臺灣博碩士論文加值系統

睡眠呼吸中止症會使患者於睡眠時期產生組織缺氧情形，不僅造成不良的睡眠品質、專注力下降增加交通意外事故的發生，也會促使交感神經活化刺激兒茶酚胺(catecholamines)的分泌增加高血壓之發生率，然而在台灣，雖然有文獻認為駕駛之高血壓盛行率高於一般民眾，可能是由於工作特質所造成，但是針對駕駛之睡眠呼吸中止症與高血壓之相關性研究卻相當稀少，因此本研究以台灣某客運公司駕駛為研究對象，希望能了解駕駛之睡眠呼吸中止症、高血壓之盛行率與其相關因子，並且進一步探討睡眠呼吸中止症與高血壓之相關性。
在此，本研究以橫斷式研究法(Cross-sectional study)，利用攜帶式血氧儀了解駕駛睡眠時期之血氧分佈情形，並且使用結構式問卷收集駕駛之高血壓狀況以及個人基本特質、健康行為、工作狀況與其他疾病和不適症狀資料。在統計方法上除了描述型分析以外，以多變項邏輯斯回歸(Multiple logistic regression)分析了解睡眠呼吸中止症、高血壓之相關因子，此外，控制睡眠呼吸中止症與高血壓之干擾因子以獲得睡眠呼吸中止症與高血壓之相關性。
結果顯示，駕駛之睡眠呼吸中止症盛行率為11~12%，其相關因子有年齡、BMI(kg/m2)、抽菸習慣、輪班方式、打鼾情形以及近一個月服用睡眠相關藥物；駕駛之高血壓盛行率為11.8%，其相關因子為年齡、BMI(kg/m2)、喝酒習慣以及腎臟疾病。最後在控制睡眠呼吸中止症與高血壓之干擾因子後，可以發現不管在何種血氧判定準則下(ODI4、ODI3以及「ODI4與ODI3判定基準」)，睡眠呼吸中止症與高血壓達到統計上顯著相關(p<0.05)，且隨著血氧飽和度下降發生次數越多的組別，其罹患高血壓之風險越高，在趨勢分析上達到統計意義(p<0.01)，意即睡眠呼吸中止症與高血壓具有劑量反應效應(Dose-response)。
因此，本研究建議駕駛應控制BMI於正常範圍之內以保持健康狀態，政府相關單位也應將睡眠呼吸中止症納入職業駕駛之例行身體檢查項目中，以避免睡眠呼吸中止症所帶來之傷害。

The sleep apnea syndrome causes the patients hypoxia during sleeping, not only make low sleep quality, adding of traffic accident from decreasing of attention and also cause sympathetic activation to stimulate secrete of catecholamines to add the incidence of hypertension. However, there are evidences show the prevalence of hypertension in drivers is higher then public humans in Taiwan. Maybe it is caused by special working type, but little is known about the sleep apnea syndrome and hypertension among drivers. Therefore, this study selected the drivers of some bus company in Taiwan to be our study population and we hope to realize the prevalence, related factors of sleep apnea syndrome and hypersention, and further more understanding the relationship between sleep apnea syndrome and hypertension.
This research conducted a Cross-sectional study, we use pulse oximetry to understand a variation of blood oxygen of sleeping and collected the hypertension situation, personal based-information about demography, healthy habits, working conditions and history of disease by questionnaires. On the statistical analysis, in addition the describable analysis, we also use the Multiple logistic regression to understand the related factors of sleep apnea syndrome and hypertension, and controling the confounding factors of sleep apnea syndrome and hypertension to get the association of sleep apnea syndrome and hypertension among drivers.
The results of sleep apnea syndrome prevalence of drivers is 11-12% and the related factors are age, BMI(kg/m2), smoking habit, the type of working shifts, snore and taking sleep-related medicine during recently month; the hypertension prevalence of drivers is 11.8%, and the related factors are age, BMI(kg/m2), drinking habits and Kidney disease. Finally when we controling the confounding factors of sleep apnea syndrome and hypertension, we can find that which criterion of oxygen desaturation index, the sleep apnea syndrome and hypertension are significance association, and when we do the analysis for trend, we can find that the risk of hypertension increasing when the oxygen desaturation index raise (p<0.01). That means that Sleep apnea syndrome and hypertension have dose response.
Therefore, this research suggest that drivers should be control the BMI in the correct range to maintain healthy situation, and the government need to add the testing item of sleep apnea syndrome into the routine health examine among occupational drivers to avoid the hurm from sleep apnea syndrome.

