CPAP与SOA治疗OSAHS患者认知障碍的疗效比较
【摘要】
目的：比较合并认知障碍的中度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）患者使用经鼻持续正压通气（continuous positive airway pressure，CPAP）或者自行调节式口腔矫治器（Self-adjusting Oral Appliance，SOA）治疗后的疗效。
方法：经蒙特利尔认知评估量表（Montreal Cognitive Assessment，MOCA）评估和多导睡眠监测（polysomnography，PSG）监测及纳入、排除标准筛选出的56例合并认知功能障碍的中度OSAHS患者，分为两组，分别行自行调节式口腔矫治器治疗或CPAP治疗，并采用MOCA和PSG对患者行治疗前1周及治疗3个月后再次行认知功能检查和PSG检测。
对所获资料用SPSS 19.0进行卡方比较、均数比较、配对t检验、两独立样本t检验。
结果：中度OSAHS患者睡眠呼吸暂停低通气指数（apnea hypopnea index，AHI）、最低血氧饱和度（lowest blood oxygen saturation，LSaO2）、MOCA评分在治疗前1周及治疗3个月后比较差异有统计学意义（P<0.01）；两治疗组治疗前及治疗后MOCA量表中的记忆项和注意力项得分比较差异有统计学意义（P<0.01）；视空间/执行功能项和抽象能力项SOA组得分比较差异有统计学意义（P<0.01），CPAP组差异有统计学意义（P<0.05）；命名项、语言项和定向力项差异无统计学意义（P＞0.05）。两治疗组治疗后睡眠呼吸参数、MOCA总分及各项评分比较差异无统计学意义（P＞0.05）。
结论：CPAP与SOA治疗中度OSAHS患者疗效相当，都是治疗中度患者的有效方法；二者在治疗并认知功能障碍的中度OSAHS患者时，对于认知功能的恢复有效且程度相当，在临床皆可作为合并认知功能障碍中度患者的治疗方式。
【关键词】自行调节式口腔矫治器；持续正压通气；阻塞性睡眠呼吸暂停低通气综合征；认知功能障碍
Effectiveness of Continuous Positive Airway Pressureversus Self-adjustable Oral Appliance in Treating Patients with Cognitive Impairment in Moderate Obstructive Sleep Apnea-Hypopnea Syndrome(https://www.daowen.com)
ABSTRACT
Objective：To evaluate the effectiveness of continuous positive airway pressureversus Self-adjustable Oral Appliance in treating patients with cognitive impairment and moderate obstructive sleep apnea-hypopnea syndrome.
Methods：56 patients were diagnosed cognitive impairment and moderate OSAHS according MOCA scores and PSGparameters.By usingMOCA and PSG to analyze and contrast the state before and after treating with Self-adjustable Oral Appliance therapy or CPAP therapy to study the effectiveness of two treatments.
Statistical analysis software Package of SPSS（version 19.0）was used in all analyses，including Chi-square test，conducting mean comparison，paired t-test，two-sample t-test.
Results：The changes of apnea hyponea index（AHI），lowest blood oxygen saturation（LSaO2），and Montreal Cognitive Assessment（MOCA）scores between a week before and the three months’therapy by SOA or CPAP in patients with cognitive impairment and moderate OSAHS are of statistical significance（P<0.01）；the same change is appeared in memory and attention of MOCA in both two groups（P<0.01），which scores increased significantly.Executive function and abstraction were increased in SOA groups（P<0.01）and CPAP groups（P<0.05）.However，naming and language were almost not changed（P＞0.05）.There was no statistical differencein AHI、LSaO2and totalMOCAscores and each score itemsafter 3 months’therapy by SOA or CPAP in patients with cognitive impairment and moderate OSAHS（P＞0.05）.
Conclusion：The results may be explained by therapy of CPAP or SOA resulting insimilar effectiveness on moderate OSAHS.And treatment by CPAP or SOA can both improve cognitive functionand reverse it to a same extent inmoderate OSAHS patients.Both of them can be an effectiveness therapy for patients who have cognitive impairment and moderate obstructive sleep apnea-hypopnea syndrome.
Key words：Continuous Positive Airway Pressure；Obstructive Sleep Apnea-Hypopnea Syndrome；Self-adjustable Oral Appliance；Cognitive Impairment