有頭部創傷或PTSD的退伍軍人常發生睡眠異常


  【24drs.com】研究發現,參與伊拉克或阿富汗戰役,有創傷後壓力症候群(PTSD)或頭部傷害的美國退伍軍人,發生睡眠異常的比率相當高。
  
  華盛頓特區Walter Reed陸軍醫學中心的Jacob Collen醫師指出,這些是不易根除的疾病;未治療的睡眠呼吸中止、未治療的PTSD ,是會發生一段時間的後遺症,不論是在一般民眾或退伍軍人體系遇到這些病患,非軍系的醫師可能不是很暸解這是必須進行綜合性的睡眠評估。
  
  Collen醫師等人在美國胸腔科醫學會年會中發表研究結果。
  
  這項研究的對象包括135名PTSD士兵,116人有創傷性腦部傷害(TBI),66人兩者皆有;研究人員指出,睡眠問題相當常見,超過三分之二(71.3%)的睡眠時間可說是支離破碎,近9成(87.4%)有嗜睡症,也就是在應該清醒的時間也睡著。
  
  針對逾80%的病患進行多層次睡眠檢查,發現56.3%有阻塞性睡眠呼吸中止、48.7%有失眠。
  
  Collen醫師發現,睡眠異常會因為有或沒有傷害與傷害類型而有異;在有TBI的士兵中,爆炸傷害與失眠及焦慮有關,鈍器傷害是阻塞性睡眠呼吸中止的獨立預測因子。
  
  TBI受害者中,爆炸傷害者63%有失眠,鈍器傷害者則是40%有此問題(p=0.022),而爆炸傷害者僅25.9%有睡眠呼吸中止,鈍器頭部傷害者則是54.3%(p=0.003)。
  
  研究人員發現,整體而言,睡眠呼吸中止在沒有TBI者更顯著發生(78.3% vs 28.8%;p<0.001)。
  
  在PTSD病患中,沒有遭受生理傷害者比較常發生睡眠呼吸中止;有PTSD和睡眠呼吸中止的士兵中,只有約三分之一發生過戰鬥傷害(37%),有PTSD但無睡眠呼吸中止的退伍軍人中,超過三分之二發生過戰鬥傷害(71%;p<0.001)。
  
  Collen醫師表示,PTSD資料點出的問題是,在進行部署之前,是否有未診斷的睡眠呼吸中止可以視為發生PTSD的風險因素,我們沒有資料支持這些,但這是個有趣的問題。
  
  賓州匹茲堡Allegheny綜合醫院胸腔科與睡眠醫學專家、未參與該研究的Brian Carlin醫師表示,士兵的睡眠問題比率過高。頭部創傷受害者有失眠問題不令人驚訝,但是,睡眠呼吸中止確實很令人意外。發生過鈍器傷害的士兵約半數有睡眠呼吸中止;在與這些士兵健康程度等因素相仿的族群中,睡眠呼吸中止比率約為4%-5%。
  
  現在還不清楚頭部創傷和睡眠障礙之間的關係。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6641&x_classno=0&x_chkdelpoint=Y
  

Sleep Disorders Common in Veterans With Head Trauma or PTSD

By By Rob Goodier
Medscape Medical News

HONOLULU (Reuters Health) Oct 25 - New research shows high rates of sleep disorders among veterans of America's wars in Iraq and Afghanistan who have post-traumatic stress disorder (PTSD) or head injury.

Dr. Jacob Collen, who led the study at Walter Reed Army Medical Center in Washington, DC, told Reuters Health, "These are durable diseases. Untreated sleep apnea, untreated PTSD -- the sequelae of those go on for some time. So, when these patients are encountered in the civilian population or in the VA (Veterans Affairs system), it's important for non-military physicians who really aren't as familiar with this to pursue a comprehensive sleep evaluation."

Dr. Collen and his team presented their research October 24 at the annual meeting of the American College of Chest Physicians in Honolulu.

The researchers studied 135 soldiers with PTSD, 116 with traumatic brain injury, and 66 with both. "Sleep complaints were universal," they wrote in their abstract for the meeting. More than two-thirds (71.3%) had restless nights of fragmented sleep. Nearly nine in ten (87.4%) were hypersomniacs, sleepy during waking hours.

Polysomnography performed on more than 80% of the patients found obstructive sleep apnea in 56.3% and insomnia in 48.7%.

"We found that sleep disorders appear to break down by presence or absence of injury and by the type of injury," Dr. Collen said.

In soldiers with TBI, Dr. Collen said, "blast injuries appeared to be associated with insomnia and anxiety, and blunt trauma was an independent predictor of obstructive sleep apnea."

Among the traumatic brain injury (TBI) victims, 63% with blast injuries had insomnia, compared to 40% of those with blunt trauma (p=0.022). But only 25.9% of those with blast injuries had sleep apnea, compared to 54.3% of those with blunt head trauma (p=0.003).

Overall, sleep apnea was significantly more common in patients without TBI, the researchers found (78.3% vs 28.8%; p<0.001).

And in the PTSD patients, sleep apnea was more common in those who hadn't suffered physical injuries. Among the soldiers with PTSD and sleep apnea, only about a third had battle injuries (37%), whereas more than two-thirds of veterans with PTSD but without sleep apnea had been injured in battle (71%; p<0.001).

The PTSD data "raise the question of whether having undiagnosed obstructive sleep apnea before you deploy could act as a risk factor for developing PTSD," Dr. Collen said. "We don't have data to support that, it was just an interesting question."

Dr. Brian Carlin, a pulmonologist and sleep medicine specialist at Allegheny General Hospital in Pittsburgh, Penn., who was not involved in the study, called the rates of sleep problems among the soldiers "inordinately high."

Insomnia among head-injury victims was not a surprise, Dr. Carlin said, but sleep apnea is. "Almost half of the soldiers who had blunt trauma had sleep apnea. In a presumably healthy and relatively fit population (similar to the soldiers), the rate of sleep apnea is probably 4% to 5%," Dr. Carlin said.

"You just wonder now what is the relationship between trauma to the head and sleep disorders."

    
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