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- BIOVIP.COM 来源：生命经纬
2011年08月13日
据8月10日刊《美国医学会杂志》上的一则研究披露，睡眠呼吸紊乱的老年妇女（显示有缺氧症）会比那些没有罹患这种疾病的妇女更容易出现认知功能损害或痴呆症。
加州大学旧金山分校的Kristine Yaffe, M.D.及其同事对多导睡眠图（是在睡眠中对生理活动的监测）所测得的普遍存在的睡眠呼吸紊乱与之后的轻度认知功能损害和痴呆症的诊断之间的关系进行了检查。该研究包括了298名在研究开始的时候没有罹患痴呆症的妇女（其平均年龄为82.3岁）；她们在2002年1月和2004年4月间的一个骨质疏松性骨折研究的亚组研究中接受了整晚的多导睡眠图检查。睡眠呼吸紊乱被定义为每小时睡眠时的睡眠呼吸暂停-低通气指数为15或以上。睡眠呼吸暂停-低通气指数是在每小时的睡眠中发生呼吸完全停止（无呼吸）和呼吸部分阻塞（呼吸不足）的次数。这些人的认知状态（正常、痴呆或轻度的认知损害）是根据在2006年11月至2008年9月间所收集的资料确定的。研究人员对这些人的缺氧症、睡眠片断化以及睡眠持续时间进行了测量以调查它们在睡眠呼吸紊乱与认知功能损害之间所存在的任何联系的基础机制。
在这298名妇女中，有35.2%的人符合睡眠呼吸紊乱的诊断标准。在对其经过平均4.7年的跟踪之后，这些妇女中有35.9%的人发生了轻度的认知功能损害或痴呆症（轻度认知功能损害：20.1%；痴呆症：15.8%）。有47位罹患普遍存在的睡眠呼吸紊乱的妇女（占44.8%）发生了轻度的认知功能损害或痴呆症，而没有睡眠呼吸紊乱的妇女的这一数字为31.1%。对这些数据的分析表明，睡眠呼吸紊乱的存在与随后出现的轻度认知功能损害或痴呆症几率的增加有关。
研究人员写道：“鉴于在老年人中的睡眠呼吸紊乱和认知功能损害的发生率都很高，这两种病况间存在关系--即使是不太大--的可能性都可能对公众健康产生重大影响。此外，缺氧症--而非睡眠片断化或时间不足--看来与发生轻度认知功能损害或痴呆症有关的发现为人们提供了睡眠呼吸紊乱可能促发认知功能损害的机制的相关线索。认知功能损害与睡眠呼吸紊乱风险增加有关的发现开启了一条对发生轻度认知损害或痴呆症风险进行另外的研究，以及对以包括睡眠呼吸紊乱的睡眠质量作为治疗标靶的预防性策略进行探索的新的通路。”
英文论文摘要：
Sleep-Disordered Breathing, Hypoxia, and Risk of Mild Cognitive Impairment and Dementia in Older Women
ABSTRACT
Context Sleep-disordered breathing (characterized by recurrent arousals from sleep and intermittent hypoxemia) is common among older adults. Cross-sectional studies have linked sleep-disordered breathing to poor cognition; however, it remains unclear whether sleep-disordered breathing precedes cognitive impairment in older adults.
Objectives To determine the prospective relationship between sleep-disordered breathing and cognitive impairment and to investigate potential mechanisms of this association.
Design, Setting, and Participants Prospective sleep and cognition study of 298 women without dementia (mean [SD] age: 82.3 [3.2] years) who had overnight polysomnography measured between January 2002 and April 2004 in a substudy of the Study of Osteoporotic Fractures. Sleep-disordered breathing was defined as an apnea-hypopnea index of 15 or more events per hour of sleep. Multivariate logistic regression was used to determine the independent association of sleep-disordered breathing with risk of mild cognitive impairment or dementia, adjusting for age, race, body mass index, education level, smoking status, presence of diabetes, presence of hypertension, medication use (antidepressants, benzodiazepines, or nonbenzodiazepine anxiolytics), and baseline cognitive scores. Measures of hypoxia, sleep fragmentation, and sleep duration were investigated as underlying mechanisms for this relationship.
Main Outcome Measures Adjudicated cognitive status (normal, dementia, or mild cognitive impairment) based on data collected between November 2006 and September 2008.
Results Compared with the 193 women without sleep-disordered breathing, the 105 women (35.2%) with sleep-disordered breathing were more likely to develop mild cognitive impairment or dementia (31.1% [n = 60] vs 44.8% [n = 47]; adjusted odds ratio [AOR], 1.85; 95% confidence interval [CI], 1.11-3.08). Elevated oxygen desaturation index (≥15 events/hour) and high percentage of sleep time (>7%) in apnea or hypopnea (both measures of disordered breathing) were associated with risk of developing mild cognitive impairment or dementia (AOR, 1.71 [95% CI, 1.04-2.83] and AOR, 2.04 [95% CI, 1.10-3.78], respectively). Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment.
Conclusion Among older women, those with sleep-disordered breathing compared with those without sleep-disordered breathing had an increased risk of developing cognitive impairment.
KEYWORDS: aging, anoxia, cognition disorders, dementia, risk factors, sleep apnea syndromes, women's health.
Figure. Progression of Patients Through the Study of Osteoporotic Fractures' Sleep and Cognition Study
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