Рецепт. 2022; : 52-60
Структура когнитивных нарушений у пациентов с апноэ во сне в остром периоде инфаркта мозга
https://doi.org/10.34883/PI.2022.25.1.007Аннотация
Цель исследования. Изучить влияние апноэ во сне на структуру когнитивных нарушений у пациентов в остром периоде инфаркта мозга.
Материалы и методы. Проведено исследование когнитивных функций по Монреальской шкале оценки когнитивных функций в остром периоде инфаркта мозга (ИМ) 74 пациентам с апноэ во сне (АС) и 40 пациентам без АС. В основной группе 20 пациентам в течение 7–10 дней выполнялась СИПАП-терапия.
Результаты. У пациентов с АС наблюдались более выраженные, чем у пациентов без АС, нарушения зрительно-конструктивных/исполнительных навыков, внимания и отсроченного воспроизведения (р<0,05), при этом наиболее тяжелый когнитивный дефицит в данных сферах и абстракции выявлен у пациентов с тяжелой степенью АС (р<0,05). Значимое улучшение в сфере отсроченного воспроизведения установлено у пациентов, получавших СИПАП-терапию, в сравнении с остальными пациентами основной группы (р=0,001).
Заключение. Пациенты с ИМ нуждаются в ранней диагностике АС и когнитивных нарушений для проведения своевременных лечебных и реабилитационных мероприятий.
Список литературы
1. Sharma R., Mallick D., Llinas R.H. Early Post-stroke Cognition: In-hospital Predictors and the Association with Functional Outcome. Front Neurol. 2020;11:613607. DOI: https://doi.org/10.3389/fneur.2020.613607
2. Mijajlović M.D., Pavlović A., Brainin M. Post-stroke dementia – a comprehensive review. BMC Med. 2017;15(1):11. DOI: https://doi.org/10.1186/s12916-017-0779-7
3. Horstmann S., Rizos T., Rauch G. Feasibility of the Montreal Cognitive Assessment in acute stroke patients. Eur J Neurol. 2014;21(11):1387–93. DOI: https://doi.org/10.1111/ene.12505
4. Cumming T.B., Bernhardt J., Linden T. The montreal cognitive assessment: short cognitive evaluation in a large stroke trial. Stroke. 2011;42(9):2642– 4. DOI: https://doi.org/10.1161/STROKEAHA.111.619486
5. Lal C., Strange C., Bachman D. Neurocognitive impairment in obstructive sleep apnea. Chest. 2012;141(6):1601–1610. DOI: https://doi.org/10.1378/chest.11-2214
6. Leng Y., McEvoy C.T., Allen I.E. Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment: A Systematic Review and Meta-analysis. JAMA Neurol. 2017;74(10):1237–1245. DOI: https://doi.org/10.1001/jamaneurol.2017.2180
7. Fan X., Song J., Xie F. Influences of severe obstructive sleep apnea on cognitive function. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021;35(6):511–516. DOI: https://doi.org/10.13201/j.issn.2096-7993.2021.06.006 (in Chinese).
8. Chen H.D., Wang J., Wang X.S. Relationship between cognitive impairment and sleep-related respiratory indexes in patients with obstructive sleep apnea. Zhonghua Yi Xue Za Zhi. 2020;100(37):2929–2933. DOI: https://doi.org/10.3760/cma.j.cn112137-20200224-00435 (in Chinese).
9. Mekky J.F., Yousof S., Elsayed I. Assessment of the cognitive functions in adult Egyptian patients with obstructive sleep apnea using the Montreal Cognitive Assessment: a retrospective large scale study. J Clin Sleep Med. 2021. DOI: https://doi.org/10.5664/jcsm.9704
10. Chen X., Zhang R., Xiao Y. Reliability and Validity of the Beijing Version of the Montreal Cognitive Assessment in the Evaluation of Cognitive Function of Adult Patients with OSAHS. PLoS One. 2015;10(7): e0132361. DOI: https://doi.org/10.1371/journal.pone.0132361
11. Chen R., Xiong K.P., Huang J.Y. Neurocognitive impairment in Chinese patients with obstructive sleep apnoea hypopnoea syndrome. Respirology. 2011;16(5):842–8. DOI: https://doi.org/10.1111/j.1440-1843.2011.01979.x
12. Gonzalez-Aquines A., Martinez-Roque D., Baltazar Trevino-Herrera A. Sindrome de apnea obstructiva del sueño y su relacion con el ictus isquemico [Obstructive sleep apnea syndrome and its relationship with ischaemic stroke]. Rev Neurol. 2019;69(6):255–260. DOI: https://doi.org/10.33588/rn.6906.2019061 (in Spanish).
