改良悬雍垂腭咽成形术治疗OSAHS伴认知功能障碍患者疗效及对呼吸功能脑电图和MMSE评分的影响

doi:10.3969/j.issn.1006-6233.2023.09.024

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摘要 目的: 观察改良悬雍垂腭咽成形术(H-UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴认知功能障碍患者疗效及对呼吸功能、脑电图和蒙特利尔认知评估量表(MMSE)评分的影响。方法: 选取雅安市人民医院耳鼻喉头颈外科于2020年2月至2022年2月收治的中重度OSAHS伴认知功能障碍患者124例为研究对象,采用简单随机法分为两组,单组62例。保守组采用行为治疗干预,观察组采用H-UPPP联合行为治疗干预。比较两组多导睡眠参数、蒙特利尔认知评估量表(MOCA)评分、睡眠评估量表(ESS)评分、LMT延迟回忆(LMT DR)评分、Rey-Osterrieth复杂图形测试(CFT)、逻辑记忆测试(LMT)、CFT延迟回忆(CFT DR)评分、MMSE评分及P300潜伏期的差异,统计两组6个月后脑电图异常率和总有效率。结果: 保守组治疗6个月后呼吸暂停低通气指数(AHI)较前下降,LSpO₂较前升高(P<0.05)。观察组治疗6个月后AHI、SaO₂<90%的时间占总监测时间百分比(TS90%)、(N1+N2)%较前下降,LSpO₂、N3%、快眼动睡眠期占总监测时间百分比(REM%)较前升高(P<0.05)。观察组AHI、LSpO₂、TS90%、(N1+N2)%、N3%、REM%治疗前后差值高于保守组(P<0.05)。保守组治疗6个月后ESS评分较前下降(P<0.05)。观察组治疗6个月后ESS评分较前下降,MMSE评分、MOCA评分较前升高(P<0.05)。观察组治疗6个月后ESS评分低于保守组(P<0.05)。保守组治疗6个月后CFT、LMT评分及其延迟回忆评分与治疗前比较,差异无统计学意义(P>0.05)。观察组治疗6个月后LMT评分、LMT DR评分较前升高,但CFT评分、CFT DR评分与治疗前比较,差异无统计学意义(P>0.05)。观察组MMSE评分、MOCA评分、ESS评分治疗前后差值高于保守组(P<0.05)。保守组治疗6个月后P300潜伏期结果与治疗前比较,差异无统计学意义(P>0.05)。观察组治疗6个月后Fz、Cz、Pz、C4点P300潜伏期较前下降,但C3点P300潜伏期与治疗前比较,差异无统计学意义(P>0.05)。观察组P300潜伏期治疗前后差值高于保守组(P<0.05)。观察组6个月后脑电图异常率为24.19%(15/62)明显低于保守组的50.00%(31/62),总有效率为88.71%(55/62)明显高于保守组的56.45%(35/62),有统计学差异(P<0.05)。结论: 改良悬雍垂腭咽成形术治疗OSAHS伴认知功能障碍可有效改善患者睡眠结构和脑电活动状态,有利于患者认知功能的恢复。

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关键词 ：改良悬雍垂腭咽成形术, 阻塞性睡眠呼吸暂停低通气综合征, 认知功能障碍, 睡眠结构, 脑电活动状态, 呼吸功能

Abstract：Objective: To observe the curative effect of modified uvulopalatopharyngoplasty (H-UPPP) in the treatment of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) with cognitive impairment and the effects on respiratory function, electroencephalogram and Montreal cognitive assessment scale ( MMSE) score. Methods: A total of 124 patients with moderate and severe OSAHS and cognitive impairment who were admitted to the Department of Otolaryngology, Head and Neck Surgery of Ya'an People's Hospital from February 2020 to February 2022 were selected as the research subjects. They were divided into two groups by simple random method, 62 patients in each group. The conservative group was treated with behavioral therapy intervention, and the observation group was treated with H-UPPP combined with behavioral therapy intervention. The differences of polysomnography parameters, Montreal Cognitive Assessment Scale (MOCA) score, Sleep Assessment Scale (ESS) score, LMT Delayed Recall (LMT DR) score, Rey Osterlieth Complex Graph Test (CFT), Logical Memory Test (LMT), CFT Delayed Recall (CFT DR) score, MMSE score and P300 latency between the two groups were compared, and the abnormal rate and total effective rate of EEG in the two groups after 6 months were counted. Results: The apnea hypopnea index (AHI) decreased and LSpO2 increased in conservative group after 6 months of treatment (P<0.05). After 6 months of treatment, AHI and SaO2<90% accounted for the percentage of total monitoring time (TS90%) and (N1+N2) % in the observation group decreased, while LSpO2, N3% and REM sleep period accounted for the percentage of total monitoring time (REM%) increased (P<0.05). The differences of AHI, LSpO2, TS90%, (N1+N2) %, N3% and REM% before and after treatment in observation group were higher than those in conservative group (P<0.05). ESS score in conservative group decreased after 6 months of treatment (P<0.05). After 6 months of treatment, ESS score decreased, MMSE score and MOCA score increased in observation group (P<0.05). The ESS score of observation group was lower than that of conservative group after 6 months of treatment (P<0.05). There was no significant difference in CFT, LMT, and delayed recall scores in the conservative group after 6 months of treatment compared with those before treatment (P>0.05). After 6 months of treatment, the LMT score and the LMT DR Score in the observation group were higher than before, but there was no statistical significance in CFT score and CFT DR Score compared with before treatment (P>0.05). The difference of MMSE score, MOCA score and ESS score before and after treatment in observation group was higher than that in conservative group (P<0.05). There was no significant difference in P300 incubation period in the conservative group after 6 months of treatment compared with before treatment (P>0.05). After 6 months of treatment, the latency of P300 at Fz, Cz, Pz and C4 points decreased, but there was no significant difference in the latency of P300 at C3 points compared with before treatment (P>0.05). The difference of P300 latency before and after treatment in observation group was higher than that in conservative group (P<0.05). After 6 months, the abnormal rate of EEG in the observation group was 24.19% (15/62), which was significantly lower than that in the conservative group (50.00% (31/62), and the total effective rate was 88.71% (55/62), which was significantly higher than that in the conservative group (56.45% (35/62), with statistical difference (P>0.05).Conclusion: Modified uvulopalatopharyngoplasty in the treatment of OSAHS with cognitive impairment can effectively improve the sleep structure and EEG activity status of patients, and is conducive to the recovery of cognitive function of patients.

Key words： Modified uvulopalatopharyngoplasty Obstructive sleep apnea hypopnea syndrome Cognitive dysfunction Sleep structure EEG activity status Respiratory function

基金资助:四川省医学科研课题,(编号:S20049)

通讯作者: 徐艳红

引用本文:

朱玉博, 程蕾蕾, 朱荣飞, 刘秋蕊, 徐艳红. 改良悬雍垂腭咽成形术治疗OSAHS伴认知功能障碍患者疗效及对呼吸功能脑电图和MMSE评分的影响[J]. 河北医学, 2023, 29(9): 1543-1548.
ZHU Yubo, CHENG Leilei, ZHU Rongfei, et al. Efficacy of Modified Uvulopalatopharyngoplasty in the Treatment of OSAHS Patients with Cognitive Impairment and Its Effect on Respiratory Function, Electroencephalogram and MMSE Score. HeBei Med, 2023, 29(9): 1543-1548.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.09.024 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I9/1543

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