Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/81166
標題: 阻塞型睡眠呼吸中止症白天嗜睡因素探討及血中發炎指數分析
Factors influencing daytime sleepiness and serum inflammatory marker changes in patients with obstructive sleep apnea syndrome
作者: 江慧雯
Chiang, Hui-Wen
關鍵字: 阻塞型睡眠呼吸中止症;Obstructive sleep apnea syndrome;白天過度嗜睡;艾普沃斯嗜睡量表;多項式睡眠生理檢查;高敏感度反應性C 蛋白;同半胱胺酸;Excessive daytime sleepiness;Epworth sleepiness scale;Polysomnography;High sensitivity C-reactive protein;Homocysteine
出版社: 生命科學院碩士在職專班
引用: 劉勝義,蕭光明。2004。臨床睡眠檢查學。p.83-175。臺北:合記出版社。 鈴木一郎。2003。打呼的危險真相。p.104-119。臺北:世茂出版社。 王拔群,李學禹,莊銘隆,黃玉書,陳彥宏,邱國樑,陳濘宏。2003。中文版 Epworth嗜睡量表之信效度研究。臺灣精神醫學 17(1):14-22。 陳濘宏。2005。阻塞型睡眠呼吸中止症。台灣醫學 9(3):1-6。 徐嘉吟,方信智。2006。心血管疾病的新指標—高敏感性C-反應蛋白 (hs-CRP)。基層醫學 21(3):63-67。 Alves Eda, S., Ackel-D''Elia, C., Luz, G. P., Cunha, T. C., Carneiro, G., Tufik, S., Bittencourt, L. R., and de Mello, M. T. (2013). Does physical exercise reduce excessive daytime sleepiness by improving inflammatory profiles in obstructive sleep apnea patients? Sleep Breath, 17(2), 505-510. Andersen, M. L., Bittencourt, L. R., Antunes, I. B., and Tufik, S. (2006). Effects of progesterone on sleep: a possible pharmacological treatment for sleep-breathing disorders? Curr Med Chem, 13(29), 3575-3582. Arnardottir, E. S., Maislin, G., Schwab, R. J., Staley, B., Benediktsdottir, B., Olafsson, I., Juliussion, S., Romer, M., Gislason, T., and Pack, A. I. (2012). The interaction of obstructive sleep apnea and obesity on the inflammatory markers C-reactive protein and interleukin-6: the icelandic sleep apnea cohort. Sleep, 35(7), 921-932. Basta, M., Lin, H. M., Pejovic, S., Sarrigiannidis, A., Bixler, E. O., and Vgontzas, A. N. (2008). Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences. J Clin Sleep Med, 4(1), 19-25. Behan, M., and Wenninger, J. M. (2008). Sex steroidal hormones and respiratory control. Respir Physiol Neurobiol, 164(1-2), 213-221. Benzaquen, L. R., Yu, H., and Rifai, N. (2002). High sensitivity C-reactive protein: an emerging role in cardiovascular risk assessment. Crit Rev Clin Lab Sci, 39(4-5), 459-497. Bixler, E. O., Kales, A., Soldatos, C. R., Kales, J. D., and Healey, S. (1979). Prevalence of sleep disorders in the Los Angeles metropolitan area. Am J Psychiatry, 136(10), 1257-1262. Bixler, E. O., Vgontzas, A. N., Lin, H. M., Calhoun, S. L., Vela-Bueno, A., and Kales, A. (2005). Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab, 90(8), 4510-4515. Bravo Mde, L., Serpero, L. D., Barcelo, A., Barbe, F., Agusti, A., and Gozal, D. (2007). Inflammatory proteins in patients with obstructive sleep apnea with and without daytime sleepiness. Sleep Breath, 11(3), 177-185. Canapari, C. A., Hoppin, A. G., Kinane, T. B., Thomas, B. J., Torriani, M., and Katz, E. S. (2011). Relationship between sleep apnea, fat distribution, and insulin resistance in obese children. J Clin Sleep Med, 7(3), 268-273. Capuron, L., Gumnick, J. F., Musselman, D. L., Lawson, D. H., Reemsnyder, A., Nemeroff, C. B., and Miller, A. H. (2002). Neurobehavioral effects of interferon-alpha in cancer patients: phenomenology and paroxetine responsiveness of symptom dimensions. Neuropsychopharmacology, 26(5), 643-652. Capuron, L., Pagnoni, G., Demetrashvili, M. F., Lawson, D. H., Fornwalt, F. B., Woolwine, B., Berns, G.S., Nemeroff, C.B., and