阻塞性睡眠呼吸暂停患者空间导航能力特征及其相关因素的研究

Spatial navigation ability characteristics and associated factors in obstructive sleep apnea patients

中文关键词:  阻塞性睡眠呼吸暂停  认知功能  空间导航  睡眠结构  多导睡眠监测

英文关键词:Obstructive Sleep Apnea  Cognitive Function  Spatial Navigation  Sleep Stages  Polysomnography

中文摘要:

      背景 阻塞性睡眠呼吸暂停（OSA）是认知功能障碍的潜在可改变危险因素，而空间导航能力是早期识别认知功能受损的敏感指标。目前，临床以多导睡眠监测（PSG）作为OSA诊断的金标准，并以呼吸暂停低通气指数（AHI）划分严重程度。然而，仅依靠AHI难以解释OSA患者认知功能受损的个体差异。已有研究提示，睡眠结构紊乱可通过独立于AHI的机制损害空间记忆巩固，影响空间导航能力，但这一结论在常规就诊的OSA患者中尚缺乏验证。目的 评估不同严重程度的OSA患者的认知功能及空间导航能力，分析OSA患者空间导航能力的相关因素，为OSA患者认知功能受损的早期识别与干预提供参考。方法 采用横断面设计，连续纳入2024年3月8日—2025年9月12日在内蒙古自治区精神卫生中心门诊就诊，完成PSG监测并符合《成人阻塞性睡眠呼吸暂停诊治指南》中OSA诊断标准的患者135例。根据AHI将患者分为轻度组（5≤AHI＜15次/h）、中度组（15≤AHI＜30次/h）和重度组（AHI≥30次/h），分别收集PSG数据并通过简易精神状态评价量表（MMSE）、连线测试的AB两部分（TMT-A、TMT-B）、THINC综合工具（THINC-it）中的Spotter测试（CRT）和Codebreaker测试（DSST）对其进行认知功能评估，通过圣巴巴拉方向感量表（SBSOD）和计算机空间导航测试（AMUNET）评定空间导航能力。结果 在135例OSA患者中，轻度组46例（34.07%），中度组47例（34.82%），重度组42例（31.11%）。在认知功能方面，三组OSA患者MMSE评分和TMT-A、TMT-B、CRT及DSST测试结果比较，差异均无统计学意义（H=0.290、5.248、5.442、1.047、2.494，P均＞0.05）；在空间导航能力评估中，三组SBSOD评分及AMUNET各子任务指标比较，差异均无统计学意义（F=0.494，H=3.125、0.160、0.988、0.173，P均＞0.05）；FDR校正的Spearman相关分析显示，在睡眠结构指标中，N2期持续时间及占比、REM潜伏期与AMUNET空间记忆能力的延迟环境参照导航子任务呈正相关（r=0.239~0.296），而REM期及N3期的持续时间和占比与之呈负相关（r=-0.175~-0.223），PFDR均＜0.05。SBSOD评分与TMT-A/B结果呈正相关（r=0.236~0.278），与MMSE评分呈负相关（r=-0.311）；AMUNET测试中的环境参照导航子任务指标与CRT结果呈正相关（r=0.013），自我参照导航、环境参照导航子任务指标与TMT-A/B结果呈正相关（r=0.191~0.265），自我参照导航、环境参照导航和自我+环境参照导航子任务指标与MMSE评分及DSST结果呈负相关（r=-0.207~-0.318），PFDR均＜0.05。进一步分层回归结果显示，在控制性别、年龄、基础疾病及整体认知水平后，N2%仍为空间记忆子任务的独立关联因素（β=0.242，95% CI：0.104~1.463）。结论 不同严重程度的OSA患者初诊未治阶段的认知功能及空间导航能力不存在基于AHI分层的差异；空间记忆能力与睡眠结构指标存在关联，其中N2%是空间记忆能力的独立正向关联因素。

英文摘要:

