The Effect Of Serum HIF-1and Ngb On Decisionmaking Dysfunction In Stroke Patients With Obstructive Sleep Apnea Hypopnea Syndrome(OSAHS)

Objectives 1 To investigate the correlation between the levels of HIF-1 and Ngb and the decision-making dysfunction of patients with obstructive sleep apnea hypopnea syndrome(OSAHS) combined cerebral infarction; 2 To investigate the assessment influence of HIF-1 and Ngb on the decision-making dysfunction of OSAHS patients with cerebral infarction.Methods 164 patients with complained of cerebral infarction and diagnosed with obstructive sleep aplnea-hypopnea syndrome(OSAHS) in the Affiliated Hospital of North China University of Science and Technology from 2013.3 to 2014.10 were chosen as case group and 168 cerebral infarction patients without OSAHS during the same period were collected as control group. All the subjects received Iowa gambling task(IGT) evaluation for decision-making dysfunction; the levels of serum Hypoxia-Inducible Factor-1(HIF-1) and Neuroglobin(Ngb) were determined by enzyme-linked immunosorbent(ELISA) method. The sleep phase indexes were monitored by Polysomnography(PSG). All data were analyzed by statistical software SPSS13.0, Data were expressed as mean±standard deviation( sx ±), Count data was adopted by chi-square test, Measurement data was adopted by( sx ±), Specific sensitivity was adopted by ROC curve analysis, Correlation analysis was adopted by Pearson, predictive factors was adopted by Multiple stepwise regression analysis, the difference was statistical significance(P<0.05).Results 1 The comparison of general information showed that there were no significant difference in gender, age, education, body mass index(BMI), infarction areas, infarction volume, with or without hypertension, hyperglycemia or other chronic diseases between the case group and the control group(P>0.05). It is comparable. 2 In the case group, the levels of serum HIF-1 and Ngb levels were both higher than those in the control group(P<0.05); The HIF-1 and Ngb levels in moderate and severe OSAHS groups were significantly higher than those in mild OSAHS group; The HIF-1 and Ngb levels in severe OSAHS group were significantly higher than those in moderate OSAHS group. AHI were respectively positive correlated with HIF-1 and Ngb levels(P<0.01), while respectively negative correlated with LSa O2(P<0.01). 3 The proportion of decisionmaking dysfunction impairment in the case group was 48.17%, which significantly higher than that in the control group(33.93%)(c2=12.339,P<0.05); In the case group, except for the first and second stage, the scores of the other stages of the IGT were significant lower than those in the control group(P<0.05); There were no significant difference between the different phase in the control group(F=0.582,P>0.05); In the case group,there were no significant difference between the different phase(F=0.545,P>0.05).4 In the case group, the cases of decision-making dysfunction impairment were 23 patients with mild OSAHS, 28 patients with moderate OSAHS, 27 patients with severe OSAHS, expectively accounting for 34.3%, 53.8%, 60%. The difference was statistically significant(c2=8.319,P<0.05). The scores of all stages in IGT in moderate and severe OSAHS groups were significantly lower than those in mild OSAHS group; The scores of all stages in IGT in severe OSAHS group were significantly lower than those in moderate OSAHS group; The results of correlation analysis showed that the each stage of IGT score were respectively negative correlated with Apnea Hypopnea Index(AHI), while positive correlated with Lowest Oxygen Saturation(LSa O2)(P<0.01). 5 The results of correlation analysis between IGT scores and HIF-1, Ngb level in the case group showed that the HIF-1 and Ngb levels of decision-making dysfunction case were higher than those of non-decision-making dysfunction case in the case group(P<0.05); The each stage of IGT score were respectively negative correlated with HIF-1 and Ngb levels(P<0.01). 6 ROC curve showed that the area of HIF-1 under the ROC curve for evaluating decision-making dysfunction was 0.858(P<0.05), sensitivity and specificity respectively were 0.785 and 0.882(P<0.05); while the area of Ngb under the ROC curve for evaluating execution dysfunction was 0.884(P<0.05), sensitivity and specificity respectively were 0.772 and 0.929(P<0.05). 7 The multiple step regression of the effects of factors on decision-making dysfunction in the case group showed that the decisionmaking dysfunction appears to be related to Ngb and HIF-1.Conclusions 1 Patients of OSAHS combined with cerebral infarction prone to have decision-making dysfunction, which related to higher serum HIF-1 and Ngb levels. 2 The levels of HIF-1 and Ngb will reflect to the decision-making dysfunction of patients of OSAHS combined with cerebral infarction; and Ngb level was superior to the HIF-1 level for the early evaluation decision-making dysfunction in patients of OSAHS combined with cerebral infarction.