阻塞性睡眠呼吸中止症候群與腦中風

6

ၡāāࢋ

ᙯᔣෟĈܡ๫ّ ( Obstructive ) ײӛͤ̚া ( Sleep apnea ) ཝ̚ࢲ ( Stroke )

ᖎ̬ܡ๫ّჂ্ײӛͤ̚া࣏ཏ

ܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞࡭ঽ፟ᖼ

ܡ๫ّჂ্ײӛͤ̚া࣏ཏ ( obstructive sleep apnea-hypopnea syndrome )ĂߏˠдჂᛇॡĂ˯ײ ӛ྽ ( Β߁ᆄݟă˾ݟٕಘొ ) ൴Ϡͅᖬّ۞๲

ౝĂЯ҃૆ҝײӛ྽Ăౄјײӛត෱˧Ăͷײӛ ঈ߹ഴ̈ćՀᚑࢦ۰Ăົౄјײӛ྽ԆБ૆๫Ă

҃ౄјԆБӛ̙ז۩ঈ̈́ோि

Ą̂кᇴঽˠߏ Яࠎ۲ࡡĂ࿅к۞਌۹௡ᖐჸ᎕дײӛ྽׹ಛĂ ࠤٕШّ͕гᑅ࢝זײӛ྽ĂЯ҃ۡତٕมତг

ౄјײӛ྽ব৫

Ą˵ѣঽˠߏЯࠎჯ޺ײӛ྽఼

ၰ۞҉҇ૺ˧̙֖Ă҃टٽயϠ๲ౝٙ࡭

Ąѣֱ

ঽˠ݋ߏЯࠎ׎΁ࣧЯౄјײӛ྽۞ব৫ĂтА

ّ͇۞˭͐বٕ̈ޢᒺĂ޴ॿཛྷٕᚙጫݬ ( ܸჍ̈

Ҏᐝ )࿅̂ĂٕߏАّ͇۞្ᗞ৿ౝٙ࡭

Ą

ܡ๫ّჂ্ײӛͤ̚া࣏ཏ̝ᓜԖাې̈́׀൴া

౵૱֍۞ܡ๫ّჂ্ײӛͤ̚া࣏ཏᓜԖাې ࠎχᕋ̈́Ϩ͇๝ჂĂд֖ૉॡม۞Ⴢ্ޢ̪ᛇჂ̙

࿸Ăᅅ۰ౄјϨ͇ڦຍ˧൑ڱܜॡมะ̚Ă̍үड़ தҲऴĂᚑࢦ۰݋ົౄјฟٕ֘ፆү፟׍ॡЯχሼ Ⴢ҃឵јຍγխचĂࠤҌౄјѪ˸

Ą׎΁ᓜԖܑ

னΒ߁ĈჂᛇ̚யϠோिຏăಆिĂٕజ˾ͪ๦

ᏹĂჂ্̚൴Ϡ̙ځࣧЯ̝਒್ă͕ଙ҃ᏹֽĂछ ˠϫ༜̝ײӛͤ̚Ă؆มᐛԌĂّᇒ˭ࢫČඈ

Ą

҃д̈׊۞ܡ๫ّჂ্ײӛͤ̚া࣏ཏ͞ࢬĂົౄ

јጯආ˯ኝڦຍ˧൑ڱܜॡมะ̚Ă૱χሼჂĂጱ

࡭ጯ௫ਕ˧ָ̙ćѣֱጯආ݋Ξਕͽ࿅જ۞ଐڶֽ

ܲ޺୻ᏹĂ҃జᄱ෧ࠎ࿅જ׊

Ą

д׀൴া͞ࢬĂ౵Пᐍ۞ߏჂ্̚൴Ϡ͕ඔ ൭ă͕҉ୟ๫ٕཝ̚ࢲ( stroke )ĂՀѣΞਕ൴ϠჂᛇ

̚↢Ѫ

Ą҃੼ҕᑅ݋ߏ౵૱֍۞׀൴া̝˘

Ą ܡ๫ّჂ্ײӛͤ̚া࣏ཏᄵ൴າౘ΃ᔁা࣏ཏ

۞൴Ϡ݋ߏ౵ܕሤܝ۞ྖᗟĂ͹ࢋߏጱ࡭਍फ৵ ԩّ۞யϠĂࠤҌ੼ҕ਌া۞൴Ϡ

ĄΩγĂЯ Ⴢ্ָ̙ጱ࡭۞ˠॾপኳԼត ( т൏ᇋăε্ă තঈᇷᛒăᛒજ̙щඈ )ĂࠤҌᎮଈᇎ៭াٕε্

াĂͽ̈́੃ጸ˧ඈৠགྷᄮۢΑਕ۞ੜ̼Ă˵ߏ׀

൴া̝˘

ĄЯѩĂдѐࡔᅅᅅಶ൴Ϡ۲ࡡăᎤ

