Relationship of Cognitive Function with Emotion and Sleep Architecture in Patients with OSAHS

Abstract

Background Obstructive sleep apnea-hypopnea syndrome （OSAHS） is a sleep-related breathing disease，which influences patients' sleep quality and emotion regulation due to long-term intermittent hypoxemia and sleep fragmentation. It has a close relationship with cognitive function. Objective To explore the relationship of cognitive function with emotion and sleep architecture in patients with OSAHS. Methods A retrospective analysis was conducted. Participants were 116 cases of OSAHS diagnosed by polysomnography（PSG） recruited from Sleep Medical Center，Shengjing Hospital of China Medical University from September 2019 to December 2020. Clinical data were collected，including results of PSG and questionnaires before PSG〔including Generalized Anxiety Disorder（GAD-7），Patient Health Questionnaire-9（PHQ-9）， Montreal Cognitive Assessment（MoCA），Mean Memory and Executive Screening（MES），Insomnia Severity Index（ISI）， Epworth Sleepiness Scale（ESS）〕. According to the total score of MoCA，participants were divided into normal cognition group （≥ 26 points， n=79） and abnormal cognition group （<26 points， n=37）. Pearson and Spearman correlation analyses were used to study the correlation of cognitive function with PSG indicators. Multiple linear regression analysisi was used to explore the factors associated with cognitive function. Results There were no significant differences in emotion functions between normal cognition group and abnormal cognition group. Both groups had significant differences in mean age，sex ratio，MES score，total arousals，arousals in non-rapid eye movement（NREM），arousals in rapid eye movement（REM），total sleep time（TST）， wake after sleep onset（WASO），sleep efficiency，percentage of stage N3 sleep（N3/TST%） and percentage of REM（REM/ TST%） （P<0.05）. Correlation analyses showed that MoCA score was negatively correlated with age，apnea hypopnea index （AHI），and WASO（P<0.05），and positively correlated with TST，sleep efficiency，REM/TST%，total arousals and arousals in REM（P<0.05）. The score of delayed recall in the MoCA scale was negatively correlated with age and WASO （P<0.05），and positively correlated with sleep efficiency，REM/TST%，total arousals and arousals in REM（P<0.05）.The total score of MES was negatively correlated with age（P<0.05），and positively correlated with REM/TST%，total arousals， and arousals in NREM and REM（P<0.05）. Multiple linear regression analysis showed that age，AHI and REM/TST% were associated with MoCA score（P<0.05），and age was associated with delayed recall score and MES score（P<0.05）. The final regression model established using stepwise regression revealed that the MoCA score had a stronger correlation with age and REM/ TST%，and MoCA score was negatively correlated with age（P<0.05），and positively correlated with REM/TST%（P<0.05）. Conclusion The decline of cognitive function in OSAHS patients was significantly correlated with the reduction of REM. No obvious abnormality in emotion was found in these patients with cognitive dysfunction. The relationship between cognitive function and sleep architecture in OSAHS patients can be further clarified in future research.

Keywords

• sleep apnea，obstructive；cognitive function；emotion；sleep architecture；root cause analysis