- 學位論文
腦中風患者睡眠型態與睡眠呼吸中止症嚴重度相關因素探討
Severity of sleep apnea syndrome and related factors in patients with stroke
摘要
背景：腦中風患者是罹患睡眠呼吸中止症的高危險群。睡眠呼吸中止症會增加再次中風機會與死亡率，故找出腦中風患者罹患睡眠呼吸中止症的相關危險因子與避免再次中風是相當重要的議題。 目的：以往的研究僅針對睡眠呼吸中止症本身相關因素的探討，對於腦中風患者的睡眠型態與那些因素可能導致睡眠呼吸中止症並不清楚 ，故此研究以病歷回溯資料進行腦中風患者睡眠型態及睡眠呼吸中止症嚴重度相關因素探討。 方法：研究樣本為中部某醫院復健科病房的腦中風患者，收案樣本數為165件。資料回溯期間為2011年1月1日到2013年5月31日，共計二年五個月。收集之病歷資料包含腦中風患者的人口學特性、腦中風狀態 、人體測量學、健康行為、過去病史、生化檢查與血壓值等；其中生化檢查為住院第二天的抽血檢測數據，血壓值為睡眠檢查當天晚上測量得到的數據並經患者與家屬同意後在住院期間安排整夜多項睡眠檢測儀檢查而測得的多項睡眠生理檢測儀(PSG)報告。 結果：研究對象中罹患睡眠呼吸中止症(AHI>15次/小時)佔80.0%，睡眠型態中的睡眠效率(70.3%±16.4)偏低，睡眠呼吸中止症(AHI≧30次 /小時)睡眠效率只有69.3%±16.0。研究對象不論睡眠呼吸中止症嚴重程度其睡眠潛伏期皆大於15分鐘且快速動眼期時間越短，顯見睡眠呼吸中止症越嚴重者其睡眠效率低且快速動眼期時間短，有較差品質的睡眠。以Spearman相關分析發現研究對象的性別(r=0.159,p=0.041)及有心律不整病史者(r=0.176,p=0.024)與睡眠呼吸中止症嚴重度指數達統計上顯著相關性(p<0.05)；以皮爾森相關分析(Pearson correlation)發現研究對象的年齡(r=0.262,p=0.001)、身體質量指數(r=0.245,p=0.002)、頸圍(r=0.199,p=0.012)、腰圍(r=0.225, p=0.005)與睡眠呼吸中止症嚴重度指數達統計上顯著相關性(p<0.05) ，顯示男性、年齡越大、有心律不整病史者、身體質量指數越高、頸圍與腰圍粗大者，罹患睡眠呼吸中止症越嚴重。 結論與護理實務應用：本研究發現腦中風病人罹患睡眠呼吸中止症的比率高達80.0%，其睡眠品質差且血氧飽和濃度低，男性、年齡越大 、有心律不整病史、身體質量指數高、頸圍與腰圍粗大者，罹患睡眠呼吸中止症越嚴重。臨床上應提升臨床人員對腦中風病人睡眠問題的重視，鼓勵腦中風患者積極治療，以降低疾病的傷害程度。
並列摘要
Background: Stroke patients are the high risk group of sleep apnea. Patients with sleep apnea often have higher stroke recurrence and mortality. It is crucial to identify risk factors on sleep apnea in stroke patients to prevent the recurrence of stroke. Previous studied had only focused on factors which are correlated with sleep apnea in general populations. It is not clear if stroke related factors may be correlated with the severity of apnea in patients with stroke. Aims: This study used a cross-sectional study design to investigate the relation of stroke status, sleep pattens and severity of sleep apnea syndrome in patients with stroke. Methods: Data of 165 stroke patients were retrieved from a rehabilitation hospital from January in 2011 to March in 2013. The medical records including demographic characteristics, stroke status, anthropometry, health behaviors, medical history, biochemical examination and blood pressure were collected. Polysomnography examination was performed during hospitalization after the agreement of patients and their families. Results: Eighty percent of stroke patients were suffering from sleep apnea (AHI> 15 times / hour). Sleep efficiency was low (70.3%±16.4) in stroke patients, and even as low as 69.3% (SD 16.0) in those with severe sleep apnea (AHI≧30 times/hour). Severity of sleep apnea in stroke patients was associated with male gender (r=0.159, p=0.041), history of arrhythmia (r=0.176, p=0.024), increased age (r=0.262, p=0.001), increased body mass index (r=0.245, p=0.002), larger neck circumference (r=0.199, p=0.012), and waist circumference(r=0.225, p=0.005). Conclusions: Patients with stroke have a higher ratio of sleep apnea. Gender, age, history of arrhythmia, body mass index, neck circumference and waist circumference are correlated with severity of sleep apnea. This study highlights the importance of sleep problems and related treatment in patients with stroke.