【摘要】 目的：评价阿尔茨海默病（AD）源性轻度认知障碍（MCI）患者临床表型和夜间睡眠结构特征与认知损害的相关性。方法：依据脑脊液或正电子发射计算机断层显像，检测β-淀粉样蛋白（Aβ）浓度或沉积状态，区分AD源性MCI和非AD源性MCI患者。所有MCI患者接受多导睡眠监测（PSG）,APOE基因检测，蒙特利尔认知评估量表中文版（MoCA），汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）测评。结果 :(1)两组睡眠障碍率、教育年限数、职业性质、合并多个危险因素率和APOE ε4突变率等临床表型存在显著差异（P<0.05）；(2)两组体质量指数（BMI）,MoCA和HAMA评分存在显著差异（P<0.05）；(3)两组N1期睡眠（N1）/总睡眠时间（TST）%,N2期睡眠（N2）/TST%,N3期睡眠（N3）/TST%和快速眼球运动睡眠（REM）/TST%，睡眠期平均血氧浓度，睡眠呼吸暂停低通气指数（AHI）和阻塞性睡眠呼吸暂停（OSA）指数均有显著差异（P<0.05）；(4) AD源性MCI患者的临床表型（睡眠障碍、APOEε4突变、合并多个危险因素、从事脑力职业和BMI等）与睡眠结构微观参数（N1/TST%、N2/TST%、REM/TST%和OSA指数等）与认知评分密切相关（P<0.05）；(5)性别、睡眠障碍、APOE ε4突变、BMI、N1/TST%、N2/TST%、REM/TST%和OSA指数等指标是MCI群体AD的患病风险预测指标（P<0.05）；(6) N1/TST%、N2/TST%、 REM/TST%和OSA指数与MoCA总分呈显著线性相关（P<0.01）。结论：AD源性MCI患者存在睡眠障碍率高，APOE ε4突变率高，合并多个危险因素率低，脑力职业占比高和BMI低等临床表型。AD源性MCI患者睡眠结构参数N1/TST%,N2/TST%,REM/TST%和OSA指数与认知损害显著相关。MCI患者N1、N2和REM期睡眠占比的特征性改变，可能是早期预警AD源性MCI患者的潜在生物学指标。更多还原

【Abstract】 Objective: To evaluate clinical phenotypes and nocturnal sleep structure characteristics with mild cognitive impairment due to Alzheimer’s disease(AD). Methods: Based on cerebrospinal fluid or positron emission tomography imaging to detect the concentration or deposition status of β-amyloid protein(Aβ) to distinguish between MCI due to AD and control group. All patients underwent polysomnography monitoring(PSG), APOE gene testing, Montreal Cognitive Assessment(MoCA), Hamilton Anxiety Scale(HAMA), and Hamilton Depression Scale(HAMD) assessments. Results:(1) Significant differences were found in clinical characteristics such as sleep disturbance, body mass index(BMI), education years, occupations, combined with risk factors, and APOEε4 gene mutation(P<0.05);(2) There were statistically significant differences in MoCA and HAMA scores between these two groups(P<0.05);(3) Significant differences in N1/total sleep time(TST)%, N2/TST%, N3/TST% and rapid eye movement sleep time(REM)/TST%, average blood oxygen concentration during night-sleep time, sleep-related apnea-hypopnea index(AHI), obstructive sleep apnea(OSA) index between these two groups(P<0.05);(4) Clinical phenotypes including sleep disorders, APOE ε4 mutation, multiple risk factors, cognitively demanding occupations and sleep microstructural parameters were significantly correlated with MCI due to AD(P<0.05);(5) Gender, sleep disturbance, APOEε4 gene mutation, BMI and polysomnographic indices(N1/TST%, N2/TST%, REM/TST% and OSA index) were key factors in MCI due to AD(P<0.05);(6) N1/TST%, N2/TST%, REM/TST% and OSA index demonstrated significant linear correlations with MoCA scores(P<0.01). Conclusion: Patients with MCI due to AD exhibited distinct clinical features, including a higher prevalence of sleep disorders, elevated APOE ε4 allele carrier rates, lower prevalence of multiple risk factors, a higher proportion of cognitively demanding occupations and lower BMI. Sleep parameters, including N1/TST%, N2/TST%, REM/TST% and OSA index, demonstrated significant correlations with cognitive impairment. Characteristic changes in the proportion of N1, N2 and REM sleep among MCI patients may serve as potential biomarkers for early identification of MCI due to AD.更多还原