台北市室外空氣污染與失眠之相關性研究

Abstract

背景 空氣汙染已被證實造成許多健康效應，包含中樞神經系統疾病與憂鬱焦慮情緒。過去少有研究探討空氣汙染與失眠的相關性。本研究探討台北市室外空氣懸浮微粒與失眠的相關性。 方法 本研究為一個回溯性觀察研究。研究材料為臺北市立聯合醫院醫療資訊系統資料庫。從2014年1月到2014年6月，收集5108個松德、忠孝、陽明、和平、婦幼、仁愛、中興院區內科與家醫科門診病人、年紀大於18歲且教育資訊完整者為研究對象。依據研究其間是否有國際疾病分類標準的失眠診斷碼與安眠藥的使用次數分為失眠組與非失眠組。依據住家地址最近空氣品質測站的觀測值估計診斷失眠組發病與非失眠組最後一次就診日前1年的懸浮微粒暴露量。利用羅吉氏回歸估算懸浮微粒暴露與失眠的相關性。 結果 失眠組1年平均PM2.5的暴露濃度為25.5 (µg/m3)，非失眠組1年平均PM2.5的暴露濃度為20.5 (µg/m3)。校正年紀、性別、重大疾病史、教育程度與樓層、居住地周圍50公尺內的道路面積後，前1年 (勝算比1.610, 95%信賴區間 [1.562,1.660]) 平均PM2.5濃度顯著地增加失眠的風險。在校正年紀、性別、重大疾病史、教育程度與常見空氣汙染物NOx、O3後，前1年平均PM2.5(1.624, [1.570,1.681])與臭氧(1.198, [1.094,1.311])濃度顯著地增加失眠的風險。在敏感性分析中，PM2.5與臭氧對於有慢性疾病者造成失眠的風險高於無慢性疾病者。在無疾病次分組中，前1年平均PM2.5與臭氧暴露對於失眠的風險分別為 (1.351, [1.218-1.499])及(1.166, [0.833-1.633])。在有疾病次分組中，前1年平均PM2.5與臭氧暴露對於失眠的風險分別為(1.657, [1.599-1.717])及(1.190, [1.084-1.308])。 結論與建議 台北市長期PM2.5及臭氧的暴露與成年人安眠藥治療下的失眠症有正相關性。且這些相關性在有慢性重大疾病者，包含精神疾病、慢性心衰竭、缺血性心臟病、腦血管疾病、失智症、糖尿病、慢性阻塞性肺病、氣喘、消化性潰瘍疾病、逆流性食道炎、慢性腎臟病、惡性腫瘤等，大於無慢性重大疾病者。未來針對空氣汙染的健康效應研究應包含睡眠障礙。

Background Ambient air pollution is known to cause negative health effects, including central nervous system diseases and depressive symptoms. In this study, we examined the associations between ambient fine particle (PM2.5) exposure and the prevalence of insomnia in Taipei City. Method We conducted an observational study from January 2014 to December 2016 using a health information system of electrical medical records from Taipei City Hospital. A total of 5,108 study subjects over 18 years old with complete educational information were from the family medicine and internal medicine outpatients of Songde Branch, Zhongxiao Branch, Yangming Branch, Heping Fuyou Branch, Renai Branch, and Zhongxing Branch of Taipei City Hospital. These patients were grouped into insomniacs and non-insomniacs following the International Statistical Classification of Diseases and Related Health Problems codes of primary insomnia diagnosis and the prescription times of anxiolytics and hypnotics during the observation period. We estimated the individual concentrations of average air pollutant PM2.5 exposure by using the nearest air quality monitoring stations built during the Taiwan Environmental Protection Administration relative to the residential address. Logistic regression analysis was employed to examine the independent effects of PM2.5 concentrations on insomnia. Results The average 1-year PM 2.5 levels for insomniacs was 25.5 µg/m3, whereas that for non-insomniacs was 18.67 µg/m3. After adjusting for age, gender, chronic major diseases, educational level, influence of height with residence floor level, and road area within radius of 50 m, previous 1-year (the odds ratio 1.610, 95% CI [1.562,1.660]) mean PM2.5 showed a statistically significant positive association with insomnia. After adjusting for age, gender, chronic major diseases, educational level, and traffic-related air pollution of NOx and ozone, previous 1-year mean PM2.5 (1.624, [1.570, 1.681]) and previous 1-year mean ozone (1.198, [1.094, 1.311]) exposure showed a statistically significant positive association with insomnia. Subgroup analysis revealed that the influence of PM2.5 and ozone on insomnia were higher in people with chronic disease than in those without chronic disease. In the subgroup without chronic major diseases, the effects of PM2.5 and ozone on insomnia in previous 1-year exposure were (1.351, [1.218-1.499]) and (1.166, [0.833-1.633]), respectively. In the subgroup with chronic major diseases, the effects of PM2.5 and ozone on insomnia in previous 1-year exposure were (1.190, [1.084-1.308]), respectively. Conclusions This study demonstrated a positive association between long term PM2.5 and ozone exposure and prevalence of hypnotic-treated insomnia by utilizing data from Taipei City Hospital from 2014 to 2016. The effect of PM2.5 and ozone on insomnia were higher in people with chronic major diseases, including psychiatric disease, congestive heart failure, ischemic heart disease, cerebrovascular disease, dementia, diabetes, chronic obstructive pulmonary disease, asthma, peptic ulcer disease, reflux esophagitis, chronic kidney disease and malignancy than in those without chronic major diseases. Future health impact assessment on air pollution should include sleep disturbance as an important health outcome.