| 摘要: | 背景
睡眠障礙是現代人們普遍的健康問題之一，而阻塞型睡眠呼吸中止症是一種常見的睡眠障礙，通常會好發在男性、肥胖及長期酗酒或服用安眠藥的成年人。臨床診斷上通常使用睡眠多項生理檢查來診斷睡眠障礙。阻塞型睡眠呼吸中止症之主要參考指標為呼吸中止指數。由於睡眠過程被干擾，不僅會影響日常工作與生活品質，進而導致白天疲倦、嗜睡，甚至可能引起車禍或意外傷害等。因此，如何改善阻塞型睡眠呼吸中止症是值得探討的健康議題。
目的
探討有氧運動與阻力訓練是否能降低阻塞型睡眠呼吸中止症的嚴重程度。
方法
本研究利用系統性文獻回顧與統合分析，針對PubMed、Embase資料庫進行系統性的文獻搜尋至2021年2月。納入的文章主要包括關於有氧運動與阻力訓練是否能改善阻塞型睡眠呼吸中止症的隨機對照試驗或臨床試驗。評估的主要結果為呼吸中止指數(Apnea-hypopnea index, AHI)；次要結果包括缺氧指數(Oxygen desaturation index, ODI)、身體質量指數(Body mass index, BMI)、覺醒指數(Arousal index, ARI)、睡眠效率(Sleep efficiency)、脈搏血氧飽和度(Oxyhemoglobin saturation, SpO2)、快速動眼期(Rapid eye movement, REM)。使用Cochrane risk of bias tool來評估納入文章的偏差風險。使用Review Manager (RevMan 5.4)軟體進行統合分析、敏感度分析、異質性評估、次族群分析及出版偏差之評估。
結果
本研究最後共納入9篇合適的文獻進行統合分析。關於呼吸中止指數AHI的分析結果，運動訓練能平均顯著降低5.29，另外，有氧運動加上阻力訓練平均顯著降低5.71；運動時間持續12週平均顯著降低5.90；對平均年齡55歲以上者平均顯著降低6.11；男性比佔70%以下者平均顯著降低5.09；運動訓練加CPAP平均顯著降低10.43及對於心血管疾病族群平均顯著降低8.59。
另外，在敏感度分析中，發現運動訓練的介入使喚醒指數ARI平均顯著降低5.86。關於其他指標的統合分析結果，運動訓練介入讓ODI平均降低2.23；BMI平均降低0.63；睡眠效率平均增加5.68%；血氧飽和度SpO2<90%平均降低0.43%及REM的比例平均降低0.32，但皆未達到統計上顯著。
結論
本研究結果發現運動訓練的介入能夠改善阻塞型睡眠呼吸中止症的嚴重度。尤其對有氧運動加上阻力訓練、運動時間持續12週、平均年齡55歲以上、男性比佔70%以下、合併CPAP治療及心血管疾病族群，運動訓練都具有更加顯著的改善效果。雖然運動訓練可以改善阻塞型睡眠呼吸中止症的嚴重度，但仍需適度控制飲食、抽菸及喝酒等危險因子，才能真正有效治療阻塞型睡眠呼吸中止症，進而提升患者的生活品質。
Background
Sleep disorder is one of human health problems worldwide and obstructive sleep apnea (OSA) is a common sleep disorder. OSA is prevalent in men, obese people and adults with long-term alcohol or taking sleeping pills. Polysomnography (PSG) is usually used to examine sleep disorders for clinical diagnosis. Apnea Hypopnea Index (AHI) and oxygen desaturation levels are used to indicate the severity of OSA. Since the sleep is interrupted, it will not only affect daily work and quality of life, thus leading to daytime fatigue, sleepiness and may cause a car accident or accidental injury and so. Therefore, how to improve obstructive sleep apnea is a health issue worthy of discussion.
Aim
To explore whether aerobic exercise and resistance training can reduce the severity of obstructive sleep apnea.
Methods
This study is a systematic review and meta-analysis. We search the PubMed, Embase databases of eligible literatures till February 2021. Included studies consisted of those randomized controlled trials or clinical trials regarding whether aerobic exercise and resistance training can improve OSA. The major outcome is apnea-hypopnea index (AHI) and secondary outcomes include oxygen desaturation index (ODI), body mass index (BMI), arousal index (ARI), sleep efficiency, oxyhemoglobin saturation (SpO2), rapid eye movement (REM). We used the Cochrane risk of bias tool to assess the risk of bias for included studies. Review Manager 5.4 software was applied to conduct meta-analysis, sensitivity analysis, heterogeneity, subgroup analysis and evaluation of publication bias.
Results
Finally, a total of 9 eligible literatures were included in the present meta-analysis. Regarding the effects of exercise on AHI, exercise training resulted in a significant mean reduction of -5.29 in AHI. Moreover, significant mean reductions in AHI were found for aerobic exercise plus resistance training (-5.71), exercise duration for 12 weeks (-5.90), older (≥55 years) individuals (-6.11), those studies with male subjects accounted for less than 70% (-5.09), exercise training combined CPAP treatment (-10.43) and individuals with cardiovascular diseases (-8.59) in subgroup analyses.
In the sensitivity analysis, we found a significant mean reduction of -5.86 in ARI. Regarding the secondary outcomes, non-significant mean reductions were found for ODI (-2.23), BMI (-0.63), SpO2 <90% (-0.43%) and the proportion of REM (-0.32) as well as the non-significant increase in sleep efficiency (5.68%) in the present meta-analyses.
Conclusion
Our findings suggest that exercise training can significantly reduce the severity of OSA. Especially for those with aerobic exercise plus resistance training, exercise duration for 12 weeks, over 55 years old adults, male accounted for less than 70%, combined with CPAP therapy and those with cardiovascular diseases. Although exercise training can reduce the severity of OSA, appropriate diet, quit smoking and alcohol drinking and other risk factors are important to improve the quality of life and effectively treat OSA patients. |
