2012-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/655718摘要：安眠鎮定藥物在老年精神病人引發複雜睡眠行為的危險因子研究背景：安眠鎮定藥物在許多國家被廣泛使用或濫用。近年來安眠鎮定藥物引起的複雜睡眠異常行為廣為世人注意，尤其是台灣，但針對此主題的實證研究全世界只有我們在2010年發表的一篇個案對照研究。該研究我們發現zolpidem >10mg/天是一個複雜睡眠異常行為的關鍵危險因子,以及幾個潛在危險因子。雖然有了初步重要發現，但其結果是否能類推到老年精神病人，仍然未知。此外，安眠鎮定藥物造成複雜睡眠異常行為的腦中機制仍不清楚。目的: 在老年精神病人族群，以個案對照法研究安眠鎮定藥物引發相關複雜睡眠異常行為之臨床危險預測因子及腦代謝變化。方法: 本研究將在台大醫院及分院門診招募使用安眠鎮定藥物的老年精神病人。每位個案填寫相關問卷，包括基本人口學變項，目前及小時候的睡眠習慣，及相關複雜睡眠異常行為。複雜睡眠異常行為包括夢遊並操弄物品、睡眠飲食及其他失憶的複雜睡眠異常行為。研究助理將每3個月追蹤訪談一次，前後追蹤半年，以確定個案是否再發生複雜睡眠異常行為。同時訪談同住的家屬以確定病人的報告是否正確。預計招募至少402位老年精神病人，包括134位輕度認知障礙，134位能行動的輕中度失智症，及134位其他官能症病人（如焦慮、憂鬱、失眠、適應障礙等）。我們將比較兩組（有、無複雜睡眠異常行為）間各種臨床變項之差異。此外，10名有複雜睡眠異常行為者及10名無複雜睡眠異常行為者將接受18F-FDG腦正子攝影檢查（一次有用安眠鎮定藥,一次沒有使用），以比較安眠鎮定藥造成的腦血流變化。最後並以multiple logistic regression找出顯著的預測因子。假設： 根據我們之前的研究，我們假設（1）某些安眠鎮定藥（特別是zolpidem）是引發複雜睡眠異常行為的危險因子，（2）高劑量安眠鎮定藥比低劑量更危險，（3）對老年精神病人，zolpidem誘發複雜睡眠異常行為的劑量將不超過10mg/天，（4）某些診斷（如失智症）是造成複雜睡眠異常行為的危險因子，（5）有複雜睡眠異常行為的病人與沒有複雜睡眠異常行為的病人比較，服用安眠鎮定藥後腦中的代謝變化不同。總結而言，本創新研究將提供重要資料，以回答到目前為止全世界尚未瞭解的臨床問題。<br> Abstract: Risk predictors for hypnosedative-related complex sleep behaviors in geriatric psychiatric patientsBackground: Hypnosedatives have been widely used or abused in many countries. In recent years, complex sleep-related behaviors (CSBs) induced by hypnosedatives have been the focus of much attention, especially in Taiwan. However, no empirical study has systemically investigated the risk predictors for CSBs in hypnosedative users except one case control study we published in 2010. In that study, we found that a higher dosage of zolpidem (>10 mg/day) is the key risk predictor for CSBs and some other factors are potential risk factors. Although having interesting and important findings, whether such findings can be generalized to the geriatric psychiatric patients are unknown. Besides, the underlying brain mechanism is still unknown.Objective: To explore the clinical risk predictors and neuroimaging changes for CSBs in geriatric psychiatric patients taking hypnosedative agents by using a case-control design.Method: Patients using hypnosedatives will be enrolled from the outpatient clinics of the NTUH and its branch hospitals. All patients will complete a questionnaire, which included demographic data, current and childhood sleep habits, and nature of CSBs. CSBs are defined as somnambulism with object manipulation, sleep related eating and other amnestic sleep-related behaviors. These patients will be contacted every 3 months and followed up for 6 months to make sure whether there is recurrence (for those who report positive history of CSBs) or occurrence of CSBs (for those do not report positive history of CSBs). A cohabitant member will be contacted for confirmation of the patient’s self report.We plan to collect at least 402 elderly hypnosedative users, with 134 patients with mild cognitive impairment, 134 ambulatory patients with mild to moderate dementia and 134 patients with neurotic disorder (such as anxiety, depression, sleep and adjustment disorders etc.). Demographic, clinical variables and potential precipitating factors will be compared in those with CSBs and those without. A total of 10 subjects with CSBs and 10 age, sex, diagnosis-matched subjects without CSBs will receive 18F-FDG brain PET imaging examinations twice (on hypnosedative and off hypnosedative), to compare whether there is any (within and between subject) metabolic change related to administration of the suspecting hypnosedative agent. Multiple logistic regression analyses will be performed to identify significant risk predictors for CSBs in those geriatric psychiatric patients.Hypothesis: Based on our previous study, we hypothesize that (1) certain hypnosedatives (especially zolpidem) are risk factors for CSBs in the geriatric psychiatric population, (2) a higher dose is associated with higher risk for CSBs, (3) the dose of zolpidem related to increased risk for CSBs could be <= 10 mg/day in geriatric psychiatric patients (especially those with MCI and dementia), (4) certain diagnosis (e.g. dementia) is associated with increased risk for hypnosedatives-related CSBs, (5) there are different metabolic changes (as measured with FDG-PET) in the brain of the psychogeriatric patients with CSBs related to hypnosedative use (especially zolpidem) as compared with those without CSBs.In summary, this novel study may provide important findings to answer daily clinical questions that are lack of research in the world up to now.