【作者】 祝道松；

【导师】 张家维；

【作者基本信息】 广州中医药大学 ， 针灸推拿， 2012， 博士

【摘要】 优质的睡眠质量不但可以让生理与心理能得到充分的休息与调适,进而会提升生活质量和学习与工作效率,以创造和谐的家庭及社会关系和公司绩效,甚至可以减少交通或工安意外所造成的公共安全问题,因此关于睡眠的研究是一项值得注意的议题。而在睡眠的相关的疾病中,以睡眠呼吸暂停综合征最为困扰着人们的生活,根据调查,在台湾估计有超过四十万人患有这项疾病,其中阻塞型睡眠呼吸暂停综合征与许多疾病互为因果关系,例如心血管疾病与肥胖等代谢性疾病。西方主流医学在治疗方面包括了保守治疗、连续气道正压呼吸器(CPAP)治疗、口内装置治疗,以及手术,中医则以中药及针灸治疗为主,但是针刺有人害怕,服用中药更有人嫌苦,因此无创的「耳穴治疗」可说是中医的第三条思路。1研究目的：1.1研究耳压治疗阻塞型睡眠呼吸暂停综合征的临床疗效。1.2研究阻塞型睡眠呼吸暂停综合征在中医体质证型之分类统计。1.3研究耳穴贴压治疗阻塞型睡眠呼吸暂停综合征对睡眠呼吸、睡眠质量及睡眠效率的影响。2研究方法：本研究通过前瞻性随机对照试验,将2010年11月～2012年4月就诊于台湾彰滨秀传医院睡眠中心符合诊断标准和纳入标准的合格受试对象60例,随机分为耳穴磁珠贴压组30人(治疗组)、耳穴胶布贴压组30人(对照组)。两组耳穴取穴相同,治疗组给予耳穴磁珠贴压治疗,对照组给予胶布贴于耳穴并指压之。两组均每周贴敷1次,两次为1个疗程。治疗前两组均填写嗜睡量表、阿森斯失眠量表、匹兹堡睡眠品质量表、打鼾问卷、倦怠评量表及医院焦虑与忧郁量表,并进行中医体质的评估；治疗前后监测PSG睡眠监测参数的变化,包括呼吸紊乱指数(AHI)、打鼾指数、最低血氧饱和度(LSaO2).氧降指数(Denaturation Index)、治疗前后的4期睡眠时间比率(S1、S2、S3、S4)快速动眼期比率(REM%)、全部入眠时间(TST)、睡眠效率(Sleeping Effieciency)、总觉醒次数(Total Arousal)、与周期性肢动指数(PLM)等指标。试验结束后对本病中医体质辨证及改善睡眠的疗效进行评估。3结果：3.1一般资料治疗组和对照组在年龄、治疗前BMI、性别构成、运动状况、抽烟状况及喝酒状况方面比较,均无统计学差异(P>0.05)。两组具有可比性。3.2阻塞型睡眠呼吸暂停综合征的中医体质辨证研究发现阻塞型睡眠呼吸暂停综合征病患大多不具单纯一种体质,多为兼夹数种体质,其中具有气虚体质和痰湿体质的各占65%,具有血瘀体质的占38%、气郁体质的占33%、阴虚体质的占38%、湿热体质的占40%。3.3耳穴治疗对阻塞型睡眠呼吸暂停综合征患者睡眠的改善治疗前两组的AHI、打鼾次数、打鼾指数、LSaO2比较,差异均无统计学意义(P>0.05)。治疗组AHI治疗前后比较,差异具有显着的统计学意义(P<0.01)；对照组AHI治疗前后比较,差异具有统计学意义(P<0.05)；两组治疗后AHI降低程度的比较,差异具有显着的统计学意义(P<0.01)。治疗组打鼾次数及打鼾指数治疗前后比较,差异均具有显着的统计学意义(P<0.01)；对照组打鼾次数治疗前后比较,差异均具有显着的统计学意义(P<0.01)；两组治疗后打鼾次数降低程度的比较,差异均具有显着的统计学意义(P<0.01)。治疗组LSaO：治疗前后比较,差异无统计学意义(P>0.05)；对照组LSaO。治疗前后比较,差异无统计学意义(P>0.05)；两组治疗后LSaO2改善情况的比较,差异无统计学意义(P>0.05)。然而,治疗前两组氧降指数比较,差异无统计学意义(P>0.05)；治疗组和对照组的氧降指数治疗前后比较,差异均具有显着的统计学意义(P<O.01)；两组治疗后氧降指数改善情况的比较,差异无统计学意义(P>0.05)两组治疗前各睡眠结构参数(四期睡眠时间比率、快速动眼期比率)的差异均无统计学意义(P>0.05)。治疗组S1治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组S1治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后S1降低的比较,差异无统计学意义(P>0.05)治疗组S2、S3、S4治疗前后比较,差异无统计学意义(P>0.05)；对照组S2、S3、S4治疗前后比较,差异无统计学意义(P>0.05)；两组治疗后S2、S3、S4改变的比较,差异无统计学意义(P>0.05)治疗组REM%治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组REM%治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后REM%提高情况的比较,差异具有显着性统计学意义(P<0.01)。治疗前两组全部入眠时间(TST)、睡眠效率(SE)、总觉醒时间(Total Arousal)、周期性肢动指数(PLM)比较,差异无统计学意义(P>0.05)。治疗组TST治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组TST治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后TST改变的比较,差异具有显着性统计学意义(P<0.01)。治疗组SE治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组SE治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后SE改变的比较,差异无统计学意义(P>0.05)治疗组Total Arousal治疗前后比较,差异具有统计学意义(P<0.05)；对照组Total Arousal治疗前后比较,差异具有统计学意义(P<0.05)：两组治疗后Total Arousal改变的比较,差异无统计学意义(P>0.05)治疗组PLM治疗前后比较,差异具有显着性统计学意义(P<0.01)；对照组PLM治疗前后比较,差异具有显着性统计学意义(P<0.01)；两组治疗后PLM改变的比较,差异无统计学意义(P>0.05)4结论：4.1阻塞型睡眠呼吸暂停综合征患者的体质类型主要为气虚体质和痰湿体质；4.2耳穴贴压治疗能有效改善阻塞型睡眠呼吸暂停综合征的呼吸、睡眠质量及睡眠效率。更多还原

