二手菸暴露對青少年睡眠品質與鼻眼過敏症狀之影響

The Impact of Secondhand Smoke Exposure on Sleep Quality and Rhinoconjunctivitis Symptoms in Adolescents

林明弘(Ming-Hung Lin)

指導教授 ： 李永凌

國立臺灣大學/公共衛生學院/流行病學與預防醫學研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.10623

摘要

背景：台灣學童與青少年睡眠問題的盛行率約10~35%。青少年的睡眠問題已知會造成其學校表現、身心健康及行為等方面的不良影響。而二手菸暴露對於青少年睡眠品質及鼻眼過敏症狀的影響仍未有定論。
研究目的：利用結構性問卷及生物檢體的量測，探討二手菸暴露對於青少年睡眠品質及鼻眼過敏症狀的影響。
研究方法：本研究於2009年7月至2010年8月間，於北台灣七所國中及兩家醫院招募451位四至九年級之學童自願者，接受一對一面談，自填結構式問卷並留取尿液檢體。問卷中以中文版匹茲堡睡眠品質量表(PSQI)評估其睡眠狀況，以中文版鼻結膜炎生活品質問卷(RQLQ)評估其鼻眼過敏症狀，且於問卷中詳細詢問二手菸暴露情形，並測量其尿液中cotinine濃度與肌酸酐之比值(CCR)作為二手菸暴露程度的生物指標。最後利用邏輯斯迴歸及複線性迴歸模式作資料分析。
研究結果：在這451位青少年中，有氣喘病史者較無氣喘者有較高之睡眠問題盛行率(20.2% vs. 11%, P = 0.008)。在調整年齡、性別、身體質量指數、異位性皮膚炎、過敏性鼻炎、戶外運動時間、重要環境因子及青春期等可能之干擾因素後，有氣喘的青少年若尿液中CCR越高，睡眠品質不佳的危險性越大(aOR = 3.46, 95%CI = 1.20~10.0, P for trend = 0.01)；目前家中有二手菸暴露者，睡眠品質不佳的危險性是家中沒有二手菸暴露者的2.69倍(95%CI 1.21~6.00)；若家中有兩人以上吸菸，則睡眠品質不佳的危險性是家中無人吸菸者的4.66倍(95%CI 1.47~14.7)。在沒有氣喘的青少年中也有類似傾向，但未達統計顯著。若以性別做分層，則發現女孩氣喘者睡眠品質受二手菸暴露的影響比男孩氣喘者更大。在PSQI七個面向中，以「睡眠潛伏期」、「睡眠效率」及「日間功能障礙」受二手菸暴露的影響較大。另外，有氣喘的青少年相較於無氣喘者，前者鼻眼過敏症狀較嚴重，而二手菸暴露也會稍加重有氣喘者的鼻眼症狀(β = 0.24, 95%CI = -0.07~0.55, P for trend = 0.07)，其中以「日常活動」及「眼部症狀」受二手菸暴露的影響較大。而在無氣喘的青少年中，自陳有二手菸暴露者會有較嚴重的鼻眼症狀，但其尿液CCR量測則未能呈現相同的關係。
結論：本研究發現，青少年受二手菸暴露程度越高，有睡眠問題的危險性越大，尤其是有氣喘病史者及女性。二手菸暴露對青少年之鼻眼過敏症狀亦有不良的影響。這些發現為二手菸防治提供了重要的理由。

關鍵字

二手菸 ； 睡眠品質 ； 鼻眼過敏 ； 青少年 ； 氣喘

並列摘要

Background: Sleep problems during childhood and adolescence have been linked with poor school performance, somatic complaints, behavioral problems, and mental health problems. The prevalence of sleep disorders is around 10 ~ 35 % among school-aged children and adolescents in Taiwan. The association between secondhand smoke (SHS) exposure, sleep problems and rhinoconjunctivitis symptoms among adolescents is still inconsistent.
Objective: The aim of this study was to explore the impact of SHS exposure on adolescent sleep quality and rhinoconjunctivitis symptoms, based on biological specimen for exposure measurement and validated questionnaire for outcome assessment. We hypothesized that adolescents undergoing more SHS exposure would have poorer sleep quality and more severe rhinoconjunctivitis symptoms.
Methods: Adolescents (n=451) aged 10~16 years were enrolled from the Genetic and Biomarkers Study for Childhood Asthma, which recruited 4-9th grade schoolchildren from 7 junior high schools and 2 hospitals in northern Taiwan from July 2009 to August 2010. All participants received face-to-face interview and completed a comprehensive questionnaire including information on demographic features, environmental factors, Chinese version of the Pittsburg Sleep Quality Index (PSQI) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Spot urine of each participant was collected to measure the urinary cotinine/creatinine ratio (CCR). Multiple logistic regression and multiple linear regression models were conducted for analysis.
Results: Participants with asthma had higher proportion of poor sleep than those without asthma (20.2% vs. 11.0%, P=0.008). After adjustment for the potential confounders including age, sex, body mass index, atopic diseases, outdoor exercise, pubertal status, and environmental factors such as carpet use, cockroach and mold presence at home, the asthmatic children with increased urinary CCR level had higher risk of poor sleep (aOR = 3.46, 95%CI = 1.20~10.0, P for trend = 0.01). The asthmatic children with current household SHS exposure (aOR = 2.69, 95%CI = 1.21~6.00) or living with two or more smokers at home (aOR = 4.66, 95%CI = 1.47~14.7) also had poorer sleep quality. There were similar findings among non-asthmatic children despite not statistically significant. The adverse effects of SHS exposure on sleep quality were more prominent in asthmatic girls when stratified by gender. Among the 7 components of PSQI, “sleep latency”, “habitual sleep efficiency” and “daytime dysfunction” were most bothered by SHS exposure among asthmatic children. As for the rhinoconjunctivitis symptoms, participants with asthma had significantly higher scores of RQLQ than those without asthma. The asthmatic children with increased urinary CCR level seemed to have higher RQLQ overall scores than those with lowest CCR level (β = 0.24, 95%CI = -0.07~0.55, P for trend = 0.07), that implied worse rhinoconjunctivitis symptoms among asthmatic children exposed to more SHS. “Activity” and “eye symptoms” were the two domains most affected by the SHS exposure. Among the non-asthmatic children, those reported to have SHS exposure were found to have higher RQLQ overall score and the domain scores on “activity”, “sleep”, “non-hayfever symptoms” and “emotional”, even though no positive correlation between urinary CCR level and RQLQ scores.
Conclusions: This study demonstrated that adolescents with more SHS exposure had higher risk to suffer from sleep problems, particularly among asthmatic children and girls. SHS exposure also showed adverse impact on the rhinoconjunctivitis symptoms in adolescents. These findings provided important clinical implication for prevention program against secondhand smoke exposure.

並列關鍵字

secondhand smoke ； sleep quality ； rhinoconjunctivitis ； adolescent ； asthma

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