正文目錄
正文目錄 I
表目錄 II
中文摘要 IV
Abstract VI
符號與縮寫 VIII
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 4
第二章 文獻探討 5
第一節 睡眠呼吸中止症之定義與其相關研究 5
第二節 高血壓之定義與其相關研究 12
第三節 睡眠呼吸中止症與高血壓之相關研究 17
第三章 材料與方法 20
第一節 研究設計與研究架構 20
第二節 研究假設 22
第三節 研究工具 23
第四節 研究變項操作型定義 25
第五節 研究對象 26
第六節 資料整理與統計分析 27
第四章 結果 31
第一節 客運駕駛之基本資料及其睡眠呼吸中止症與高血壓之盛行率調查 31
第二節 客運駕駛之睡眠呼吸中止症與高血壓之相關性 35
第三節 客運駕駛之睡眠呼吸中止症相關因子 47
第四節 客運駕駛之高血壓相關因子 49
第五章 討論 50
第一節 客運駕駛之睡眠呼吸中止症與高血壓之盛行率調查 50
第二節 客運駕駛之睡眠呼吸中止症與高血壓相關性 53
第三節 睡眠呼吸中止症之相關因子 56
第四節 高血壓之相關因子 59
第五節 研究限制 61
第六章 結論與建議 62
第一節 結論 62
第二節 建議 64
參考文獻 65

表目錄
表1 客運駕駛之基本人口學特性與健康行為分布情形 70
表2 客運駕駛之工作狀況 71
表3 客運駕駛之血氧濃度分布情形 73
表4 客運駕駛之疾病與不適症狀分布情形 74
表5 年齡、BMI與駕駛年資在不同血氧濃度分組(ODI4)之分布情形 75
表6 客運駕駛之基本人口學特性在不同血氧濃度分組(ODI4)之分布情形 76
表7 客運駕駛之健康行為在不同血氧濃度分組(ODI4)之分布情形 77
表8 客運駕駛之工作狀況在不同血氧濃度(ODI4)下之分布情形 78
表8 客運駕駛之工作狀況在不同血氧濃度(ODI4)下之分布情形 79
表9 客運駕駛之疾病與不適症狀在不同血氧濃度分組(ODI4)之分布情形 80
表10 年齡、BMI與駕駛年資在不同血氧濃度分組(ODI3)之分布情形 81
表11 客運駕駛之基本人口學特性在不同血氧濃度分組(ODI3)之分布情形 82
表12 客運駕駛之健康行為在不同血氧濃度分組(ODI3)之分布情形 83
表13 客運駕駛之工作狀況在不同血氧濃度(ODI3)下之分布情形 84
表14 客運駕駛之疾病與不適症狀在不同血氧濃度分組(ODI3)之分布情形 86
表15 年齡、BMI與駕駛年資在不同血氧濃度分組(「ODI4與ODI3判定基準」)之分布情形 87
表16 客運駕駛之基本人口學特性在不同血氧濃度分組(「ODI4與ODI3判定基準」)
之分布情形 88
表17 客運駕駛之健康行為在不同血氧濃度分組(「ODI4與ODI3判定基準」)之分布情
形 89
表18 客運駕駛之工作狀況在不同血氧濃度(「ODI4與ODI3判定基準」)下之分布情形
90
表19 客運駕駛之疾病與不適症狀在不同血氧濃度分組(「ODI4與ODI3判定準」)
之分布情形 92
表20 年齡、BMI與駕駛年資在有無高血壓之分布情形 93
表21 客運駕駛之基本人口學特性在有無高血壓之分布情形 94
表22 客運駕駛之健康行為在有無高血壓之分布情形 95
表23 客運駕駛之工作狀況在有無高血壓之分布情形 96
表24 客運駕駛之疾病與不適症狀在有無高血壓之分布情形 98
表25 睡眠呼吸中止症與高血壓之影響因子總整理 99
表26以多變項邏輯斯回歸校正其他干擾因子後睡眠呼吸中止症(ODI4≧10次/時)與高
血壓之相關性 100
表27以多變項邏輯斯回歸校正其他干擾因子後睡眠呼吸中止症(ODI3≧15次/時)與高
血壓之相關性 101

表28以多變項邏輯斯回歸校正其他干擾因子後睡眠呼吸中止症(ODI4≧10次/時或ODI3
≧15次/時)與高血壓之相關性 102
表29 在BMI分層分析下，以多變項邏輯斯回歸校正其他干擾因子後睡眠呼吸中止症
(ODI4≧10次/時)與高血壓之相關性 103
表30在BMI分層分析下，以多變項邏輯斯回歸校正其他干擾因子後睡眠呼吸中止症
(ODI3≧15次/時)與高血壓之相關性 104
表31在BMI分層分析下，以多變項邏輯斯回歸校正其他干擾因子後睡眠呼吸中止症
(ODI4≧10次/時或ODI3≧15次/時)與高血壓之相關性 105
表32 睡眠呼吸中止症與心血管疾病之影響因子整理 106
表33以多變項邏輯斯回歸校正其他干擾因子後睡眠呼吸中止症(ODI4≦10次/時)與心血
管疾病之相關性 107
表34以多變項邏輯斯回歸校正其他干擾因子後睡眠呼吸中止症(ODI3≦15次/時)與心血
管疾病之相關性 108
表35以多變項邏輯斯回歸校正其他干擾因子後睡眠呼吸中止症(ODI4≧10次/時或ODI3
≧15次/時)與心血管疾病之相關性 109
表36以逐步邏輯斯回歸分析睡眠呼吸中止症(ODI4≧10次/時)之相關因子 110
表37以逐步邏輯斯回歸分析睡眠呼吸中止症(ODI3≧15次/時)之相關因子 111
表38以逐步邏輯斯回歸分析睡眠呼吸中止症(ODI4≧10次/時或ODI3≧15次/時)
之相關因子 112
表39以逐步邏輯斯回歸分析高血壓之相關因子 113
表40各國睡眠呼吸中止症之盛行率調查 114
表41各國高血壓之盛行率調查 115

1.Alchanatis M, Tourkohoriti G, Kosmas EN, Panoutsopoulos G, Kakouros S, Papadima K, et al. 2002. Evidence for left ventricular dysfunction in patients with obstructive sleep apnoea syndrome. Eur Respir J 20(5): 1239-1245.