Ԍঽă੼ҕᑅă͕ޠ̙ፋٕ͕᝙਽აĂࠤҌࡎ൒

ٕΐి۞੃ጸ˧ഴੜ۞ঽˠĂౌᑕྍ੫၆ܡ๫ّ

Ⴢ্ײӛͤ̚া࣏ཏ۞াېઇ˘ֱྙયĂࠤҌщ ଵޢᜈ۞ᑭߤĄ˘ֱܡ๫ّჂ্ײӛͤ̚া࣏ཏ

۞ᓜԖাې̈́׀൴াĂፋநણ֍ܑ˘Ą

ܡ๫ّჂ্ײӛͤ̚া࣏ཏ̝෧ᕝ

ϫ݈੫၆ܡ๫ّჂ্ײӛͤ̚া࣏ཏ҃֏Ă ᅮࢋΒӣᓜԖ۞াې̈́؆มкᐛ྽Ⴢ্ײӛϠந ᑭߤ

ĄᓜԖাې͞ࢬĂᅮࢋѣ൑ڱͽ׎΁ࣧЯ ྋᛖ۞Ϩ͇๝ჂĂٕѣ؆มோिٕ๦ᏹăͅᖬ۞

؆มᛇᏹăܧঐੵি౻۞Ⴢ্ăϨ͇িጶăٕ൑

ڱะ̚ڦຍ˧ඈাې۞Їң̝˘

Ą҃౅࿅؆ม кᐛ྽Ⴢ্ײӛϠநᑭߤĂԧࣇΞͽۢ྽ঽˠჂ

্۞ฉഇ ( Βӣཝگăீજگ̈́҉҇ૺ˧ )ăײ ӛঈ߹۞̂̈ă਒ཛొײӛ۞ྻજăҕউ፧ޘă

͕ྯిதĂ̈́Ⴢᛇݻ๕វҜඈ

Ą༊ঽˠ̪׍

ѣ਒ཛొײӛྻજĂ҃ײӛঈ߹ഴ͌ 7 0 % ͽ˯

෹࿅ 10 ࡋĂԧࣇჍࠎײӛᇶͤ ( apnea )Ą༊ײӛ

۞ঈ߹ഴ͌д 30% ז 70% Ăͷତ඾ҡᐌѣҕউ

፧ޘ˭ࢫ 4% ͽ˯ٕᛇᏹ ( arousal ) ॡĂԧࣇჍ̝

ࠎײӛ̙֖ ( hypopnea )Ą༊ײӛ྽ব৫Ϗౄјײ ӛঈ߹ഴ͌ĂҭЯࠎব৫ጱ࡭ײӛٙᅮ̝˧ณᆧ ΐ̈́਒ට̰࢑ᑅᆧΐĂ͔҃੓̝ᛇᏹĂԧࣇჍ̝

ࠎײӛӅ˧ጱ࡭̝ᛇᏹ ( respiratory effort-related arousal, RERA )

Ą༊ঽˠፋ୎Ⴢ্ॡมயϠ۞

ײӛᇶͤăײӛ̙֖̈́ײӛӅ˧ጱ࡭̝ᛇᏹְІ

̝ᓁ׶ĂੵͽᓁჂ্ॡมĂٙ଀۞ᇴࣃӈࠎঽˠ Ⴢ্ॡπӮՏ̈ॡ൴Ϡ۞ײӛள૱ְІѨᇴĂԧ ࣇჍ̝ࠎײӛ̒ᕘ޽ᇴ ( respiratory disturbance in- dex, RDI )

Ą༊ײӛ̒ᕘ޽ᇴ̈ٺ 5 ॡĂԧࣇ

ෛࠎϒ૱Ă༊޽ᇴ̬ٺ 5 ז 1 5 ̝มॡĂჍࠎᅅ ޘܡ๫ّჂ্ײӛͤ̚া࣏ཏĂ༊޽ᇴ̬ٺ 1 5 ז 30 ̝มॡĂჍࠎ̚ޘܡ๫ّჂ্ײӛͤ̚া

࣏ཏĂ༊޽ᇴ̂ٺ 30 ॡĂჍ̝ࠎࢦޘܡ๫ّჂ

্ײӛͤ̚া࣏ཏ

Ą

ܡ๫ّჂ্ײӛͤ̚া࣏ཏ̝ڼᒚ

ܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞ڼᒚ͞ёΒ߁

˭Еೀ჌Ăፋநણ֍ܑ˟

Ĉ

˘ăഴࢦĈ၆ٺវࢦ࿅ࢦ۰ĂഴࢦߏᙋځΞ ͽѣड़ॲੵܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞ܧܬˢ

