作者：郭芋妙，康美美，樊晓军，张连国，王蓉，聂秀红

单位：

1.100053北京市，首都医科大学宣武医院呼吸与危重症医学科 2.100053北京市，首都医科大学宣武医院中心实验室 通信作者：王蓉，E-mail：rong_wang72@aliyun.com 聂秀红，E-mail：xiuhongnie@126.com

Units：

1.Department of Respiratory and Critical Care Medicine, Xuanwu Hospital of Capital Medical University, Beijing 100053,China 2.Central Laboratory, Xuanwu Hospital of Capital Medical University, Beijing 100053, China Corresponding author: WANG Rong, E-mail: rong_wang72@aliyun.com NIE Xiuhong, E-mail: xiuhongnie@126.com

关键词：

睡眠呼吸暂停,阻塞性; 阻塞性睡眠呼吸暂停低通气综合征; 认知障碍; 影响因素分析; 阿尔茨海默病相关神经丝蛋白; 诊断;

Keywords：

Sleep apnea, obstructive; Obstructive sleep apnea hypopnea syndrome; Cognition disorders; Root causeanalysis; Alzheimer's disease-related neurofilament protein; Diagnosis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.131

Funds：

摘要：

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者合并认知障碍的影响因素及尿液阿尔茨海默病相关神经丝蛋白（AD7c-NTP）水平对其诊断价值。方法 选择2019年6—12月就诊于首都医科大学宣武医院呼吸与危重症医学科并经多导睡眠图（PSG）监测确诊为OSAHS的患者116例。根据蒙特利尔认知评估（MoCA）量表评分，将患者分为认知正常组80例（MoCA量表评分≥26分）和认知障碍组36例（MoCA量表评分<26分）。选取同期以打鼾为主诉就诊于首都医科大学宣武医院呼吸与危重症医学科并经PSG监测排除OSAHS的正常成年人32例作为对照组。收集受试者一般资料、PSG监测指标、MoCA量表评分、尿液AD7c-NTP水平。OSAHS患者尿液AD7cNTP水平与MoCA量表评分的相关性分析采用Spearman秩相关分析；采用多因素Logistic回归分析探讨OSAHS患者合并认知障碍的影响因素；采用ROC曲线分析尿液AD7c-NTP水平对OSAHS患者合并认知障碍的诊断价值。结果 认知正常组BMI、呼吸暂停低通气指数（AHI）、睡眠时血氧饱和度<90%的时间占睡眠总时间的百分比（SLT90%）、氧减指数（ODI）高于对照组，最长呼吸暂停时间（LAT）长于对照组，睡眠时最低血氧饱和度（LSaO2）、快速眼动睡眠期睡眠时间占总睡眠时间的百分比（REM%）低于对照组（P<0.05）；认知障碍组年龄、BMI、AHI、SLT90%、ODI、尿液AD7c-NTP水平高于对照组，LAT长于对照组，LSaO2、REM%低于对照组（P<0.05）；认知障碍组BMI、AHI、SLT90%、ODI、Ⅰ+Ⅱ期睡眠时间占总睡眠时间的百分比（Ⅰ+Ⅱ%）、尿液AD7c-NTP水平高于认知正常组，LAT长于认知正常组，LSaO2、Ⅲ期睡眠时间占总睡眠时间的百分比（Ⅲ%）低于认知正常组（P<0.05）。Spearman秩相关分析结果显示，OSAHS患者尿液AD7c-NTP水平与MoCA量表评分呈负相关（rs=-0.461,P<0.001）。多因素Logistic回归分析结果显示，ODI[OR=1.03,95%CI（1.01,1.04）]、Ⅲ%[OR=0.97,95%CI（0.95,1.00）]及尿液AD7c-NTP水平[OR=3.60,95%CI（1.02,12.72）]是OSAHS患者合并认知障碍的独立影响因素（P<0.05）。ROC曲线分析结果显示，尿液AD7c-NTP水平诊断OSAHS患者合并认知障碍的AUC为0.716[95%CI（0.612,0.819）]，最佳截断值为0.5μg/L，灵敏度为80.6%，特异度为61.3%，约登指数为0.471。结论 ODI、尿液AD7cNTP水平升高是OSAHS患者合并认知障碍的危险因素，Ⅲ%升高是OSAHS患者合并认知障碍的保护因素，且尿液AD7c-NTP水平对OSAHS患者合并认知障碍具有一定诊断价值，这有助于临床早期预测OSAHS患者合并认知障碍的风险，并尽早给予相应的干预措施，以延缓疾病进展。