2.Arabi Y, Morgan BJ, Goodman B, Puleo DS, Xie A, Skatrud JB. 1999. Daytime blood pressure elevation after nocturnal hypoxia. J Appl Physiol 87(2): 689-698.
3.Barbe, Pericas J, Munoz A, Findley L, Anto JM, Agusti AG. 1998. Automobile accidents in patients with sleep apnea syndrome. An epidemiological and mechanistic study. American journal of respiratory and critical care medicine 158(1): 18-22.
4.Benumof JL. 2001. Obstructive sleep apnea in the adult obese patient: implications for airway management. Journal of clinical anesthesia 13(2): 144-156.
5.Brooks D, Horner RL, Kozar LF, Render-Teixeira CL, Phillipson EA. 1997. Obstructive sleep apnea as a cause of systemic hypertension. Evidence from a canine model. The Journal of clinical investigation 99(1): 106-109.
6.Chiner E, Signes-Costa J, Arriero JM, Marco J, Fuentes I, Sergado A. 1999. Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax 54(11): 968-971.
7.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. 2003. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42(6): 1206-1252.
8.Cui R, Tanigawa T, Sakurai S, Yamagishi K, Iso H. 2006. Relationships between sleep-disordered breathing and blood pressure and excessive daytime sleepiness among truck drivers. Hypertens Res 29(8): 605-610.
9.Davies RJ, Ali NJ, Stradling JR. 1992. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax 47(2): 101-105.
10.de Kluizenaar Y, Gansevoort RT, Miedema HM, de Jong PE. 2007. Hypertension and road traffic noise exposure. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 49(5): 484-492.
11.Duran J, Esnaola S, Rubio R, Iztueta A. 2001. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. American journal of respiratory and critical care medicine 163(3 Pt 1): 685-689.
12.Gottlieb DJ, Whitney CW, Bonekat WH, Iber C, James GD, Lebowitz M, et al. 1999. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. American journal of respiratory and critical care medicine 159(2): 502-507.
13.Guidry UC, Mendes LA, Evans JC, Levy D, O'Connor GT, Larson MG, et al. 2001. Echocardiographic features of the right heart in sleep-disordered breathing: the Framingham Heart Study. American journal of respiratory and critical care medicine 164(6): 933-938.
14.Imadojemu VA, Gleeson K, Quraishi SA, Kunselman AR, Sinoway LI, Leuenberger UA. 2002. Impaired vasodilator responses in obstructive sleep apnea are improved with continuous positive airway pressure therapy. American journal of respiratory and critical care medicine 165(7): 950-953.
