Neurocognitive Impairment in Obstructive Sleep Apnea
Neurocognitive Impairment in Obstructive Sleep Apnea
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DOI：
10.1378/chest.11-2214
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发表时间：
2012-06-01
期刊：
影响因子：
9.6
通讯作者：
Bachman, David
中科院分区：
文献类型：
--
作者：
Lal, Chitra;Strange, Charlie;Bachman, David
阻塞性睡眠呼吸暂停综合征（OSAS）是一种常见的疾病，具有深远的健康影响。OSAS的主要后果之一是对神经认知功能的影响。一些研究表明，OSAS对归纳和演绎推理、注意力、警惕性、学习和记忆有不利影响。神经认知功能障碍可以通过韦氏成人智力量表修订版、心理警戒任务、转向清晰性能测试和重复手指敲击测试等测试客观地测量。在儿童中，除了行为问题和学习障碍外，OSAS还可能导致注意力缺陷多动障碍。认知障碍的危险因素包括年龄增长、男性、载脂蛋白E β 4等位基因阳性、目前吸烟、肥胖、高血压、糖尿病、代谢综合征、唐氏综合征、甲状腺功能减退症、大量饮酒、中风和使用精神活性药物。在细胞水平上，OSAS可能通过间歇性缺氧、激素失衡和/或全身炎症（独立地或通过发生的所产生的内皮功能障碍）引起认知障碍。在所有神经认知障碍的研究中，应测量并尽量减少白天过度嗜睡。最近的研究已经使用功能和结构神经影像学来描绘患有神经认知功能障碍的OSAS患者受影响的脑区。在这些研究中的几个共同的发现是海马体积减少。其他受影响的大脑区域包括大脑的额叶和顶叶，它们显示出灰质的局灶性减少。这些变化可以通过使用CPAP至少部分逆转，这突出了早期识别和治疗OSAS的重要性。目前这方面的数据非常有限，需要进行更多的研究。胸部2012; 141（6）：1601-1610
Obstructive sleep apnea syndrome (OSAS) is a common disorder with far-reaching health implications. One of the major consequences of OSAS is an impact on neurocognitive functioning. Several studies have shown that OSAS has an adverse effect on inductive and deductive reasoning, attention, vigilance, learning, and memory. Neurocognitive impairment can be measured objectively with tests such as the Wechsler Adult Intelligence Scale-Revised, the Psychomotor Vigilance Task, the Steer Clear Performance Test, and tests of repetitive finger tapping. In children, OSAS may cause attention-deficit hyperactivity disorder in addition to behavioral problems and learning disabilities. Risk factors for cognitive impairment include increasing age, male sex, apolipoprotein E epsilon 4 allele positivity, current cigarette smoking, obesity, hypertension, diabetes mellitus, metabolic syndrome, Down syndrome, hypothyroidism, significant alcohol consumption, stroke, and the use of psychoactive medications. At a cellular level, OSAS likely causes cognitive impairment through intermittent hypoxia, hormonal imbalance, and/or systemic inflammation, either independently or via the resultant endothelial dysfunction that occurs. Excessive daytime sleepiness should be measured and minimized in all studies of neurocognitive impairment. Recent studies have used functional and structural neuroimaging to delineate the brain areas affected in patients with OSAS with neurocognitive dysfunction. A common finding in several of these studies is decreased hippocampal volume. Other affected brain areas include the frontal and parietal lobes of the brain, which show focal reductions in gray matter. These changes can be reversed at least partially with the use of CPAP, which highlights the importance of early recognition and treatment of OSAS. The currently available data in this field are quite limited, and more research is needed. CHEST 2012; 141(6):1601-1610