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| Title: | 正壓呼吸器介入對阻塞型睡眠呼吸中止症認知功能與AMYLOID-β和TAU蛋白指標的效果探討
The Effect of Positive Airway Pressure on Cognitive Function and Amyloid-β and Tau Proteins Levels in patients with Obstructive Sleep Apnea |
| Authors: | 林家玉
Lin, Chia-Yu |
| Contributors: | 楊建銘
Yang, Chien-Ming
林家玉
Lin, Chia-Yu |
| Keywords: | 阻塞型睡眠呼吸中止症
正壓呼吸器
認知功能
Amyloid-β
Tau蛋白
Obstructive Sleep Apnea
Positive airway pressure
Cognitive functions
Amyloid-β
Tau proteins |
| Date: | 2023 |
| Issue Date: | 2023-07-06 16:58:03 (UTC+8) |
| Abstract: | 研究目的：阻塞型睡眠呼吸中止症患者（Obstructive Sleep Apnea，OSA）的認知功能有受損的表現，而近期被發現顯著累積於OSA患者腦部乙型類澱粉樣蛋白（amyloid β，Aβ）和Tau蛋白可能是背後其中一個機制；OSA主要的治療方式為正壓呼吸器（positvie airway pressure，PAP），PAP能改善OSA患者認知功能表現，但對Aβ和Tau蛋白的效果仍未知。因此，本研究欲再次驗證PAP對OSA患者認知功能表現的效果，並且探究其對血漿中Aβ和Tau蛋白指標的效果，以及前述兩者改變間的關聯性，以進一步澄清OSA患者認知功能受損的背後機制。
研究方法：共包含兩個研究，研究一為橫斷設計，受試者均為40至70歲達國際睡眠疾患分類系統第三版（International Classification of Sleep Disorders-Third Edition）重度的OSA患者，並且招募21位尚未接受治療的組別作為對照組與15位長期穩定使用PAP至少三個月的組別（PAP組），進行認知功能測驗表現（包含克氏持續度表現測驗第三版、字詞配對記憶測驗、聽覺數字記憶廣度測驗修正版及語言流暢性測驗）和血漿Aβ和Tau蛋白濃度的組間比較。接下來，研究二為縱貫設計，針對研究一對照組願意使用PAP的受試者（N = 12），進行使用至少三個月PAP的前後認知功能測驗表現和血漿中Aβ和Tau蛋白濃度的組內比較，以及前述兩者改變的相關分析。
研究結果：研究一的PAP組在字詞配對測驗和聽覺數字記憶廣度測驗修正版ISI2.0s的表現顯著好於對照組，血漿Tau蛋白濃度也顯著低於對照組。其餘認知功能表現和血漿Aβ濃度則未達顯著差異。此外，研究二的結果顯示，PAP介入的後測之字詞配對測驗表現顯著好於前測，聽覺數字記憶廣度測驗修正版ISI2.0s表現的進步則達近似顯著水準，其餘認知功能表現與血漿Aβ和Tau蛋白無任何顯著差異；相關分析中，血漿Aβ濃度降低，與字詞配對測驗立即回憶序列A表現的進步呈顯著相關，而血漿Tau蛋白濃度減少，與聽覺數字記憶廣度測驗修正版ISI2.0s和克氏持續度表現測驗第三版的部分指標的改善呈顯著相關。
結論：綜合兩研究結果，關於認知功能表現，PAP介入具有改善OSA患者語文記憶力和工作記憶表現的效果；而關於降低血漿Tau蛋白的效果仍需未來研究加以驗證。此外，雖然本研究未觀察到PAP介入對血漿Aβ和Tau蛋白有顯著效果，但是認知功能表現與血漿Aβ和Tau蛋白濃度的關聯性，可以反映出作為OSA患者認知功能受損的其中機制，以及PAP對OSA患者認知功能表現改善的可能因素之一。
Objectives: Patients with Obstructive Sleep Apnea (OSA) exhibit cognitive deficits. Recent studies have reported higher amyloid-beta (Aβ) and tau proteins in OSA patients than normal control, which might be a contributing factor for the cognitive deficits in OSA patients. Since positive airway pressure (PAP), main treatment of OSA, was found to improve patients’ cognitive function, the currently study aims to: 1) replicate the effect of PAP treatment on cognitive functions and explore the effect of PAP treatment on amyloid-beta and tau proteins, and 2) examine the association between the changes in amyloid-beta and tau proteins and improvement in cognitive function after PAP intervention, in order to further the understanding of the mechanism of cognitive deficits in OSA patients.
Methods: There are two studies. Study one is a cross-sectional design with 36 subjects who aged 40 to 70 and met the diagnosis criteria of severe OSA of International Classification of Sleep Disorders, including 21 untreated patients as control group and 15 patients using PAP stably at least three months as PAP group. All subjects received cognitive tests (Conner’s continuous performance test, edition 3 [CPT-III], verbal paired association, paced auditory serial addition test [PASAT-R], and sematic verbal fluency test) and the blood-test for plasma amyloid-beta and tau proteins. Study two is a longitudinal design with 12 subjects from the control group of Study one who were willing to undergo PAP therapy, and received cognitive tests and the blood-test for plasma amyloid-beta and tau proteins again after at least 3 months of PAP intervention.
Results: In Study one, the PAP group showed significantly better performance in verbal paired association and PASAT-R ISI2.0s ,and lower level in plasma tau proteins compared to the control group. However, no significant differences were observed in other cognitive functions or plasma Aβ levels. In Study two, the results indicated a significant improvement in verbal paired association from pre-test to post-test, and a marginally significant improvement in PASAT-R ISI2.0s. However, no significant differences were found in other measures of cognitive functions, or plasma Aβ or tau proteins levels. Additionaly, the decrease amyloid-beta after treatment correlated significantly with improved performance on the first immediate recall sequence of paired associates; tau proteins reduction correlated with improved performance on PASAT-R 2.0s and some measures of CPT-III. The rest of the comparisons and correlations did not show significant results.
Conclusions: The combined results of the two studies indicate that PAP treatment is effective in improving verbal memory and working memory; further research is needed to validate the potential effect of reducing plasma tau proteins. Additionally, although study two did not observe significant effects of PAP intervention on plasma Aβ and tau proteins, the correlation between the improvement of cognitive performance and the reduction of plasma Aβ and tau proteins levels reflects the possibility that the accumulation of Aβ and tau proteins is a possible pathophysiology for the cognitive deficits in OSA patients, as well as a potential factor for the improvement of cognitive function with PAP intervention. |
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| Description: | 碩士
國立政治大學
心理學系
108752007 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0108752007 |
| Data Type: | thesis |
| Appears in Collections: | [心理學系] 學位論文
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