背景:隨著人口的老化,阿茲海默症患者(AD)的盛行率也不
斷增加。過去研究顯示AD 患者常合併睡眠障礙,此將進一步
惡化其已受損之生活功能與生活品質;AD 患者有睡眠障礙者
常會帶給照顧者相當的壓力。探討AD 的睡眠問題本質,有助
於改善AD 患者的睡眠問題。
目的:本研究的主要目的有三:(1) 了解AD 患者睡眠障礙的
盛行率及其睡眠障礙形態,並探討影響AD 患者睡眠障礙的相
關因素;(2)藉多項睡眠生理腦波儀了解AD 患者睡眠形態與
其原發性睡眠障礙的比例;(3) 探討影響AD 患者睡眠障礙對
於照顧者的情緒健康衝擊。
方法:此為一多中心的研究,於中山醫學大學神經內科與精
神科、林新醫院神經內科、秀傳醫院神經內科與精神科等三
處醫院,以門診臨床個案為研究群體之兩年期非隨機橫斷性
研究,研究個案需符合DSM IV (診斷與統計手冊第四版) 及
NINCDS-ADRDA(National Institute of Neurological and
Communicative Disorders and Stroke-Alzheimer's
Disease and Related Disorders Association)疑似阿茲海
默症之診斷;患者目前居住於社區中,本人或其主要照顧者
可以瞭解研究內容且願意簽署同意書。預計以兩年期間收集
120 名以上AD 患者及其主要照顧者。評估項目為:患者之認
知功能、生活自理能力、睡眠品質、精神與行為症狀、生活
壓力事件、照顧者身心健康與負荷程度。此外,其中收集50
名患者進行多項睡眠生理腦波儀檢查,以了解患者原發性睡
眠障礙之盛行率。
結果: 共計三百八十四位疑似阿茲海默症之患者參與研究。
其中102 位(26.6%)為早期失智,175 位(45.6%)為輕度失
智,99 位(25.8%)為中度失智,8 位(2.1%)為重度失智。患者
中64.8%有嚴重程度不一的睡眠障礙。探討患者之日間嗜睡
程度(以Epworth Sleepiness Scale, ESS 評估)、睡眠品質
(以Pittsburgh Sleep Quality Index, PSQI 評估)以及睡眠
障礙頻率與嚴重性(以NPI 之睡眠障礙分項評估),均發現輕
度失智的患者睡眠品質相對於其他失智患者,有較佳的傾
向。隨著失智程度惡化,睡眠品質有更為嚴重的傾向,睡眠
品質之良窳與失智病程的關係,略呈U-型的形態。患者自評
健康較佳者,有較好的睡眠品質。在19 位接受多項睡眠生理
腦波儀檢查的患者中,幾乎全部的人(94.7%)均有睡眠呼吸中
止症,陣發性肢體運動疾患的盛行率也不低(57.9%);另外少
數人有快速動眼期睡眠行為疾患 (REM sleep behavior
disorder)。照顧者負擔與阿茲海默症患者睡眠障礙造成照顧
者困擾的程度有關(r=0.232; P<.0001)。105 位照顧者
(27.3%)的憂鬱達顯著程度,顯見阿茲海默症患者之照顧者心
理健康程度值得重視。
結論:阿茲海默症患者睡眠障礙的盛行率相當高,在疾病早期
便已帶給患者相當程度的困擾; 隨著病程的惡化,睡眠障礙
有趨於嚴重的傾向。阿茲海默症患者合併相當比例的原發性
睡眠障礙,且帶給其照顧者相當程度的負擔與負向心理健康
的衝擊。進一步前驅性的世代研究將有助於了解阿茲海默症
患者睡眠障礙的演變以及對於患者功能的影響。
Background: For patients with AD, sleep problems
exert an additional burden to the compromised
functioning and quality of life. The nature of sleep
disturbance of AD should be clarified.
Objectives: The primary aims of present study
encompass three parts: (1) to elucidate the
prevalence and nature of sleep disturbances in
community-dwelling patients of AD. (2) to explore
primary sleep disorder by the aids of polysomnography
(PSG) examination. (3) to investigate the burden of
sleep disturbance
Methods: The present study is a cross-sectional,
multi-centers' study. Eligible criteria of
participants are: (1) meet the criteria as probable
AD, (2) dwell in community and (3) able to provide
written informed consent. The assessment tools
include cognitive function, sleep quality, as well as
behavioral and psychological symptoms of dementia.
Results: A total of 384 participants were recruited.
Two hundred and forty nine participants (64,8%)
suffered from a variety degree of sleep disturbances.
As dementia progressed, the impact of sleep
disturbances got worse. Of 19 patients receiving PSG
examination, the prevalence of sleep apnea was very
high (94.7%). The impact of sleep disturbances was
significantly associated with caregivers' burden in
AD patients (r=0.232; P<.0001). One hundred and five
caregivers (27.3%) suffered from significant
depression.
Conclusion: As AD illness course progressed, the
impact of sleep disturbances got worse. A substantial
numbers of AD patients also suffered from primary
sleep disorders, mostly sleep apnea. The burden to
caregivers brought from sleep disturbance was huge in
AD.