ّڼᒚ͞ёĂ˵ߏڼᒚܡ๫ّჂ্ײӛͤ̚া࣏

ཏ۞ௐ˘υࢋࢋІ

Ą

˟ăᔖҺֹϡ੧ᙷ฼फ़̈́ᗉᐖщ্ᘽۏĈ੧ ჟ̈́ᗉᐖщ্ᘽົᆧΐ˯ײӛ྽҉҇۞ᗫђޘĂ˵

ົࢫҲײӛ̚ᇽ၆Ҳҕউ̈́੼჆ᅕҕা۞ͅᑕ

Ą

ܑ˘Ĉܡ๫ݭჂ্ײӛͤ̚া࣏ཏ۞ᓜԖাې̈́ᇈ࣏

ᓜԖাې ᓜԖᇈ࣏

Ś

χᕋ

۲ࡡ

Ś

Ϩ͇๝ჂĂࠤҌ൴Ϡฟ֘

˾ݟొၹౄবٕ̈ጾᑟ

ٕፆү፟׍ॡჂ඾

˭͐ޢᒺ

Ś

ϫᑝ۞ײӛᇶઃְІ ׀൴া

Ś

ჂᛇॡயϠோिຏ

੼ҕᑅ

Ś

Ⴢᛇॡజ˾ͪ๦ᏹ

າౘ΃ᔁা࣏ཏ

Ś

؆มᐛԌ

͕ҕგ়ঽĂΒӣ͕ඔ൭ă͕

Ś

̈׊࿅જ ҉ୟ๫ă͕਽ა̈́ཝ̚ࢲ

Ś

ّΑਕᅪᘣ

ৠགྷᄮۢΑਕᅪᘣ

Ś

୻୐ᏹֽᐝ൭

ჟৠ়ঽĂтᇎ៭াăᛒ៭া

Ś

୻୐ົ˾઀̈́ಘᚎ઀ ٕε্া

ˬă઎ჂĈЈ዁ॡ˯ײӛ྽۞๲ౝّͧ઎዁

ॡ੼Ăдొ̶۞ঽˠ̚Ă઎዁ॡΞͽࢫҲჂ্ײ ӛள૱۞ְІ൴ϠĂ͍׎д֗វኳณͧ ( body mass index, BMI ) ྵ̈۞ঽˠड़ڍՀр

Ą

αăڼᒚᆄ๫Ĉѣᆄ๫াې۞ˠֹϡഴᅅᆄ

๫۞ᘽۏĂѣॡΞഴᅅܡ๫ّჂ্ײӛͤ̚া࣏

ཏ۞඀ޘĂ˵Ξᆧΐ޺ᜈّঈ྽ϒᑅײӛጡֹϡ

۞නዋّ̈́ड़ڍ

Ą

̣ăჂᛇॡֹϡ޺ᜈّঈ྽ϒᑅײӛጡ ( nasal continuous positive airway pressure, nCPAP )Ĉ఺ߏϫ

݈੫၆јˠܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞ᇾ໤ڼ

ᒚ͞ё

Ąϫ݈ޙᛉĂ༊ײӛ̒ᕘ޽ᇴ̂ٺ

ॡĂٕߏײӛ̒ᕘ޽ᇴ̂ٺ

Ăͷѣ˭ЕЇң˘

࣎াېॡĂΒ߁੼ҕᑅăཝ̚ࢲă๝Ⴢă৿ҕّ

͕᝙ঽăε্Ăٕଐჰ়ঽĂ఺׌჌ଐڶౌߏତ צ޺ᜈّঈ྽ϒᑅײӛጡڼᒚ۞ዋᑕা

Ą

̱ă˾ݟፋԛ͘ఙ ( Βӣᚙጫݬፋԛ͘ఙă

޴ॿཛྷၡੵ͘ఙČඈ )Ĉ੫၆χᕋѣྵځព۞ड़ ڍĂдߙֱপؠ۞Ⴢ্ײӛͤ̚াଈ۰ĂΞͽഴ ᅅ ൴ Ϡ ۞ ඀ ޘ Ă ҃ д ొ ̶ ۞ ଈ ۰ ݋ Ξ ͽ ڼ ᕽ

