利用生物標記探討罹患睡眠呼吸中止症之職業員工發生心血管疾病之風險

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Title:	利用生物標記探討罹患睡眠呼吸中止症之職業員工發生心血管疾病之風險 Using Biomarkers to Predict the Risk of Cardiovascular Disease among Occupational Workers with Obstructive Sleep Apnea
Authors:	陳姮君
Contributors:	公共衛生學系碩士班
Keywords:	睡眠呼吸中止症;心血管疾病風險;輪班工作者 Obstructive Sleep Apnea;cardiovascular disease;shift worker
Date:	2011-07-26
Issue Date:	2011-10-17 16:16:14 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	職業員工因特殊工作型態如輪班、壓力…等，導致發生睡眠呼吸障礙 (Sleep disordered breathing, SDB) 之風險比一般人高，且其中阻塞型睡眠呼吸中止症 (obstructive sleep apnea, OSA) 證實為心血管疾病之(cardiovascular disease, CVD) 之獨立危險因子之一，過去針對職業族群進行OSA與CVD探討的研究仍屬有限。本研究以輪班員工為對象，探討OSA嚴重程度與發生CVD風險之相關，並討論OSA及發生CVD風險與生物指標，如氧化壓力及發炎反應指標之間的相關性。共189名員工進行多頻道睡眠生理檢查 (polysomnography, PSG)，計算睡眠呼吸中止及過淺指數 (apnea-hypopnea index, AHI)，AHI≧5 即認定患有 OSA，值越大表示 OSA 越嚴重，並將 AHI<5 視為正常組，另外，採集受試者血液及尿液樣本，用以測定氧化壓力指標、發炎反應指標及 CVD 初期指標，做為探討 OSA 發生 CVD 風險可能因子。CVD 十年風險指標採用 2008 年發表 Framingham CVD 預測指標，利用員工健康檢查及問卷資料即可計算。結果顯示，CVD十年風險指標與 AHI 呈現正相關 (r=0.066)，且OSA中-重度組未來發生 CVD 風險，高出正常組 2.433 倍 (p=0.025)。生物指標部分，針對 CVD 十年風險指標，可發現氧化壓力指標 MDA 會增加其風險，而抗發炎指標 IL-10 則是為CVD 十年風險指標顯著保護因子 (p=0.018)。本研究發現 AHI 與 TNF-α 及 hs-CRP 呈顯著正相關，且兩指標與 CVD 十年風險指標也呈現顯著正相關，顯示因 OSA 症狀而引起體內發炎反應，可能與未來發生 CVD 有關。結論可推測罹患 OSA 之員工，未來發生 CVD 風險高於正常員工，且其中可能與體內發炎反應有關。 Occupational workers with unusual work style such as shift work could lead the high risk of obstructive sleep apnea (OSA) occurred. Previous studies showed that OSA was one of the independent risk factor for cardiovascular disease (CVD). However, limited studies have been postulated the relations between OSA and CVD among occupational workers. The objectives of this study were to estimate the severity of OSA and risk of CVD, and to build the potential mechanistic relations of biomarkers including oxidative stress markers, inflammatory markers and early of CVD markers with OSA and CVD. We recruited 189 workers who examined by polysomnography (PSG) to gain the the apnea-hypopnea index (AHI) and divided into two groups, normal (AHI<5) and OSA (AHI≧5). Meanwhile, blood and urine samples were collected to analyses the biomarkers of interesting. CVD ten years risk is used by Framingham risk equations (2008). The results shows that AHI with CVD risk is positive correlation (p=0.058). Both tumor necrosis factor-α (TNF-α) and high-sensitivity C-Reactive Protein (hs-CRP) are also have positive correlation with AHI and the same pattern with CVD risk. In conclusion, workers with OSA could lead the raising CVD risk and the oxidative stress and inflammation might be the potential mechanism.
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