      Background Obstructive sleep apnea (OSA) is a potentially modifiable risk factor for cognitive dysfunction, and spatial navigation ability serves as a sensitive indicator for the early identification of cognitive impairment. Polysomnography (PSG) is currently the gold standard for the diagnosis of OSA, and the apnea-hypopnea index (AHI) is used to grade its severity. Nevertheless, relying solely on AHI fails to explain the individual differences in cognitive impairment among patients with OSA. Existing studies have suggested that disturbances in sleep architecture may impair spatial memory consolidation and affect spatial navigation ability through mechanisms independent of AHI. However, this conclusion has not yet been validated in OSA patients receiving routine clinical care.Objective Evaluate cognitive function and spatial navigation ability in patients with obstructive sleep apnea (OSA) of varying severity, analyze the relevant factors affecting their spatial navigation ability, and provide evidence for the early identification and intervention of cognitive impairment in OSA patients. Methods This study adopted a cross-sectional design. A total of 135 patients who visited the Outpatient Department of Inner Mongolia Mental Health Center from March 8, 2024 to September 12, 2025, completed polysomnography (PSG) and met the diagnostic criteria for obstructive sleep apnea (OSA) specified in the Guidelines for the Diagnosis and Treatment of Adult Obstructive Sleep Apnea were consecutively enrolled. The patients were divided into mild group (5≤AHI<15 events/h), moderate group (15≤AHI<30 events/h) and severe group (AHI≥30 events/h) according to the apnea-hypopnea index (AHI). PSG data were collected for all subjects. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), Trail Making Test parts A and B (TMT-A, TMT-B), as well as the Spotter test (CRT) and Codebreaker test (DSST) from the THINC-it tool. Spatial navigation ability was evaluated with the Santa Barbara Sense of Direction Scale (SBSOD) and the computerized spatial navigation test (AMUNET). Results Among the 135 OSA patients, 46 (34.07%) were assigned to the mild group, 47 (34.82%) to the moderate group, and 42 (31.11%) to the severe group. In terms of cognitive function, no statistically significant differences were observed among the three groups in scores of the Mini-Mental State Examination (MMSE), Trail Making Test Part A (TMT-A), Trail Making Test Part B (TMT-B), CRT and DSST (H = 0.290, 5.248, 5.442, 1.047, 2.494, all P > 0.05). For spatial navigation ability, there were no significant between-group differences in Santa Barbara Sense of Direction Scale (SBSOD) scores or all sub-indicators of the AMUNET test (F = 0.494; H = 3.125, 0.160, 0.988, 0.173, all P > 0.05).Spearman correlation analysis with false discovery rate (FDR) correction revealed that among sleep architecture parameters, the duration and proportion of stage N2 sleep as well as rapid eye movement (REM) latency were positively correlated with the delayed allocentric navigation subtask of spatial memory in AMUNET (r = 0.239 ~ 0.296). By contrast, the duration and proportion of REM sleep and stage N3 sleep were negatively correlated with this subtask (r = -0.175 ~ -0.223), with all PFDR < 0.05.SBSOD scores were positively correlated with TMT-A and TMT-B results (r = 0.236 ~ 0.278) and negatively correlated with MMSE scores (r = -0.311). The allocentric navigation subtask in AMUNET was positively correlated with CRT performance (r = 0.013). Egocentric and allocentric navigation subtasks were positively associated with TMT-A and TMT-B outcomes (r = 0.191 ~ 0.265). Egocentric navigation, allocentric navigation, and combined egocentric-allocentric navigation subtasks were negatively correlated with MMSE and DSST scores (r = -0.207 ~ -0.318), and all associations reached statistical significance after FDR correction (PFDR < 0.05).Hierarchical regression analysis further demonstrated that after adjusting for gender, age, underlying diseases and global cognitive function, the proportion of stage N2 sleep (N2%) remained an independent influencing factor for the spatial memory subtask (β = 0.242, 95%CI: 0.104 ~ 1.463).Conclusion No differences in cognitive function and spatial navigation ability were found among treatment-naive newly diagnosed OSA patients stratified by AHI severity. Spatial memory was correlated with sleep architecture parameters, and the percentage of N2 sleep (N2%) was an independent positive influencing factor for spatial memory.