上呼吸道阻力症候群之中西醫學整合治療－病例報告

上呼吸道阻力症候群是睡眠呼吸障礙疾病之一，常見於體型較瘦、顱顏異常的女性，由於此症每小時睡眠呼吸中止指數為正常，故常被忽略導致診治困難。本病人為19歲女性，因白天過度嗜睡前來中醫求診。自述白天常入睡而不自知，無法被喚醒；晚上難以入睡、淺眠、多夢、醒後精神倦怠。經夜間睡眠檢查發現病患每小時睡眠呼吸中止指數只有0.5次。但睡眠檢查時明顯打鼾引起腦波覺醒，加上日間過度嗜睡，故診斷為上呼吸道阻力症候群。在中醫辨證上為氣血不足、營衛不調，影響心肝脾肺等臟腑，也因宗氣不足、清氣不升影響腦竅、鼻竅、與咽喉等，治則以補益氣血與調和營衛。白天以人參養榮湯、桂枝加龍骨牡蠣湯為主、睡前以天王補心丹為主，治療約4個月後，病人日夜間症狀均改善。由此病例，我們將探討上呼吸道阻力症候群引起的勞倦之中醫病因、病機與治則，並針對陰陽平衡與睡眠的關係、桂枝加龍骨牡蠣湯的應用想法，提供中藥治療此類疾病的方向。

關鍵字

上呼吸道阻力症候群；中醫勞倦；桂枝加龍骨牡蠣湯

並列摘要

Upper Airway Resistance Syndrome (UARS) is one of the sleep-disordered breathing diseases. It's commonly seen in the women with thinner stature and craniofacial abnormalities. As the apnea-hypopnea index (AHI) is usually normal, it is often overlooked and leads to difficulties in diagnosis and treatment. Our patient is a 19-year-old female, who suffered from daytime drowsiness for several years. She also had symptoms typical for UARS, including drowsiness, tiredness, lack of concentration, snoring, less efficacy in work et al, which are very similar as obstructive sleep apnea (OSA), but the symptoms could be much more severe. The polysomnography revealed AHI only 0.5/ hour, and loud snoring with following frequent EEG arousal was noted. Therefore, UARS was still considered. In TCM theory, the differential diagnosis was deficiency of Qi and blood, which leaded to ancestral Qi insufficiency, nutrient-defense disharmony, and disturbed the function of heart, liver, spleen, lung, nasopharynx, and consciousness. Our principles were supplement of Qi and blood and harmonization of nutrient-defense. Ginseng Construction-Nourishing Decoction and Cinnamon Twig Decoction Plus Dragon Bone and Oyster Shell were the main formulas for her situation, while Celestial Emperor Heart-Supplementing Elixir was prescribed for her sleep condition. After TCM treatment for 4 months, her symptoms were improving. In this report, we elucidated the cause of disease, mechanism, and treatment for UARS related overexertion and fatigue, the relationship between Yin-Yang balance and insomnia, and provided the therapeutic opinion of application of Cinnamon Twig Decoction Plus Dragon Bone and Oyster Shell.

並列關鍵字

Upper Airway Resistance Syndrome ； Drowsiness ； Cinnamon Twig Decoction Plus Dragon Bone and Oyster Shell

參考文獻

de Godoy, LBM,Luz, GP,Palombini, LO,e Silva, LO,Hoshino, W,Guimaraes, TM,Tufik, S,Bittencourt, L,Togeiro, SM(2016).Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea.PloS ONE..11(5),e0156244.