睡眠情況與骨關節炎患者的失能及憂鬱有關


  【24drs.com】一篇新研究指出,睡眠問題與膝蓋骨關節炎患者的疼痛及憂鬱有關,不論疼痛情況有無增加,既有的睡眠問題會增加後來發生失能與憂鬱的風險,這篇研究線上登載於10月6日的關節炎照護與研究期刊。
  
  阿拉巴馬大學心智健康與老化中心的Patricia Parmelee博士表示,我們知道疼痛會造成睡眠問題, 醫生對此應有所警覺,我們率先提出睡眠問題會引起功能衰退,如果患者抱怨睡眠問題時,必須謹慎以對。
  
  研究者透過老年門診和新聞媒體募集了367名膝蓋骨關節炎患者,希望可以納入沒有尋求專業照護者。透過電子郵件讓這些參與者完成包括31種健康狀況檢視表、主觀健康問題、流行病學研究中心憂鬱量表(刪去睡眠品質問題以免干擾分析)等問卷,依據費城老年中心疼痛量表測量疼痛、以關節炎影響量表測量失能(包括手腳功能以及膝蓋相關活動,如走路),以病患有無難以入睡這個問題評估睡眠情況。
  
  共有288名患者完成1年追蹤,失去追蹤者大部份是教育程度較低、不是白人、自我報告的主觀健康較差、失能較嚴重、變得比較疼痛。
  
  回歸分析發現,原本的睡眠問題與疼痛(P < .02)及憂鬱(P < .001)有關,但與失能無關。作者們寫道,睡眠問題惡化了疼痛對憂鬱的影響,睡眠問題嚴重且疼痛高於平均值者的憂鬱症狀最嚴重。
  
  比較研究開始時和追蹤1年時的資料發現,開始時的睡眠問題與憂鬱(P < .001)及失能(P < .005)增加有關,但與疼痛無關。
  
  Parmelee博士表示,雖然結果令人鼓舞,但需後續研究以釐清病患睡眠的異常狀況。Parmelee博士指出,這個問卷本來並不是為了睡眠問題而設計,所列的問題是相當粗略的測量,我們無法得知是情緒反應還是客觀睡眠品質的問題。
  
  未參與該研究的杜克大學一般內科Kelli Allen博士表示,這項研究結果看來,應鼓勵病患向他們的照護者談論憂鬱和睡眠問題,而不是認為已經有納入關節炎的評估。
  
  Allen博士表示,研究強度包括樣本數多且一起分析4個變項(睡眠、疼痛、憂鬱、失能),縱向分析可以指出因果關係,但是仍不清楚機轉。
  
  Parmelee博士表示,希望大家記住的是,需嚴肅看待骨關節炎疼痛、睡眠問題以及情緒問題;睡眠、疼痛、情緒、能力都和你的需求與行為息息相關。
  
  她表示,下一步的研究應聚焦在釐清這些因素,以便知道如何介入。上床睡覺是不是比服用抗憂鬱藥、安眠藥或非類固醇抗發炎藥物好?哪個才是打破這個惡性循環的最佳方法?我們還不知道。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7124&x_classno=0&x_chkdelpoint=Y
  

Sleep Linked to Disability and Depression in Osteoarthritis

By Beth Skwarecki
Medscape Medical News

Sleep disturbance is associated with pain and depression in osteoarthritis of the knee, a new study reports, and baseline sleep disturbances predict increased disability and depression over time, even without increases in pain. The study was published online October 6 in Arthritis Care & Research.

"We know that pain causes sleep disturbance and ought to be on physicians' radar screens, but we're among the first to suggest having problems sleeping can cause you to experience functional decline," author Patricia Parmelee, PhD, from the Center for Mental Health and Aging at the University of Alabama, told Medscape Medical News. "When somebody complains of sleep problems, we need to take it seriously."

The researchers recruited 367 patients with physician-confirmed osteoarthritis of the knee from a variety of sources, including a geriatric clinic and announcements in news media, to include patients who had not sought specialty care. The participants completed a questionnaire by mail that included a checklist of 31 health conditions, subjective questions about health, the Center for Epidemiologic Studies Depression scale (minus a question about sleep quality to avoid confounding), pain measured by the Philadelphia Geriatric Center Pain Scale, and disability measured with the Arthritis Impact Measurement Scales, which included hand and arm function in addition to knee-related activities such as walking. The researchers assessed sleep with a single question about whether the patient had trouble sleeping.

One-year follow-up was available for 288 patients. Those lost to follow-up were more likely to be nonwhite and less educated and to have reported poorer subjective health, greater disability, and slightly greater pain.

Through regression analysis, baseline sleep disturbance was associated with pain (P < .02) and depression (P < .001), but not disability. "[S]leep disturbance exacerbated effects of pain on depression, such that depressive symptoms were greatest among those with both significant sleep problems and higher-than-average pain," the authors write.

Comparing baseline with 1-year follow-up data, sleep disturbance at baseline was linked with increased depression (P < .001) and disability (P < .005), but not pain.

Although the results are promising, says Dr Parmelee, further research is needed to pinpoint what is abnormal about patients' sleep. The questionnaire was not designed with sleep problems in mind, says Dr Parmelee, and the question used is "a very gross measure. We don't know if we're looking at an emotional response or a problem in objective sleep quality."

Kelli Allen, PhD, from the Division of General Internal Medicine at Duke University, Durham, North Carolina, who was not involved in the study, says that the results should encourage patients to talk to their healthcare provider about depression and sleep problems, rather than assuming they are an expected part of arthritis.

Strengths of the study, says Dr Allen, include the broad sample and the fact that 4 variables (sleep, pain, depression, and disability) were analyzed together. The longitudinal analysis is valuable to hint at causal relationships, although the mechanism is still unclear.

"For my money, the take-home message is we need to take osteoarthritis pain seriously, we need to take sleep disturbances seriously, and we need to take mood disturbances seriously," Dr Parmelee said. "Sleep and pain and mood and the ability to get about and do what you need and want to do are closely intertwined."

The next steps in research, she says, should focus on untangling those factors enough to know where to intervene. "Going to bed, is it better to take an antidepressant, a sleep-inducing medicine, or an [nonsteroidal anti-inflammatory drug]? Which would be the best approach to break up this cycle? We don't know that yet."

The research was supported by the National Institute of Mental Health. The authors and Dr. Allen have disclosed no relevant financial relationships.

Arthritis Care Res. Published online October 6, 2014.

    
相關報導
睡眠受干擾之後打盹可以恢復免疫系統
2015/3/3 下午 02:26:23
電腦斷層掃描可以發現中風風險高的TIA病患
2014/12/15 下午 03:31:55
低劑量Diclofenac可改善骨關節炎之疼痛
2014/11/24 下午 05:27:26

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