阻塞性睡眠呼吸暂停综合征合并高血压患者认知障碍情况及危险因素分析

摘要

目的：观察阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）合并高血压患者认知障碍情况，并探讨其危险因素。方法选取本院2010年2月至2016年2月收治的436例OSAS合并高血压患者为研究对象，采用蒙特利尔认知评估量表（Montreal cognitive assessment scale， MoCA）评价患者认知功能，并将MoCA评分＜26分的患者纳入认知障碍组，MoCA评分≥26分的患者纳入认知正常组，计算患者认知障碍发生率并比较不同人口学特征患者认知障碍发生情况，将存在统计学差异的因素纳入Logistic多因素回归分析，总结影响OSAS合并高血压患者发生认知障碍的危险因素。结果436例患者中，185例MoCA评分＜26分，认知障碍发生率为42.43%。认知障碍组与认知正常组患者视空间/执行能力、延迟记忆力、注意力及MoCA总分比较差异均具有显著性（P＜0.05）。多因素Logistic回归分析显示，年龄≥60岁、体重指数（body mass index，BMI）＞25.0 kg/m2、农民、居住于农村、不参加社会活动及失眠是影响OSAS合并高血压患者发生认知障碍的独立危险因素（P＜0.05）。结论 OSAS合并高血压患者具有较高的认知障碍发生风险，与其年龄较高、职业、居住情况等不可控危险因素有关，也与BMI和生活方式等可控危险因素有关，明确患者存在的可控危险因素并实施早期干预有望延缓认知功能损伤，降低认知障碍发生风险。%Objective To investigate the cognitive impairment in patients with obstructive sleep apnea syndrome (OSAS) complicated with hypertension and to explore the risk factors of patients with OSAS. Method From February 2010 to February 2016, 436 cases of OSAS patients with hypertension in our hospital were selected as the research objects, the Montreal cognitive assessment scale (MoCA) was used to evaluate the cognitive function, and the MoCA score< 26 points were included into cognitive impairment group, MoCA score ≥ 26 points were included into cognitive normal group. Calculated and compared the incidence of cognitive impairment the different demographic characteristics of patients with cognitive disorder, there will be significant factors into Logistic regression analysis, the risk factors of OSAS patients complicated with hypertension and summarized the influence of cognitive impairment. Result Among the 436 patients, 185 patients with MoCA score<26 points, the incidence of cognitive impairment was 42.43%. The differences were statistically significant between cognitive impairment group and cognitive normal group, depending on the spatial/executive ability, delayed memory, attention and total score (P<0.05). Multivariate analysis showed that age ≥ 60 years old, BMI > 25.0 kg/m2, farmers, rural living, not to participate in social activities and insomnia were independent risk factors for cognitive impairment of patients with OSAS complicated with hypertension (P < 0.05). Conclusion OSAS patients with cognitive impairment with hypertension have higher risk factors not controllable risk for his age, occupation and higher living conditions,the relevant factors of controllable risk with BMI and lifestyle, controllable risk factors exist in patients with clear and early intervention therapy may delay cognitive damage, reduce the occurrence of cognitive impairment risk.