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Insomnia Is Linked to Trouble Breathing By BENEDICT CAREY December 11, 2012 健康 研究发现失眠与呼吸问题有关 BENEDICT CAREY 报道 2012年12月11日 Subtle breathing problems during sleep may play a larger role in causing insomnia than the usual suspects, like stress and the need for a bathroom, a small study of poor sleepers suggests. 一项对睡眠不佳人士进行的小型研究表明，相比那些通常认为导致失眠的元凶，比如压力或想要起夜上厕所，睡眠中出现轻微的呼吸问题更有可能引起失眠。 The report, published in the current issue of the journal Sleep, found that chronic insomniacs woke an average of about 30 times a night, and that a brief respiratory problem — a drop in the volume of oxygen inhaled, due to a narrowed airway, for instance — preceded about 90 percent of those interruptions. None of the people had any idea they had breathing problems during sleep. 这项研究发表于本期的《睡眠期刊》(Sleep)，研究发现慢性失眠症患者每晚平均会醒30次左右，而在每次醒来前，有九成机会出现短暂的呼吸不顺问题，比如由于气道变窄导致氧气摄入量陡然降低。这些患者都没有意识到自己睡眠时存在呼吸问题。 The study is hardly conclusive, experts said, because it included only 20 people and had no control group of normal sleepers for comparison. But these experts said that it was worth following up, because it challenged the predominant theory of insomnia as a problem of “hyper-arousal,” in which the body idles on high psychologically and physiologically. Earlier studies have linked measures of hyper-arousal to delays in falling asleep and problems nodding off after interruptions. But the theory does not satisfactorily explain what prompts awakenings in the first place. 专家说，由于这项研究只涵盖了20人，而且没有睡眠正常人群作对比组，因此研究很难说具有决定意义。但这些专家认为研究值得继续跟进，因为它挑战了失眠症问题最主导的学说，也即是认为失眠的问题在于“高度警觉”(hyper-arousal)，从心理到生理表现为高度活跃。早前的研究将高度警觉的程度与入睡缓慢和频繁夜醒后白天打瞌睡联系在一起。但这种学说在解释起初人为什么会醒来时，理由并不充分。 The new study compared chronic insomniacs’ opinions about why they awoke at night with data from a sleep test monitoring breathing and brain waves — and does provide a possible explanation. 而这项新研究将慢性失眠症患者关于自己为什么会夜醒的认识，与睡眠测试中监控得到的呼吸和脑电波数据进行了对比，也确实提供了一个可能的解释。 “It is a striking finding that by no means can be discounted,” said Dr. Michael J. Sateia, a professor of psychiatry and sleep medicine at Dartmouth College’s school of medicine, who was not involved in the research. Still, he added, “we know arousal can in and of itself promote instability of the upper airway,” and it is not always clear which comes first. 迈克尔·J·萨特里亚(Michael J. Sateia)博士是达特茅斯学院(Dartmouth College)医学院的精神病学和睡眠医学教授，他本人并未参与这项研究，他认为：“这是一个惊人的发现，无论如何都不能对此一笑置之。”不过他还补充说：“我们知道，警觉状态本身就会加剧上呼吸道不通畅，”而且目前无法确切知道，是哪个问题发生在前。 Dr. Sateia co-wrote an editorial accompanying the study, with Wilfred R. Pigeon, of the Canandaigua V.A. Medical Center, in Canandaigua, N.Y. 萨特里亚博士与威尔弗雷德·R·皮吉恩(Wilfred R. Pigeon)共同为该研究撰写了评论文章，后者来自纽约州卡南代瓜市的V.A.医疗中心。 In the study, sleep researchers in Albuquerque interviewed 20 men and women with chronic insomnia, asking about the causes of their nightly awakenings. The people all sought help at Maimonides Sleep Arts and Sciences, a private clinic. None showed signs of having a breathing disorder like sleep apnea, or sleep-disordered breathing, a milder form. Most were taking sleep pills. 