| 摘要: | 背景： 過去有許多文獻指出,暴露於空氣污染會增加患有睡眠呼吸中止症及腦部認知功能障礙的機率。然而，鮮少有研究探討空氣汙染對於睡眠呼吸中止與失智症患者的睡眠分期的影響。
目的： 本篇研究的目的為探討空氣污染對睡眠呼吸中止症與失智症患者的睡眠分期、認知功能與腦部結構的影響。
方法： 本篇為橫斷性研究。收集2015年1月至2019年4月，年齡在20至80歲的患者，並且分為無呼吸中止症組別 (966人)及呼吸中止症組別 (3900人)。當患者被診斷為失智症時，將其納入失智症組 (50人)。本篇收集睡眠多項生理檢查、簡短智能測驗、認知能力篩檢工具與腦部結構影像之相關參數，並利用土地利用回歸模型計算臭氧 (O3) (ppb), 二氧化氮(NO2) (ppb) and 小於2.5微米的懸浮微粒 (PM2.5) (μg/m3)之一年的平均暴露量。以線性回歸評估空氣污染與睡眠參數、認知功能與腦部結構之間的關係。
結果：在無呼吸中止症組別中，增加1個四分位距O3暴露量會使睡著後醒來與醒著的時間分別增加0.093 (95% 信賴區間: 0.007 ~ 0.179) 及 0.096 (95% 信賴區間: 0.010 ~ 0.181)。在所有組別裡(無呼吸中止症、呼吸中止症與失智症)，增加1個四分位距NO2暴露量分別會增加0.174 (95% 信賴區間: 0.019 ~ 0.330), 0.227 (95% 信賴區間: 0.152 ~ 0.303) 及 0.795 (95% 信賴區間: -0.107 ~ 01.483) N1週期;並且減少0.295 (95 % 信賴區間: -0.446 ~ -0.143), 0.081 (95% 信賴區間: -0.006 ~ -0.155) 及 0.386 (95% 信賴區間: -0.463 ~ -0.309) N2週期。除此之外，NO2及PM2.5對於N1，N2及REM在呼吸中止症組的影響較非呼吸中止症影響還來的大。在探討空氣污染對於腦部結構的影響發現，所有空氣污染皆會改變失智症患者不同腦區的腦體積與厚度。
結論：長期暴露空氣污染可能會減少睡眠時間並改變睡眠周期尤其是呼吸中止症患者。除此之外，增加空氣汙染暴露量也會影響失智症患者的腦部結構。因此，患有呼吸中止或是失智症的患者應該要更加注意空氣污染的暴露，避免疾病惡化。
Background: There is plenty of evidence indicated that exposure to air pollutant is associated with increased risk of obstructive sleep apnea (OSA) and cognitive decline. However, associations between air pollution and sleep stages in OSA and dementia is poorly understood.
Objective: The objective of this study is to investigate the effect of air pollution on sleep structure, cognitive function and brain structure in OSA and dementia.
Methods: A cross sectional study was conducted. Subjects aged between 20 and 80 years old were collected from January 2015 to April 2019. Subjects with non-OSA (N= 966) and OSA group (N= 3900) was studied. Besides, subjects diagnosed with dementia (N= 50) was analyzed as sub-group. Polysomnography (PSG), mini-mental state examination (MMSE), cognitive abilities screening instrument (CASI) and brain structure were measured and collected. Exposure of ozone (O3) (ppb), nitrogen dioxide (NO2) (ppb) and particulate matter ≤ 2.5 μm (PM2.5) (μg/m3) were estimated by land use regression model. A liner regression model was conducted to assess the association of air pollution and sleep structure or cognitive performance.
Results: An increase in 1 interquartile range (IQR) of O3 was associated with 0.093 (95% CI: 0.007 ~ 0.179) and 0.096 (95% CI: 0.010 ~ 0.181) increase in wake after sleep onset (WASO) and wake duration in the non-OSA group, respectively. N1 stage was increased 0.174 (95% CI: 0.019 ~ 0.330), 0.227 (95% CI: 0.152 ~ 0.303) and 0.795 (95% CI: -0.107 ~ 01.483); N2 stage was decreased 0.295 (95 % CI: -0.446 ~ -0.143), 0.081 (95% CI: -0.006 ~ -0.155) and 0.386 (95% CI: -0.463 ~ -0.309) with increase in 1 IQR of NO2 in the non-OSA, OSA and dementia groups, respectively. Moreover, the effect of NO2 and PM2.5 on N1, N2 and REM stage were higher in the OSA group than in non-OSA group. In the brain structure, all studies air pollution had positive association with brain volume and thickness in different regions.
Conclusions: Long-term exposure to air pollution associated with shorter sleep duration, N2 stage and REM sleep stage, especially in OSA patients. Increasing in O3, NO2 and PM2.5 were also altered brain structure in dementia. According to our results, OSA and dementia patients should be aware of their daily exposure level to air pollutions to avoid affecting disease progress. |
