Seventh People' s Hospital of Shaoxing City from May 2022 to May 2023 were selected as the OSA combined with SD group, and 65 OSA patients with non-SD during the same period were selected as the OSA group. The patients' sleep structure, sleep ventilation oxygenation status, empathy, pleasure and cognitive flexibility were compared. Pearson (or Spearman) correlation analysis was performed between different sleep indicators and emotional cognitive indicators. Results The sleep efficiency (SE) of OSA patients with SD was significantly negatively correlated with the interpersonal response indicators of personal pain (r=-0.668) and empathic concern (r=-0.579), positively correlated with the abstraction (r=0.664), concrete expected pleasure (r=0.597) and abstract completion pleasure (r=0.770) of pleasure experience, and negatively correlated with the number of error responses (Re) and the number of persistent errors (Rpe) in cognitive flexibility could reach more than 0.5. The sleep latency (SL) was mainly correlated with personal pain (r=0.546) and abstract completion pleasure (r=-0.574). The percentage of rapid eye movement sleep (REM%) were more than 0.5 correlated with personal pain and most pleasure assessment indicators in empathy indicators, and the microarousal index focused on the empathy status of patients (all r>0.5). The apnea hypopnea index (AHI) and oxygen desaturation index (ODI) were correlated with the patient' s emotional and cognitive indicators (|r|>0.5). Conclusion The sleep structure and oxygenation status of OSA patients with SD have a certain impact on their interpersonal response, pleasure and cognitive flexibility, and there is a significant correlation between some indicators.
- Obstructive sleep apnea /
- Subclinical depression /
- Sleep structure /
- Ventilation oxygenation state /
- Interpersonal response /
- Pleasure /
- Cognitive flexibility

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表 1 2组阻塞性睡眠呼吸暂停患者基线资料比较

Table 1. Comparison of baseline data in two groups of obstructive sleep apnea patients

组别	例数	性别 (男性/女性，例)	年龄 (x±s，岁)	BMI (x±s)	高血压 [例(%)]	糖尿病 [例(%)]	高血脂 [例(%)]
OSA合并SD组	37	23/14	58.14±13.20	24.52±1.62	17(45.95)	12(32.43)	13(35.14)
OSA组	65	40/25	63.04±12.01	24.01±1.47	26(40.00)	19(29.23)	21(32.31)
统计量		0.004^a	1.904^b	1.604^b	0.432^a	0.114^a	0.085^a
P值		0.950	0.060	0.112	0.559	0.735	0.771
注：^a为χ²值，^b为t值。

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表 2 2组阻塞性睡眠呼吸暂停患者睡眠结构比较(x±s)

Table 2. Comparison of sleep structure in two groups of obstructive sleep apnea patients (x±s)

组别	例数	TST(min)	SE(%)	SL(min)	REM%	微觉醒指数(次/h)
OSA合并SD组	37	375.72±35.43	62.28±8.57	35.89±7.58	14.97±3.26	30.58±6.91
OSA组	65	382.24±31.70	67.67±7.21	32.68±6.92	16.56±3.42	27.30±7.42
t值		0.952	3.372	2.162	2.275	2.184
P值		0.343	0.001	0.033	0.025	0.031

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表 3 2组阻塞性睡眠呼吸暂停患者通气、耗氧情况比较

Table 3. Comparison of ventilation and oxygen consumption in two groups of patients with obstructive sleep apnea

组别	例数	AHI (x±s，次/h)	ODI (x±s，次/h)	LSaO₂ (x±s，%)	MSaO₂ [M(P₂₅, P₇₅), %]
OSA合并SD组	37	22.08±7.98	19.92±7.27	76.86±6.39	89.50(87.25, 94.00)
OSA组	65	18.03±7.53	15.80±7.18	80.98±6.04	91.00(89.00, 93.25)
统计量		2.543^a	2.753^a	3.228^a	-1.594^b
P值		0.013	0.007	0.002	0.111
注：^a为t值，^b为Z值。

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表 4 2组阻塞性睡眠呼吸暂停患者IRI-C各维度评分及总分比较(分)

Table 4. Comparison of IRI-C dimensional scores and total scores between two groups of patients with obstructive sleep apnea (points)

