癲癇患者之睡眠品質、白日嗜睡和生活品質的關聯性研究

Correlational study of sleep quality, excessive daytime sleepiness and quality of life in patients with epilepsy

曾瑞昌(Ray-Chang Tzeng)

指導教授 ： 徐崇堯博士

高雄醫學大學/醫學院/神經學科研究所/碩士(2008年)

摘要

研究背景: 癲癇症是一種慢性的腦神經系統疾病，由於各種不同的原因造成反覆的腦神經細胞不規則放電所導致。睡眠障礙(包含睡眠品質不良、白日嗜睡現象和睡眠呼吸中止症等)是癲癇病人常見的病症，它不只會影響病人的工作能力、社交情況和生活品質，進而也會惡化其疾病的病程，例如增加癲癇發作的機會、影響其認知功能和行為表現，但是此議題一直以來卻比較少被探討。而其影響的因素可能包含有癲癇發作的頻率、癲癇類型、抗癲癇藥物的副作用、睡眠結構的改變和相關睡眠疾病的產生。近年來探討癲癇和睡眠品質與生活品質相關性的一些研究，因各地區文化背景的不同、取樣的不同而有不盡相同的結果。本研究乃是在探討評估門診癲癇病患主觀的睡眠品質、白日嗜睡現象、健康生活品質，和客觀睡眠結構，且進一步探討影響健康生活品質的相關因子。
研究方法: 本研究以立意取樣總共收集有88位受試者(32位為難治型癲癇和56位為非難治型癲癇)符合收案條件，在基本人口學資料方面記錄其性別、年齡；臨床表徵資料方面為癲癇組病人詳細記錄其癲癇發作的年齡、病齡長短、發作的類型、致病的原因、共病的疾病、近半年內平均每月發作的頻率、近兩個月內使用抗癲癇藥物的種類和數量、腦波和神經影像學檢查的結果。經病人同意後完成所有量表問卷，包括匹茲堡睡眠品質量表( PSQI，Pittsburgh sleep quality index)、Epworth白日嗜睡問卷量表 (ESS, Epworth daytime sleepiness scale)和SF-36健康生活品質量表(SF-36 ,Short form-36 survey)，其中有25人接受睡眠多項生理檢查(Polysomnography，PSG)。另外也收集了46位原發性失眠症的個案，當作量表問卷的比較組。

研究結果: 難治型癲癇在睡眠品質不佳和白日嗜睡的比例要比非難治型癲癇高，但兩者之間未達顯著差異；而在健康生活品質的整體表現上，難治型癲癇也比非難治型癲癇差，但僅在社會功能(p<0.001)、因情緒角色受限(p=0.016)和心理健康總分方面(p=0.019)有顯著差異。睡眠品質與健康生活品質有顯著相關，特別是在非難治型癲癇病患的睡眠品質與生活品質中的心理健康方面(p<0.001)。在控制干擾因素後，發現年齡(p<0.001)、睡眠品質(p<0.001)和白日嗜睡(p=0.017)才是生活品質之心理健康方面的獨立影響因子；而年齡(p<0.001)則是生活品質之身體健康方面的唯一獨立影響因子。另外，失眠個案在睡眠品質與健康生活品質的整體表現，要顯著的比癲癇個案的表現差。在PSG的各分項比較中，僅在快速動眼期(REM sleep)，難治型癲癇顯著低於非難治型癲癇(p=0.031)。
結論： 整體而言，難治型癲癇患者心理健康方面的生活品質要比非難治型癲癇差；睡眠品質與健康生活品質有顯著相關，特別是在非難治型癲癇病患的睡眠品質與生活品質中的心理健康方面；在此研究發現年齡、睡眠品質和白日嗜睡才是影響生活品質之心理健康方面的重要因子。在癲癇病人的生活品質探討，各個地區研究的結果不盡相同，除了因癲癇病人的個別差異大（例如癲癇類型、癲癇頻率、發病年齡，實際病齡，用藥種類、用藥數量等）之外，國家地區之間文化的不同(例如家庭的支持和宗教的信仰)和社經地位的不同也會影響其研究的結果。這個現象的差異，需要更大型的研究來證實。

關鍵字

癲癇 ； 睡眠品質 ； 白日嗜睡 ； 生活品質 ； 睡眠多項生理檢查

並列摘要

Backgroung: Epilepsy is a chronic neurological disorder caused by abnormal and repetitive electric firing of brain cells. Sleep disturbance (including poor sleep quality, excessive daytime sleepiness and sleep apnea etc.) is common in patients with epilepsy. It could affect their working ability. social activity and quality of life. It may also worsen the course of the disease by increasing the frequency of attack, aggravating cognitive disability and behavior problems. However, there was only a few publications in the literature about it. The influencing factors on the health-related quality of life include frequency of epilepsy, type of epilepsy, side effect of anticonvulsants, change of sleep architecture, and related sleep disorders. Recent studies regarding the quality of sleep and health-related quality of life in patient with epilepsy are inconclusive. It is probably related to the cross-culture difference and different sampling method. The goal of this study was to investigate the difference of sleep quality, excessive daytime sleepiness and health-related quality of life between medically refractory and nonrefractory epilepsy and their correlation.
Method: Eighty-eight patients with epilepsy ( 32 refractory and 56 nonrefractory epilepsy patients) were recruited by purposive sampling. The demographic data including sex, age and clinical manifestations including the duration of epilepsy, type of seizure, frequency of seizure within half year, cause of the epilepsy, comorbidity, the anticonvulsant within two months and neuroimage study were collected. After obtaining the informed consent, the patients completed the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS) and the short form-36 survey (SF-36). All patients received electrocephalography (EEG or video EEG monitoring). Twenty five of them also agreed to receive polysomnography (PSG). Forty-six patients with primary insomnia were also recruited for comparison.
Result: There was no significant difference on sleep quality and excessive daytime sleepiness between the patients with medically refractory epilepsy (PMRE) and the patients with medically nonrefractory epilepsy (PMNE), but PMRE had relatively poorer sleep quality and more excessive daytime sleepiness than PMNE. In health-related quality of life, PMRE had significantly lower score on social functioning (p<0.001), role limitation due to emotional problems (p=0.016) and mental component summary (MCS) (p=0.019) than PMNE. There was significant correlation between sleep quality and health-related quality of life, especially on the mental health component in PMNE. After adjusting the confounding factors, age (p<0.001), sleep quality (p<0.001) and excessive daytime sleepiness (p=0.017) were independently associated with mental health of health-related quality of life and age (p<0.001) was the only independent factor associated with physical health of health-relted quality of life. In comparison with patients with primary insomnia (PPI), in general the PPI had significantly poorer sleep quality and poorer health-related quality of life than PMRE and PMNE. The PSG study revealed that PMRE had shorter REM sleep than PMNE (P=0.031).
Conclusion: In general, PMRE have poorer mental health of health-related quality of life than PMNE. Sleep quality was significantly correlated with the mental component of health-related quality of life, especially in PMNE. The age, sleep quality and excessive daytime sleep were the major influcing factors on mental component of health-related quality of life. The influencing factors on quality of life in patients with epilepsy were different in different publications. The possible reasons were the individual variation ( such as type of seizure, frequency of seizure, age of onset and anticonvulsant) and the corss-cultural difference (such as family support and religious belief) in epilepsy. A large-scaled study should be conducted to clarify these findings.

並列關鍵字

epilepsy ； sleep quality ； excessive daytume sleepiness ； quality of life ； polysomnography

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