探討週期性肢體抽動與阻塞型睡眠呼吸中止症患者之自律神經系統的關係

The Impact of Periodic Limb Movements in Sleep on the Autonomic Nervous System in Patients with Obstructive Sleep Apnea

吳孟霓(Meng-Ni Wu)

指導教授 ： 徐崇堯

高雄醫學大學/醫學院/神經學科研究所/碩士(2013年)

https://doi.org/10.6832/KMU.2013.00049

摘要

夜眠中週期性肢體抽動的成因與治療的必要性未明，但卻有研究發現
其與某些心血管疾病的盛行率、嚴重度、甚至死亡率有關。另外，阻塞型睡眠呼吸中止症亦與心血管疾病相關，然而對於合併上述兩種疾病的患者是否具有更高的交感神經活性與心血管疾病風險，目前未明。故本研究以探討心律變異，利用回溯、立意取樣分別分析(1) 30位合併夜眠中週期性肢體抽動及30位未合併夜眠中週期性肢體抽動的阻塞型睡眠呼吸中止症患者；與(2)使用連續陽壓呼吸治療後產生夜眠中週期性肢體抽動之阻塞型睡眠呼吸中止症患者30人，及30位未產生夜眠中週期性肢體抽動患者，其未含睡眠事件的基礎交感神經活性。結果顯示，雖然合併夜眠中週期性肢體抽動並不會增加阻塞型睡眠呼吸中止症患者之白日嗜睡及主觀睡眠障礙，但合併夜眠中週期性肢體抽動之阻塞型睡眠呼吸中止症患者，與使用連續陽壓呼吸治療後產生夜眠中週期性肢體抽動之阻塞型睡眠呼吸中止症患者，其基礎自律神經系統均具有較高的交感神經活化的傾向，因此可能具有較高的心血管疾病風險。另外，因本研究中已於研究設計中，排除所有睡眠事件及其可能對心律產生持續性影響的區段，且交感神經活化傾向在使用連續陽壓呼吸治療後產生夜眠中週期性肢體抽動之阻塞型睡眠呼吸中止症患者亦存在，而這組患者於連續陽壓呼吸治療前並未有週期性肢體抽動，故我們認為，週期性肢體抽動患者之交感神經活化傾向，並非來自於與肢體抽動相關之陣發性交感神經活化所產生的”持續”或”累積加成”影響，而是應歸因於有夜眠中週期性肢體抽動表現的患者，本身就具有較高的交感神經活化傾向，而肢體抽動與心血管疾病風險則是該傾向的不同表現。

關鍵字

阻塞型睡眠呼吸中止症 ； 週期性肢體抽動 ； 連續陽壓呼吸治療 ； 自律神經系統

並列摘要

The pathophysiology and the essentiality of intensive therapy of periodic limb movements in sleep (PLMS) are still unclear. However, the association between PLMS and prevalence, severity and mortality of cardiovascular disease had been identified and this association may result from sympathetic activation. Additionally, obstructive sleep apnea (OSA) also increases risk of cardiovascular disease. Whether combination of OSA and PLMS can cause higher risk of cardiovascular disease and sympathetic activation is not well studied. This study was designed to estimate the heart rate variability(HRV) of the background sleep in (1) 30 OSA patients with PLMS as well as 30 OSA patients without PLMS (2) 30 OSA patients with PLMS after continuous positive airway pressure(CPAP) (post-CPAP-PLMS(+)) and 30 OSA patients without PLMS after CPAP titration(post-CPAP-PLMS(-)). Although the presence of PLMS didn’t lead to daytime sleepiness or subjective sleep disturbance in OSA patients, HRV analysis revealed that all patients with PLMS, no matter before or after CPAP titration, had tendency of sympathetic activation in background sleep. The tendency may result in increasing risks of cardiovascular diseases. Besides, all segments of electrocardiogram with sleep-events and their continuous effect were excluded in this study. Furthermore, sympathetic activation of background sleep was also identified in those post-CPAP-PLMS (+) patients who didn’t have any PLMS previously. Therefore, we assumed that the sympathetic activation may not result from continuous or accumulating effects of leg movement associated surge of sympathetic activation. Conversely, it may be secondary to the innate character of tendency of sympathetic activation.

並列關鍵字

Obstructive Sleep Apnea ； Periodic Limb Movements in Sleep ； Continuous positive airway Pressure ； Autonomic Nervous System

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