高血壓患者失眠程度與自主神經活動之關係

研究目的：失眠為臨床常見之抱怨且失眠人口有逐年增加之趨勢，隨著生活型態改變，高血壓的盛行率亦逐年增加。過去研究顯示失眠患者會有過度激發的現象，自主神經活動失調即為其中問題之一。血壓調控也會受到自主神經影響，因此高血壓患者合併失眠問題的話，自主神經活動失調的情形可能更加嚴重。過去對於高血壓、失眠與自主神經活動三者之間的關係並未獲得一致性證據，仍無法釐清三者相互影響關係。本研究欲了解高血壓合併失眠困擾者，其於睡眠狀態下自主神經活動是否較失衡，並針對高血壓患者，探討其失眠程度與自主神經活動之關係。研究方法：36位45至65歲高血壓患者，以失眠量表得分來區分失眠程度，以及12位同齡健康成人作為對照組。每位參與者均需填寫睡眠相關問卷、睡眠日誌和搭配腕動儀紀錄，並記錄一個晚上的心電圖，並透過心跳變異率分析獲得自主神經活動指標。研究結果：高血壓合併失眠組的自主神經活動明顯較健康成人組活躍，其交感神經活動指標LFn.u.明顯高於健康成人組，而副交感神經活動指標HFn.u,明顯較低。三組後半夜的心跳皆較前半夜低，然而，高血壓患者前後半夜的自主神經活動型態與健康成人不同，健康成人組在後半夜心跳變異率較高，但高血壓患者在後半夜的心跳變異率則較低，且高血壓合併失眠組的前後半夜差異比值明顯高於健康組，顯示其後半夜的自主神經有過度活躍現象。在高血壓的患者中，主觀入睡時間及半夜清醒時間與前半夜LFn.u.成正相關、HFn.u.為負相關，主觀睡眠效率與前半夜HFn.u.為正相關、LFn.u.負相關。在客觀指標中，半夜清醒時間與前半夜LF/HF比率成正相關；夜間輕微覺醒次數與後半夜的LFn.u.、LF/HF比率成正相關，與HFn.u.成負相關。結論：高血壓合併失眠患者自主神經有過度活躍狀況，而此現象在後半夜更加嚴重。此外，高血壓患者後半夜的自主神經活躍程度和客觀的睡眠指標較有關係，而與主觀睡眠指標較無關聯。患者可能不易覺察後半夜的自主神經過度活躍現象，而忽略其潛在風險，故高血壓患者及臨床工作者可針對此點加以留意並發展適合的介入方式以改善睡眠品質及自主神經過度活躍之現象。

關鍵字

生態化測量；血壓；夜間心血管調控；睡眠困擾；激發狀態

並列摘要

Objective: Insomnia and hypertension are common problems for adults. People with insomnia could exist autonomic imbalance, which is characterized by sympathetic nervous system hyperactivity and parasympathetic nervous system hypoactivity. Blood pressure is also mediated by autonomic nervous system. Therefore, the autonomic imbalance in hypertensive patients comorbid insomnia may be worse. This study investigated the relationship between the severity of insomnia and nocturnal autonomic imbalance in essential hypertension. Method: This study recruited 36 essential hypertensive patients, and 12 age-matched healthy voulunteers. Insomnia Severity Index(ISI) and other sleep-related questionnaires were administrated for all participants and then they have to record sleep diaries and wrist actigraphy for continuous days. One of the night, electrocardiogram was also monitored during their sleep and heart rate variability(HRV) was calculated. After exclude obvious movements and extreme values, analysis the samples in the first half and the second half of the night. Results: The results show that the nocturnal autonomic activities in hypertensive patients with insomnia(HI) were higher than healthy adults (LFn.u. increased and HFn.u. decreased). Partial correlation shows that subjective sleep onset latency, wake after sleep onset were positive related to LFn.u. and negative related to HFn.u. in the first half of the night. Sleep efficiency was also negative related to LFn.u. and positve related to HFn.u. in the first half of the night. Objecitve arousal time was positive related to LFn.u. and LF/HF ratio and negative related to HFn.u. in the second half of the night. Conclusion: These results support the hypothesis that hypertensive patients with insomnia were hyperarousal during their sleep. The nocturnal autonomic imbalance could be related to impaired cardiovascular modulation in hypertensive patients, or increased sleep fragment frequency which could cause sympathetic nerve hyperactivity.

並列關鍵字

blood pressure ； home-measurement ； hyperarousal ； nocturnal cardiovascular modulation ； sleep disturbance

參考文獻

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中文文獻：

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台灣睡眠醫學會（2009）。國人睡眠趨勢大調查。取自http://www.tssm.org.tw/

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高血壓患者失眠程度與自主神經活動之關係

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