Miller, A. H. (2007). Basal ganglia hypermetabolism and symptoms of fatigue during interferon-alpha therapy. Neuropsychopharmacology, 32(11), 2384-2392. Cavelti-Weder, C., Furrer, R., Keller, C., Babians-Brunner, A., Solinger, A. M., Gast, H., Fontana, A., Donath, M. Y., and Penner, I. K. (2011). Inhibition of IL-1beta improves fatigue in type 2 diabetes. Diabetes Care, 34(10), e158. Chambers, J. C., Obeid, O. A., and Kooner, J. S. (1999). Physiological increments in plasma homocysteine induce vascular endothelial dysfunction in normal human subjects. Arterioscler Thromb Vasc Biol, 19(12), 2922-2927. Chen, R., Xiong, K. P., Lian, Y. X., Huang, J. Y., Zhao, M. Y., Li, J. X., and Liu, C. F. (2011). Daytime sleepiness and its determining factors in Chinese obstructive sleep apnea patients. Sleep Breath, 15(1), 129-135. Chennaoui, M., Sauvet, F., Drogou, C., Van Beers, P., Langrume, C., Guillard, M., Gourby, B., Bourrilhon, C., Florence, G., and Gomez-Merino, D. (2011). Effect of one night of sleep loss on changes in tumor necrosis factor alpha (TNF-alpha) levels in healthy men. Cytokine, 56(2), 318-324. Cohrs, S., Meier, A., Neumann, A. C., Jordan, W., Ruther, E., and Rodenbeck, A. (2005). Improved sleep continuity and increased slow wave sleep and REM latency during ziprasidone treatment: a randomized, controlled, crossover trial of 12 healthy male subjects. J Clin Psychiatry, 66(8), 989-996. Colt, H. G., Haas, H., and Rich, G. B. (1991). Hypoxemia vs sleep fragmentation as cause of excessive daytime sleepiness in obstructive sleep apnea. Chest, 100(6), 1542-1548. Dagan, Y., Doljansky, J. T., Green, A., and Weiner, A. (2006). Body Mass Index (BMI) as a first-line screening criterion for detection of excessive daytime sleepiness among professional drivers. Traffic Inj Prev, 7(1), 44-48. Das, M., Das, R., Khastgir, U., and Goswami, U. (2005). REM sleep latency and neurocognitive dysfunction in schizophrenia. Indian J Psychiatry, 47(3), 133-138. Davies, R. J., and Stradling, J. R. (1996). The epidemiology of sleep apnoea. Thorax, 51 (Suppl 2), S65-70. De Gennaro, L., Violani, C., Ferrara, M., Casagrande, M., and Bertini, M. (1995). Increase of REM duration and decrease of REM latency after a prolonged test of visual attention. Int J Neurosci, 82(3-4), 163-168. Dixon, J. B., Dixon, M. E., Anderson, M. L., Schachter, L., and O''Brien P, E. (2007). Daytime sleepiness in the obese: not as simple as obstructive sleep apnea. Obesity, 15(10), 2504-2511. Drager, L. F., Lopes, H. F., Maki-Nunes, C., Trombetta, I. C., Toschi-Dias, E., Alves, M. J., Fraga, R.F., Jun, J. C., Negrao, C. E., Krieger, E. M., Polotsky, V. Y., and Lorenzi-Filho, G. (2010). The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome. PLoS One, 5(8), e12065. Gastaut, H., Tassinari, C. A., and Duron, B. (1966). Polygraphic study of the episodic diurnal and nocturnal (hypnic and respiratory) manifestations of the Pickwick syndrome. Brain Res, 1(2), 167-186. George, C. F., Boudreau, A. C., and Smiley, A. (1996a). Comparison of simulated driving performance in narcolepsy and sleep apnea patients. Sleep, 19(9), 711-717. George, C. F., Boudreau, A. C., and Smiley, A. (1996b). Simulated driving performance in patients with obstructive sleep apnea. Am J Respir