阻塞型睡眠呼吸中止症患者行為監控能力的探討

Action Monitoring in Obstructive Sleep Apnea

周秉松(Ping-Song Chou)

指導教授 ： 賴秋蓮

高雄醫學大學/醫學院/醫學系神經學科碩士班/碩士(2015年)

摘要

阻塞型睡眠呼吸中止症(obstructive sleep apnea, OSA)是成年人常見之睡眠障礙，疾病特色為因反覆的呼吸中止和呼吸不足而產生間斷性缺氧以及睡眠片段化。本研究藉完整的額葉功能評估、行為監控能力評估及事件相關電位配合睡眠多項生理檢查，探討OSA患者認知功能表現、事件相關電位及其可能之致病機轉。

本研究收集了25名經PSG確定為OSA的患者與12名控制組，均接受額葉功能測驗、旁側抑制作業(Flanker task)及事件相關電位(P300、error-related negativity (ERN), error positivity (Pe))。相較於控制組，OSA患者的部分認知功能有顯著降低，主要在注意力、高階執行功能及行為監控能力方面。在事件相關電位上，OSA患者P300及ERN的潛時顯著延長，但Pe和正常人則無顯著差異。

本研究結論為 1) 在OSA患者確實存在著額葉功能障礙，受影響的主要是整體認知功能、注意力、高階執行功能及行為監控能力 2) 睡眠片段化及間斷性缺氧頻率會影響注意力功能，而睡眠片段化及夜間低血氧嚴重度和行為監控能力則有密切相關性。

關鍵字

阻塞型睡眠呼吸中止症 ； 旁側抑制作業 ； 錯誤相關電位

並列摘要

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by chronic intermittent hypoxia and sleep fragmentation. Patients with OSA often complain poor attention, impaired vigilance and cognitive decline. Using comprehensive Frontal Test Battery, Flanker task and event-related potentials (P300, error-related negativity (ERN) and error positivity (Pe)), the aims of this study are 1) to evaluate the cognitive deficit, particularly action monitoring, 2) to investigate the effect of OSA on P300, ERN and Pe, and 3) to clarify the possible mechanism of cognitive dysfunction in patients with OSA syndrome.

25 OSA patients, based on polysomnography (PSG) (male: 19, mean age: 49.7 ± 8.6 years) and 12 normal controls (male: 6, mean age: 43.9 ± 8.7 years) underwent comprehensive Frontal Test Battery, Flanker task and event-related potentials assessments (P300, error-related negativity and error positivity).

In comparison with controls, the OSA patients showed significant impairment in global cognition, attention and high executive function. Besides, the OSA patients have lower correct rate and lower error correcting rate in Flanker task. The OSA patients also have significant prolonged P300 and ERN latencies.

Furthermore, the arousal index was significantly correlated with attention and performance of Flanker task. The oxygen desaturation index was significantly correlated with attention. The duration and severe of nocturnal hypoxia was significantly correlated with amplitude of ERN.

We conclude that the OSA patients may manifest with significant frontal dysfunction, mainly on attention, executive function and action monitoring. We suggest that the attentional impairment might be due to sleep fragmentation and intermittent hypoxia, and the impairment of action monitoring might be due to sleep fragmentation and severity of nocturnal hypoxia.

並列關鍵字

obstructive sleep apnea ； Flanker task ； error-related negativity ； error positivity

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