阻塞性睡眠呼吸暂停患者脑白质损伤与嗜睡、睡眠紊乱和认知减退关系的研究OA
The relationship between white matter injury and sleepiness,sleep disorders,and cognitive decline in patients with obstructive sleep apnea
目的 探索阻塞性睡眠呼吸暂停(OSA)患者脑白质损伤与嗜睡、睡眠质量下降和认知功能减退的关系.方法 选取2018年1月～2023年5月行多导睡眠监测(PSG)确诊为OSA患者55例,非OSA的健康对照者29名.所有受试者均行扩散峰度成像(DKI)检查及Epworth嗜睡量表(ESS)、匹兹堡睡眠质量指数(PSQI)、蒙特利尔认知评估量表(MoCA)评分,寻找峰度各向异性分数(KFA)减低的脑区并进行OSA患者KFA值减低脑区与其呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、各量表评分值之间两两的偏相关性分析.结果 OSA组在右外囊、双放射冠、双上纵束、胼胝体及后扣带回区域的KFA值低于对照组(P<0.05).在OSA组中:ESS评分与右后放射冠、左上纵束、胼胝体体部、胼胝体压部的KFA值呈负相关(r=-0.287、-0.286、-0.276、-0.449,P<0.05);PSQI评分与右后放射冠、左后放射冠、胼胝体压部的KFA值呈负相关(r=-0.390、-0.274、-0.348,P<0.05);MoCA评分与右后放射冠、右上纵束、左前放射冠、左后放射冠、左上放射冠、左上纵束、胼胝体膝部、胼胝体体部的KFA值呈正相关(r=0.290、0.389、0.298、0.278、0.340、0.473、0.344、0.344,P<0.05).视空间与执行功能评分与AHI、LSaO2、ESS评分以及右后放射冠、左上放射冠、左上纵束、胼胝体压部的KFA值呈相关性(r=-0.350、0.470、-0.343、0.401、0.284、0.387、0.274,P<0.05).结论 OSA患者存在部分脑区白质的损害,其中以胼胝体、后放射冠、上纵束的损伤对患者嗜睡、睡眠质量下降和认知功能障碍的影响最大,尤其是视空间与执行功能的下降,与放射冠和上纵束的白质损伤密切相关.
OBJECTIVE To explore the relationship between white matter damage and sleepiness,decreased sleep quality,and cognitive decline in patients with OSA.METHODS There were 55 confirmed cases of OSA diagnosed by polysomnography(PSG)from January 2018 to May 2023 were selected,with 29 non-OSA controls also diagnosed by PSG.DKI scanning and Epworth sleepiness scale(ESS),Pittsburgh sleep quality index(PSQI),and Montreal cognitive assessment(MoCA)scores were performed for all subjects.Differences in kurtosis fractional anisotropy(KFA)of various brain regions were compared between the two groups to identify differential brain regions,and pairwise correlations were analyzed between KFA reduction and apnea-hypopnea index(AHI),lowest oxygen saturation(LSaO2)and various scale scores in OSA patients.RESULTS The KFA values in right external capsule,bilateral corona radiata,bilateral superior longitudinal fasciculus,corpus callosum,posterior cingulate gyrus of OSA group were lower than control group(P<0.05).For the OSA group:The correlation between ESS scores and KFA values of right posterior corona radiata,left superior longitudinal fasciculus,body of corpus callosum,splenium of corpus callosum are all negative(r=-0.287,-0.286,-0.276,-0.449,P<0.05).The correlation between PSQI scores and KFA values of right posterior corona radiata,left posterior corona radiata,splenium of corpus callosum are all negative(r=-0.390,-0.274,-0.348,P<0.05).The correlation between MoCA scores and KFA values of right posterior corona radiata,right superior longitudinal fasciculus,left anterior corona radiata,left posterior corona radiata,left superior corona radiata,left superior longitudinal fasciculus,genu of corpus callosum,body of corpus callosum,are all positive(r=0.290,0.389,0.298,0.278,0.340,0.473,0.344,0.344,P<0.05).The correlation between visuospatial and executive function scores and AHI,LSaO2,ESS scores and KFA values of right posterior corona radiata,left superior corona radiata,left superior longitudinal fasciculus and splenium of corpus callosum are all significant(r=-0.350,0.470,-0.343,0.401,0.284,0.387,0.274,P<0.05).CONCLUSION Patients with OSA exhibit damage to the white matter in certain brain regions.The damage to the corpus callosum,posterior corona radiata,and superior longitudinal fasciculus has the greatest impact on patients'sleepiness,reduced sleep quality,and cognitive impairment.In particular,the impairment in visuospatial and executive function is closely associated with white matter damage in the corona radiata and superior longitudinal fasciculus.
翟曜耀;刘晓霞;孟婵;赵蕾;张志明;吴大海
中国人民解放军北部战区总医院耳鼻咽喉头颈外科,辽宁 沈阳 110015中国医科大学附属盛京医院放射科,辽宁 沈阳 110004中国人民解放军北部战区总医院耳鼻咽喉头颈外科,辽宁 沈阳 110015中国人民解放军北部战区总医院耳鼻咽喉头颈外科,辽宁 沈阳 110015中国人民解放军北部战区总医院耳鼻咽喉头颈外科,辽宁 沈阳 110015中国人民解放军北部战区总医院耳鼻咽喉头颈外科,辽宁 沈阳 110015
阻塞性睡眠呼吸暂停白质扩散峰度成像视空间与执行功能
Obstructive sleep apneaWhite matterDiffusion kurtosis imagingVisuospatial and executive function
《中国耳鼻咽喉头颈外科》 2025 (4)
244-250,7
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