【Abstract】 Good quality of sleep not only comforts human body physiologically and psychologically but also increases life quality and learning and working efficiency. Besides, it further creates harmonious family and social relationship and corporative performance. Moreover, it could decrease the public security problems caused by traffic and industrial accidence. Therefore, sleep related studies worth being concerned. Among the sleep related diseases, sleep apnea syndrome annoys people mostly. According to a survey, it is estimated to have over four hundred thousand people caught by this disease. Among them, obstructive sleep apnea syndrome has causal relationships with many diseases, such as CVA disease and obesity related metabolic diseases. The treatment methods in western medicine include conservative treatment, CPAP, oral device, and surgery. In TCM, Chinese herbal medicine and acupuncture treatment are the mainstream, but some people are afraid of acupuncture, some people detest bitterness of taking herbal medicine. Therefore, auricular points treatment might be the third train of thought in TCM.1. Object ive1.1The research is to study the clinical effect of the auricular therapy on the Obstructive Sleep Apnea Syndrome. 1.2It is also to find out the constitution of TCM syndrome classification statistics of the OSA patients.1.3The research also study how this treatment affect the Sleep and Respiratory System, sleep quality and sleep efficiency.2. MethodsThe prospective randomized controlled study chose60cases from Taiwan Chang foreshore show Chwan Hospital Sleep Center during December2010to April2012, which were in accordance with the diagnostic and indrawing standards, to be the subjects of the study. The patients were randomly divided into2groups, with30cases in the treatment group treated with auricular point sticking and pressing bead and30cases in the control group treated with auricular point sticking plaster pressure. The two groups were treated with same auricular point, once a week. With two weeks a course, both groups received one course in total. Before treatment two groups were filled in sleepiness scale, Athens’ insomnia scale, Pittsburgh sleep quality index, snoring, Burnout Fatigue Severity Scale and the Hospital Anxiety and Depression Scale, and traditional Chinese medicine constitution assessment; before and after treatment monitoring of PSG sleep monitoring parameters, Including the respiratory disturbance index (AHI), snoring index, the lowest oxygen saturation (LSaO2), mean oxygen saturation decreased index (Denaturation Index), before and after treatment of stage4sleep time ratio (S1, S2, S3, S4), a rapid eye movement stage ratio (REM%), total sleep time, sleep efficiency (TST)(Sleeping Effieciency), the total number of awakening (Total Arousal), and periodic limb movement index (PLM) and other indicators. After the test we have an assessment of the disease in traditional Chinese medicine constitution differentiation and improving sleep effect.3.Results3.1Physical Datas There were no significant differences in the age, BMI before the treatment, gender, exercise, smoking and drinking status were not statistically different (P>0.05). The two groups were comparable.3.2Obstructive sleep apnea syndrome differentiation of traditional Chinese Medicine physiqueThe study find that the obstructive sleep apnea syndrome patients are more likely with a composite constitution, for several physical and clamp, which has the constitution of qi deficiency and phlegm dampness constitution each accounted for65%, with