探討胃食道逆流疾病病患之症狀、內視鏡發現與睡眠、生活品質之關聯性

Abstract

背景: 目前逐漸認知睡眠問題是一個重要的健康議題，胃食道逆流疾病是一個重要打斷睡眠的原因，同時也影響著生活品質，但它們的關係目前仍在爭議中。 方法: 從2012年9月至2013年5月，在馬偕紀念醫院因典型胃食道逆流疾病症狀如胃酸逆流或心口灼熱感就診的病人，在解釋後病患同意接受胃鏡進一步檢查並納入研究者，我們以標準化問卷記錄病患狀況，相關症狀以胃食道逆流疾病問卷(GerdQ)評估嚴重度,以Pittsburgh Sleep Quality Index (PSQI)與short form 36 health survey questionnaire (SF-36)記錄睡眠與生活品質，病患在接受胃鏡檢查後，胃食道逆流疾病的嚴重度以Los Angeles classification分類。 結果: 共有164名病患被納入本研究，平均年齡為42.9 ± 12.0歲，47.0% (n=77) 為女性、53% (n=87) 為男性、 BMI 為23.6 ± 3.8；定義睡眠品質不佳為PSQI> 6 者有90人 (54.9%)，PSQI> 5 者有110人(67.1%)；在全部病患中，有89 人(54.3%) 是非糜爛型逆流症(non-erosive reflux disease, NERD)、75 人(45.7%)是逆流性食道炎(reflux esophagitis, RE)；在男性、BMI較高與有抽煙者有較高機會罹患逆流性食道炎. 在睡眠品質方面，非糜爛型逆流症的病患與使用睡眠藥物相關，較嚴重的症狀(GerdQ≥9)影響睡眠比內視鏡發現重要。在生活品質方面，分析發現相較於非糜爛型逆流症，逆流性食道炎的病患有較佳之活力狀態(vitality) (β= 3.94; 95% CI 0.54, 7.33) 與一般健康狀況(general mental health) (β= 3.08; 95% CI 0.17, 5.99)；另一方面，較嚴重的症狀(GerdQ ≥ 9)的病患有較差的生理功能(physical functioning) (β= -4.22; 95% CI -0.85, -0.29)與因身體健康所引起限制(role limitation due to physical problem) (β= -14.84; 95% CI -27.14, -2.54)。 以非糜爛型逆流症與逆流性食道炎分組討論，我們發現在非糜爛型逆流症病患中 GerdQ≥9 只跟daytime dysfunction (β= 0.59; 95% CI 0.19, 0.99) 相關，而逆流性食道炎病患中 GerdQ≥9 跟sleep disturbance (β= 0.30; 95% CI 0.06, 0.55), use of sleeping medicine (β= 0.33; 95% CI 0.06, 0.59) 跟 PSQI總分(β= 2.05; 95% CI 0.47, 3.64)都有相關性。在生活品質方面，GerdQ≥9 只在非糜爛型逆流症病患中與physical functioning (β= -6.03; 95% CI -10.55, -1.51), role limitation due to physical problem (β= -18.06; 95% CI -34.08, -2.03) 與 role limitation due to emotional problem (β= -19.82; 95% CI -37.27, -2.38)有負相關，逆流性食道炎病患則無任何關係。 結論: 不管是睡眠或生活品質，症狀的嚴重度(GerdQ≥ 9)比內視鏡發現重要；在睡眠品質面向，逆流性食道炎的病患合併有GerdQ≥ 9者有較差的睡眠品質；在生活品質方面，非糜爛性食道炎的病患合併有GerdQ≥ 9者有較差的生活品質。

Background Sleep problems are increasingly recognized as an important health outcome. Gastroesophageal reflux disease (GERD) is a major cause of disrupted sleep with inverse effect in healthy-related quality of life (HRQL). The relationships between GERD and sleep, HRQL are controversial. Methods and materials Consecutive participants with typical symptoms of GERD, such as acid reflux or heartburn, and performed esophagogastroduodenoscopy were enrolled from September 2012 to May 2013 at the Mackay Memorial Hospital. The symptoms were measured with GERD questionnaire (GerdQ), sleep quality was measured with Pittsburgh Sleep Quality Index (PSQI), and the HRQL was measured with short form 36 health survey questionnaire (SF-36). Definition and severity of GERD were assessed with Los Angeles classification by esophagogastrodeudenoscopy. Results One hundred and sixty-four patients were enrolled. The mean age was 42.9 ± 12.0 years, 47.0% (n=77) were female, 53% (n=87) were male, and BMI was 23.6 ± 3.8. Poor sleep quality with PSQI >6 and >5 were found in 54.9% and 67.1% patients respectively. Of the all patients, 89 (54.3%) patients were classed as non-erosive reflux disease (NERD), and 75 (45.7%) patients reflux esophagitis (RE). Male gender (p=0.004), high BMI (p=0.03) and smoking (p=0.03) were the risk of RE. None of the associated symptoms was the risk of RE. In the sleep quality, use of sleeping medicine was related to NERD. There was stronger effect of symptoms (GerdQ ≥ 9) than endoscopy findings. In the HRQL, the La class A & B was related to positive effect of vitality (β= 3.94; 95% CI 0.54, 7.33) and general mental health (β= 3.08; 95% CI 0.17, 5.99) than NERD. In addition, GerdQ ≥ 9 was related to inverse effect of physical functioning (β= -4.22; 95% CI -0.85, -0.29) and role limitation due to physical problem (β= -14.84; 95% CI -27.14, -2.54). In the stratification NERD and RE, GerdQ ≥ 9 was related to daytime dysfunction (β= 0.59; 95% CI 0.19, 0.99) in NERD only and sleep disturbance (β= 0.30; 95% CI 0.06, 0.55), use of sleeping medicine (β= 0.33; 95% CI 0.06, 0.59) and total score of PSQI (β= 2.05; 95% CI 0.47, 3.64) in RE. In the HRQL, patient with GerdQ≥9 only had inverse association in physical functioning (β= -6.03; 95% CI -10.55, -1.51), role limitation due to physical problem (β= -18.06; 95% CI -34.08, -2.03) and role limitation due to emotional problem (β= -19.82; 95% CI -37.27, -2.38) in NERD. Conclusion Either sleep quality or HRQL, the effect of GerdQ≥9 was stronger than the endoscopic findings. In PSQI components, RE with GerdQ≥9 had stronger inverse effect. In SF-36 domains, NERD with GerdQ≥9 had stronger inverse effect.