老年轻度认知障碍患者睡眠障碍与认知功能的关系

doi:10.3969/j.issn.1004-583X.2022.07.004

摘要/Abstract

摘要：

目的探讨老年轻度认知障碍(mild cognitive impairment, MCI)患者的睡眠障碍(sleep disorders,SD)情况及其与认知功能的关系。方法纳入2018年11月至2019年1月在四川省南充市某社区筛查的MCI患者171例。采用匹兹堡睡眠指数量表(Pittsburgh sleep quality index,PSQI)评估患者的总体睡眠状况,根据评分结果,将入组患者分为MCI伴SD组(MCI-SD组)和MCI不伴SD组(MCI-NSD组)。采用蒙特利尔认知评估量表基础版(montreal cognitive assessment-basic,MoCA-B)、简明精神状态量表(mini-mental status examination,MMSE)、听觉词汇学习测验(auditory verbal learning test,AVLT)、波士顿命名测试(Boston naming test,BNT)、动物语言流畅性(animal verbal fluency test,AFT)、形状连线测试(trail making test, TMT)评估MCI患者的总体认知、记忆、语言、执行功能,对比分析两组总体认知功能及各认知领域的差异。结果 171例MCI患者中70例(40.9%)存在SD。两组性别、年龄、受教育水平差异无统计学意义(均 $P$ >0.05),在睡眠质量、入睡时间、睡眠时间、睡眠效率、夜间睡眠障碍、催眠药物及日间功能等方面差异有统计学意义(均 $P$ <0.05)。与MCI-NSD组相比,MCI-SD组的MoCA-B、MMSE、BNT评分明显降低,TMT-A总耗时数明显增加(均 $P$ <0.05)。MCI-SD组入睡时间与MMSE总分呈负相关,与TMT-A总耗时数呈正相关;睡眠效率与MMSE总分呈负相关;PSQI总分与MoCA-B及MMSE总分呈负相关,与TMT-A总耗时数呈正相关。BNT、TMT-A总耗时数是MCI患者合并SD的独立危险因素(均 $P$ <0.05)。结论 MCI患者具有较高的SD发生率,长期睡眠障碍可能会导致或加重认知功能障碍的下降,尤其是对语言命名与执行功能的影响可能更显著。

关键词: 认知功能障碍, 睡眠障碍, 认知

Abstract:

Objective To explore the sleep disorders (SD) in elderly patients with mild cognitive impairment (MCI) and corresponding correlations with cognitive function. Methods A total of 171 eligible patients with MCI in a community located in Nanchong, Sichuan from November 2018 to January 2019 were included. The overall sleep conditions of patients was assessed by the Pittsburgh sleep quality index (PSQI). The enrolled patients were divided into MCI with SD group (MCI-SD group) and MCI without SD group (MCI-NSD group) according to scoring results. Montreal cognitive assessment-basic (MoCA-B), mini-mental status examination (MMSE), auditory verbal learning test (AVLT), Boston naming test (BNT), animal verbal fluency test (AFT), trail making test (TMT) were applied to evaluate the overall cognition, memory, language and executive function of MCI patients, and the differences in overall cognitive function and cognitive domain between two groups were comparatively analyzed. Results SD was found in 70 (40.9%) out of 171 MCI patients, and the differences in the gender, age and education level between two groups were not statistically significant (all $P$ >0.05), while the differences in the sleep quality, time of sleep onset, sleep duration, sleep efficiency, night sleep disorders, hypnotic drug and daytime function were statistically significant (all $P$ <0.05). Compared to the MCI-NSD group, MoCA-B, MMSE, and BNT scores of MCI-SD group were significantly lowered, and the total time spent on TMT-A was significantly increased (all $P$ <0.05). The time to fall asleep in the MCI-SD group was negatively correlated with the total score of MMSE and positively correlated with the total time spent in TMT-A; the sleep efficiency was negatively correlated with total scores of MMSE; total scores of PSQI were negatively correlated with total scores of MoCA-B and MMSE and were positively correlated with the total time spent in TMT-A. The total time spent on BNT and TMT-A was considered to be an independent risk factor for MCI patients complicated with SD (all $P$ <0.05). Conclusion MCI patients are found to have higher incidence of SD, and long-term sleep disorder may lead to or aggravate the decline of cognitive dysfunction, especially the impacts on language naming and executive function may be more significant.