3,14

ĄᓜԖ˯Ă˯ᗠహᗠྵܜă޴ॿཛྷྵཚ̝̂ଈ ۰Ăͽ̈́׌઎ݟಘጨᖴ҇ྵк۰ĂྵዋЪତצ఺

ᇹ۞͘ఙڼᒚ

Ą

˛ă˾ටͰइᒣϒጡĈΞͽഴ͌χᕋ̈́ഴᅅ ܡ๫ّჂ্ײӛͤ̚া࣏ཏ൴Ϡ۞඀ޘ

Ąଂঽ ˠ۞ᓜԖপᇈ҃֏Ăѐࡔྵᅅă֗វኳณͧ( body mass index, BMI ) ྵ̈ăᐚಛྵൺăײӛ̒ᕘ޽ᇴ

ྵ͌ă઎዁۞ײӛ̒ᕘ޽ᇴͧπ዁ॡ͌۰Ăͽ̈́

ֹϡ˾ටͰइᒣϒጡޢ˭͐Ξͽـ݈ࡎ΍ྵк ۰Ăֹϡ˾ටͰइᒣϒጡ۞ड़ڍ̈́࿰ޢྵָ

Ą

ٙͽĂ˾ටͰइᒣϒጡዋЪֹϡдᅅޘז̚ޘܡ

๫ّჂ্ײӛͤ̚া࣏ཏঽଈ

ĄҭߏĂ̙ޙᛉ

༊ઇࢦޘܡ๫ّჂ্ײӛͤ̚া࣏ཏଈ۰۞ௐ˘

ቢڼᒚ͞ёĂ˵̙ޙᛉֹϡдࢦޘ๝ჂাېٕჂ ᛇॡົ൴Ϡᚑࢦҕউ፧ޘள૱۞ଈ۰֗˯

Ą

ˣăᗞࢬፋԛ͘ఙĈ੫၆្ᗞ৿ౝ۰ࠎڼᒚ

ࢵᏴĂҭд׎΁ܧ្ᗞ৿ౝ۰Ă݋ࠎ౵ޢ˘ቢ۞

ڼᒚ͞ё

Ą

˝ă޴ॿཛྷ̈́ཛྷᇹវၡੵ͘ఙĈࠎ̈׊ܡ๫

ّჂ্ײӛͤ̚া࣏ཏଈ۰۞ࢵᏴڼᒚ͞ё

Ą

˩ăঈ̷გ͘ఙĈࠎ౵ѝڼᒚჂ্ײӛͤ̚

া۞͞ёĂϫ݈˵ߏ౵ޢ˘ቢ۞ڼᒚ͞ё

Ą ڼᒚ۞͞ёிкĂ੫၆̙Т۞ଐԛĂᑕྍᏴ ፄ̙Т۞ڼᒚ͞ёĂٙͽଈ۰ᑕྍྫྷჂ্ᗁጯ۞

૞యᗁरઇ·̶۞੅ኢĂჂ্૞యᗁर˵ᑕྍ੫ ၆ঽଈ۞Ч჌ଐڶү̶ژĂͽԱ΍၆ঽଈ౵ዋЪ

۞ڼᒚ͞ёĄ

ܡ๫ّჂ্ײӛͤ̚া࣏ཏᄃཝ̚ࢲ

ܡ๫ّჂ্ײӛͤ̚া࣏ཏߏཝ̚ࢲ۞፾ϲПᐍ Я̄

ܡ๫ّჂ্ײӛͤ̚া࣏ཏдཝ̚ࢲ۞ঽˠ

̚ܧ૱૱֍ĂѣಡӘ޽΍Ĉ૟ܕ 6 0 % ۞ཝ̚ࢲ ঽˠົЪ׀ѣܡ๫ّჂ্ײӛͤ̚া࣏ཏĂٙͽ ܡ๫ّჂ্ײӛͤ̚া࣏ཏĂ၆ٺཝ̚ࢲ҃֏Ă ߏ˘࣎ "Вঽ"ĂϺٕߏ˘࣎ "፾ϲ۞ПᐍЯ̄"Ă

