睡眠醫學-單單打鼻鼾真的無傷大雅?
各位讀者在看完十多篇關於睡眠窒息症的文章後，都可能有同一問題: 若果一個人只是打鼻鼾(snoring)而沒有睡眠窒息症，那又會不會構成健康風險呢?
到現時為止什麼是打鼻鼾(snoring)沒有標準定義的。打鼻鼾是因為睡覺時，脷和咽喉肌肉鬆弛，令到呼吸道收窄，空氣過呼吸道時，震動了軟顎同咽喉的軟組織，引發出異常聲音(1)。正因為沒有標準定義，因此它的流行性(prevalence)
在不同的研究有很大差異-由2至85%不等，一般來說男性較多(2)。大部份專家都認同打鼻鼾(simple snoring, SS)與阻塞性睡眠窒息症(OSA)是同一疾病光譜的兩極(a continuum of snoring from SS through Upper Airway Resistance
Syndrome up to and through degrees of OSA)(3,4)。上呼吸道感染/發炎(5) 、鼻塞(6) 、吸煙(7) 、高BMI(8,9) 、在郊野居住(10)及男性(11)均是令人打鼻鼾的高危因素。
許多時候都是發鼻鼾聲者(snorer)的家人(尤其是同房/床)忍受不了那鼻鼾聲，因而催促病人求診。有研究指出女性同房/床家人(female bed partners of male snorers)會有較差的睡眠質素及”瞓下醒下”(12)。有40%的室友或同床者(bed partners)因不能忍受那鼻鼾聲而分房睡，亦有三成人因鼻鼾聲破壞了雙方的關係(13)。另外鼻鼾聲甚至可能令室友或同床者失聰(unilateral
high frequency hearing loss)(14)! 若能根治了患者的鼻鼾聲，就會減少同床者患上抑鬱的風險(15)。
至於若病人只有打鼻鼾(snoring)而沒有睡眠窒息症，那麼這些病人究竟身體/生理上有無受損呢! 持正反兩方意見的醫學文獻甚多:一個追蹤發鼻鼾聲者達十年的研究，並無發現此等人仕有較高的心血管病風險(16)；當然有學者不同意，認為每多10%打鼻鼾時間，就會增加頸動脈硬化優勢化40% (in the odds of
carotid atherosclerosis )
(17)。奈何後來另一位學者又發報完全相反的研究結果-頸動脈收窄(carotid
stenosis) 與打鼻鼾無關(18)。在一個有5995人參與的研究(19)，發覺死亡率(all
cause mortality)與打鼻鼾的程度(snoring
index) 掛鈎。但其他醫學評論(review)又不盡同意(20)，現在可以說大家仍未能確定單單打鼻鼾本身是否獨立地傷害健康。
儘管打鼻鼾未必構成健康風險，但它總是惱人，使人尷尬的。使用手術( palatal implant system
and radiofrequency thermal ablation)治理鼻鼾聲較理想(21) 。
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