Key words: cognitive dysfunction, sleep disorder, cognition

中图分类号:

R741

李钟梅, 冉丽, 蒋依, 郭志伟, 母其文. 老年轻度认知障碍患者睡眠障碍与认知功能的关系[J]. 临床荟萃, 2022, 37(7): 607-611.

Li Zhongmei, Ran Li, Jiang Yi, Guo Zhiwei, Mu Qiwen. Correlations between sleep disorder and cognitive function in elderly patients with mild cognitive impairment[J]. Clinical Focus, 2022, 37(7): 607-611.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.07.004

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I7/607

图/表 5

表1 两组人口学资料比较

组别	例数	年龄(岁)	性别(例)		文化程度(例)
组别	例数	年龄(岁)	男	女	文盲	小学	初中	高中	大学
MCI-SD组	70	67.21±4.65	19	51	13	33	22	1	1
MCI-NSD组	101	67.95±5.07	42	59	11	43	33	11	3
统计值		$t$ =0.966	χ²=3.758		χ²=7.647
$P$ 值		0.336	0.530		0.105

表1 两组人口学资料比较

组别	例数	年龄(岁)	性别(例)		文化程度(例)
组别	例数	年龄(岁)	男	女	文盲	小学	初中	高中	大学
MCI-SD组	70	67.21±4.65	19	51	13	33	22	1	1
MCI-NSD组	101	67.95±5.07	42	59	11	43	33	11	3
统计值		$t$ =0.966	χ²=3.758		χ²=7.647
$P$ 值		0.336	0.530		0.105

表2 两组PSQI量表及其子项目比较( x -±s,分)

组别	例数	PSQI量表总分	睡眠质量评分	入睡时间评分	睡眠时间评分	睡眠效率评分	夜间睡眠障碍评分	催眠药物评分	日间功能评分
MCI-SD组	70	9.57±2.76	1.61±0.71	2.07±1.01	1.74±0.96	1.73±1.18	1.66±0.56	0.19±0.67	0.57±0.71
MCI-NSD组	101	3.54±1.58	0.72±0.55	0.63±0.77	0.50±0.72	0.27±0.63	1.18±0.50	0.00±0.00	0.29±0.48
$t$ 值		16.502	8.847	10.039	9.251	9.475	5.74	2.334	2.914
$P$ 值		0.000	0.000	0.000	0.000	0.000	0.000	0.023	0.004

表2 两组PSQI量表及其子项目比较( x -±s,分)

组别	例数	PSQI量表总分	睡眠质量评分	入睡时间评分	睡眠时间评分	睡眠效率评分	夜间睡眠障碍评分	催眠药物评分	日间功能评分
MCI-SD组	70	9.57±2.76	1.61±0.71	2.07±1.01	1.74±0.96	1.73±1.18	1.66±0.56	0.19±0.67	0.57±0.71
MCI-NSD组	101	3.54±1.58	0.72±0.55	0.63±0.77	0.50±0.72	0.27±0.63	1.18±0.50	0.00±0.00	0.29±0.48
$t$ 值		16.502	8.847	10.039	9.251	9.475	5.74	2.334	2.914
$P$ 值		0.000	0.000	0.000	0.000	0.000	0.000	0.023	0.004

表3 两组认知功能比较( x -±s,分)

组别	例数	MoCA-B 总分	MMSE 总分	AVLT评分		BNT评分	VFT评分	TMT总耗时数(s)
组别	例数	MoCA-B 总分	MMSE 总分	延迟回忆	再认	BNT评分	VFT评分	TMT-A	TMT-B
MCI-SD组	70	17.67±4.59	24.64±3.89	2.37±2.17	16.89±3.81	15.64±5.05	11.50±3.84	140.99±62.39	285.19±96.89
MCI-NSD组	101	19.64±3.74	25.81±3.19	2.75±2.24	17.49±3.64	18.50±4.57	11.68±3.58	114.07±43.21	263.05±85.97
$t$ 值		3.089	2.152	1.109	1.039	3.857	0.319	3.127	1.571
$P$ 值		0.002	0.033	0.269	0.300	0.000	0.750	0.002	0.118