˘ۡߏ˘࣎ۋᛉ۞યᗟ

Ąд 1996 ז 1999 ѐม ѣˬቔࡁտಡӘឰԧࣇՀቁܫĈܡ๫ّჂ্ײӛ

ͤ̚া࣏ཏߏౄјཝ̚ࢲ۞˘࣎ПᐍЯ̄Ąௐ

˘Ăдཝ̚ࢲᄃൺᇶّཝ৿ҕ ( transient ischemia attack, TIA ) ۞ঽˠ̚ĂЪ׀ѣܡ๫ّჂ্ײӛͤ̚

া࣏ཏ۞஽Җதߏ˘ᇹ۞Ăͷౌ੼ٺ၆໰௡

Ą ௐ˟Ăд͇၌˯ ( supratentorial ) ͇̈́၌˭ ( in- fratentorial ) ׌̙࣎Тડા൴Ϡཝ̚ࢲ۞ঽˠĂ

׀൴ѣܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞஽Җத࠹

ТĂ҃ͷĂ׌௡มܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞

ᚑࢦ඀ޘ˵ౌߏ˘ᇹ۞

ĄௐˬĂ༊ཝ̚ࢲ̈́ൺ ᇶّཝ৿ҕ఺׌௡ঽˠĂᄃّҾăѐࡔ̈́֗វኳ ณͧ ( body mass index, BMI ) ˬ჌୧Іౌ࠹༊۞

ܑ˟Ĉܡ๫ّჂ্ײӛͤ̚া࣏ཏΞӀϡ̝ڼᒚ͞ё

Ś

ഴࢦ

Ś

ᔖҺֹϡ੧ᙷ̈́ᗉᐖщ্ᘽ

Ś

઎Ⴢ

Ś

ڼᒚᆄ๫

Ś

Ⴢᛇॡֹϡ޺ᜈّঈ྽ϒᑅײӛጡ

Ś

˾ݟፋԛ͘ఙĞΒӣᚙጫݬፋԛ͘ఙă޴ॿཛྷၡੵ͘ఙČ ඈğ

Ś

˾ටͰइᒣϒጡ

Ś

ᗞࢬፋԛ͘ఙ

Ś

ঈ̷გ͘ఙ

Ś

޴ॿཛྷ̈́ཛྷᇹវၡੵ͘ఙĞዋϡٺ̈׊ܡ๫ّჂ্ײӛ̚

ͤা࣏ཏğ

၆໰௡ઇͧྵĂѣཝ̚ࢲٕൺᇶّཝ৿ҕঽΫ۞

఺׌௡ঽˠĂ׀൴ѣܡ๫ّჂ্ײӛͤ̚া࣏ཏ

۞ͧத࠹ТĂ҃ͷౌځព੼ٺ၆໰௡

ĄٙͽĂ

ૄٺൺᇶّཝ৿ҕ۞ঽˠ̙ົ᏷঻Їң۞ৠགྷᅪ ᘣĂ̙̈́Тડાཝ̚ࢲౄјޢᜈৠགྷ҉҇Αਕᇆ ᜩ۞̙ТĂҭݒጾѣ࠹Тܡ๫ّჂ্ײӛͤ̚া

࣏ཏ۞஽ҖதĂ҃ͷдߙֱγд୧І࠹༊۞ଐڶ

˭Ăཝ̚ࢲٕൺᇶّཝ৿ҕ۞ঽˠ̚Ăܡ๫ّჂ

্ײӛͤ̚া࣏ཏ۞ͧதځព੼ٺ၆໰௡Ăԧࣇ Ξͽଯኢ΍Ĉ"ܡ๫ّჂ্ײӛͤ̚া࣏ཏߏౄ

јൺᇶّཝ৿ҕ̈́ཝ̚ࢲ۞ПᐍЯ̄"Ą҃дܕ ഇ˘ֱ੫၆̚ѐˠ۞݈ᖀّࡁտ˵ಡጱĂܡ๫ّ

Ⴢ্ײӛͤ̚া࣏ཏᆧΐཝ̚ࢲ۞Пᐍّ

Ą ܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞ঽˠ˘ਠౌЪ

׀ѣ۲ࡡă੼ҕᑅă΃ᔁা࣏ཏඈඈâֱΞਕ

ౄјཝ̚ࢲ۞ПᐍЯ̄

Ąଂ˘ֱͽـ۞៍၅ ࡁտ̚൴னĂᓜԖ˯ႷҬܡ๫ّჂ্ײӛͤ̚া

࣏ཏ۞াېĂΞਕߏౄјཝ̚ࢲ۞˘࣎፾ϲПᐍ

Я̄

Ą P a l o m a k i ඈˠಡӘĂགྷ࿅Νੵ੼ҕ

ᑅă۲ࡡăಅ੧Ϋ݄̈́ېજਔ়ঽ۞ᇆᜩĂᎮଈ ѣχᕋ়ঽ۰Ă׎൴Ϡཝ̚ࢲ۞౼ზͧ ( relative risk ) ࠎ 8.026 Ąд 2001 ѐ˵ಡጱ࿅Ăܡ๫ّჂ্

ײӛͤ̚া࣏ཏົ಼̈۞ăҭѣຍཌྷ۞ᆧΐཝ̚

ࢲ۞൴ϠதĂࡗ 1.58 ࢺ

Ą 2006 ѐѣ˘ቔ੠ᖸ 6 ѐ۞͵΃ᓜԖࡁտ൴னĂགྷ࿅७ϒѐࡔăّҾă ٩໬̈́ಅ੧Ϋă֗វኳณͧăќᒺ̈́නૺҕᑅă ᓁᓙ׽ዔณ̈́ᎤԌঽă͕ٗᝫજĂͽ̈́੼ҕᑅঽ ΫඈĂкีౄјཝ̚ࢲ۞ПᐍЯ̄ޢĂࢦޘܡ๫

ّჂ্ײӛͤ̚া࣏ཏ ( RDI Ÿ 30/h ) ߏдҁѐˠ

̚Ă͔൴ཝ̚ࢲ۞፾ϲПᐍЯ̄ĂПᐍͧ( haz- ard ratio ) ࠎ 2.52 ( 95% CI=1.04 to 6.01, P=0.04 )