Crit Care Med, 154(1), 175-181. Guilleminault, C., Partinen, M., Quera-Salva, M., Hayes, B., Dement, W., and Nino-Murcia, G. (1988). Determinants of daytime sleepiness in obstructive sleep apnea. Chest, 94(1), 32-37. Hayashida, K., Inoue, Y., Chiba, S., Yagi, T., Urashima, M., Honda, Y., and Itoh, H. (2007). Factors influencing subjective sleepiness in patients with obstructive sleep apnea syndrome. Psychiatry Clin Neurosci, 61(5), 558-563. Hoffstein, V., and Mateika, S. (1992). Differences in abdominal and neck circumferences in patients with and without obstructive sleep apnoea. Eur Respir J, 5(4), 377-381. Hofmann, M. A., Lalla, E., Lu, Y., Gleason, M. R., Wolf, B. M., Tanji, N., Ferran, L. J., Jr., Kohl, B., Rao, V., Kisiel, W., Stern, D. M., and Schmidt, A. M. (2001). Hyperhomocysteinemia enhances vascular inflammation and accelerates atherosclerosis in a murine model. J Clin Invest, 107(6), 675-683. Hsieh, S. W., Lai, C. L., Liu, C. K., Hsieh, C. F., and Hsu, C. Y. (2012). Obstructive sleep apnea linked to wake-up strokes. J Neurol, 259(7), 1433-1439. Ip, M. S., Lam, B., Lauder, I. J., Tsang, K. W., Chung, K. F., Mok, Y. W., and Lam, W. K. (2001). A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong. Chest, 119(1), 62-69. Iranzo, A. (2010). Excessive daytime sleepiness in OSA. Sleep apnoea, p. 17-30. European Respiratory Monograph. Ishman, S. L., Cavey, R. M., Mettel, T. L., and Gourin, C. G. (2010). Depression, sleepiness, and disease severity in patients with obstructive sleep apnea. Laryngoscope, 120(11), 2331-2335. Kapsimalis, F., and Kryger, M. H. (2002). Gender and obstructive sleep apnea syndrome, part 1: Clinical features. Sleep, 25(4), 412-419. Kent, B. D., Ryan, S., and McNicholas, W. T. (2011). Obstructive sleep apnea and inflammation: relationship to cardiovascular co-morbidity. Respir Physiol Neurobiol, 178(3), 475-481. Khalyfa, A., Serpero, L. D., Kheirandish-Gozal, L., Capdevila, O. S., and Gozal, D. (2011). TNF-alpha gene polymorphisms and excessive daytime sleepiness in pediatric obstructive sleep apnea. J Pediatr, 158(1), 77-82. Kirilly, E., Molnar, E., Balogh, B., Kantor, S., Hansson, S. R., Palkovits, M., and Bagdy, G. (2008). Decrease in REM latency and changes in sleep quality parallel serotonergic damage and recovery after MDMA: a longitudinal study over 180 days. Int J Neuropsychopharmacol, 11(6), 795-809. Knorst, M. M., Souza, F. J., and Martinez, D. (2008). [Obstructive sleep apnea-hypopnea syndrome: association with gender, obesity and sleepiness-related factors]. J Bras Pneumol, 34(7), 490-496. Lasselin, J., Laye, S., Dexpert, S., Aubert, A., Gonzalez, C., Gin, H., and Capuron, L. (2012). Fatigue symptoms relate to systemic inflammation in patients with type 2 diabetes. Brain Behav Immun, 26(8), 1211-1219. Le Bon, O., Staner, L., Hoffmann, G., Kentos, M., Pelc, I., and Linkowski, P. (2001). Shorter REM latency associated with more sleep cycles of a shorter duration in healthy humans. Psychiatry Res, 104(1), 75-83. Lee, S. J., Kang, H. W., and Lee, L. H. (2011). The relationship between the Epworth Sleepiness Scale and polysomnographic parameters in obstructive sleep apnea patients. Eur Arch Otorhinolaryngol, 269, 1143-1147. Li, K. K., Kushida, C., Powell, N. B., Riley, R. W., and Guilleminault, C. (2000). Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope, 110(10), 1689-1693. Lira, F. S., Rosa, J. C., Dos Santos, R. V., Venancio, D. P., Carnier, J., Sanches Pde, L., do Nascimento, C. M., de Piano, A., Tock, L., Tufik, S., deMello, M. T., Damaso, A. R., and Oyama, L. M. (2011). Visceral fat decreased by long-term interdisciplinary lifestyle therapy correlated positively with interleukin-6 and tumor necrosis factor-alpha and negatively with adiponectin levels in obese adolescents. Metabolism, 60(3), 359-365. Liuzzo, G., and Rizzello, V. (2001). C-reactive protein and primary prevention of ischemic heart disease. Clin Chim Acta, 311(1), 45-48. Lurie, A. (2011). Inflammation, oxidative stress, and procoagulant and thrombotic activity in adults with obstructive sleep apnea. Adv Cardiol, 46, 43-66. Marks, G. A., Shaffery, J. P., Oksenberg, A., Speciale, S. G., and Roffwarg, H. P. (1995). A functional role for REM sleep in brain maturation. Behav Brain Res, 69(1-2), 1-11. Martins, A. B., Tufik, S., and Moura, S. M. (2007). Physiopathology of obstructive sleep apnea-hypopnea syndrome. J Bras Pneumol, 33(1), 93-100. McDowell, I. F., and Lang, D. (2000). Homocysteine and endothelial dysfunction: a link with cardiovascular disease. J Nutr, 130(2S Suppl), 369S-372S. Mignot, E., Young, T., Lin, L., Finn, L., and Palta, M. (1998). Reduction of REM sleep latency associated with HLA-DQB1*0602 in normal adults. Lancet, 351(9104), 727. Miller, M. A. (2011). Association of inflammatory markers with cardiovascular risk and sleepiness. J Clin Sleep Med, 7(5 Suppl), S31-33. Mirrakhimov, A. E., Sooronbaev, T., and Mirrakhimov, E. M. (2013). Prevalence of obstructive sleep apnea in Asian adults: a systematic review of the literature. BMC Pulm Med, 13, 10. Morehouse, R. L., Flanigan, M., MacDonald, D. D., Braha, D., and Shapiro, C. (1998). Depression and short REM latency in subjects with chronic fatigue syndrome. Psychosom Med, 60(3), 347-351. Morrissey, M. J., Duntley, S. P., Anch, A. M., and Nonneman, R. (2004). Active sleep and its role in the prevention of apoptosis in the developing brain. Med Hypotheses, 62(6), 876-879. Mudd, S. H., Finkelstein, J. D., Refsum, H., Ueland, P. M., Malinow, M. R., Lentz, S. R., Jacobsen, D. W., Brattstrom, L., Wilcken, B., Wilcken, D. E., Blom, H. J., Stabler, S. P., Allen, R H., Selhub, J., and Rosenberg, I. H. (2000). Homocysteine and its disulfide derivatives: a suggested consensus terminology. Arterioscler Thromb Vasc Biol, 20(7), 1704-1706. Oliveira, E. B., Gotschlich, C., and Liu, T. Y. (1979). Primary structure of human C-reactive protein. J Biol Chem, 254(2), 489-502. Pack, A. I. (2006). Advances in sleep-disordered breathing. Am J Respir Crit Care Med, 173(1), 7-15. Panossian, L. A., and Veasey, S. C. (2012). Daytime sleepiness in obesity: mechanisms beyond obstructive sleep apnea-a review. Sleep, 35(5), 605-615. Pashayan, A. G., Passannante, A. N., and Rock, P. (2005). Pathophysiology of obstructive sleep apnea. Anesthesiol Clin North America, 23(3), 431-443. Petersen, A. M., and Pedersen, B. K. (2005). The anti-inflammatory effect of exercise. J Appl Physiol, 98(4), 1154-1162. Pizza, F., Contardi, S., Mondini, S., Trentin, L., and Cirignotta, F. (2009). Daytime sleepiness