阻塞性睡眠呼吸中止症患者情緒狀態與疾病嚴重度的關聯：探討自主神經系統及嗜睡程度的中介影響

The Association between Severity of Obstructive Sleep Apnea Syndrome and Mood Status: An Exploration of Possible Mediating Effects by Autonomic Nerve System and Excessive Sleepiness

本研究探討阻塞性睡眠呼吸中止症（obstructive sleep apnea syndrome, OSAS）對情緒的影響是否透過「自主神經系統變化」、「嗜睡程度」的中介影響，進一步了解OSAS患者的情緒狀態。研究結果發現OSAS嚴重程度與OSAS患者整體的焦慮評量有相關，特別是與貝氏焦慮量表中「神經生理」、「自主神經症狀」兩項以生理症狀為主的因素達顯著相關，進一步透過逐步迴歸的統計方式，發現呼吸阻塞指標中的Apnea-Hypopnea Index可以解釋及預測貝氏焦慮量表中的「神經生理」和「自主神經症狀」因素，其他的情緒指標（「活力」、「疲勞」、「憤怒」、「自尊」、「沮喪」、「憂鬱」）則未有顯著差異。雖然結果顯示OSAS患者的嚴重程度的確與「自主神經系統」及「嗜睡程度」有相關，且進一步透過逐步迴歸的統計方式，發現排除掉「呼吸變淺」（Hypopnea）變項後，反映完全阻塞的Apnea Index可以獨立解釋及預測自主神經系統活動程度。但「自主神經系統」及「嗜睡程度」此兩項變項並未與任何情緒指標呈現顯著相關。研究結果支持OSAS與焦慮症狀的關聯性，但無法確認其中介的機制，臨床上除了關注OSAS患者呼吸中止所引起生理上相關的症狀外，也需注意患者對OSAS疾病所產生認知上的困惑及擔心感覺。

Although some studies have indicated that patients with obstructive sleep apnea syndrome (OSAS) show more mood disturbances than normal individuals, a review of the literature reveals that the findings are inconsistent across different studies. In order to clarify this issue, the present study measured multiple dimensions of mood, in addition to measuring depression and anxiety. Further, the present study assessed the potential mediating effects of autonomic nervous system and level of sleepiness in the relationship between OSAS and mood. The results showed significant correlations between OSAS severity and anxiety, especially the Beck Anxiety Inventory (BAI) factors of “neurophysiological symptoms” and “autonomic symptoms.” In terms of the potential mediating factors, although OSAS severity correlated significantly with autonomic nerve system and level of sleepiness, no correlation was found between these 2 factors and mood ratings. Thus, autonomic nerve system and level of sleepiness were not found as significant mediators. Results of regression analyses further support that OSAS severity may have an effect on subjective feelings of anxiety and confusion. Since the symptoms that show highest association with OSAS severity are the physiological symptoms of anxiety, an alternative explanation of these findings is that the mood changes in OSAS may reflect the physical symptoms and physiological consequences of OSAS. The findings imply that clinical assessment and intervention of OSAS should pay attention not only to the direct physiological symptoms of OSAS, but also the symptoms associated with confusion and worry