Ą གྷϤ఺ֱಡӘĂԧࣇΞͽቁܫĈܡ๫ّჂ্ײӛ

ͤ̚া࣏ཏĂߏ൴Ϡཝ̚ࢲ۞፾ϲПᐍЯ̄Ą

ܡ๫ّჂ্ײӛͤ̚া࣏ཏౄјཝ̚ࢲ۞Ξਕঽ ந፟ᖼ

ܡ๫ّჂ্ײӛͤ̚া࣏ཏౄјཝ̚ࢲ۞፟

ᖼߏкЯّ۞Ăٙѣܡ๫ّჂ্ײӛͤ̚া࣏ཏ

ဦ˘Ĉܡ๫ّჂ্ײӛͤ̚া࣏ཏౄјཝ̚ࢲ۞ᖼ፟

ౄј͕ҕგ়ঽ۞Ξਕঽந፟ᖼĂТॡ˵ౌߏᄵ

൴ཝ̚ࢲ൴ү۞፟ᖼĂტЪፋநтဦ˘

Ą

఺ֱ፟ᖼт˭Ĉ

˘ăҲҕউĂͽ̈́ҕউ۞Г᛿߹Ĉܡ๫ّჂ

্ײӛͤ̚া࣏ཏώ֗۞পّಶΒӣมᕝّ۞৿

উĂтڍҕউ፧ޘ͉ҲĂಶΞਕۡତጱ࡭ཝొ৿

উĂౄјཝ̚ࢲĄੵѩ̝γĂ৿উώ֗Ăͽ̈́৿

উޢ۞ҕউГ᛿߹ٙౄј̝࿅উ̼யۏĂౌົౄ

ј൴ۆͅᑕ̬ኳ˯̿Ăͽ̈́Чีҕგঽត۞ૄЯ

ͅᑕ˯̿Ăซ҃ౄјҕგ̰ϩ௟ࡪ๋चĂ˵ົౄ

јԊొٕБّ֗۞൴ۆͅᑕĄ

˟ăϹആّ۞੼჆ᅕҕা̈́Ҳ჆ᅕҕাĈ఺

ᇹ۞ត̼Ăੵ˞ౄјЯ࿅ᅕٕ࿅ែٙயϠ̝উঈ

ֻᑕԼតĂ҃ౄј৿উ̈́ҕউГ᛿߹۞Чีͅᑕ

̝γĂᔘົౄјϹຏৠགྷ߿ّ۞˯̿Ă҃ޢౄј

੼ҕᑅăҕგ̰ϩ௟ࡪ๋चඈĂޢᜈົౄјҕგ ർ̼̈́ཝ̚ࢲ۞჌჌፟ᖼĄੵѩ̝γĂᔘົᇆᜩ

͕᝙Ăౄј͕ޠ̙ፋ۞൴ϠĂ̝ޢ͔੓ҕং۞ԛ јĂ҃ౄјཝ̚ࢲĄ

ˬăͅᖬ۞ᛇᏹĈͅᖬ۞ᛇᏹ˵ߏܡ๫ّჂ

্ײӛͤ̚া࣏ཏౄј۞াې̝˘Ă҃ͅᖬ۞ᛇ ᏹົౄј޺ᜈّ۞؆ม੼ҕᑅăϹຏৠགྷ߿ّ۞

˯̿Ăͽ͕̈́ޠ̙ፋĂ఺ֱౌΞਕౄјޢᜈ۞ҕ გ̰ϩ๋चĄ

αă਒ට̰࢑ᑅ۞گજĈ਒ට̰࢑ᑅ۞گ જĂߏЯࠎײӛ҉҇ࠎ˞ҹڇײӛ྽ܡ˧ᆧΐ҃

யϠ۞Ă҃఺ᇹ۞ត̼Ăົౄј͕۱۞Ϲ̢ү ϡĂ͔҃੓Ϲຏৠགྷ߿ّ۞˯̿Ăౄј͕ޠ̙

ፋĂ఺ֱౌົ͔൴т˯ٙࢗ۞˘ాҚϠநត̼Ă ซ҃ጱ࡭ཝ̚ࢲ۞൴ϠĄ

̣ă਍फ৵ԩّĈܡ๫ّჂ্ײӛͤ̚া࣏

ཏົౄј۞਍फ৵ԩّ

Ă఺ΞਕߏགྷϤܡ๫ّ

Ⴢ্ײӛͤ̚া࣏ཏౄј۞উ̼ᑅ˧ٙౄј۞Ą

҃਍फ৵ԩّ۞ᆧΐĂ˵ົ͔൴ҕგ̰ϩ௟ࡪ۞

๋चĂ͔҃੓ޢᜈ˘ాҚ۞׀൴াĄ

݈ࢬٙ೩ז۞Чีܡ๫ّჂ্ײӛͤ̚া࣏

ཏĂౌົౄјҕგ̰ϩ௟ࡪ۞๋चĂ҃ҕგ̰ϩ

௟ࡪ๋चΞۡତౄјඓېજਔർ̼Ă͔൴ཝ̚

ࢲĄ̰ϩ௟ࡪΑਕεአ ( dysfunction ) ˵ົౄјཝొ

ҕ߹ณ۞ഴ͌Ă҃ౄјཝ̚ࢲĄдགྷ្۞Ն˪ઙ

෹ࢰگᑭߤ̚൴னĂ̂̚ཝજਔҕ߹ณĂдܡ๫

ّჂ্ײӛְͤ̚І൴Ϡ۞ТॡĂົѣ 1 5 % ז 20% ۞ഴ͌ć҃дײӛְͤ̚ІඕՁ۞ॡ࣏Ă̂

ཝ۞ҕ߹ณົАᆧΐ 15% Ă̝ޢ˫ତ඾˘߱ҕ߹

ณࢫҲҌૄ໤ቢ˭ 23% ۞ॡഇ

ĄΩѣࡁտព ϯĂдܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞ঽˠ̚Ăཝ

ొҕგ၆੼჆ᅕҕাॡٙࢫҲ۞ཝొҕგᕖૺͅ

ᑕĂдགྷ࿅޺ᜈّঈ྽ϒᑅײӛጡڼᒚޢĂޭೇ

ϒ૱

ĄΩγĂܡ๫ّჂ্ײӛͤ̚া࣏ཏౄј۞

͕ޠ̙ፋĂͽ̈́ҕგ̰ϩ௟ࡪ๋चᄵ൴۞጖ҕঽ តĂౌΞਕጱ࡭ҕং۞൴ϠĂซ҃யϠཝ̚ࢲĄ

ཝ̚ࢲౄјܡ๫ّჂ্ײӛͤ̚া࣏ཏ

ᔵ൒ܡ๫ّჂ্ײӛͤ̚া࣏ཏߏౄјཝ̚

ࢲ۞፾ϲПᐍЯ̄Ă࠹҃ͅ֏Ăཝ̚ࢲ˵ົౄј ܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞൴Ϡ

ĄଂᓜԖ˯۞

៍၅ԧࣇ൴னĈᐌ඾ཝ̚ࢲଐڶ۞ԼචĂߙֱঽ ˠ۞ܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞ᚑࢦ඀ޘ˵ྫྷ

