全身性紅斑性狼瘡女性睡眠與晝夜血壓相關性之探討

Abstract

全身性紅斑性狼瘡(systemic lupus erythematosus, SLE)病患常有睡眠困擾的主訴且常有罹患高血壓的風險。部分研究顯示睡眠與血壓有相關性，目前在SLE病患中尚未有研究詳細探討兩者之間的相關。本研究目的針對國內SLE女性的睡眠型態及晝夜血壓變化做初步探討，並加入健康控制組比較睡眠型態。最後分析SLE病患睡眠型態與其他變項之間的相關性。 本研究採前瞻式觀察性設計，以方便取樣收集臺北榮民總醫院之過敏免疫風溼科門診SLE女性及年齡相符且無急慢性疾病之健康控制組女性，共有83位SLE女性(平均年齡: 38.17 ± 10.83歲)及84位健康控制組女性(平均年齡: 36.68 ± 9.97歲)納入本研究進行調查。所有參與者皆完成7日睡眠日誌、中文版匹茲堡睡眠量表比較主觀睡眠型態，個人基本屬性問卷及醫院焦慮憂鬱量表；SLE組另填寫疼痛量表及評估疾病活動度，其中有69位SLE女性佩戴腕動計連續7日評估客觀睡眠型態，44位SLE女性佩戴24小時攜帶型自動血壓監測計1日紀錄晝夜血壓變化。 研究結果發現SLE女性的匹茲堡睡眠量表總分高於健康控制組女性(7.77 ± 3.55 vs 5.15 ± 2.33, p < 0.01)，顯示有較差的主觀睡眠品質；總分大於5分者為主觀睡眠品質不良，其中包含60位SLE女性及35位健康控制組 (72.3% vs 41.7%, p < 0.01)。睡眠日誌發現SLE女性比健康控制組有較長的睡眠潛伏期及每日小睡時間、較低的睡眠效率與夜間醒來次數較多，佩戴腕動計的SLE女性平均夜間睡眠總時間為392.23 ± 57.10分鐘，睡眠效率為84.53 ± 6.47%，睡眠效率<85%之SLE女性共有31人(44.9%)。28位(63.6%)SLE女性其夜間血壓為不下降型。腕動計睡眠效率較佳者，其晝夜血壓下降幅度百分比也較多。SLE女性較差的主觀睡眠型態相關因素包含身體質量指數較高(p < 0.05)、使用類固醇、焦慮及憂鬱次量表分數較高與有疼痛情形者(p < 0.01)。 SLE病患普遍有較差的主、客觀睡眠型態，建議臨床人員提升對SLE病患睡眠問題的重視，尤其是使用類固醇、身體質量指數較高及有憂鬱傾向的病患，應給予相關治療，改善睡眠品質。

Objectives: To compare sleep patterns in women with and without systemic lupus erythematosus (SLE), to identify correlates of sleep quality in women with SLE, and examine the association between sleep patterns and nocturnal blood pressure (BP) dipping for women with SLE. Methods: 83 women with SLE (mean age=38.17 ± 10.83 years old) and 84 women without SLE (mean age=36.68 ± 9.97 years old) completed the Pittsburgh Sleep Quality Index (PSQI), a 7-day sleep diary, and the Hospital Anxiety and Depression Scale. Pain severity and disease activity index were assessed in women with SLE. Sixty-nine women with SLE also wore a wrist actigraphy for 7 consecutive days to assess objective sleep patterns. Forty-four women with SLE underwent 24-h ambulatory BP monitoring. Results: Global PSQI scores in women with SLE were significantly higher than those without (7.77 ± 3.55 vs 5.15 ± 2.33, p < 0.01). Poor subjective sleep quality (PSQI>5) was presented in 60 women with SLE and 35 controls (72.3% vs 41.7%, p < 0.01). Sleep diary data showed that women with SLE had longer sleep latency and nap duration, lower sleep efficiency (SE), and more nocturnal awakenings than women without SLE. Among the women with SLE, total sleep time at night based on actigraphy was 392.23 ± 57.10 minutes and SE was 84.53 ± 6.47%, with 31 women (44.9%) having a SE of <85%. Twenty-eight women with SLE (63.6%) were classified as non-dippers. The magnitude of BP dipping was higher in women with better SE. Higher body mass index (p < 0.05), prednisolone use, higher anxiety and depressive symptoms as well as pain serevity (p < 0.01) were significantly correlated with higher PSQI scores in women with SLE. Conclusions: Objective and subjective poor sleep qualities were common in women with SLE. Prednisolone use, body mass index and depressive symptoms were relevant factors to poor sleep quality in women with SLE.