Abstract：

【Abstract】　Objective To investigate the influencing factors and diagnostic value of urine Alzheimer's diseaseassociated neurofilament protein (AD7c-NTP) for cognitive impairment in patients with obstructive sleep apnea hypopneasyndrome (OSAHS) . Methods A total of 116 patients who were diagnosed with OSAHS by polysomnography (PSG)monitoring and admitted to the Department of Respiratory and Critical Care Medicine of Xuanwu Hospital of Capital MedicalUniversity from June to December 2019 were selected. According to the Montreal Cognitive Assessment (MoCA) Scale score,the patients were divided into cognitive normal group (80 patients, MoCA Scale score ≥ 26) and cognitive impairment group(36 patients, MoCA Scale score < 26) . In the same period, 32 normal adults with snoring as the chief complaint and excludedOSAHS by PSG monitoring who were admitted to the Department of Respiratory and Critical Care Medicine of XuanwuHospital of Capital Medical University were selected as the control group. General data, PSG monitoring indicators, MoCAScale score and urine AD7c-NTP levels of the subjects were collected. Spearman rank correlation analysis was used to analyzethe correlation between urine AD7c-NTP levels and MoCA Scale scores in OSAHS patients. Multivariate Logistic regressionanalysis was used to investigate the influencing factors of cognitive impairment in patients with OSAHS. ROC curve was usedto analyze the diagnostic value of urine AD7c-NTP levels for cognitive impairment in patients with OSAHS. Results BMI,apnea hypopnea index (AHI) , percentage of sleep time spend when oxygen saturation lower than 90% (SLT90%) and oxygendesaturation index (ODI) in cognitive normal group were higher than those in control group, longest apnea time (LAT) waslonger than that in control group, while lowest arterial oxygen saturation (LSaO2) and percentage of rapid eye movement stagein total sleep time (REM%) were lower than those in control group (P <0.05) . Age, BMI, AHI, SLT90%, ODI and urine AD7cNTP level in cognitive impairment group were higher than those in control group, LAT was longer than that in control group,while LSaO2, REM% were lower than those in control group (P <0.05) . BMI, AHI, SLT90%, ODI, percentage of stageⅠ+Ⅱintotal sleep time (Ⅰ+Ⅱ%) and urine AD7c-NTP level in the cognitive impairment group were higher than those in the cognitivenormal group, LAT was longer than that in the cognitive normal group, while LSaO2, percentage of stage Ⅲ in total sleep time(Ⅲ%) were lower than those in the cognitive normal group (P <0.05) . Spearman rank correlation analysis showed that urineAD7c-NTP level was negatively correlated with MoCA Scale score in OSAHS patients (rs=-0.461, P <0.001) . MultivariateLogistic regression analysis showed that ODI [OR=1.03, 95%CI (1.01, 1.04) ] , Ⅲ% [OR=0.97, 95%CI (0.95, 1.00) ] and urineAD7c-NTP level [OR=3.60, 95%CI (1.02, 12.72) ] were independent influencing factors of cognitive impairment in patientswith OSAHS (P <0.05) . ROC curve analysis results showed that the AUC of urine AD7c-NTP level for the diagnosis ofcognitive impairment in patients with OSAHS was 0.716 [95%CI (0.612, 0.819) ] , the optimal cut-off value was 0.5μg/L, thesensitivity was 80.6%, the specificity was 61.3%, and the Youden index was 0.471.Conclusion Increased ODI and urinaryAD7c-NTP level are risk factors for cognitive impairment in patients with OSAHS, the increase of Ⅲ% is a protective factorfor cognitive impairment in patients with OSAHS, and the urine AD7c-NTP level has a certain diagnostic value for cognitiveimpairment in patients with OSAHS, which helps to predict the risk of cognitive impairment in patients with OSAHS early, andgive corresponding intervention measures as soon as possible to delay disease progression.

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