Effects of obstructive sleep apnea on sleep quality, cognition, and driving performance in patients with cirrhosis.
Effects of obstructive sleep apnea on sleep quality, cognition, and driving performance in patients with cirrhosis.
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DOI：
10.1016/j.cgh.2014.08.028
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发表时间：
2015-02
期刊：
影响因子：
--
通讯作者：
Wade JB
中科院分区：
文献类型：
--
作者：
Bajaj JS;Thacker LR;Leszczyszyn D;Taylor SA;Heuman DM;Raman S;Sterling RK;Siddiqui MS;Stravitz RT;Sanyal AJ;Puri P;Luketic V;Matherly S;Fuchs M;White MB;Noble NA;Unser AB;Wade JB
肝硬化患者的睡眠障碍被认为是由肝性脑病（HE）引起的。阻塞性睡眠呼吸暂停（OSA）对肝硬化患者的认知、睡眠参数或驾驶的影响尚不清楚。我们对118名受试者进行了横断面前瞻性研究。受试者被分为4组：OSA合并肝硬化组（无HE或腹水，n=34）、单纯肝硬化组（n=30）、单纯OSA合并肝硬化组（n=29）和无OSA合并肝硬化组（对照组，n=25）。所有OSA患者均未接受持续气道正压（CPAP）治疗。受试者接受了认知测试（精神运动速度和注意力的纸笔测试，以及执行功能测试）、睡眠评估（白天嗜睡和夜间睡眠质量）和单调的驾驶模拟（随着时间的推移，车道偏差越来越大表明表现不佳）。我们还对CPAP治疗前后伴有肝硬化（n=10）和无肝硬化（n=7）的OSA患者进行了测试。OSA组（伴或不伴肝硬化）的受试者白天嗜睡和睡眠质量比单独肝硬化的受试者或对照组更差。在仅患有阻塞性睡眠呼吸暂停的受试者中，36%的人精神运动速度和注意力受损，而在两组肝硬化患者中，这一比例为60%。相比之下，有或没有肝硬化的OSA患者的执行功能都比没有OSA的患者差。两个OSA组的模拟器性能（车道偏差）随着时间的推移而恶化。CPAP治疗显著提高了有肝硬化和无肝硬化受试者的执行功能和睡眠质量，减少了模拟器巷偏差和嗜睡。在CPAP治疗后，只有无肝硬化的OSA患者的纸笔测试成绩有明显改善。在评估肝硬化患者的睡眠损害时应考虑OSA。在肝硬化和OSA患者中，精神运动速度和注意力问题可能与肝硬化有关，而执行功能和模拟器性能则受到OSA的影响。CPAP治疗可改善OSA患者的执行功能和模拟器性能，无论是否肝硬化。
In patients with cirrhosis, sleep disturbances are assumed to result from hepatic encephalopathy (HE). The effects of obstructive sleep apnea (OSA) on cognition, sleep parameters, or driving in patients with cirrhosis are unclear. We performed a cross-sectional, prospective study of 118 subjects. Subjects were assigned to 1 of 4 groups: those with OSA and cirrhosis (without HE or ascites, n=34), those with only cirrhosis (n=30), those with only OSA only (n=29), and those without OSA or cirrhosis (controls, n=25). None of OSA patients were receiving continuous positive airway pressure (CPAP) therapy. Subjects underwent cognitive testing (paper–pencil tests for psychomotor speed and attention, as well as executive function tests), sleep assessment (daytime sleepiness and night-time sleep quality) and a monotonous driving simulation (worsening lane deviations over time indicate poor performance). We also tested patients with OSA, with cirrhosis (n=10) and without cirrhosis (n=7), before and after CPAP therapy. Daytime sleepiness and sleep quality were worse in subjects in the OSA groups (with or without cirrhosis) than subjects with cirrhosis alone or controls. Of subjects with only OSA, 36% had impaired psychomotor speed and attention, compared to >60% of subjects in both cirrhosis groups. In contrast, executive function was uniformly worse in subjects with OSA, with or without cirrhosis, than groups without OSA. Simulator performance (lane deviations) worsened over time in both OSA groups. CPAP therapy significantly increased executive function and sleep quality, and reduced simulator lane deviations and sleepiness, in subjects with and without cirrhosis. After CPAP therapy, performance on the paper–pencil test performance improved significantly only in subjects with OSA without cirrhosis. OSA should be considered in evaluating sleep impairment in patients with cirrhosis. In patients with cirrhosis and OSA, psychomotor speed and attention issues are likely related to the cirrhosis, whereas executive function and simulator performance are affected by the OSA. CPAP therapy improves executive function and simulator performance in patients with OSA, regardless of cirrhosis.
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影响因子：
4.3
作者：
Kappus, Matthew R.;Leszczyszyn, David J.;Bajaj, Jasmohan S.
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