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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
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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.
其他識別: U0005-1708201318034400
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