15.Ip MS, Lam B, Chan LY, Zheng L, Tsang KW, Fung PC, et al. 2000. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. American journal of respiratory and critical care medicine 162(6): 2166-2171.
16.Ip MS, Lam B, Lauder IJ, Tsang KW, Chung KF, Mok YW, et al. 2001. A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong. Chest 119(1): 62-69.
17.Kaewboonchoo O, Saleekul S, Powwattana A, Kawai T. 2007. Blood lead level and blood pressure of bus drivers in Bangkok, Thailand. Industrial health 45(4): 590-594.
18.Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V, et al. 2000. Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation 102(21): 2607-2610.
19.Kim J, In K, Kim J, You S, Kang K, Shim J, et al. 2004. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. American journal of respiratory and critical care medicine 170(10): 1108-1113.
20.Lavie P, Herer P, Hoffstein V. 2000. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ (Clinical research ed 320(7233): 479-482.
21.Lindberg E, Janson C, Gislason T, Svardsudd K, Hetta J, Boman G. 1998. Snoring and hypertension: a 10 year follow-up. Eur Respir J 11(4): 884-889.
22.Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C. 2000. Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. The Laryngoscope 110(10 Pt 1): 1689-1693.
23.Manuel C. Jorge II MD, Alexander R. Abe, M.D., Salvador G. Silverio, M.D., Prescillano V. Zamora, Jr.,M.D., and Glenford R. Refre, M.D.,. 2005. The Preavalence ofObstructive sleep apnea symptoms and excessive daytime sleepiness among Filipino office workers consulting at their medical clinic. phil J Internal Medicine 43: 307-311.
24.Marrone O, Bonsignore MR, Fricano L, Lo Coco R, Cerasola G, Bonsignore G. 1998. Gender and the systemic hypertension-snoring association: a questionnaire-based case-control study. Blood pressure 7(1): 11-17.
25.Mina R, Casolin A. 2007. National standard for health assessment of rail safety workers: the first year. The Medical journal of Australia 187(7): 394-397.
26.Moreno CR, Carvalho FA, Lorenzi C, Matuzaki LS, Prezotti S, Bighetti P, et al. 2004. High risk for obstructive sleep apnea in truck drivers estimated by the Berlin questionnaire: prevalence and associated factors. Chronobiology international 21(6): 871-879.
27.Moreno CR, Louzada FM, Teixeira LR, Borges F, Lorenzi-Filho G. 2006. Short sleep is associated with obesity among truck drivers. Chronobiology international 23(6): 1295-1303.
28.Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. 2000. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. Jama 283(14): 1829-1836.
29.Niijima K, Enta K, Hori H, Sashihara S, Mizoue T, Morimoto Y. 2007. The usefulness of sleep apnea syndrome screening using a portable pulse oximeter in the workplace. Journal of occupational health 49(1): 1-8.
30.NW Ks. 2005. Treatment options for adults with obstructive sleep apnea. American sleep apnea association.
31.Okabayashi K, Kasahara E, Uchiyama H, Yokota K, Togashi Y, Kono C, et al. 2007. Obstructive sleep apnea-hypopnea syndrome patients with overweight and hypertension in a Japanese workplace. Journal of occupational health 49(2): 117-124.
32.Ong KC, Clerk AA. 1998. Comparison of the severity of sleep-disordered breathing in Asian and Caucasian patients seen at a sleep disorders center. Respiratory medicine 92(6): 843-848.
33.Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. 2002. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. American journal of respiratory and critical care medicine 166(2): 159-165.
34.Peppard PE, Young T, Palta M, Skatrud J. 2000. Prospective study of the association between sleep-disordered breathing and hypertension. The New England journal of medicine 342(19): 1378-1384.
35.Popov AI, Salamatina LV, Prokopenko LV, Buganov AA. 2007. [Arterial hypertension and risk factors in automobile drivers of Far North]. Meditsina truda i promyshlennaia ekologiia(1): 16-22.
36.Puvanendran K, Goh KL. 1999. From snoring to sleep apnea in a Singapore population. Sleep Res Online 2(1): 11-14.
37.Ragland DR, Greiner BA, Holman BL, Fisher JM. 1997. Hypertension and years of driving in transit vehicle operators. Scandinavian journal of social medicine 25(4): 271-279.
38.Redline S, Tishler PV, Hans MG, Tosteson TD, Strohl KP, Spry K. 1997. Racial differences in sleep-disordered breathing in African-Americans and Caucasians. American journal of respiratory and critical care medicine 155(1): 186-192.