13. Brown D.L., Shafie-Khorassani F., Kim S. Sleep-Disordered Breathing Is Associated with Recurrent Ischemic Stroke. Stroke. 2019;50(3):571–576. DOI: https://doi.org/10.1161/STROKEAHA.118.023807
14. Buzunov R., Palman A., Melnikov A. Diagnosis and treatment of obstructive sleep apnea syndrome in adults. Recommendations of the Russian Society of Somnologists. Effective Pharmacotherapy. 2018;(35):34–43. (in Russian).
15. Julayanont P., Phillips N., Chertkow H. Cognitive Assessment (MoCA): Concept and Clinical Review. Cognitive Screening Instruments. Springer, London. 2013. DOI: https://doi.org/10.1007/978-1-4471-2452-8_6
16. Slonkova J., Bar M., Nilius P. Spontaneous improvement in both obstructive sleep apnea and cognitive impairment after stroke. Sleep Med. 2017;32:137–142. DOI: https://doi.org/10.1016/j.sleep.2016.11.024
17. Aaronson J.A., van Bennekom C.A., Hofman W.F. Obstructive Sleep Apnea is Related to Impaired Cognitive and Functional Status after Stroke. Sleep. 2015;38(9):1431–7. DOI: https://doi.org/10.5665/sleep.4984
18. Aaronson J.A., Hofman W.F., van Bennekom C.A. Effects of Continuous Positive Airway Pressure on Cognitive and Functional Outcome of Stroke Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. J Clin Sleep Med. 2016;12(4):533–41. DOI: https://doi.org/10.5664/jcsm.5684
19. Kim H., Im S., Park J.I, Kim Y. Improvement of Cognitive Function after Continuous Positive Airway Pressure Treatment for Subacute Stroke Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. Brain Sci. 2019;9(10):252. DOI: https://doi.org/10.3390/brainsci9100252
Recipe. 2022; : 52-60
The Structure of Cognitive Impairments in Patients with Sleep Apnea in the Acute Period of Cerebral Infarction
https://doi.org/10.34883/PI.2022.25.1.007Abstract
Objective. To study the effect of sleep apnea on the structure of cognitive impairment in patients in the acute period of cerebral infarction.
Materials and methods. A study of cognitive functions according to the Montreal Cognitive Assessment in the acute period of cerebral infarction (CI) was carried out in 74 patients with sleep apnea (SA) and 40 patients without SA. In the main group 20 patients underwent CPAP therapy.
Results. In patients with SA, more pronounced disorders of visual-constructive/executive skills, attention and delayed reproduction (p<0.05) were observed than in patients without SA, while the most severe cognitive deficits in these areas and abstractions were found in patients with severe SA (p<0.05). A significant improvement in the field of delayed reproduction was found in patients receiving CPAP therapy in comparison with the rest of the patients in the main group (p=0.001).
Conclusion. Patients with CI require early diagnosis of SA and cognitive impairment in order to carry out timely treatment and rehabilitation measures.
References
1. Sharma R., Mallick D., Llinas R.H. Early Post-stroke Cognition: In-hospital Predictors and the Association with Functional Outcome. Front Neurol. 2020;11:613607. DOI: https://doi.org/10.3389/fneur.2020.613607
2. Mijajlović M.D., Pavlović A., Brainin M. Post-stroke dementia – a comprehensive review. BMC Med. 2017;15(1):11. DOI: https://doi.org/10.1186/s12916-017-0779-7
3. Horstmann S., Rizos T., Rauch G. Feasibility of the Montreal Cognitive Assessment in acute stroke patients. Eur J Neurol. 2014;21(11):1387–93. DOI: https://doi.org/10.1111/ene.12505
4. Cumming T.B., Bernhardt J., Linden T. The montreal cognitive assessment: short cognitive evaluation in a large stroke trial. Stroke. 2011;42(9):2642– 4. DOI: https://doi.org/10.1161/STROKEAHA.111.619486
5. Lal C., Strange C., Bachman D. Neurocognitive impairment in obstructive sleep apnea. Chest. 2012;141(6):1601–1610. DOI: https://doi.org/10.1378/chest.11-2214
6. Leng Y., McEvoy C.T., Allen I.E. Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment: A Systematic Review and Meta-analysis. JAMA Neurol. 2017;74(10):1237–1245. DOI: https://doi.org/10.1001/jamaneurol.2017.2180
7. Fan X., Song J., Xie F. Influences of severe obstructive sleep apnea on cognitive function. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021;35(6):511–516. DOI: https://doi.org/10.13201/j.issn.2096-7993.2021.06.006 (in Chinese).
