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標題: | 台灣老年人睡眠品質及日間嗜睡程度與認知功能之關聯研究 Association of Sleep Quality and Daytime Sleepiness with Cognitive Function in a Cohort of Taiwanese Elderly |
作者: | Deng-Yu Han 韓登宇 |
指導教授: | 程蘊菁(Yen-Ching Chen) |
關鍵字: | 睡眠品質,日間嗜睡度,因素分析,老年人,認知功能, sleep quality,daytime sleepiness,factor analysis,elderly,cognition, |
出版年 : | 2017 |
學位: | 碩士 |
摘要: | 背景 睡眠是與認知功能息息相關的重要生理功能,而睡眠障礙的發生率隨著年齡老化亦逐漸增加。不良的睡眠品質常是神經退化疾病的表現,但其本身也可能是造成老年人神經退化的危險因子之一。日間嗜睡度則可視為一長期睡眠品質不佳的指標。過往研究指出此兩者與老年人的輕度認知功能障礙、失智症的發生、認知功能下降,以及各種認知功能測驗表現具有關聯性,但各研究間之發現卻相當歧異,且控制之相關變項多半相當有限。本研究旨在藉由詳細的認知功能評估與變項控制進一步找出老年人睡眠品質及日間嗜睡度與認知功能之關聯性。
方法 本研究納入258位65歲以上居家老年人進行分析。匹茲堡睡眠品質量表(PSQI)與愛普沃斯嗜睡度量表(ESS)分別用來評估睡眠品質與日間嗜睡度。整體性認知功能以MoCA-T評估,而特定認知功能領域則分別以邏輯記憶、語言流暢度、數字廣度以及路徑描繪測試等測驗評估。此外,PSQI以其內建之七個面向,而ESS則將其含括之八種情境以因素分析後所得之三個因素(低、中及高入眠度),以複線性與羅吉斯迴歸分別與認知功能進行關聯性之探討。 結果 不良的睡眠品質(較高的PSQI總分)與較差的執行功能相關 (路徑描繪測試B,OR= 1.10, 95% CI=1.003 to 1.20)。較高的日間嗜睡度(較高的ESS總分)與較差的邏輯記憶相關(第一次回憶: β=-0.03, 95% CI= -0.06 to -0.002;第一次主題: β=-0.03, 95% CI= -0.06 to -0.01, OR=1.07, 95% CI= 1.004 to 1.14). 較差的“睡眠品質”面向與較差的邏輯記憶功能表現(第一次回憶: β= -0.23, 95% CI= -0.44 to -0.02; 第二次回憶: β= -0.21, 95% CI= -0.43 to -0.004; 第一次主題: β= -0.20, 95% CI= -0.40 to -0.002, 第二次主題: β= -0.25, 95% CI= -0.45 to -0.05, OR=1.96, 95% CI=1.17 to 3.29)具有相關性。較短的睡眠時間(較高的該面向分數)與較好的邏輯記憶功能(第一次主題: OR= 0.66, 95% CI= 0.45 to 0.96)與好的語言流暢度(總分: OR= 0.68, 95% CI=0.47 to 0.99)具有相關性。較差的睡眠效率(較高的該面向分數)則與較差的注意力(逆序數字廣度: β= -0.21, 95% CI= -0.37 to -0.04; OR=1.59, 95% CI=1.05 to 2.47)相關。較常使用安眠藥(較高的該面向分數)與較差的語言流暢度相關(水果: OR=1.36, 95% CI=1.001 to 1.85)。在閱讀、看電視、午餐後及公開場合靜坐實有較高嗜睡度時(較高的ESS第一因素分數)與較差的整體認知功能(MoCA-T: β= -0.31, 95% CI= -0.52 to -0.11, OR=1.35, 95% CI=1.09 to 1.68)。而在下午躺著休息與坐車一小時狀況下有較高嗜睡度者(較高的ESS第二因素分數) 其整體認知功能(MoCA-T: β=0.43, 95% CI= 0.21 to 0.65)、語言流暢度(總分: OR=0.41, 95% CI=0.18 to 0.96)以及執行功能(路徑描繪測試B: β= 0.09, 95% CI= 0.003 to 0.18, OR=0.71, 95% CI=0.55 to 0.93)的表現則較佳。至於在聊天與開車中有較高嗜睡度者(較高的ESS第三因素分數)則具有較差的邏輯記憶(第二次回憶: β= -0.34, 95% CI= -0.66 to -0.01;第二次主題: β= -0.34, 95% CI= -0.66 to -0.03, OR=2.55, 95% CI=1.13 to 5.75),較好的專注力(逆序數字廣度: OR=0.41, 95% CI=0.18 to 0.96),以及較差的執行功能(路徑描繪測試A, β= -0.48, 95% CI= -0.78 to -0.18; 路徑描繪測試B: OR=2.87, 95% CI=1.17 to 7.06)。 結論 老年人較差的睡眠品質與較差的執行功能有相關性,兒較高的日間嗜睡度與不良的記憶功能具有關聯。而睡眠品質的不同面向與不同入眠度的情境下的高嗜睡度則與認知功能有著不同的關聯。未來應考慮進行世代追蹤研究以釐清兩者之因果關係。 Background Sleep is a vital physiologic function that links to cognition, and prevalence of sleep disorders increases with aging. Poor sleep quality can be a consequence of neurodegeneration but also an important risk factor of cognitive dysfunction in the elderly. Daytime sleepiness is an indicator of compromised long-term sleep quality. Previous studies linked poor sleep quality and excessive daytime sleepiness with incidence of mild cognitive impairment (MCI) and dementia, and cognitive decline in elders, but the findings were inconsistent, and limited variables were adjusted. This study aimed to delineate the association of sleep quality, daytime sleepiness, with cognition in the elderly via detailed cognitive assessment and adjustment of covariates. Methods Two-hundred and fifty-eight community-dwelling elders aged 65 or older were included in the study. Sleep quality was assessed with Pittsburgh Sleep Quality Index (PSQI), and daytime sleepiness with Epworth Sleepiness Scale (ESS). Montreal Cognitive Assessment (MoCA-T) was