表3 两组认知功能比较( x -±s,分)

组别	例数	MoCA-B 总分	MMSE 总分	AVLT评分		BNT评分	VFT评分	TMT总耗时数(s)
组别	例数	MoCA-B 总分	MMSE 总分	延迟回忆	再认	BNT评分	VFT评分	TMT-A	TMT-B
MCI-SD组	70	17.67±4.59	24.64±3.89	2.37±2.17	16.89±3.81	15.64±5.05	11.50±3.84	140.99±62.39	285.19±96.89
MCI-NSD组	101	19.64±3.74	25.81±3.19	2.75±2.24	17.49±3.64	18.50±4.57	11.68±3.58	114.07±43.21	263.05±85.97
$t$ 值		3.089	2.152	1.109	1.039	3.857	0.319	3.127	1.571
$P$ 值		0.002	0.033	0.269	0.300	0.000	0.750	0.002	0.118

表4 MCI-SD组认知功能与睡眠状况的相关性分析

项目	MoCA-B总分		MMSE总分		AVLT延迟回忆		AVLT再认
项目	$r$ 值	$P$ 值	$r$ 值	$P$ 值	$r$ 值	$P$ 值	$r$ 值	$P$ 值
PSQI总分	-0.237	0.049	-0.280	0.019	-0.048	0.696	-0.161	0.182
睡眠质量	-0.132	0.274	0.035	0.772	-0.057	0.639	-0.123	0.309
入睡时间	-0.190	0.114	-0.266	0.026	-0.050	0.678	-0.164	0.174
睡眠时间	-0.077	0.526	-0.183	0.129	-0.175	0.147	0.002	0.988
睡眠效率	-0.191	0.114	-0.320	0.007	-0.102	0.402	-0.112	0.356
夜间睡眠障碍	-0.038	0.754	-0.010	0.934	0.156	0.197	-0.123	0.311
催眠药物	-0.052	0.668	-0.037	0.759	0.015	0.899	0.182	0.131
日间功能	-0.042	0.731	-0.028	0.820	-0.101	0.406	0.041	0.735
项目	BNT评分		VFT评分		TMT-A		TMT-B
项目	$r$ 值	$P$ 值	$r$ 值	$P$ 值	$r$ 值	$P$ 值	$r$ 值	$P$ 值
PSQI总分	-0.042	0.730	0.020	0.869	0.236	0.049	0.094	0.440
睡眠质量	-0.035	0.773	0.028	0.819	0.233	0.053	0.052	0.667
入睡时间	-0.088	0.467	-0.210	0.810	0.370	0.002	0.089	0.466
睡眠时间	0.036	0.766	0.131	0.280	0.085	0.486	-0.035	0.772
睡眠效率	-0.074	0.541	0.008	0.951	0.137	0.258	0.107	0.376
夜间睡眠障碍	0.020	0.871	0.141	0.245	0.139	0.251	0.116	0.339
催眠药物	-0.009	0.941	-0.065	0.591	-0.030	0.807	-0.053	0.661
日间功能	0.068	0.579	-0.055	0.651	-0.061	0.615	0.024	0.841