඾ԼචĂϤѩԧࣇΞͽ઄నĂཝ̚ࢲΞਕೋ̼ܡ

๫ّჂ্ײӛͤ̚া࣏ཏĂࠤٕߏౄјܡ๫ّჂ

্ײӛͤ̚া࣏ཏ۞யϠ

Ąཝ຅ٕ̂ཝΗ஧ཝ̚

ࢲĂ၆˯ײӛ྽ă҈ม̈́ፖჽඈ҉҇۞םአّౄ

ј۞๋चĂߏౄјܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞

ࣧЯ

Ą҃ཝ̚ࢲࡶᇆᜩז˟উ̼჆ຏᑕአ༼̚

ᇽĂౄј၆੼჆ᅕҕা۞ͅᑕࢫҲĂ˵Ξਕߏೋ

̼ܡ๫ّჂ্ײӛͤ̚া࣏ཏᚑࢦޘ۞˘࣎Я̄

39

Ąੵ˞ܡ๫ّჂ্ײӛͤ̚া࣏ཏ̝γĂཝ̚ࢲ

˵ΞਕౄјౘΫёײӛ ( Cheyne-Stokes breathing )Ă

ٕߏ׎΁ݭё۞̚ᇽّჂ্ײӛͤ̚া

Ą

ඕኢ

ܡ๫ّჂ্ײӛͤ̚া࣏ཏົౄјᚑࢦ۞׀

൴াĂΒ߁๝Ⴢ҃ౄјຍγխचă੼ҕᑅă͕᝙

ঽăЧีҕგ়ঽăາౘ΃ᔁা࣏ཏăৠགྷᄮۢ

Αਕᅪᘣ̈́ჟৠ়ঽඈĂ༊൒˵Β߁ཝ̚ࢲĄ҃

д׊ආ͞ࢬĂ݋Ξਕᇆᜩጯ௫ਕ˧Ăٕజᄱ෧ࠎ

࿅જ׊Ąдܡ๫ّჂ্ײӛͤ̚া࣏ཏ۞ڼᒚ

˯Ăѣк჌͞ёΞͽᏴፄĂᅮЈᏥ૞య۞Ⴢ্ᗁ ጯᗁरֽෞҤĄдᓜԖ˯Ăܡ๫ّჂ্ײӛͤ̚

া࣏ཏ૱૱टٽజنෛĂ҃ౄјᚑࢦ۞ޢڍĂٙ

ѣ۞ᗁरдࢬ၆ѣχᕋă๝Ⴢă۲ࡡă؆ม൴Ϡ

̝ಆᏹٕ๦ᏹă੼ҕᑅ̈́؆ม͕᝙ঽ൴ү̝ঽ

ଈĂౌᑕྍࢋڦຍܡ๫ّჂ্ײӛͤ̚া࣏ཏх д۞ΞਕّĄ

ણ҂͛ᚥ

1.Christian G, Ali B. Clinical Features and Evaluation of Obstructive Sleep Apnea-Hypopnea Syndrome and the Upper Airway Resistance Syndrome. In: Meir HK, Thomas R, William CD, editors. Principles and Practice of Sleep Medicine. 4th ed.

Philadelphia: Elsevier Saunders 2005; 1043-52.

2.ౘᑹԈĄܡ๫ّჂ্ײӛͤ̚াĄέ៉ᗁጯ 2005; 9: 361-6.

3.Barbara P, Meir HK. Management of Obstructive Sleep-Apnea- Hypopnea Syndrome: Overview. In: Meir HK, Thomas R, William CD, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Elsevier Saunders 2005; 1109-21.

4.Richard JS, Samuel TK, John ER. Anatomy and Physiology of Upper Airway Obstruction. In: Meir HK, Thomas R, William CD, editors. Principles and Practice of Sleep Medicine. 4th ed.

Philadelphia: Elsevier Saunders 2005; 983-1000.

5.Blunden S, Lushington K, Kennedy D. Cognitive and be- havioural performance in children with sleep-related obstruc- tive breathing disorders. Sleep Med Rev 2001; 5: 447-61.

6.Richard LV, Murray AM. Sleep-Related Cardiac Risk. In: Meir HK, Thomas R, William CD, editors. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Elsevier Saunders 2005;

1161-70.

7.Claudio LB. Sleep and Stroke. In: Meir HK, Thomas R, William CD, editors. Principles and Practice of Sleep Medicine. 4th ed.

Philadelphia: Elsevier Saunders 2005; 811-30.

8.Terry Y, Shahrokh J. Systemic and Pulmonary Hypertension in Obstructive Sleep Apnea. In: Meir HK, Thomas R, William CD, eds. Principles and Practice of Sleep Medicine. 4th ed.

Philadelphia: Elsevier Saunders 2005; 1192-202.

9.Naresh MP, Brock AB. Sleep apnea and metabolic dysfunction.

In: Meir HK, Thomas R, William CD, eds. Principles and prac- tice of sleep medicine. 4th ed. Philadelphia: Elsevier Saunders 2005; 1034-42.

10.Terri EW, Charles FPG. Cognition and Performance in Patients with Obstructive Sleep Apnea. In: Meir HK, Thomas R, William CD, eds. Principles and Practice of Sleep Medicine. 4th ed.

Philadelphia: Elsevier Saunders 2005; 1023-33.

11.Max H, Meir HK. Monitoring Techniques for Evaluating Suspected Sleep-Disordered Breathing. In: Meir HK, Thomas R, William CD, eds. Principles and Practice of Sleep Medicine.

4th ed. Philadelphia: Elsevier Saunders 2005; 1378-93.

12.Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clini- cal research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22: 667-89.

13.Patrick JS Jr, Charles WA Jr, Mark HS. Medical Therapy for Obstructive Sleep Apnea-Hypopnea Syndrome. In: Meir HK, Thomas R, William CD, editors. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Elsevier Saunders 2005; 1053-

65.

14.Nelson BP, Robert WR, Christian G. Surgical Management of Sleep-Disordered Breathing. In: Meir HK, Thomas R, William CD, eds. Principles and Practice of Sleep Medicine. 4th ed.

Philadelphia: Elsevier Saunders 2005; 1081-97.

15.Kathleen AF, Alan AL. Oral Appliances for Sleep-Disordered Breathing. In: Meir HK, Thomas R, William CD, editors.

Principles and Practice of Sleep Medicine. 4th ed. Philadelphia:

Elsevier Saunders 2005; 1098-108.

16.Ronald G. Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea-Hypopnea Syndrome. In: Meir HK, Thomas R, William CD, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Elsevier Saunders 2005; 1066- 80.

17.Brietzke SE, Gallagher D. The effectiveness of tonsillectomy and adenoidectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a meta-analysis. Otolaryngol Head Neck Surg 2006; 134: 979-84.

18.Kaneko Y, Hajek VE, Zivanovic V, Raboud J, Bradley TD.

