目的

分析睡眠呼吸暂停（obstructive sleep apnea，OSA）程度与慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者认知功能减退的临床意义。

方法

选取2022 年1 月至2024 年8 月我院收治的COPD 患者118 例为对象，根据呼吸暂停低通气指数（apnea hypopnea index，AHI）分为对照组38 例（AHI＜5 次/h）、轻度组38 例（5 次/h≤AHI ＜15 次/h）、中度组30 例（15 次/h≤AHI＜30 次/h）和重度组12 例（AHI≥30 次/h）。 比较每组患者临床资料、肺功能及认知功能。 采用Pearson 相关性分析和多元线性回归分析睡眠呼吸暂停程度与COPD 患者认知功能的相关性。

结果

每组第一秒用力呼气容积/用力肺活量（forced expiratory volume in the first second / forced vital capacity，FEV₁/FVC）、第一秒用力呼气容积占预计值百分比（forced expiratory volume in the first second as a percentage of predicted value，FEV₁%Pred）差异有统计学意义，对照组、轻度组、中度组及重度组FEV₁/FVC 分别为（61.25±4.09）%、（58.64±5.17）%、（52.65±6.22）%、（48.97±4.19）%，FEV₁%Pred 分别为（75.33±2.75）%、（72.61±4.86）%、（62.64±5.44）%、（58.67±4.59）%；重度组FEV₁/FVC、FEV₁%Pred 低于对照组、轻度组和中度组（P＜0.05）。 每组视空间/执行功能、注意力、记忆力及蒙特利尔认知评估量表（montreal cognitive assessment scale，MoCA）总评分差异有统计学意义（P＜0.05），重度组视空间/执行功能、注意力、记忆力及MoCA 评分分别为（3.31±0.67）分、（4.66±0.15）分、（3.52±0.29）分、（24.18±2.01）分，对照组分别为（4.58±0.12）分、（5.61±0.27）分、（4.39±0.24）分、（28.33±1.17）分（P＜0.05）；Pearson 相关性分析显示，AHI 与MoCA 呈负相关（r=-0.616，P=0.001）。 多元逐步回归分析显示，AHI 可负向影响COPD 患者认知功能（P＜0.05）。 118 例OSA 与CODP 患者认知功能减退经救治后生存者98 例（83.05%），救治疗效不佳死亡者20 例（16.95%）。

结论

OSA 程度与COPD 患者认知功能减退风险有关，判断COPD 患者OSA 病情，早期识别及救治OSA，有助于降低认知功能减退风险。

Objective

To analyze the clinical analysis between the severity of sleep apnea and the risk of cognitive decline in patients with chronic obstructive pulmonary disease （COPD）.

Methods

A total of 118 COPD patients admitted to our hospital from January 2022 to August 2024 were enrolled. They were divided into four groups based on the apnea hypopnea index （AHI）：control group 38 cases （AHI＜5 events/h），mild group 38 cases （5 events/h≤AHI＜15 events/h），moderate group 30 cases （15 events/h≤AHI＜30 events/h），and severe group12 cases （ AHI≥30 events/h）. General data，pulmonary function，and cognitive function were compared among the groups. Pearson correlation analysis and multiple linear regression were used to assess the correlation between sleep apnea severity and cognitive function in COPD patients.

Results

Significant differences were observed among the groups in forced expiratory volume in the first second/forced vital capacity（FEV₁/FVC） and forced expiratory volume in the first second as a percentage of predicted value （FEV₁%Pred）. The FEV₁/FVC values for the control，mild，moderate，and severe groups were （61.25±4.09）%，（58.64±5.17）%，（52.65±6.22）%，and （48.97±4.19）%，respectively. FEV₁%Pred values were （75.33±2.75）%，（72.61±4.86）%，（62.64±5.44）%，and （58.67±4.59）%，respectively. The severe group had significantly lower FEV₁/FVC and FEV₁%Pred compared to the control，mild，and moderate groups （P ＜0.05）. Significant differences were also observed in visuospatial/executive function，attention，memory，and total Montreal Cognitive Assessment Scale （MoCA） scores among the groups （P＜0.05）. The severe group scored （3.31±0.67），（4.66±0.15），（3.52±0.29），and （24.18±2.01） in these domains，respectively，while the control group scored （4.58±0.12），（5.61±0.27），（4.39±0.24），and （28.33±1.17） （P＜0.05）. Pearson correlation analysis revealed a negative correlation between AHI and MoCA scores （r=-0.616，P =0.001）.Multiple stepwise regression analysis indicated that AHI negatively impacted cognitive function in COPD patients （P ＜0.05）. Among 118 patients with OSA and CODP who had cognitive decline，98（83.05%）survived after treatment，and 20（16.95%） died due to poor treatment efficacy.

Conclusion

The severity of sleep apnea is associated with the risk of cognitive decline in COPD patients. Assessing sleep apnea in COPD patients and implementing early interventions may help reduce the risk of cognitive impairment.