8. Chen H.D., Wang J., Wang X.S. Relationship between cognitive impairment and sleep-related respiratory indexes in patients with obstructive sleep apnea. Zhonghua Yi Xue Za Zhi. 2020;100(37):2929–2933. DOI: https://doi.org/10.3760/cma.j.cn112137-20200224-00435 (in Chinese).
9. Mekky J.F., Yousof S., Elsayed I. Assessment of the cognitive functions in adult Egyptian patients with obstructive sleep apnea using the Montreal Cognitive Assessment: a retrospective large scale study. J Clin Sleep Med. 2021. DOI: https://doi.org/10.5664/jcsm.9704
10. Chen X., Zhang R., Xiao Y. Reliability and Validity of the Beijing Version of the Montreal Cognitive Assessment in the Evaluation of Cognitive Function of Adult Patients with OSAHS. PLoS One. 2015;10(7): e0132361. DOI: https://doi.org/10.1371/journal.pone.0132361
11. Chen R., Xiong K.P., Huang J.Y. Neurocognitive impairment in Chinese patients with obstructive sleep apnoea hypopnoea syndrome. Respirology. 2011;16(5):842–8. DOI: https://doi.org/10.1111/j.1440-1843.2011.01979.x
12. Gonzalez-Aquines A., Martinez-Roque D., Baltazar Trevino-Herrera A. Sindrome de apnea obstructiva del sueño y su relacion con el ictus isquemico [Obstructive sleep apnea syndrome and its relationship with ischaemic stroke]. Rev Neurol. 2019;69(6):255–260. DOI: https://doi.org/10.33588/rn.6906.2019061 (in Spanish).
13. Brown D.L., Shafie-Khorassani F., Kim S. Sleep-Disordered Breathing Is Associated with Recurrent Ischemic Stroke. Stroke. 2019;50(3):571–576. DOI: https://doi.org/10.1161/STROKEAHA.118.023807
14. Buzunov R., Palman A., Melnikov A. Diagnosis and treatment of obstructive sleep apnea syndrome in adults. Recommendations of the Russian Society of Somnologists. Effective Pharmacotherapy. 2018;(35):34–43. (in Russian).
15. Julayanont P., Phillips N., Chertkow H. Cognitive Assessment (MoCA): Concept and Clinical Review. Cognitive Screening Instruments. Springer, London. 2013. DOI: https://doi.org/10.1007/978-1-4471-2452-8_6
16. Slonkova J., Bar M., Nilius P. Spontaneous improvement in both obstructive sleep apnea and cognitive impairment after stroke. Sleep Med. 2017;32:137–142. DOI: https://doi.org/10.1016/j.sleep.2016.11.024
17. Aaronson J.A., van Bennekom C.A., Hofman W.F. Obstructive Sleep Apnea is Related to Impaired Cognitive and Functional Status after Stroke. Sleep. 2015;38(9):1431–7. DOI: https://doi.org/10.5665/sleep.4984
18. Aaronson J.A., Hofman W.F., van Bennekom C.A. Effects of Continuous Positive Airway Pressure on Cognitive and Functional Outcome of Stroke Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. J Clin Sleep Med. 2016;12(4):533–41. DOI: https://doi.org/10.5664/jcsm.5684
19. Kim H., Im S., Park J.I, Kim Y. Improvement of Cognitive Function after Continuous Positive Airway Pressure Treatment for Subacute Stroke Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. Brain Sci. 2019;9(10):252. DOI: https://doi.org/10.3390/brainsci9100252