and driving performance in patients with obstructive sleep apnea: comparison of the MSLT, the MWT, and a simulated driving task. Sleep, 32(3), 382-391. Qureshi, A., and Ballard, R. D. (2003). Obstructive sleep apnea. J Allergy Clin Immunol, 112(4), 643-651. Ramesh, V., Nair, D., Zhang, S. X., Hakim, F., Kaushal, N., Kayali, F., Wang, Y., Li, R. C., Carreras, A., and Gozal, D. (2012). Disrupted sleep without sleep curtailment induces sleepiness and cognitive dysfunction via the tumor necrosis factor-alpha pathway. J Neuroinflammation, 9(1), 91. Reynolds, C. F., 3rd, Kupfer, D. J., McEachran, A. B., Taska, L. S., Sewitch, D. E., and Coble, P. A. (1984). Depressive psychopathology in male sleep apneics. J Clin Psychiatry, 45(7), 287-290. Rifai, N., and Ridker, P. M. (2001). High-sensitivity C-reactive protein: a novel and promising marker of coronary heart disease. Clin Chem, 47(3), 403-411. Romero-Corral, A., Caples, S. M., Lopez-Jimenez, F., and Somers, V. K. (2010). Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest, 137(3), 711-719. Rosenberg, R., and Doghramji, P. (2009). Optimal treatment of obstructive sleep apnea and excessive sleepiness. Adv Ther, 26(3), 295-312. Rotenberg, V. S., Shami, E., Barak, Y., Indursky, P., Kayumov, L., and Mark, M. (2002). REM sleep latency and wakefulness in the first sleep cycle as markers of major depression: a controlled study vs. schizophrenia and normal controls. Prog Neuropsychopharmacol Biol Psychiatry, 26(6), 1211-1215. Roure, N., Gomez, S., Mediano, O., Duran, J., Pena Mde, L., Capote, F., and Barbe, F. (2008). Daytime sleepiness and polysomnography in obstructive sleep apnea patients. Sleep Med, 9(7), 727-731. Ruhle, K. H., Kuhtin, O., Domanski, U., Franke, K. J., and Nilius, G. (2012). [Detection of daytime sleepiness using epworth sleepiness scale and a 3-item questionnaire in obstructive sleep apnea]. Pneumologie, 66(3), 184-187. Ryan, S., Taylor, C. T., and McNicholas, W. T. (2009). Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Postgrad Med J, 85(1010), 693-698. Sahlman, J., Seppa, J., Herder, C., Peltonen, M., Peuhkurinen, K., Gylling, H., and Tuomilehto, H. (2012). Effect of weight loss on inflammation in patients with mild obstructive sleep apnea. Nutr Metab Cardiovasc Dis, 22(7), 583-590. Santos, R. V., Tufik, S., and De Mello, M. T. (2007). Exercise, sleep and cytokines: is there a relation? Sleep Med Rev, 11(3), 231-239. Seneviratne, U., and Puvanendran, K. (2004). Excessive daytime sleepiness in obstructive sleep apnea: prevalence, severity, and predictors. Sleep Med, 5(4), 339-343. Stavaras, C., Pastaka, C., Papala, M., Gravas, S., Tzortzis, V., Melekos, M., Seitanidis, G., and Gourgoulianis, K. I. (2012). Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome. Int J Impot Res, 24(6), 228-233. Stefos, G., Staner, L., Kerkhofs, M., Hubain, P., Mendlewicz, J., and Linkowski, P. (1998). Shortened REM latency as a psychobiological marker for psychotic depression? An age-, gender-, and polarity-controlled study. Biol Psychiatry, 44(12), 1314-1320. Sun, Y., Ning, Y., Huang, L., Lei, F., Li, Z., Zhou, G., and Tang, X. (2012). Polysomnographic characteristics of daytime sleepiness in obstructive sleep apnea syndrome. Sleep Breath, 16(2), 375-381. Thomas, K. S., Motivala, S., Olmstead, R., and Irwin, M. R. (2011). Sleep depth and fatigue: role of cellular inflammatory activation. Brain Behav Immun, 25(1), 53-58. Ulfberg, J., Carter, N., and Edling, C. (2000). Sleep-disordered breathing and occupational accidents. Scand J Work Environ Health, 26(3), 237-242. Ulfberg, J., Carter, N., Talback, M., and Edling, C. (1996). Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea. Chest, 110(3), 659-663. Vennelle, M., Engleman, H. M., and Douglas, N. J. (2010). Sleepiness and sleep-related accidents in commercial bus drivers. Sleep Breath, 14(1), 39-42. Verma, S., Szmitko, P. E., and Yeh, E. T. (2004). C-reactive protein: structure affects function. Circulation, 109(16), 1914-1917. Vgontzas, A. N. (2008). Excessive daytime sleepiness in sleep apnea: it is not just apnea hypopnea index. Sleep Med, 9(7), 712-714. Vgontzas, A. N., Papanicolaou, D. A., Bixler, E. O., Hopper, K., Lotsikas, A., Lin, H. M., and Chrousos, G. P. (2000). Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab, 85(3), 1151-1158. Vgontzas, A. N., Papanicolaou, D. A., Bixler, E. O., Kales, A., Tyson, K., and Chrousos, G. P. (1997). Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. J Clin Endocrinol Metab, 82(5), 1313-1316. Wiener, R. C., Zhang, R., and Shankar, A. (2012). Elevated serum C-reactive protein and markers of sleep disordered breathing. Int J Vasc Med, 2012, 914593. Ye, L. (2011). Factors influencing daytime sleepiness in Chinese patients with obstructive sleep apnea. Behav Sleep Med, 9(2), 117-127. Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., and Badr, S. (1993). The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med, 328(17), 1230-1235. Young, T., Peppard, P. E., and Gottlieb, D. J. (2002a). Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med, 165(9), 1217-1239. Young, T., Shahar, E., Nieto, F. J., Redline, S., Newman, A. B., Gottlieb, D. J., and Samet, J. M. (2002b). Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med, 162(8), 893-900. Zhong, Z. Q., Tao, Y., Zhang, Z. P., Zhou, J. Y., Lei, F., Du, L. N., and Tang, X. D. (2011). [Relationship between excessive daytime sleepiness and oxygen saturation in obstructive sleep apnea-hypopnea syndrome]. Zhonghua Yi Xue Za Zhi, 91(1), 40-43.
摘要: 
阻塞型睡眠呼吸中止症(OSAS) 為常見的睡眠疾病,是指睡覺時喉嚨附近的軟組織鬆弛造成上呼吸道阻塞,引發睡眠時呼吸暫停,患者常於睡眠過程中出現體內間歇性缺氧現象。常見症狀有打鼾、睡眠呼吸中斷,白天過度嗜睡(Excessive daytime sleepiness, EDS)等。過去學者已詳細探討OSAS白天過度嗜睡與交通事故的關連性。然而,造成OSAS患者白天過度嗜睡的相關因子目前仍未有定論,因此值得深入探討,以利未來治療。本研究之目的為探討OSAS患者白天過度嗜睡與多項睡眠生理指標及血中發炎指標之相關性。本研究分兩部分:第一部分,探討EDS與多項睡眠生理指標關係。採回朔性研究,收集2012年06月至2013年05月臺灣中部睡眠檢查中心OSAS病患之多項式睡眠生理檢查(Polysomnography, PSG)報告。經篩選後,一共有283位病患的資料符合收入條件,其中艾普沃斯嗜睡量表(Epworth sleepiness scale, ESS)分數等於或大於10分之患者被分為白天過度嗜睡(EDS)組,而ESS分數小於10分的患者則被分為非白天過度嗜睡(No-EDS)組,進而比較兩組睡眠檢查結果之差異,以找出OSAS患者是否會有白天過度嗜睡的預測因子。並進一步分層分析,探討在各個次族群OSAS患者白天過度嗜睡的相關因子。第二部分,探討EDS與血中發炎指標關係。採前瞻性研究,以男性OSAS患者為研究對象,檢驗體內發炎物質高敏感度反應性C 蛋白(High sensitivity C-reactive protein, Hs-CRP)及同半胱胺酸(Homocysteine, Hcy)之含量。一共有30位病患的資料符合收入條件,其中20位患者ESS分數等於或大於10分被分為EDS組,10位患者ESS分數小於10分則被分為No-EDS組。同時以年齡配對之健康男性成人為健康對照組。比較三組血中Hs-CRP及Hcy含量差異。本研究發現臺灣OSAS合併EDS的比例為39.2%。OSAS患者合併EDS之預測因子包括:快速動眼潛伏期(Rapid eye movement latency, REML)、身體質量指數(Body mass index, BMI)以及睡眠效率(Sleep efficiency, SE)。其中,男性和重度OSAS患者白天過度嗜睡的預測因子有REML、SE,獨立預測因子為REML;女性,特別是育齡女性OSAS患者白天過度嗜睡的獨立預測因子為BMI。此外,發炎指標與白天嗜睡相關性部分,結果發現,EDS組血中發炎指標(Hs-CRP)較No-EDS組及健康對照組顯著上升(P value 分別為0.031及0.036)。而No-EDS組與健康對照組相近,無統計上差異(P=0.825)。Hs-CRP上昇是男性OSAS病患白天過度嗜睡的獨立預測因子。此研究幫助我們瞭解造成臺灣睡眠呼吸中止症患者,白天過度嗜睡的相關因子,未來並期待能針對原因給於適切治療,以期提升個人工作能力表現,並降低公共危害事件發生率。

