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研究生:林佩蓉
研究生(外文):Pei-Jung Lin
論文名稱:快速動眼期睡眠在難治型癲癇病患的角色:一病例對照研究
論文名稱(外文):The role of REM sleep in medicaully intractable epilepsy:a case control study
指導教授:徐崇堯徐崇堯引用關係
指導教授(外文):Chung-Yao Hsu
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:醫學系神經學科碩士班
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:88
中文關鍵詞:癲癇難治型癲癇快速動眼期睡眠腦波睡眠多項生理檢查人體
外文關鍵詞:epilepsymedically intractable epilepsyrapid eye movement(REM)sleepsleep electroencephalogram(EEG)polysomnographyhuman
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癲癇與睡眠的關係一直被廣為研究,睡眠剝奪易誘發癲癇的發作,而睡眠腦波能夠增加癲癇放電波的偵測率,與健康個案比較,癲癇病患的睡眠障礙比例較高,且睡眠品質也較差。不過當我們把睡眠各個週期分開來看,當中的快速動眼期卻極少有癲癇發作及放電。另外,儘管抗癲癇藥物的發展日新月異,統計上仍有約三成的病患得不到理想的病情控制,也就是所謂的難治型癲癇。因為這些現象促使我們針對癲癇病患進一步去研究睡眠特徵,尤其是快速動眼期的睡眠特徵。於是我們收集了難治型癲癇患者(20人)及非難治型癲癇患者(28人)共48人,安排了全夜多項生理睡眠檢查及收集與睡眠品質及生活品質有關的問卷量表,針對睡眠,尤其是快速動眼期的各項生理指數進行各項巨觀及微觀的分析,包含有睡眠多項生理檢查的參數、快速動眼期之動眼密度、無肌肉失張力快速動眼期睡眠比例、快速動眼期之腦波頻譜分析,及同步快速動眼期之心率變異分析,還有關於睡眠品質、日間嗜睡、及生活品質量表之分析。
我們發現主觀的睡眠品質及生活品質在兩組病患間並無顯著的差異。日間嗜睡指數雖在非難治型癲癇的患者略高,但可能是其他干擾因子所導致。在睡眠結構方面,我們發現在控制包含抗癲癇藥物數目、安眠藥之使用有無,及年齡等相關干擾因子之後,難治型癲癇病患的快速動眼期所佔整體睡眠時間之比例明顯減少,睡眠效率也明顯較低。而在快速動眼期的腦波頻譜分析中,難治型癲癇患者的慢速波(delta波)相對強度明顯增強,且快速波(beta波及alpha波)的相對強度明顯減弱。在快速動眼期的心率變異部分兩組病患並無明顯的差異。同步的腦波與心率變異分析也沒有顯著的相關。我們因此更加確立快速動眼期於難治型癲癇患者所佔的重要角色,並嘗試去假設並釐清其間的交互關係。



The interrelationship is complex between sleep and epilepsy. Sleep deprivation can precipitate epileptic seizures. And epileptiform discharges are more frequently detected in sleep than in awake. However, epileptic discharges occur rarely during REM sleep and REM sleep was ever stated to have some “protective effect” for epilepsy. Although more and more new anti-epileptic drugs are available, 30% of epilepsy patients still do not have satisfied seizure control, and some of them suffer from drug-resistant or medically intractable epilepsy. We tried to study REM sleep in epilepsy patients in both medically intractable and non-intractable groups. We collected 48 epilepsy patients, 28 of them were non-intractable patients and 20 of them were medically intractable patients. They received overnight polysomnography study and wrote a series of questionnaires about sleep quality, life quality, and daytime sleepiness. We analyzed both macrostructure and microstructure of REM sleep.
We found that there was significantly lower percentage of REM sleep in medically intractable epilepsy patients. In power spectrum of EEG during REM sleep, there is significantly decreased beta and alpha relative power and increased delta relative power in medically intractable epilepsy patients. In simultaneous heart rate variability analysis, there seems no significant difference exist between these two groups. So we emphasize the important role of REM sleep in medically intractable epilepsy. We also try to clarify those complexed interrelationships between sleep and epilepsy, at least to some degree.


中文摘要 ………………………………………………… 1
英文摘要 …………………………………………… 3
第一章 研究背景與目的 ………………………………… 5
1.1 研究背景 ………………………………… … 5
1.2 研究動機與目的 …………………………… 6
第二章 文獻資料回顧 ……………………………… … 7
2.1 癲癇症 …………………………………………… 7
2.2 難治型癲癇 ……………………………………… 8
2.3 睡眠結構與生理 …………………………………… 9
2.4 癲癇和睡眠 ………………………………………… 11
2.5 癲癇和快速動眼期睡眠 …………………………… 13
2.6 睡眠中的自主神經功能 ……………………………… 13
2.7研究假設 ……………………………………………… 14
第三章 研究方法 … ……………………………………… 15
3.1 研究對象 …………………………………………… 15
3.2 研究工具 …………………………………………… 15
3.2.1 睡眠多項生理檢查……………………………… 15
3.2.2 快速動眼期之腦波頻譜分析 ………………… 18
3.2.3 快速動眼期之心率變異分析 …………………… 19
3.2.4 睡眠相關問卷量表 ……………………………… 20
3.3 研究流程 ……………………………………………… 22
3.4 統計方法 …………………………………………… 24
第四章 研究結果 ……………………………………… 25
4.1 流行病學資料………………………………………… 25
4.2 問卷量表分析 …………………………… 26
4.3 睡眠的巨觀結構 …………………………………… 28
4.4 睡眠及快速動眼期的微觀結構 ……………………… 29
4.4.1 眼動密度與覺醒指數 …………………………… 29
4.4.2 快速動眼期的腦波頻譜分析…………………………31
4.4.3快速動眼期的心率變異分析 …………………………32
4.5 多變項分析 ………………………………… 32
第五章 討論 ……………………………………………… 42
5.1 頑性癲癇之成因與人口學特徵 …………………… 42
5.2 癲癇病患的睡眠品質與生活品質 …………………… 43
5.3 睡眠巨觀結構之差異 ………………………………… 44
5.4 睡眠微觀結構之差異 …………………………………46
5.5 快速動眼期微觀結構之差異 ……………………… 46
5.6 自主神經系統的角色 ……………………………… 50
5.7綜合意見 ……………………………………………… 52
5.8 研究限制 …………………………………… ……… 53
第六章 結論與展望 ……………………………………… 54
參考文獻 …………………………………………………… 55
附錄一 匹茲堡睡眠品質量表……………………………… 76
附錄二Epworth白日嗜睡量表……………………………… 78
附錄三SF-36 ………… ………………………………… …79









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