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，以期为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次/h≤AHI<15次/h）、中度组（15次/h≤AHI<30次/h）和重度组（AHI≥30次/h），分别收集PSG数据。采用简易精神状态评价量表（MMSE）、连线测试（包含TMT-A和TMT-B）、THINC集成工具（THINC-it）中的Spotter测试（CRT）和Codebreaker测试（DSST）进行认知功能评定，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CRT反应时间和DSST的连续回答正确次数、MMSE评分以及TMT-A和TMT-B的完成时间比较，差异均无统计学意义（P均>0.05）；在空间导航能力方面，三组SBSOD评分、AMUNET中的4个子任务评定结果比较，差异均无统计学意义（P均>0.05）。Spearman相关分析结果显示，AMUNET中的延迟环境参照导航子任务评定结果与睡眠结构指标中的N2期持续时间、N2%及快速眼动睡眠潜伏期（REML）均呈正相关（r=0.277、0.296、0.239，P_FDR均<0.05），与快速眼动睡眠（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）。SBSOD评分与TMT-A及TMT-B完成时间均呈正相关（r=0.236、0.278），与MMSE评分呈负相关（r=-0.311）；AMUNET中的环境参照导航子任务评定结果与CRT反应时间呈正相关（r=0.013），自我参照导航、环境参照导航子任务评定结果与TMT-A和TMT-B完成时间均呈正相关（r=0.191~0.265），自我参照导航、环境参照导航以及自我+环境参照导航子任务评定结果与MMSE评分及DSST连续回答正确次数均呈负相关（r=-0.318~-0.207），P_FDR均<0.05。分层多元线性回归分析结果显示，控制基本资料及整体认知水平后，N2%可正向预测AMUNET中的延迟环境参照导航子任务评定结果（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. Existing evidence indicates that sleep architecture disruption impairs spatial memory consolidation and subsequently alters spatial navigation through pathways independent of AHI， yet this hypothesis remains unvalidated in routine clinical OSA cohorts.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， so as to provide clinical evidence for the early identification and intervention of cognitive impairment in OSA patients.Methods This cross-sectional study consecutively enrolled 135 outpatients from the Mental Health Center of Inner Mongolia Autonomous Region from March 8， 2024 to September 12， 2025. All participants completed PSG monitoring and fulfilled the OSA diagnostic criteria outlined in the Guidelines for the Diagnosis and Treatment of Adult Obstructive Sleep Apnea. Subjects were stratified into mild （5 ≤AHI < 15 events/h）， moderate （15 ≤ AHI < 30 events/h）， and severe （AHI ≥ 30 events/h） groups based on AHI values， and all PSG sleep architecture parameters were extracted for statistical analysis. Global cognitive function was evaluated using the Mini-Mental State Examination （MMSE）， the Trail Making Test （including TMT-A and TMT-B）， and two subtasks from the THINC Integrated Toolkit （THINC-it）： the Spotter test （choice reaction time， CRT） and the Codebreaker test （digit symbol substitution test， DSST）. Spatial navigation performance was assessed through the Santa Barbara Sense of Direction Scale （SBSOD） and the computerized AMUNET spatial navigation test.Results Among the 135 OSA patients， 46 （34.07%） were classified into the mild group， 47 （34.82%） into the moderate group， and 42 （31.11%） into the severe group. In terms of cognitive function， there were no statistically significant intergroup differences across three groups in CRT， consecutive correct DSST responses， MMSE scores， and completion time of TMT-A and TMT-B （P>0.05）. Regarding spatial navigation performance， no statistically significant differences were observed among three groups in SBSOD scores and the outcomes of the four AMUNET subtasks （P>0.05）. Spearman correlation analyses revealed that the performance on the delayed allocentric AMUNET subtask was positively correlated with stage N2 duration， percentage of stage N2 sleep （N2%）， and rapid eye movement （REM） latency （r=0.277， 0.296， 0.239， P_FDR<0.05）. In contrast， this subtask exhibited negative correlations with REM duration， percentage of REM sleep （REM%）， stage N3 duration and percentage of stage N3 sleep （N3%） （r=-0.223–-0.175， P_FDR<0.05）. SBSOD score was positively correlated with the completion time of TMT-A and TMT-B （r=0.236， 0.278）， and negatively correlated with MMSE scores （r=-0.311）. For AMUNET indices， performance on the allocentric navigation subtask showed a positive correlation with CRT （r=0.013）. Moreover， performance of both egocentric and allocentric navigation subtasks yielded positive correlations with the completion time of TMT-A and TMT-B （r=0.191–0.265， P_FDR<0.05）. Performance on the egocentric， allocentric， and combined egocentric–allocentric navigation subtasks was negatively correlated with MMSE scores and the consecutive correct DSST responses （r=-0.318–-0.207， P_FDR<0.05）. Hierarchical multiple liner regression analysis demonstrated that after controlling for baseline characteristics and global cognitive function， N2% emerged as a positive predictor of the delayed allocentric navigation subtask performance （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 of spatial memory performance. ［Funded by Natural Science Foundation Project of Inner Mongolia Autonomous Region （number， 2024QN08050）； Science and Technology Project for High-Level Clinical Specialty Development of Public Hospitals of the Capital Region under the Autonomous Region Health Commission of Inner Mongolia Autonomous Region in 2023 （number， 2023SGGZ047）］