Relationship of sleep apnea to functional capacity and length of hospitalization following stroke. Sleep 2003; 26: 293-7.

19.Bassetti C, Aldrich MS, Chervin RD, Quint D. Sleep apnea in patients with transient ischemic attack and stroke: a prospective study of 59 patients. Neurology 1996; 47: 1167-73.

20.Bassetti C, Aldrich MS, Quint D. Sleep-disordered breathing in patients with acute supra- and infratentorial strokes. A prospec- tive study of 39 patients. Stroke 1997; 28: 1765-72.

21.Bassetti C, Aldrich MS. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep 1999; 22: 217-23.

22.Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 2005; 172: 1447-51.

23.Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term car- diovascular outcomes in men with obstructive sleep apnoea-hy- popnoea with or without treatment with continuous positive air- way pressure: an observational study. Lancet 2005; 365: 1046- 53.

24.Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353: 2034-41.

25.Neau JP, Meurice JC, Paquereau J, Chavagnat JJ, Ingrand P, Gil R. Habitual snoring as a risk factor for brain infarction. Acta Neurol Scand 1995; 92: 63-8.

26.Palomaki H, Partinen M, Juvela S, Kaste M. Snoring as a risk factor for sleep-related brain infarction. Stroke 1989; 20: 1311- 5.

27.Parra O, Arboix A, Bechich S, et al. Time course of sleep-relat- ed breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 2000; 161: 375-80.

28.Wessendorf TE, Teschler H, Wang YM, Konietzko N, Thilmann AF. Sleep-disordered breathing among patients with first-ever stroke. J Neurol 2000; 247: 41-7.

29.Shahar E, Whitney CW, Redline S, et al. Sleep-disordered

breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001;

163: 19-25.

30.Munoz R, Duran-Cantolla J, Martinez-Vila E, et al. Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke 2006;

37: 2317-21.

31.Richard LV, Mark EJ. Cardiac Arrythmogenesis during Sleep:

Mechanisms, Diagnosis, and Therapy. In: Meir HK, Thomas R, William CD, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Elsevier Saunders 2005; 1171-9.

32.Shahrokh J. Sleep and Cardiovascular Disease: Present and Future. In: Meir HK, Thomas R, William CD, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Elsevier Saunders 2005; 1157-60.

33.Virend KS, Shahrokh J. Cardiovascular Effects of Sleep-Related Breathing Disorders. In: Meir HK, Thomas R, William CD, eds.

Principles and Practice of Sleep Medicine. 4th ed. Philadelphia:

Elsevier Saunders 2005; 1180-91.

34.Jan H, Karl AF, Yuksel P. Coronary Artery Disease and Obstructive Sleep Apnea. In: Meir HK, Thomas R, William CD, eds. Principles and Practice of Sleep Apnea. 4th ed. Philadelphia:

Elsevier Saunders 2005; 1203-7.

35.Balfors EM, Franklin KA. Impairment of cerebral perfusion dur- ing obstructive sleep apneas. Am J Respir Crit Care Med 1994;

150: 1587-91.

36.Fischer AQ, Chaudhary BA, Taormina MA, Akhtar B.

Intracranial hemodynamics in sleep apnea. Chest 1992; 102:

1402-6.

37.Diomedi M, Placidi F, Cupini LM, Bernardi G, Silvestrini M.

Cerebral hemodynamic changes in sleep apnea syndrome and effect of continuous positive airway pressure treatment.

Neurology 1998; 51: 1051-6.

38.Urban PP, Morgenstern M, Brause K, et al. Distribution and course of cortico-respiratory projections for voluntary activa- tion in man. A transcranial magnetic stimulation study in healthy subjects and patients with cerebral ischemia. J Neurol 2002; 249:

735-44.

39.Morrell MJ, Heywood P, Moosavi SH, Guz A, Stevens J.

Unilateral focal lesions in the rostrolateral medulla influence chemosensitivity and breathing measured during wakefulness, sleep, and exercise. J Neurol Neurosurg Psychiatry 1999; 67:

637-45.

Obstructive Sleep Apnea-Hypopnea Syndrome and Stroke

Yu-Ting Chou

, Shaw-Wei Leu

, Tsung-Ming Yang

, Ming-Szu Hung

, Chin-Kuo Lin

, Ju-Fang Chang

, and Cheng-Ta Yang

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repetitive episodes of upper airway obstruction that occur during sleep. The symptoms of OSAHS include habitual snoring and daytime sleepi- ness with brings accident events. Children of OSAHS have the symptoms of learning problem with impaired school performance and hyperactivity, which may be misdiagnosed as attention deficit/hyperactivity disorder. The com- plications of OSAHS are known as hypertension, cardiovascular and cerebrovascular disease, metabolic syn- drome, cognitive dysfunction and psychiatric disorders. The diagnosis of OSAHS is based on clinical symptoms and polysomnography study. Treatment of OSAHS should be tailored to individual condition. Since more and more clinical studies were reported, the debate of OSAHS as an independent risk factor for stroke is confirmed.

Mechanisms, which OSAHS inducing cardiovascular disease, are the same pathogenicc pathway for stroke. This article described the pathophysiology, clinical symptoms, complication, diagnosis and treatment of OSAHS, and the association between OSAHS and stroke were reviewed. ( J Intern Med Taiwan 2008; 19: 205-212 )

1

Division of pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi

2

Sleep Center, Chang Gung Memorial Hospital, Chiayi

3

Chang Gung University College of Medicine

4

Chang Gung Institute of Technology