| 摘要: | 背景：阻塞型睡眠呼吸中止症（Obstructive sleep apnea, OSA）是目前最重要的睡眠相關疾病，研究顯示OSA與氧化壓力、發炎反應及新陳代謝症候群有高度相關。肥胖者常合併OSA，故生活型態的調整以及體重控制就相當重要。本研究目的是探討重度OSA患者以特殊植化素功能性食品、魚油、維生素C以及輔酵素Q10等營養素介入後之影響。
方法：本研究採用單臂前後測臨床試驗（single-arm pre-post clinical trial），共成功取得29名男性重度OSA患者進行本試驗，平均年齡為39.17±7.30歲，受試者給予12週的營養素介入。本研究進行採用工具包括生理指標測量（anthropometrics）、睡眠多項生理檢查（polysomnography, PSG）、艾普沃斯睡眠量表（Epworth Sleepiness Scale, ESS）、生活品質量表，並抽血檢測多項生化指標、抗氧化酵素、氧化壓力、發炎激素等，來測定營養介入前後之各項指標變化。
結果：經過12週後，受試者體重、身體質量指數（body mass index, BMI）、頸圍、腰圍、臀圍、腰臀比、及體脂率皆呈現統計學上明顯下降（P<0.05）。睡眠呼吸干擾指數（apnea-hypopnea index, AHI）從53.43±18.82降到34.38±24.41（P<0.001）。氧去飽和指數（oxygen desaturation index, ODI）以及ESS分數也明顯減少。收縮壓及舒張壓在介入12週後也統計上明顯下降（P＝0.004）。新陳代謝症的總組成因子數（metabolic syndrome variables）統計上有顯著的減少（P＝0.001）。另外總膽固醇、低密度膽固醇LDL、三酸甘油脂、肝功能酵素GPT、肌酸酐以及尿酸皆有統計上顯著下降，高密度膽固醇HDL也顯著上升。血液氧化壓力指標丙二醛
（malondialdehyde, MDA）以及8-isoprostane也呈現下降（P<0.001），紅血球之抗氧化酵素過氧化氫?（catalase）、穀胱甘?過氧化? （glutathione peroxidase, GPx），以及超氧化物岐化?（superoxide dismutase, SOD）活性都顯著增加（P<0.001）。發炎指標方面，包括高敏感C反應蛋白（high sensitive-C reactive protein, hs-CRP）、介白素6（interleukin-6, IL-6）、介白素8（interleukin-8, IL-8）以及腫瘤壞死因子α（tumor necrotic factor, TNF-α）都呈現顯著下降（P<0.001）。在生活品質指標SF-36量表八個項目中有五個項目，包括身體功能、身體角色功能、一般健康、社會功能和活力，均有顯著進步。
結論：合併肥胖的重度OSA患者，以特殊植化素功能性食品、魚油、維生素C以及輔酵素Q10等營養素介入12週後，可以有效改善其生理指標、新陳代謝症、氧化壓力、發炎指數，並且能改善睡眠以及整體生活品質。
Background：Obstructive sleep apnea（OSA）is an increasing sleeping disorder occurred owing to the repeatedly collapse and obstruction of the upper respiratory tract during the sleep. OSA is considered to be highly associated with the metabolic syndrome. Moreover, life style modification and body weight control should be taken into consideration beforehand while treating OSA patients with obesity. The purpose of this study is to examine how intervention of specific phytochemical-containing medical functional food, fish oil, vitamin C and Coenzyme Q10 affect patient with OSA.
Method：Twenty-nine severe OSA patients had received daily multiple nutrient supplements for 12 weeks. At the beginning and the end of the trial, several elements were examined, which are anthropometric measurements, polysomnography（PSG）, Epworth Sleepiness Scale（ESS）, health-related quality of life, blood biochemistry, inflammatory cytokines, antioxidant enzymes, and oxidative stress marker malondialdehyde （MDA）.
Results：The average age of test completing participants are 39.17± 7.30 years old. After the intervention, which lasted for 12 weeks, the body weight, BMI, neck circumference, waist circumference, hip circumference, waist to hip ratio and body fat percentage had shown significant decrease. The apnea-hypopnea index （AHI） reduced from 53.43 ± 18.82 to 34.38 ± 24.41 （P<0.001） and oxygen desaturation index（ODI）also decreased（P＝0.044）. Also, the ESS showed decrease（P＝0.006）.Subjects had experienced reductions in both systolic and diastolic blood pressure at the end of the trial （P＝0.004）. In the blood biochemistry, the total cholesterol, LDL, TG, TG／HDL, GPT, Cr, uric acid increase and HDL were shown to be decreasing significantly. The mean number of metabolic syndrome variables in the beginning is 3.00 ± 1.34 and drop to 2.14 ± 1.03 at the end of trial, with the total reduction of 0.86 ± 1.19（P＝0.001）.The plasma oxidative products MDA and 8-isoprostane had decreased（P<0.001）. Moreover, the erythrocyte catalase, glutathione peroxidase, and superoxide dismutase(SOD) increased（P<0.001）. The inflammatory protein hs-CRP(high sensitive C reactive protein), IL-6(interleukin-6), IL-8(interleukin-8), and TNF-α(tumor necrotic factor-α) showed decrease（P<0.001）. In the SF-36 generic questionnaire, there are 5 dimensions shown to be enhancing significantly, inclusive of the physical functioning, role-physical, general health, social functioning, and vitality.
Conclusion：According to the outcome of the trail, the capability of some specific phytochemical-containing medical food and nutritional supplement therapy is shown to be able to improve metabolic variable, oxidant-antioxidant balance, inflammatory status, AHI, ODI, and the quality of life for patients with severe OSA conditions. As for the suggestion for future studies, further large-scale studies are needed to have a better understanding over the influence of nutritional supplement therapy on OSA patients more holistically. |