blood stasis constitution accounted for38%, qi stagnation constitution accounted for33%, accounting for38%of yin deficiency constitution, damp heat constitution accounted for40%.3.3The sleep improvement of OSAS patients with auricular therapyIn two groups before treatment, the number of AHI snoring, snoring index, LSaO2comparison, there were no significant differences between them (P>0.05). Comparing the AHI before and after treatment, significant differences could be seen in both groups (P<0.01in treatment group, P<0.05in control group), comparison of AHI reduction of two groups after treatment has statistical significance (P<0.01).Comparing the number of snoring and the snoring index before and after treatment, significant differences could be seen in both groups (P <0.01), comparison of the number of snoring and the snoring index reduction of two groups after treatment have statistical significance (P<0.01).LSaO2in both groups before and after treatment, the difference were not statistically significant (P>0.05), the LSaO2improvemen t after treatment between two groups was not statistically significa nt (P>0.05).The sleep structure parameters (stage4sleep time ratio, REM ra tio) in two groups were not statistically significant (P>0.05). Com paring the S1before and after treatment, significant differences co uld be seen in both groups (P<0.01). Comparison of S1reduction of two groups after treatment has no statistical significance (P>0.05).Comparing the S2, S3, S4before and after treatment, no signific ant differences could be seen in both groups (P>0.05). Comparison o f S2, S3, S4change of two groups after treatment have no statistica1significance (P>0.05).But in the contrast of REM%before and after treatment, there were significant differece in both groups (P<0.01). And there was significant differece in the REM%improvement (P<0.01)There were no significant differences in the total sleep time (TST), and sleep efficiency (SE), total wake time (Total Arousal), periodic limb movement index (PLM) in both groups before treatment (P>0.05).Comparing the TST before and after treatment, significant differences could be seen in both groups (P<0.01). Comparison of TST change in two groups after treatment has statistical significance (P<0.01).Comparing the SE before and after treatment, significant differences could be seen in both groups (P<0.01). Comparison of SE change in two groups after treatment has no statistical significance (P>0.05).Comparing the Total Arousal before and after treatment, significant differences could be seen in both groups (P<0.05). Comparison of Total Arousal change intwo groups after treatment has no statistical significance (P>0.05).Comparing the PLM before and after treatment, significant differences could be seen in both groups (P<0.01). Comparison of PLM change in two groups after treatment has no statistical significance (P>0.05).4. Conclusion 4.1In patients with obstructive sleep apnea syndrome constitution types are mainly QI deficiency and phlegm dampness constitution;4.2Auricular therapy can effectively improve obstructive sleep apnoea breathing, sleep quality and sleep efficiency.更多还原