(Upper-Airway Stimulation ) 自費50萬治療睡眠呼吸中止: 舌下神經刺激

舌下神經刺激 揮別打鼾 博士頭痛8年 竟是睡眠呼吸中止 2017年09月17日 【江慧珺╱台北報導】35歲余先生擁有台大生化博士高學歷，卻患嚴重睡眠呼吸中止症，每晚睡眠都重度缺氧，白天頭痛痛了8年，午覺完反而更累，且血壓飆高，記憶力也受影響；醫師建議，此症若不治療，恐提高中風、心肌梗塞風險，應儘速就醫，現治療方式多元，除有呼吸器與手術治療外，還有最新舌下神經刺激新技術問世，都有助睡覺呼吸不卡卡。國泰醫院昨舉辦睡眠呼吸中止症國際研討會，汐止國泰睡眠中心負責醫師方麗娟說，據調查國內有失眠、打鼾、睡眠呼吸障礙等人口約2成，大概有4、500萬人，多在40到60歲，以男性為多，且半數都有呼吸中止問題。

患者療法需評估 針對睡眠呼吸中止症，台大醫院北護分院院長黃國晉說，此症患者的睡眠時間不一定短，但無法進入深層睡眠，這樣晚上會睡不好，白天常嗜睡、打盹，還有病人因此出車禍，長期恐釀心血管疾病，猝死威脅增。至於睡眠呼吸中止症成因，方麗娟說，肥胖、顎骨發育不完全，或舌頭肌肉無力，都是可能因素；若睡覺時會安靜一陣又突然打呼，且每小時超過5次，即可能罹患此症。 治療上，方麗娟解釋，陽壓呼吸器是最簡單療法，還有止鼾牙套，但必須固定戴著睡覺，常有患者戴不住；手術則有扁桃腺切除、舌根切除等，另顎骨呼吸道拉提手術則可修改顎骨結構、減輕症狀，前述余先生即以此術改善生活品質，不過每名患者適合療法不同，需審慎評估。

有如心臟節律器 史丹佛醫學院睡眠外科助理教授柳勇全醫師，昨則在研討會發表最新的「舌下神經刺激器」技術，該刺激器有如心臟節律器，當感應到呼吸中止，便會釋放微量電流，刺激舌頭，使其不堵塞呼吸道，未來2年內可望引進台灣。柳勇全是台灣醫師操作舌下神經刺激器第一人，他說，該刺激器會植入患者右胸皮下，並延伸出2條導線，1條往下接到肺部，1條向上連接舌下神經，在睡前啟動刺激器開關後，一旦導線偵測到呼吸中止、肺部暫停擴張，電流會立刻釋放出來，這會刺激舌頭些微往前、不再擋住呼吸道，呼吸也就此通暢。

自費價須50萬元 對於舌下神經刺激器，柳勇全說，比起其他外科治療，此術式侵入性較小，療效也較佳，最適合高齡族群，已在全球頂尖的《新英格蘭醫學期刊》發表成果，但自費價約50萬元，且對於呼吸道太窄、完全堵塞的患者仍不適用，還是得考慮其他手術。若想自行改善打呼，柳勇全則建議，可運用簡單的口肌訓練法，如用舌頭輪流向左右臉頰推頂，或捲舌、用舌頭捲棉線，或唱歌，加強舌頭肌肉力量，睡覺時便不易往後掉，從幼童階段起練習或術後復健，效果最好。

睡眠呼吸中止症小檔案 成因：睡眠時因呼吸道肌肉放鬆而變得狹窄，加上口咽、鼻咽等處結構較狹小，導致呼吸氣流受阻 好發族群：50歲以上、肥胖族群，男性較女性多 症狀：打呼、呼吸暫停、易醒、缺氧、心跳與血壓升高 健康威脅：白天疲憊、頭痛、高血壓，若長期未改善，恐使中風、心肌梗塞風險提高 治療方式：陽壓呼吸器、軟組織手術、顎骨呼吸道拉提手術等，現還有最新的舌下神經刺激器可選擇 資料來源：方麗娟醫師

Upper-Airway Stimulation for Obstructive Sleep Apnea  N Engl J Med 2014; 370:139-149January 9, 2014DOI: 10.1056/NEJMoa1308659

BACKGROUND Obstructive sleep apnea is associated with considerable health risks. Although continuous positive airway pressure (CPAP) can mitigate these risks, effectiveness can be reduced by inadequate adherence to treatment. We evaluated the clinical safety and effectiveness of upper-airway stimulation at 12 months for the treatment of moderate-to-severe obstructive sleep apnea.

METHODS Using a multicenter, prospective, single-group, cohort design, we surgically implanted an upper-airway stimulation device in patients with obstructive sleep apnea who had difficulty either accepting or adhering to CPAP therapy. The primary outcome measures were the apnea–hypopnea index (AHI; the number of apnea or hypopnea events per hour, with a score of ≥15 indicating moderate-to-severe apnea) and the oxygen desaturation index (ODI; the number of times per hour of sleep that the blood oxygen level drops by ≥4 percentage points from baseline). Secondary outcome measures were the Epworth Sleepiness Scale, the Functional Outcomes of Sleep Questionnaire (FOSQ), and the percentage of sleep time with the oxygen saturation less than 90%. Consecutive participants with a response were included in a randomized, controlled therapy-withdrawal trial.

RESULTS The study included 126 participants; 83% were men. The mean age was 54.5 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 28.4. The median AHI score at 12 months decreased 68%, from 29.3 events per hour to 9.0 events per hour (P<0.001); the ODI score decreased 70%, from 25.4 events per hour to 7.4 events per hour (P<0.001). Secondary outcome measures showed a reduction in the effects of sleep apnea and improved quality of life. In the randomized phase, the mean AHI score did not differ significantly from the 12-month score in the nonrandomized phase among the 23 participants in the therapy-maintenance group (8.9 and 7.2 events per hour, respectively); the AHI score was significantly higher (indicating more severe apnea) among the 23 participants in the therapy-withdrawal group (25.8 vs. 7.6 events per hour, P<0.001). The ODI results followed a similar pattern. The rate of procedure-related serious adverse events was less than 2%.

CONCLUSIONS In this uncontrolled cohort study, upper-airway stimulation led to significant improvements in objective and subjective measurements of the severity of obstructive sleep apnea. (Funded by Inspire Medical Systems; STAR ClinicalTrials.gov number, NCT01161420.)