摘 要
鼻炎患者常常同時伴有睡眠問題，包括難以入睡，睡眠中斷，以及跟上呼吸道有關的睡眠呼吸障礙 (sleep-disordered breathing)，包括阻塞性睡眠呼吸中止症等。阻塞性睡眠呼吸中止症除了會引起心臟病，高血壓，血 糖不易控制，中風等慢性疾病之外，另外也與白天的疲勞、睏倦有關，並可能損害學習力、記憶力，工作效率 與課業表現，甚至導致憂鬱等精神方面的症狀。因此鼻炎的治療應該不只著重改善鼻部症狀，也應聚焦在改善 睡眠情形，如此，才能改善鼻炎病患整體健康，以及生活品質。
key words : 鼻炎，睡眠，睡眠品質，生活品質，睡眠呼吸障礙，臨床治療指引
比氣喘患者下呼吸道阻塞的時間稍為延遲13。 鼻塞的出現，會增加短暫覺醒(microarousals)16 以及呼吸中止的次數17，許多研究顯示，光是鼻塞， mediators)，如 histamine, interleukin (IL)-1β， IL-4，
及IL-10 等，會直接作用在中樞神經系統而影響睡眠 以及白天的疲勞與嗜睡26-28，Histamine 本身也是調 節生理時鐘的神經傳導物質(neurotransmitter) 之一，
會影響人的睡眠與清醒的週期26，因鼻過敏引起的高 濃度 interleukin (IL)-1β， IL-4, 與 IL-10 會增加快速 動眼期潛時(REM latency)，減少快速動眼期的時間 (REM duration) 28。根據研究，這些鼻炎引起的發炎
tumor necrosis factor (TNF)， and IL-6，在阻塞型睡 眠呼吸中止(OSA) 的患者身上也可看到，另外，在 夜睡眠檢查(overnight polysomnography) 的客觀研究
7,11,16,17,28,39,40,41。 鼻類固醇(topical nasal corticosteroid) 製劑以外的其 他 藥 物， 包 括 SSRI(selective serotonergic reuptake inhibitor)，protriptyline, methylxanthine 衍 生 物， 以 及estrogen 製劑，都不建議用來治療睡眠呼吸中止 medicamentosa)43。
抗 乙 醯 膽 鹼 製 劑(anticholinergic agent ) 如 ipratropium bromide 對鼻塞緩解效果不大，但有研究 認為還是可以改善睡眠與生活品質46。
白 細 胞 三 烯 受 器 拮 抗 物(leukotriene receptor antagonists), 如 montelukast 或合併抗組織胺的使用曾 被證實對睡眠與生活品質的改善有幫助47,48。其作用 機轉可能是因緩解鼻塞，或減少發炎中間物，或是二
第 卷 別冊 (1) 2015 73 (verbal memory)62，再者，鼻內類固醇在同時有過敏 性鼻炎與阻塞型睡眠呼吸中止的患者身上，也可降低 呼吸中止(apnea) 及通氣量不足 (hypopnea) 的次數，
以及主觀上的鼻塞與白天的警覺(alertness) 程度，然 而，對枕邊人主觀的鼾聲噪音感受並無顯著改善63， 所有種類的鼻內類固醇都能在某種程度上改善 生活品質3，其中可能包括因鼻塞，流鼻水引起的負 面情緒，專心度與學校功課表現46。
環境控制法(Environmental Control Intervention) 環境控制法指環境，被褥傢俱的清潔以及過敏
研究應該著重於免疫療法(immunotherapy) 療效的驗 證，以及發展主，客觀的睡眠品質評估工具，以更準 確地驗證鼻炎對睡眠的影響。
圖1. 鼻塞的晝夜節律變化，一般在清晨最嚴重．摘自 Reinberg et al.13 與 Craig et al.14
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