组别	例数	观点采择[M(P₂₅, P₇₅)]	个人痛苦(x±s)	想象力(x±s)	共情关心(x±s)	总分(x±s)
OSA合并SD组	37	9.00(8.00, 12.00)	9.22±2.52	12.39±2.00	15.11±2.50	46.42±4.34
OSA组	65	10.00(8.00, 12.00)	7.82±2.33	11.67±2.26	11.97±2.00	41.53±5.05
统计量		-0.621^a	2.828^b	1.274^b	6.924^b	4.901^b
P值		0.534	0.006	0.078	＜0.001	＜0.001
注：^a为Z值，^b为t值。

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表 5 2组阻塞性睡眠呼吸暂停患者TEPS各维度评分及总分比较(分)

Table 5. Comparison of TEPS dimensional scores and total scores between two groups of patients with obstructive sleep apnea (points)

组别	例数	抽象预期快感 (x±s)	具体预期快感 [M(P₂₅, P₇₅)]	抽象完成性快感 (x±s)	具体完成性快感 (x±s)	总分 (x±s)
OSA合并SD组	37	14.81±2.39	13.00(12.00, 15.00)	23.14±3.21	14.14±2.23	65.67±5.48
OSA组	65	15.82±2.18	15.00(13.00, 17.00)	24.62±2.72	14.65±2.42	70.03±3.83
统计量		2.165^a	-2.938^b	2.469^a	1.050^a	4.700^a
P值		0.033	0.003	0.015	0.296	＜0.001
注：^a为t值，^b为Z值。

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表 6 2组阻塞性睡眠呼吸暂停患者WCST测试评分比较

Table 6. Comparison of WCST test scores between two groups of patients with obstructive sleep apnea

组别	例数	Rc (x±s，次)	Re (x±s，次)	Rpe (x±s，次)	Cc [M(P₂₅, P₇₅)]
OSA合并SD组	37	61.08±2.96	42.03±3.75	22.94±2.12	2.00(2.00, 3.00)
OSA组	65	62.33±3.26	40.06±3.64	21.39±2.44	2.00(3.00, 3.00)
统计量		1.910^a	2.580^a	2.310^a	-1.386^b
P值		0.059	0.011	0.002	0.166
注：^a为t值，^b为Z值。

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表 7 OSA合并SD患者睡眠结构、通气耗氧水平与人际反应、快感以及认知灵活性的相关性

Table 7. Correlation analysis between sleep structure, ventilation, oxygen consumption, and interpersonal reactivity, pleasure, and cognitive flexibility in patients with OSA and SD

指标	类别	统计量	IRI-C			TEPS				WCST测试
指标	类别	统计量	个人痛苦^a	共情关心^a	总分^a	抽象预期快感^a	具体预期快感^b	抽象完成快感^a	总分^a	Re^a	Rpe^a
睡眠结构指标	SE(%)	r值	-0.668	-0.597	-0.567	0.664	0.597	0.770	0.456	-0.516	-0.506
		P值	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	0.005	0.001	0.002
	SL(min)	r值	0.546	0.436	0.498	-0.353	-0.246	-0.574	-0.409	0.427	0.473
		P值	0.001	0.008	0.002	0.035	0.148	＜0.001	0.013	0.009	0.004
	REM%	r值	-0.593	-0.415	-0.456	0.538	0.621	0.544	0.597	-0.340	-0.400
		P值	＜0.001	0.012	0.005	0.001	＜0.001	0.001	＜0.001	0.042	0.016
	微觉醒指数(次/h)	r值	0.520	0.586	0.466	-0.429	-0.360	-0.396	-0.403	0.354	0.397
		P值	0.001	＜0.001	0.004	0.009	0.031	0.017	0.015	0.034	0.016
通气氧合指标	AHI(次/h)	r值	0.627	0.529	0.544	0.506	0.574	0.501	0.542	0.491	0.584
		P值	＜0.001	0.001	0.001	0.002	＜0.001	0.002	0.001	0.002	＜0.001
	ODI(次/h)	r值	0.590	0.535	0.519	0.491	0.534	0.534	0.515	0.520	0.553
		P值	＜0.001	0.001	0.001	0.002	0.001	0.001	0.001	0.001	＜0.001
	LSaO₂(%)	r值	-0.485	-0.385	-0.421	0.431	0.346	0.370	0.361	-0.212	-0.223
		P值	0.003	0.020	0.011	0.009	0.039	0.026	0.031	0.215	0.192
注：^a为正态分布计量资料，采用Pearson相关分析；^b为非正态分布计量资料，采用Spearman相关分析。

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