強直性脊柱炎患者睡眠質量評估及抗TNF-α治療對睡眠障礙的療效觀察

強直性脊柱炎（Ankylosing spondylitis,AS）是一種主要侵犯脊柱並累及骶髂關節和周圍關節的慢性進行性炎性疾病，多累及年輕人，尤其是青年男性。在治療過程中，我們一般只關注患者的疼痛及炎症指標的改善情況，往往忽視了疾病對患者睡眠的影響。

研究目的：本研究旨在探討強直性脊柱炎（AS）患者睡眠質量（SQ）與疾病活動（DA）之間的關係，並評估抗腫瘤壞死因子α（抗TNF-α）治療對睡眠障礙的療效。

研究材料與方法：本研究共納入了34名符合AS修訂的紐約分類標準的患者。患者分為以下兩組：I組（n = 15），DA高，接受抗TNF-α治療，Ⅱ組（n= 19）病情緩解。 DA通過BASDAI(Bath AS Disease Activity Index,疾病活動指數)進行評估。2組在基線期及第I組在抗TNF-α治療的3個月後分別使用匹茲堡睡眠質量指數（PSQI）和多導睡眠監測（PSG）來確定睡眠障礙及其模式。

研究結果：基線期結果評估顯示，在所有患者中，有57.9％的患者存在SQ。 PSG結果顯示患者中表現為阻塞性睡眠呼吸暫停綜合征，打鼾和周期性腿部運動的比率分別是73.7％，74.4％和26.3％。在抗TNF-α治療之前，I組的PSQI和打鼾評分明顯較高（P= 0.0001，P = 0.012）。雖然抗TNF-α治療第3個月I組PSQI評分明顯降低（P=0.005），但PSG參數無變化（P> 0.05）。

研究結論：AS患者，特別是DA患者，抗TNF-α治療可改善SQ，但是PSG沒有任何改善。因此，可以得出結論，PSG參數可能與AS本身的疾病發病機制相關，而不與疾病活動相關。

附註：多導睡眠監測（PSG）是一種綜合記錄睡眠期間發生的生物物理變化的方法。PSG在睡眠期間監測許多身體功能，包括腦（EEG），眼睛運動（EOG），肌肉活動或骨骼肌活化（EMG）和心律（ECG）等等。

Abstract

INTRODUCTION: This study was conducted to investigate the relationship between sleep quality (SQ) and disease activity (DA) in patients with ankylosing spondylitis (AS) and to evaluate the response to anti-tumor necrosis factor α (anti-TNF-α) therapy on sleep disorders.

MATERIALS AND METHODS: A total of 34 patients who met the modified New York classification criteria for AS were included in this prospective study. Patients were divided into two groups as follows: Group I (n=15) with high DA and receiving anti-TNF-α therapy, and Group II (n=19) in remission. DA was assessed by the Bath AS Disease Activity Index. Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were used to determine disorders and patterns of sleep, respectively, in both groups at baseline as well as at the third month of anti-TNF-α therapy in Group I.

RESULTS: Baseline evaluation revealed impaired SQ in 57.9% of all patients. PSG demonstrated obstructive sleep apnea syndrome, snoring and periodic leg movements in 73.7%, 74.4% and 26.3% of patients, respectively. Prior to anti-TNF-α therapy, PSQI and snoring score were significantly higher in Group I (P=0.0001, P=0.012, respectively). Although there was a significant reduction in PSQI scores in Group I (P = 0.005) at the third month of anti-TNF-α therapy, no change was observed in PSG parameters (P > 0.05).

CONCLUSION: Sleep disorders increase in AS, particularly in patients with high DA. Anti-TNF-α therapy has improved SQ without any improvement in PSG. Therefore, it may be concluded that PSG parameters might be more associated with disease pathogenesis rather than DA in patients with AS.

參考文獻：Evaluation of sleep quality in patients with ankylosing spondylitis and efficacy of anti-TNF-α therapy on sleep problems: A polisomnographic study.International Journal of Rheumatic Diseases 2017

來源：廣東省第二人民醫院風濕免疫科

譯者：鄧偉明

點擊展開全文

喜歡這篇文章嗎？立刻分享出去讓更多人知道吧！