used to evaluate global cognitive function; logic memory tests, digit span, verbal fluency tests, and trail-making tests were utilized to assess domain-specific cognitions. In addition, multiple linear and logistic regressions was used to explore the association of the 7 perspectives of PSQI and the 3 factors identified from the 8 circumstances of ESS with cognition. Results Poor sleep quality (higher PSQI total score) was associated with poor performance in executive function (trail-making test B, OR= 1.10, 95%CI=1.003 to 1.20). More daytime sleepiness (higher ESS total score) was associated with poor logical memory performance (recall I: β=-0.03, 95% CI= -0.06 to -0.002; thematic I: β=-0.03, 95% CI= -0.06 to -0.01, OR=1.07, 95% CI= 1.004 to 1.14). Poorer “sleep quality” (higher score in this perspective of PSQI) was associated with poor memory (logical memory – recall I: β= -0.23, 95% CI= -0.44 to -0.02; recall II: β= -0.21, 95% CI= -0.43 to -0.004; thematic I: β= -0.20, 95% CI= -0.40 to -0.002, thematic II: β= -0.25, 95% CI= -0.45 to -0.05, OR=1.96, 95% CI=1.17 to 3.29). Shorter “sleep duration” was associated with good memory (logical memory-thematic I: OR= 0.66, 95% CI= 0.45 to 0.96) and good verbal fluency (total: OR= 0.68, 95% CI=0.47 to 0.99). Poor “sleep efficiency” (higher score in this perspective) was associated with poor attention (digit span backward: β= -0.21, 95% CI= -0.37 to -0.04; OR=1.59, 95% CI=1.05 to 2.47). More frequent use of hypnotics (higher score in the perspective “sleep medication”) was associated with poor verbal fluency (fruits: OR=1.36, 95% CI=1.001 to 1.85). More sleepiness when reading, watching TV, sitting after lunch and in public (higher ESS factor 1 score) was associated with poor global cognition (MoCA-T score: β= -0.31, 95% CI= -0.52 to -0.11, OR=1.35, 95% CI=1.09 to 1.68). Higher level of sleepiness when lying down in the afternoon and as a passenger for 1 hour (higher ESS factor 2 score) was associated with good global cognition (MoCA-T score: β=0.43, 95% CI= 0.21 to 0.65), good verbal fluency (total: OR=0.41, 95% CI=0.18 to 0.96,), and better executive function (trail-making test B: β= 0.09, 95% CI= 0.003 to 0.18, OR=0.71, 95% CI=0.55 to 0.93). More sleepiness when talking and driving (higher ESS factor 3 score) was associated with lower logical memory (recall II: β= -0.34, 95% CI= -0.66 to -0.01; thematic II: β= -0.34, 95% CI= -0.66 to -0.03, OR=2.55, 95% CI=1.13 to 5.75), good attention (digit span backward: OR=0.41, 95% CI=0.18 to 0.96), and poor executive function (trail-making test A, β= -0.48, 95% CI= -0.78 to -0.18; trail-making test B: OR=2.87, 95% CI=1.17 to 7.06). Conclusion While poor sleep quality was associated with poor executive function, higher level of daytime sleepiness was associated with poor memory function in the elderly. Different perspectives of sleep quality and daytime sleepiness under circumstances of different somnificity may differentially associate with elders’ cognition. Future longitudinal study is warranted to explore the causal relationship between daytime sleepiness and cognition. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/20577 |
DOI: | 10.6342/NTU201702390 |
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顯示於系所單位: | 流行病學與預防醫學研究所 |
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