睡眠醫學二十三之失眠加睡眠窒息症
很久沒有跟振華(假名)茶聚了，他突然電聯我，但第一句話竟然是:「唉!瞓得又死、唔瞓得重死!」我自然追問他此話何解。振華告訴我他公司最近重組分折再上市，工作壓力超巨大，所以近來他開始患上了失眠。本來他已經有睡眠窒息症需要配帶連續正氣壓機(CPAP)，現在又得了失眠--當然瞓唔著就無睡眠窒息症、但失眠就更痛苦了!
我隨即安慰振華，這兩種睡眠問題其實都是十分普遍的，學者在1973年第一次匯報這兩者並存的案例[1]。在睡眠窒息病患者中同樣出現失眠病徵的有6%至84%[2-6]，相反在那些尋求治理失眠者當中，有7至69%同時出現睡眠窒息病徵[7-11]。有理由相信這些文獻極可能低估了兩者並存的案例，原因可能是不同研究採用不同的失眠定意、不同類型的失眠又有不同睡眠窒息的病發率[2,4] 。至於失眠的發病率是否與睡眠窒息症的病情有關，不同的研究又得出相反的結論[12,13]。
患有並存病症[OSA -INSOMNIA comorbid conditions]
的人與患上單一疾病的分別如下:那些主要為睡眠窒息病徵求診的多為女性[14,15]、易有腿不寧症[restless legs syndromes][6.13]。而那些主要為失眠求診的多為男性[11,16]、肥胖及年長[7,11]、出現更多睡眠窒息病徵[17,18]。患有並存病症 [OSA
-INSOMNIA comorbid conditions]的病人會更容易患上抑鬱及其他精神問題[19], 心臟病[20]，甚至不能工作[21]，但這些現象究竟是因還是果卻不得而知。
當睡眠窒息症與失眠同時發生在同一病人身上，失眠問題會影響睡眠窒息症的治療效果[22-25]: 減少病人長期依時使用連續正壓機[CPAP]。但睡眠窒息症是否會影響失眠的治療結果就不得而知[26,27]。雖然醫學界已經掌握如何治療單獨失眠及睡眠窒息症，但怎樣去醫治並存病症就並不簡單，舉例說某些安眠藥{Benzodiazepines}會加劇睡眠窒息病徵 [28,29] ，另一方面並存病患者使用連續正壓機[CPAP] 又能否改善並存的失眠呢就不得而知? 由於現在還未有完整的指引，唯有採用各種方法同時醫治失眠及睡眠窒息症吧!
說到這裡振華已呼呼入睡了! 喂未帶呼吸機[CPAP] 呀!
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