阻塞性呼吸中止症患者之日間功能與睡眠探討

Daytime function and Sleep in patients with Obstructive Sleep Apnea

張馨方(Shin-Fang Chang)

指導教授 ： 李佩玲

國立臺灣大學/醫學院/臨床醫學研究所/碩士(2021年)

https://doi.org/10.6342/NTU202104062

摘要

阻塞性呼吸中止症是一常見於中老年之睡眠呼吸疾患。病患常見之症狀包含反覆性的上呼吸道塌陷，夜間睡眠血氧降低以及睡眠片段之情況。由於睡眠結構遭受破壞，慢波睡眠以及動眼期睡眠減少，病人常於日間呈現過度嗜睡之情形，注意力以及警覺性，記憶力及執行功能皆會因此受損，同時也會合併較高的交通意外風險以及生活品質下降之情形。罹患阻塞性呼吸中止症的患者常常亦會共病情緒疾患，像是焦慮症或是憂鬱症，而現存之文獻也顯示阻塞性呼吸中止症會增加神經退化疾病的風險，更有可能加速輕度認知障礙或是失智症之發生。
阻塞性呼吸中止症的患者症狀極為多變，而以日間嗜睡為主要表現之患者目前研究認為有可能和後續是否產生神經退化疾病關聯性最高。對於此一面向之研究目前尚缺乏較大型的研究，而長期對於此類患者的追蹤研究也仍缺乏。有鑑於此，於此論文之第一部份我們希望能藉由對一大型阻塞性呼吸中止症患者族群之研究，探討日間嗜睡與其之關聯性。其中我們特別希望可以針對不同年齡，特別是老年族群的阻塞性呼吸中止症的患者進行分析，探討是否有更高的神經退化風險或是日間功能受損之情況。
於此論文之第二部分，則專注於快速動眼期睡眠行為障礙的患者，特別是針對同時罹患阻塞性睡眠呼吸中止症的病人。快速動眼期睡眠行為障礙患者之睡眠品質與認知功能皆會受到疾病影響，而此論文亦假設其與阻塞性睡眠呼吸中止症之共病將會加劇疾病之不良影響。目前對於此一議題之研究尚稀少，故研究者希冀由文獻回顧與分析之方法，探討兩者共病之時對於睡眠效率，主觀之日間嗜睡以及認知功能之影響。

關鍵字

阻塞性呼吸中止症 ； 認知功能退化 ； 日間功能 ； 過度日間嗜睡 ； 快速動眼期睡眠行為障礙

並列摘要

Obstructive sleep apnea is a common sleep disorder seen in middle-aged to older aged adults. Patients often present with repetitive upper airway collapse, nocturnal hypoxemia and frequent sleep interruption. Due to these disturbances in sleep structure, percentage of slow wave sleep and rapid eye movement sleep is decreased, and patient would often present with daytime symptoms such as excessive daytime sleepiness, impaired attention and vigilance, memory impairment, impaired executive function as well as increased risks of vehicle accidents and decreased quality of life. Patients with obstructive sleep apnea also frequent suffer from mood disorder such as anxiety and depression, and existing studies also suggest that the present of obstructive sleep apnea leads to neurodegeneration and possibly accelerate the onset of mild cognitive impairment and dementia. However, patients with obstructive sleep apnea present with diverse symptoms, and those present with excessive daytime sleepiness had been speculated as most afflicted with obstructive sleep apnea-related neurocognitive sequalae, though large-scale and long term follow up studies are still few. Therefore, in our first part of studies, we wish to study upon the relationship of excessive daytime sleepiness and obstructive sleep apnea, and to determine in a large clinical cohort, the factors associated with excessive daytime sleepiness in obstructive sleep apnea patients. We wish to especially focus on older adults with obstructive sleep apnea, as this group of patients may be more at risk for future neurodegeneration and daytime function impairment. In our second part of study, we again wish to focus upon rapid eye movement disorder and its effect on patient already afflicted with obstructive sleep apnea. REM sleep behavior disorder negatively influences sleep quality and cognitive function, which we hypothesize may worsen the existing clinical sequalae of obstructive sleep apnea. Though the high prevalence of OSA has been reported, the impact of concomitant OSA on sleep consolidation and daytime function in RBD patients is unclear. Therefore, we aim to further clarify with a meta-analysis the impact of obstructive sleep apnea on the sleep efficiency, subjective sleepiness, and neurocognitive function in patients with rapid eye movement disorder.

並列關鍵字

obstructive sleep apnea ； excessive daytime sleepiness ； rapid eye movement disorder ； daytime function ； cognitive impairment

參考文獻

References

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