表4 MCI-SD组认知功能与睡眠状况的相关性分析

项目	MoCA-B总分		MMSE总分		AVLT延迟回忆		AVLT再认
项目	$r$ 值	$P$ 值	$r$ 值	$P$ 值	$r$ 值	$P$ 值	$r$ 值	$P$ 值
PSQI总分	-0.237	0.049	-0.280	0.019	-0.048	0.696	-0.161	0.182
睡眠质量	-0.132	0.274	0.035	0.772	-0.057	0.639	-0.123	0.309
入睡时间	-0.190	0.114	-0.266	0.026	-0.050	0.678	-0.164	0.174
睡眠时间	-0.077	0.526	-0.183	0.129	-0.175	0.147	0.002	0.988
睡眠效率	-0.191	0.114	-0.320	0.007	-0.102	0.402	-0.112	0.356
夜间睡眠障碍	-0.038	0.754	-0.010	0.934	0.156	0.197	-0.123	0.311
催眠药物	-0.052	0.668	-0.037	0.759	0.015	0.899	0.182	0.131
日间功能	-0.042	0.731	-0.028	0.820	-0.101	0.406	0.041	0.735
项目	BNT评分		VFT评分		TMT-A		TMT-B
项目	$r$ 值	$P$ 值	$r$ 值	$P$ 值	$r$ 值	$P$ 值	$r$ 值	$P$ 值
PSQI总分	-0.042	0.730	0.020	0.869	0.236	0.049	0.094	0.440
睡眠质量	-0.035	0.773	0.028	0.819	0.233	0.053	0.052	0.667
入睡时间	-0.088	0.467	-0.210	0.810	0.370	0.002	0.089	0.466
睡眠时间	0.036	0.766	0.131	0.280	0.085	0.486	-0.035	0.772
睡眠效率	-0.074	0.541	0.008	0.951	0.137	0.258	0.107	0.376
夜间睡眠障碍	0.020	0.871	0.141	0.245	0.139	0.251	0.116	0.339
催眠药物	-0.009	0.941	-0.065	0.591	-0.030	0.807	-0.053	0.661
日间功能	0.068	0.579	-0.055	0.651	-0.061	0.615	0.024	0.841

表5 MCI患者合并SD的危险因素分析

变量	回归系数	标准误	Waldχ²值	$P$ 值	$O R$ 值	95% $C I$
变量	回归系数	标准误	Waldχ²值	$P$ 值	$O R$ 值	下限	上限
性别	-0.022	0.038	0.329	0.566	0.978	0.908	1.054
年龄	-0.037	0.410	0.008	0.928	0.431	0.431	2.155
受教育水平	-	-	-	>0.05	-	-	-
MoCA-B总分	-0.031	0.059	0.279	0.597	0.969	0.863	1.088
MMSE总分	0.023	0.063	0.134	0.715	1.023	0.905	1.157
AVLT延迟回忆	-0.056	0.089	0.339	0.528	0.946	0.795	1.125
AVLT再认	-0.033	0.054	0.364	0.546	0.968	0.870	1.077
BNT评分	-0.114	0.051	5.076	0.024	0.892	0.808	0.985
VFT评分	0.099	0.054	3.376	0.066	1.104	0.993	1.226
TMT-A	0.013	0.005	7.042	0.008	1.013	1.003	1.023
TMT-B	0.005	0.003	2.891	0.089	0.995	0.990	1.001

表5 MCI患者合并SD的危险因素分析

变量	回归系数	标准误	Waldχ²值	$P$ 值	$O R$ 值	95% $C I$
变量	回归系数	标准误	Waldχ²值	$P$ 值	$O R$ 值	下限	上限
性别	-0.022	0.038	0.329	0.566	0.978	0.908	1.054
年龄	-0.037	0.410	0.008	0.928	0.431	0.431	2.155
受教育水平	-	-	-	>0.05	-	-	-
MoCA-B总分	-0.031	0.059	0.279	0.597	0.969	0.863	1.088
MMSE总分	0.023	0.063	0.134	0.715	1.023	0.905	1.157
AVLT延迟回忆	-0.056	0.089	0.339	0.528	0.946	0.795	1.125
AVLT再认	-0.033	0.054	0.364	0.546	0.968	0.870	1.077
BNT评分	-0.114	0.051	5.076	0.024	0.892	0.808	0.985
VFT评分	0.099	0.054	3.376	0.066	1.104	0.993	1.226
TMT-A	0.013	0.005	7.042	0.008	1.013	1.003	1.023
TMT-B	0.005	0.003	2.891	0.089	0.995	0.990	1.001

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