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

Spatial navigation performance and associated factors in patients with obstructive sleep apnea

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

英文关键词:Obstructive sleep apnea  Cognitive function  Spatial navigation performance  Sleep architecture  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OSA的严重程度。然而，仅依靠AHI难以解释OSA患者认知功能受损的个体差异。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患者认知功能及空间导航能力，分析患者空间导航能力的相关因素。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并符合OSA诊断标准的患者135例。根据AHI分为轻度组、中度组和重度组。采用MMSE、TMT、THINC-it中的Spotter测试(CRT)和Codebreaker测试(DSST)进行认知功能评定，通过SBSOD和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%)。三组认知功能及空间导航能力比较，差异均无统计学意义(P均>0.05)。Spearman相关分析显示，AMUNET延迟环境参照导航子任务与N2期持续时间、N2%及REML均呈正相关(r=0.277、0.296、0.239，P_FDR均<0.05)，与REM持续时间、REM%、N3期持续时间及N3%均呈负相关(r=-0.223~-0.175，P_FDR均<0.05)。分层多元线性回归显示，控制基本资料及整体认知水平后，N2%可正向预测延迟环境参照导航子任务(β=0.242，95%CI: 0.104~1.463)。结论 不同严重程度的OSA患者认知功能及空间导航能力相当；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) represents a potential modifiable risk factor for cognitive impairment, while spatial navigation performance serves as a sensitive marker to detect such deficits at an early stage. Currently, polysomnography (PSG) is the gold standard for OSA diagnosis, with the apnea hypopnea index (AHI) used to stratify the disease severity. Nevertheless, AHI alone cannot fully explain the individual variability in cognitive impairment among OSA patients. Objective To compare the global cognitive function and spatial navigation performance across OSA patients of varying severities, and to analyze associated factors of spatial navigation performance. Methods This cross-sectional study consecutively enrolled 135 outpatients. Subjects were stratified into mild, moderate, and severe groups based on AHI values. Global cognitive function was evaluated using MMSE, TMT, and THINC-it (CRT and DSST). Spatial navigation performance was assessed through SBSOD and AMUNET. Results Among the 135 OSA patients, 46 (34.07%) were mild, 47 (34.82%) moderate, and 42 (31.11%) severe. No statistically significant intergroup differences were observed in cognitive function or spatial navigation (P>0.05). Spearman correlation analyses revealed that delayed allocentric AMUNET subtask was positively correlated with N2 duration, N2%, and REM latency (r=0.277, 0.296, 0.239, P_FDR<0.05), and negatively correlated with REM duration, REM%, N3 duration, and N3% (r=-0.223~-0.175, P_FDR<0.05). Hierarchical multiple linear regression demonstrated that N2% emerged as a positive predictor of delayed allocentric navigation (β=0.242, 95% CI: 0.104~1.463). Conclusion Patients with OSA across all severity strata exhibit comparable global cognitive function and spatial navigation performance. Spatial memory is associated with sleep architecture parameters, among which N2% acts as an independent positive predictor.