- 期刊
阻塞型睡眠呼吸中止症患者伴隨失眠之非藥物處置：個案報告
Nonpharmacological Interventions for Obstructive Sleep Apnea Cormorbid with Insomnia: Case Report
摘要
目的：本個案報告係呈現以側睡治療法及認知行為治療法來治療阻塞型睡眠呼吸中止症伴隨失眠患者之效果。 方法：病人為47歲，男性，主訴為失眠及打鼾，且被診斷為重度睡眠呼吸中止症。在側睡治療法方面，教導個案睡衣背部縫高爾夫球，維持側睡姿勢，以減少睡眠呼吸中止症的發生。在認知行為治療法方面，包括使用刺激控制法、睡眠限制法、教導放鬆技巧及修正睡眠衛生習慣，以改善個案失眠困擾。在睡眠評估方面，則以睡眠日誌及睡眠多頻道檢查(polysomnography, PSG)進行評估。 結果：個案共進行9次的個別心理治療，每週一次，每次50分鐘。在客觀評估方面，睡眠多頻道檢查結果顯示，個案治療前與治療後的呼吸障礙指數(respiratory disturbance index, RDI)從每小時34.3次降到7.6次，入睡時間則從12.5分鐘降到4分鐘。在主觀評估方面，睡眠日誌記錄結果顯示，個案入眠時間從55分鐘降到15分鐘，平均睡眠時間從4.9小時增加到6.9小時，平均睡眠品質及平均白天清醒度兩者均從3.67分增加到4分。 結論：側睡治療合併認知行為治療法可以有效地改善與睡姿有關的阻塞型睡眠呼吸中止症伴隨失眠的問題，加上這些治療法具經濟且實施容易的特性，更適合於臨床上的應用。
並列摘要
Objective: The present case report demonstrates the efficacy of non-pharmacological strategies, namely positional therapy and cognitive behavior therapy (CBT), in the management of insomnia and sleep apnea symptoms in patients with obstructive sleep apnea comorbid with insomnia. Method: The patient was a 47-year-old male with a chief complain of insomnia and snoring, and was diagnosed with a severe sleep apnea syndrome. Positional therapy was introduced to reduce sleep apnea by having the patient wear night clothes with two golf balls stitched on its back, in order to keep a lateral sleep position. In addition, CBT for insomnia was applied with the following components: stimulus control instruction, sleep restriction therapy, relaxation training, and sleep hygiene education to eliminate his insomnia. Sleep diary and polysomnography (PSG) were used to evaluate the patient's progress and treatment effects. Results: The treatment consisted of nine weekly 50-minutes individual sessions. The patient's sleep apnea and insomnia symptoms were improved significantly after treatment. Respiratory disturbance index decreased from 34.3/hr to 7.6/hr, PSG sleep onset latency decreased from 12.5min. to 4 min., subjective sleep latency decreased from 55min. to 15min., and average sleep time increased from 4.9hrs to 6.9hrs. The ratings on both quality of sleep and daytime alertness improved from 3.67 points to 4 points. Conclusion: Positional therapy in combination with CBT for insomnia can improve position-related obstructive sleep apnea symptoms and associated insomnia. Because these non-pharmacological strategies are safe, inexpensive, and can be conducted relatively easily, they could be the treatment of choice for patients with insomnia complaints associated with position-related sleep apnea.