在进行该项研究时，新墨西哥州阿尔伯克基市的睡眠研究人员与20位患慢性失眠的病人进行会谈，了解他们频繁夜醒的原因。这些人都曾在一家名为迈蒙尼德睡眠艺术与科学(Maimonides Sleep Arts and Sciences)的私人诊所寻求过帮助。这当中没有人表现出呼吸失调症的症状，这种失调症重则会导致睡眠呼吸暂停，轻则会出现睡眠呼吸障碍。其中大部分人都在服用安眠药。 The group members attributed most of their awakenings to nightmares, a need for the bathroom, pain or “racing thoughts.” 受访者将自己夜醒的主要原因归咎于做恶梦、想上厕所、身体疼痛或者“思维过于活跃”。 But their sleep told a different story. The participants each spent a night at the sleep clinic, wired to sensors that tracked brain waves and breathing. Researchers charted every awakening, when brain waves shifted to a waking state for at least 16 seconds, and every breathing issue causing oxygen intake to dip well below normal. 但他们的睡眠却在提供另外一套说法。参与试验的人士都在睡眠诊所里度过了一晚，身体连接着传感器，用于追踪他们的脑电波和呼吸。研究者记录下他们每次苏醒的情况（脑电波会转变成清醒状态并维持至少16秒），以及每次出现的呼吸不顺问题，这会导致氧气摄取量猛降到远低于正常值。 “Almost all of the awakenings turned out to be preceded within a second by an abnormal breathing process — which led to the awakening,” said Dr. Barry Krakow, medical director of the Maimonides clinic and its research arm, the Sleep and Human Health Institute. “基本上在每次醒来前的一秒内，都会发生一次呼吸不顺——这就是导致他们苏醒的原因，”巴里·克拉科夫(Barry Krakow)博士这样说。他是迈蒙尼德诊所及其研究机构睡眠与人类健康研究所(Sleep and Human Health Institute)的医学主任。 Dr. Krakow’s co-authors were Victor A. Ulibarri and Shara Kikta, both of Maimonides; and Edward Romero, a third-year student at the University of New Mexico School of Medicine. 克拉科夫的合作者包括了两位来自迈蒙尼德诊所的同事维克多·乌里巴里(Victor A. Ulibarri)和莎拉·奇奇塔(Shara Kikta)，以及在新墨西哥州州立大学医学院读三年级的爱德华·罗梅罗(Edward Romero)。 Sleep medicine specialists usually treat insomnia with talk therapy intended to unwind people’s mistaken, and often subconscious, assumptions about sleeping. These include thinking of sleep as an exercise in frustration and approaching the bed with performance anxiety. Medications can help, too, but rarely resolve the underlying problems. 睡眠医学专家在治疗失眠症时，通常采用谈话疗法，目的是消除人们对于睡眠错误的、同时往往又是下意识的猜想。这些猜想包括将睡眠看成是让人苦恼的事情，并且带着表现焦虑（performance anxiety，指担心某种行为无法取得预期中的结果，因而令人产生焦虑情绪）上床睡觉。药物对失眠也会有用，但基本不可能解决深层次的问题。 The new finding, if replicated, suggests that breathing disorders may be an underappreciated cause of insomnia and treatment of those problems could help. Doctors can prescribe dental inserts to keep airways open during sleep, or in more extreme cases, a “positive airway pressure” machine, known as a CPAP. 如果这项新的发现结果能得以重复，那就意味着呼吸问题可能是引发失眠的未得到足够的重视的原因之一，而对症治疗有可能对睡眠有帮助。医生可让这类病人戴牙套以保证睡眠时气道通畅，或者在更极端的病例中，使用一种名为“正压呼吸器”、简称CPAP的仪器。 Such sleep therapies can run into the thousands of dollars and are not always covered by insurers. “A larger, controlled replication study would not only clarify the central question of whether” breathing problems are common in insomniacs, Dr. Sateia and Dr. Pigeon wrote in their editorial, but “perhaps even change reimbursement policies.” 这类睡眠治疗有可能要花费数千美元，而且通常不能被医疗保险报销。萨特里亚和皮吉恩在他们的评论中写道，“一项大型对照重复研究将不仅能阐明核心问题，”也就是呼吸问题是否常见于失眠症中，此外“还甚至有可能因此改写保险条款。” 本文最初发表于2012年12月4日。 翻译：Noey |
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