39.Robert Buckman and Patsy Westcott. 2002. What you really need to know about hight blood pressure. Triumphpublish.
40.Sano K, Nakano H, Ohnishi Y, Ishii Y, Nakamura T, Matuzawa K, et al. 1998. [Screening of sleep apnea/hypopnea syndrome by home pulse oximetry]. Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society 36(11): 948-952.
41.Santoro, A., P. D'Alessio, and A. Bergamaschi. 2007. [Suitability to the specific task of drivers suffering from hypertension]. G Ital Med Lav Ergon 29:505-7.
42.Sato S, Taoda K, Wakaba K, Kitahara T, Nishiyama K. 1999. [Effect of the long distance truck driving in Hokkaido on cardiovascular system]. Sangyo eiseigaku zasshi = Journal of occupational health 41(6): 206-216.
43.Series F, Chakir J, Boivin D. 2004. Influence of weight and sleep apnea status on immunologic and structural features of the uvula. American journal of respiratory and critical care medicine 170(10): 1114-1119.
44.Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, et al. 2001. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. American journal of respiratory and critical care medicine 163(1): 19-25.
45.Siedlecka J. 2006. [Selected work-related health problems in drivers of public transport vehicles]. Medycyna pracy 57(1): 47-52.
46.Tafil-Klawe, M., J. J. Klawe, et al. 2007. "Daily changes in cardiac and vascular blood pressure components during breath holding episodes in obstructive sleep apnea patients after day-shift and night-shift work." J Physiol Pharmacol 58 Suppl 5(Pt 2): 685-90.
47.Tanigawa T, Tachibana N, Yamagishi K, Muraki I, Kudo M, Ohira T, et al. 2004. Relationship between sleep-disordered breathing and blood pressure levels in community-based samples of Japanese men. Hypertens Res 27(7): 479-484.
48.Tishler PV, Larkin EK, Schluchter MD, Redline S. 2003. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. Jama 289(17): 2230-2237.
49.Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. 2004. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men. American journal of respiratory and critical care medicine 169(2): 168-173.
50.Wolk R, Shamsuzzaman AS, Somers VK. 2003. Obesity, sleep apnea, and hypertension. Hypertension 42(6): 1067-1074.
51.Young T, Paita, M., Dempsey, J., Skatrud, J., Weber, S., Badr, S. 1993. The occurrence of sleep-disordered breathing among middle-ages adults. The New England journal of medicine 328: 1230-1235.
52.Young T, Peppard PE, Gottlieb DJ. 2002. Epidemiology of obstructive sleep apnea: a population health perspective. American journal of respiratory and critical care medicine 165(9): 1217-1239.

53.Zhang L, Samet J, Caffo B, Punjabi NM. 2006. Cigarette smoking and nocturnal sleep architecture. American journal of epidemiology 164(6): 529-537.
54.行政院衛生署國民健康局(2003)。台灣地區高血壓、高血糖、高血脂盛行率調查報告。
55.杜宗禮、許嘉和(1996)。台灣地區勞動工作者營養狀況和慢性疾病研究，行政院勞委會勞工安全衛生研究所。
56.李佩玲(2005)。中樞型睡眠呼吸中止及換氣量低下症候群，台灣醫學雜誌 9(3): 367-374。
57.吳造中(2003)。隱形殺手-高血壓，長春月刊。
58.吳輝秋(2005)。認識高血壓，高學縣醫師會誌(18): 29-36。
59.梅約醫學中心(2001)。高血壓，天下生活出版股份有限公司。
60.陳堂麒(2006)。 台灣逾30萬人罹患阻塞型睡眠呼吸中止症重疊症候群，生技與醫療器材報導月刊。
61.陳俊良(1995)。台北市公車司機職業健康調查研究，國立陽明大學公共衛生研究所碩士論文。.
62.陳濘宏(2005)。 阻塞型睡眠呼吸中止症，台灣醫學雜誌 9(3): 361-366。
63.馮志中(2005)。 僅1成4的高血壓患者可以有效控制病情，知識與財富。
64.黃绣月、項怡平(2004)。 睡眠呼吸中止症，臨床藥學 21(4)。
65.詹淇斐、余豎文(2005)。 台北縣客運公司司機體檢結果，北市醫學雜誌 2(6): 26-34。
66.顏敏如(2001)。台北市計程車駕駛心血管疾病危險因子之橫斷性研究，國立陽明大學環境衛生研究所碩士論文。