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder. It is characterized by repetitive episodes of upper airway obstruction that are often followed by hypoxemia and sleep fragmentation. Common symptoms include snoring, sleep apnea, excessive daytime sleepiness (EDS) and so on. Researches have explored in detail about the association between EDS and accidents. However, the etiologies of EDS in OSAS remain uncertain. Therefore, worthy of further exploration in order to facilitate future treatment. This study aimed to investigate: 1. characteristics and polysomnography variables in OSAS patients with and without EDS; 2. investigate the correlation between inflammatory markers: high sensitivity C-reactive protein (Hs-CRP) and homocysteine (Hcy) levels and the EDS severity in OSAS patients. Methods: The study in two parts. The first part of the study, we retrospectively reviewed the polysomnography (PSG) results. After screening, a total of 283 patients were enrolled in the final analyses. Patients with an Epworth Sleepiness Scale (ESS) score equal to or more than 10 comprised the EDS group. Patients with an ESS score less than 10 were included in the No-EDS group. We compared the PSG results between the two groups to survey for possible predictors of EDS in OSAS patients. And further stratified analysis to explore daytime sleepiness related factors in various sub-populations of OSAS. The second part, we prospected enrolled male OSAS patients to analyze in vivo inflammatory substances of Hs-CRP and Hcy levels. A total of 30 patients fit inclusion criteria, of which 20 patients with ESS score is equal to or greater than 10 points are divided into EDS group, 10 patients with ESS score less than 10 points were divided into No-EDS group. Besides, age-matched healthy male adult blood samples for the healthy control group. We compared these three groups of serum Hs-CRP and Hcy differences. Results: The prevalence ration of EDS in OSAS is 39.2%. Our results showed that, the predictors of EDS in OSAS are rapid eye movement latency (REML), body mass index (BMI), and sleep efficiency (SE). Among them, REML and SE are predictors of EDS in male and severe OSAS patients and regression analysis showed that REML is an independent predictor of EDS. BMI in an independent predictor of EDS in women, particularly women of childbearing age. In addition, markers of inflammation associated with daytime sleepiness part, regression analysis revealed that Hs-CRP level is significant associated with EDS severity in male OSAS. Conclusion: This study explore factors associated with EDS in Taiwan OSAS patients. Look forward to the future for these factors given appropriate treatment in order to enhance OSAS patients'' ability to work performance, and reduce the incidence of public hazard events.
URI: http://hdl.handle.net/11455/81166
其他識別: U0005-1708201318034400
Appears in Collections:生命科學院

Show full item record
 

Google ScholarTM

Check


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.