Sleep Patterns,neuropsychological Characteristics In Stroke And High Risk Of Stroke Combined With OSAHS And Relevant Clinical Research About CPAP

Objective: 1.To evaluate and analysis patients ’ general condition, sleep and neuropsychological(cognitive function, depression)assessment scores,polysomnography indicators, exploring sleep and neuropsychological characteristics in stroke or high risk of stroke combined with obstructive sleep apnea/hyponea syndrome(OSAHS). 2.To further evaluate the effect of 3 months use of Automatic Continuos Positive Airway Pressure(Auto-CPAP) on subjective sleep situation, neuropsychological assessment scores and objective sleep structure, respiratory parameters in stroke or high risk of stroke combined with OSAHS.Methods: 1.Selected 43 patients who were stroke or high risk of stroke combined with OSAHS in General hospital of Tianjin medical university as OSAHS group from May 2014 till January 2015, while selected 17 patients were stroke or high risk of stroke not combined with OSAHS. Disease history and basic condition of the two groups were matched. Divided the OSAHS group into mild OSAHS group, moderate OSAHS group, severe OSAHS group through AHI.Registered the basic informations and related risk factors of all the research objects. Registered the polysomnography parameters including the lowest arterial oxygen saturation, apnea and hypopnea index, sleep latency, REM sleep latency, sleep efficiency, the percentage of each sleep stage of the total sleep time;Evaluated the subjective sleep quality by the Epworth Sleeping Scale(ESS) and Pittsburgh Sleep Quality Index(PSQI); Evaluated global cognitive function by Montreal Cognitive Assessment(Mo CA) and Mini Mental State Exam(MMSE); Evaluated memory and attention by Digit Span Test(DST)and Hopkins verbal Learning Test(HVLT); Evaluated depression by 9 items patient health questionnaire(PHQ9). Analysis the changes about these:the differences of subjective sleep quality, cognitive function and depression scores between the OSAHS group and the Non-OSAHS group;2. the differences of cognitive function scores between mild OSAHS group, moderateOSAHS group and severe OSAHS group; the differences of objective sleep structure and respirator parameters between the OSAHS group and the Non-OSAHS group. 2.Divided the research objects combined with OSAHS who were in accordance with CPAP therapy indicatio into treatment group(19cases) and control group(27cases) through the choice of Auto-CPAP treatment. 5 patients falled off from the treatment group in 3 months.Evaluated the subjective sleep qulatity,cognitive function and depression of the rest 41 cases via the same scales as before 3 months later. The rest research objects from treatment group were reexamined polysomnography.Analysis the changes about these:1.the differences of subjective sleep quality, cognitive function and depression scores before and after 3 months Auto-CPAP treatment in the treatment group;2. the differences of objective sleep structure and respirator index before and after 3 months Auto-CPAP treatment in the treatment group;3. the differences of subjective sleep quality, cognitive function, depression scores between control group and treatment group 3 months later.Results: 1.Compared with Non-OSAHS group, the sleep condition related scale scores of ESS and PSQI is higer in the OSAHS group who were stroke or high risk of stroke, the differences were statistically significant, P<0.05; the scores of global cognitive function scales Mo CA and MMSE had a decreasing tendency,but there was no statistical difference, P >0.05; the scores of memory and attention scales had a decreasing tendency,but there was no statistical difference, P >0.05;the score of depression scale PHQ9 was higher,the difference was statistically significant, P<0.05. 2.Compared with mild and moderate OSAHS group, the scores of global cognitive function scales Mo CA decreased significantly in the severe OSAHS group, P < 0.05. the memory scale HVLT’ total scores and delayed recall scores decreased significantly, P<0.05; 3.Compared with Non-OSAHS group,the ratio of NREM Stage 1, the sum of NREM Stage 1 and 2 were higher, the ratio of NREM Stage 2 and NREM Stage3 were lower in the OSAHS group, the difference was statistically significant, P<0.05. sleep latency, REM sleep latency, Sleep efficiency and the ratio of REM Stage had nosignificant difference in the two group, P >0.05;the Apnea-hypopnea index was higher and the lowest arterial oxygen saturation was lower in the OSAHS group,the difference was statistically significant, P<0.05. 4.The subjective sleep quality scores of Epworth and PSQI were lower after three months Auto-CPAP treatment in the treatment group than before, the difference was statistically significant, P < 0.05. The cognitive function scores had no statistical difference beore and after the CPAP treatment, P>0.05. 5.There were no difference about Sleep latency, REM sleep latency, Sleep efficiency and the ratio of NREM Stage1 ~ NREM Stage 3, Rapid eye movements Stage before and after 3 momths CPAP treatment;The Apnea-hypopnea index decreased and the lowest arterial oxygen saturation increased significantly after 3 months CPAP treatment than before,the difference was statistically significant, P<0.05. 6.Compared with control group at the time of three months follow-up,sleep quality scores of Epworth and PSQI were lower in the treatment group than in the control group, the difference was statistically significant, P<0.05.;The scores of global cognitive function scales Mo CA and MMSE had a inecreasing tendency,but there was no statistical difference, P >0.05; the scores of memory and attention scales had a inecreasing tendency,but there was no statistical difference, P >0.05; the score of depression scale PHQ9 was lower,the difference was statistically significant, P<0.05.Conclusion: 1.The stoke or high risk of stroke combined with OSAHS have poor subjective sleep quality,and easy to be sleepy and depressed;but OSAHS does not cause obvious damage on general cognitive function and domains such as memory, attention in the stoke or high risk of stroke. 2. The global cognitive function,memory and attention are obviously injured in the stoke or high risk of stroke combined with severe OSAHS. 3.OSAHS can aggravate the disorders of sleep structure. 4.There months CPAP treatment can improve subjective sleep quality and depression but can not improve the cognitive function in the stoke or high risk ofstroke combined with OSAHS,Prompting that the cognitive impairment in high risk of stroke combined with OSHSA is difficult to correct.There is still a serious sleep structure disorder after 3 months CPAP treatment compared with before in the treatment group; Compared with before, The Apnea-hypopnea index lowed and the lowest oxygen saturation improved after 3 momths treatment by CPAP,but still not reach the normal level, prompting that the high risk of stroke combined with OSA should insist on CPAP treatment every night.