Study On Basic Cognitive Function And Decision-making Function In Patients With Obstructive Sleep Apnea Hypopnea Syndrome

Objective To explore the abnormality of cognitive function in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)and analyze the factors affecting cognitive function.Method From May 2021 to January 2023,54 patients with OSAHS and 27 patients without OSAHS were diagnosed by sleep breath monitor.General data such as years of education,age,sex,body mass index,smoking history,drinking history,past disease history and so on were collected.The sleep monitoring data such as apnea hypopnea index(AHI),average blood oxygen saturation,total times of hypopnea,total times of oxygen reduction,lowest blood oxygen saturation and hypopnea index were recorded simultaneously.The risk decision-making function of the subjects was tested by the dice game test(GDT)with known risk probability,and the overall cognitive function of the subjects was tested by the Montreal Cognitive Assessment scale(MoCA)and the Mini-mental State Examination(MMSE).Epworth sleep scale(ESS)and Pittsburgh Sleep Quality Index(PSQI)scale were used to evaluate the degree of daytime drowsiness and night sleep quality of the participants.Results(1)General information:OSAHS patients and non-OSAHS patients showed no significant differences in gender(χ~2=1.286,P=0.257),age(t=1.543,P=0.127)and years of education(Z=-1.513,P=0.130).The Body Mass Index(BMI)of OSAHS patients was higher than that of non-OSAHS patients,and the difference was statistically significant(Z=-2.245,P=0.025).There was no significant difference in smoking years(Z=-1.311,P=0.190)and daily smoking amount(Z=-0.383,P=0.702)between OSAHS patients and non-OSAHS group.There was a statistically significant difference between the OSAHS patient group and the non-OSAHS group in terms of alcohol consumption history(χ~2=8.100,P=0.004).(2)Sleep monitoring data:In the analysis of sleep monitoring results,the apnea hypopnea index(AHI)of OSAHS patients was significantly higher than that of non-OSAHS patients,and the difference was statistically significant(Z=-7.304,P=0.000).There were statistically significant differences in hypopnea index(Z=-3.247,P=0.001),longest apnea time(Z=-4.383,P=0.000),lowest oxygen saturation(Z=-3.417,P=0.001),average oxygen saturation(Z=-4.235,P=0.000)and oxygen reduction index(Z=-5.551,P=0.000)between OSAHS patients and non-OSAHS patients.(3)Basic cognitive function:In MoCA test results,the total score of OSAHS patients was lower than that of non-OSAHS patients,and the difference was statistically significant(Z=-3.680,P=0.000).In the test results of each item of MoCA,there were statistically significant differences in visuospatial executive function(Z=-3.002,P=0.003),delayed recall(Z=-1.976,P=0.048)and language(Z=-2.674,P=0.007)between the two groups;there was no significant difference in attention(Z=-0.042,P=0.967),abstract ability(Z=-0.075,P=0.940)and orientation(Z=-0.503,P=0.615).As for the MMSE test results,there was a statistically significant difference in total scores between the OSAHS patients and non-OSAHS patients(Z=-2.424,P=0.015).The results of the MMSE subitems showed that the recall ability of the OSAHS patients was worse than that of the non-OSAHS patients,and the difference was statistically significant(Z=-2.300,P=0.021),while there were no significant differences in orientation(Z=-0.707,P=0.480),immediate memory(Z=-0.905,P=0.365),attention and calculation ability(Z=-1.244,P=0.214),and language ability(Z=-0.349,P=0.727).(4)Cognitive function of decision making:In the GDT test,there were statistically significant differences in total assets(Z=-3.277,P=0.001)and negative feedback utilization rate(Z=-4.895,P=0.000)between the OSAHS and non-OSAHS patients,but no statistically significant differences in the number of safe options(Z=-0.527,P=0.598)and risk options(Z=-0.527,P=0.598).(5)Sleep:It was found that there was a statistically significant difference in the total ESS score between the OSAHS patient group and the non-OSAHS patient group(Z=-5.076,P=0.000).There were statistically significant differences in PSQI total score(Z=-2.227,P=0.026),sleep quality(Z=-2.529,P=0.011)and daytime dysfunction(Z=-3.443,P=0.001)of sub-items between the OSAHS patients and the non-OSAHS patients.There was no significant difference in bedtime(Z=-0.150,P=0.881),sleep time(Z=-0.147,P=0.883),sleep efficiency(Z=-0.694,P=0.488)and sleep disorder(Z=-0.951,P=0.342).(6)Analysis of influencing factors of negative feedback utilization rate:Multiple linear regression analysis found that the negative feedback utilization rate in GDT test was negatively correlated with AHI(P=0.029)and hypoventilation index(P=0.037),but had no significant correlation with MoCA total score,ESS total score,PSQI total score,smoking years,drinking or not.Conclusions OSAHS patients have impairment of risk decision making and executive function closely related to frontal lobe function,as well as delayed memory and impaired language ability,while immediate memory,attention,abstraction and orientation are relatively preserved.Impaired risk decision-making function was associated with AHI and hypoventilation index.Compared with non-OSAHS patients,OSAHS patients had more obvious daytime sleepiness and worse subjective sleep quality at night.