阿茲海默氏病與睡眠問題

Alzheimer's Disease and Sleep Problems

高慧如(Hui-Ju Kao)

《台灣老年醫學暨老年學雜誌》 3卷4期 (2008/11) Pp. 262-271

https://doi.org/10.29461/TGG.200811.0002

摘要

阿茲海默氏病是最常見的老年失智症，與睡眠各個面向的關係仍不十分清楚。阿茲海默氏病患者在代表睡眠品質的睡眠參數像是夜間總睡眠時間、睡眠效率、睡眠片段化都比常態老化者來得差；在睡眠結構上增加了第一階睡眠的百分比而減少慢波睡眠的百分比，快速動眼期的百分比也明顯減少；快速動眼期的量化腦波可以作爲阿茲海默氏病鑑別診斷的依據。阿茲海默氏病患者的睡眠困擾會影響照護難度，是提早進入照護機構的重要因素。對阿茲海默氏病患者睡眠困擾的處置，建議應該先做包含有睡眠衛生的行爲處置再考慮藥物治療。其他睡眠疾病像是睡眠呼吸中止症在阿茲海默氏病患者的發生率較高，但兩者是否有病理基因上的相關仍不明確。治療阿茲海默氏病乙醯膽鹼酶抑制劑藥物有個案報告會有鮮活夢境或夢魘的產生，可能與快速動眼期乙醯膽鹼活性有關。特定基因如單胺氧化酶-A的變異型與阿茲海默氏病的睡眠困擾有顯著相關，但確切的作用機轉仍不清。我們期望經由了解阿茲海默氏病與睡眠，提供阿茲海默氏病患者更好的照護品質。

關鍵字

阿茲海默氏病 ； 失智症 ； 睡眠

並列摘要

Alzheimer's disease (AD) is the most common type of senile dementia. However, its associations with various aspects of sleep medicine remain insufficiently delineated. The parameters related to sleep quality are comprehensively reviewed to compare the major differences between AD patients and their healthy controls. The three most obvious deficits of sleep in AD patients were shorter total sleep time, poorer sleep efficiency, and fragmented sleep. As for sleep architecture, increased percentage in stage 1 sleep are more frequently observed in AD patients, while, as compared to the healthy controls, slow-wave sleep and rapid eye movement (REM) sleep report decreased percentage. Quantitative REM sleep electroencephalogram provides useful information in differential diagnosis of AD. From a clinical perspective, sleep disturbance in AD patients can increase the difficulty in care of patients and usually signals the need for earlier beginning of institutional care. Non-pharmacological behavior therapy, such as sleep hygiene, is recommended as the first-line strategy of choice. Other distinct types of disorders, such as sleep apnea syndrome, can also concomitantly occur in AD patients, thereby posing questions about pathogenetic links between the two diseases. In addition, isolated case reports of vivid dream and/or nightmares suggest a REM sleep-related cholinergic activity in AD patients taking acetylcholinesterase inhibitor. Although genetic variation at the enzyme monoamine oxidase has been shown to be associated with sleep disturbance in AD, the underlying mechanism remains unclear. The more we understand about the relationship between Alzheimer's disease and sleep, the better quality of care we can provide for AD patients.

並列關鍵字

Alzheimer's disease ； dementia ； sleep