Abstract：
BACKGROUND: Pupillary unrest in ambient light (PUAL) describes the fluctuation of pupil diameter observed in normal, awake subjects under typical levels of indoor light. PUAL becomes low to absent in young healthy subjects during opioid intoxication. We sought to determine the age-related distribution of PUAL values in a random sample of ambulatory participants.
METHODS: Subjects ≥18 years of age were recruited. All were identified by age range (18-29, 30-49, 50-69, and ≥70), and surveyed for diabetes, beta-blocker use, and prior 24-hour opioid use. Relationship between mean PUAL, age group, comorbidity and opioid use were examined by Kruskal Wallis test, and PUAL and was modeled using stepwise multilevel linear regression, including diabetes, beta blocker use, prior 24-hour opioid use, autonomic dysfunction, and pupil diameter as fixed effects and subject as random effect.
RESULTS: Among 150 subjects, 17 reported diabetes, 12 reported beta-blocker use, 14 reported prior 24-hour opioid use, and 120 reported no comorbid conditions. PUAL declined in higher age categories (by 0.0307, P < 0.001), with diabetes (by 0.0481, P = 0.025), and with beta-blocker use (by 0.0616, P = 0.005). Opioid related PUAL decline was observed, but statistical significance varied by model. Among healthy subjects, no PUAL value fell within range indicating high likelihood of opioid toxicity based on previous data from healthy subjects undergoing opioid infusion.
CONCLUSIONS: PUAL declined in higher age groups, diabetes and beta-blocker use, conditions associated with impaired autonomic function, and with opioid use but significance varied depending on the chosen model.
METHODS: Subjects ≥18 years of age were recruited. All were identified by age range (18-29, 30-49, 50-69, and ≥70), and surveyed for diabetes, beta-blocker use, and prior 24-hour opioid use. Relationship between mean PUAL, age group, comorbidity and opioid use were examined by Kruskal Wallis test, and PUAL and was modeled using stepwise multilevel linear regression, including diabetes, beta blocker use, prior 24-hour opioid use, autonomic dysfunction, and pupil diameter as fixed effects and subject as random effect.
RESULTS: Among 150 subjects, 17 reported diabetes, 12 reported beta-blocker use, 14 reported prior 24-hour opioid use, and 120 reported no comorbid conditions. PUAL declined in higher age categories (by 0.0307, P < 0.001), with diabetes (by 0.0481, P = 0.025), and with beta-blocker use (by 0.0616, P = 0.005). Opioid related PUAL decline was observed, but statistical significance varied by model. Among healthy subjects, no PUAL value fell within range indicating high likelihood of opioid toxicity based on previous data from healthy subjects undergoing opioid infusion.
CONCLUSIONS: PUAL declined in higher age groups, diabetes and beta-blocker use, conditions associated with impaired autonomic function, and with opioid use but significance varied depending on the chosen model.
摘要：
背景：环境光（PUAL）中的瞳孔不稳描述了在正常情况下观察到的瞳孔直径的波动，在典型的室内光线下清醒的受试者。在阿片类药物中毒期间，年轻健康受试者的PUAL变得低到不存在。我们试图在门诊参与者的随机样本中确定PUAL值的年龄相关分布。
方法：招募年龄≥18岁的受试者。全部按年龄范围（18-29、30-49、50-69和≥70）确定，并调查了糖尿病，β受体阻滞剂的使用，以及之前使用24小时阿片类药物。平均PUAL之间的关系，年龄组,合并症和阿片类药物的使用通过KruskalWallis测试进行检查，和PUAL，并使用逐步多级线性回归进行建模，包括糖尿病,β受体阻滞剂的使用，在使用阿片类药物24小时之前，自主神经功能障碍,瞳孔直径为固定效应，受试者为随机效应。
结果：在150名受试者中，17例报告糖尿病，12报告使用β受体阻滞剂，14之前报告的24小时阿片类药物使用，120人报告没有合并症。PUAL在较高年龄类别中下降(0.0307，P<0.001)，糖尿病患者（0.0481，P=0.025），和β受体阻滞剂的使用（由0.0616，P=0.005）。观察到阿片类药物相关的PUAL下降，但统计显著性因模型而异。在健康的受试者中，根据接受阿片类药物输注的健康受试者以前的数据,PUAL值没有落在表明阿片类药物毒性可能性高的范围内.
结论：PUAL在高年龄组有所下降，糖尿病和β受体阻滞剂的使用，与自主神经功能受损相关的疾病，和阿片类药物的使用，但意义取决于所选择的模型。
方法：招募年龄≥18岁的受试者。全部按年龄范围（18-29、30-49、50-69和≥70）确定，并调查了糖尿病，β受体阻滞剂的使用，以及之前使用24小时阿片类药物。平均PUAL之间的关系，年龄组,合并症和阿片类药物的使用通过KruskalWallis测试进行检查，和PUAL，并使用逐步多级线性回归进行建模，包括糖尿病,β受体阻滞剂的使用，在使用阿片类药物24小时之前，自主神经功能障碍,瞳孔直径为固定效应，受试者为随机效应。
结果：在150名受试者中，17例报告糖尿病，12报告使用β受体阻滞剂，14之前报告的24小时阿片类药物使用，120人报告没有合并症。PUAL在较高年龄类别中下降(0.0307，P<0.001)，糖尿病患者（0.0481，P=0.025），和β受体阻滞剂的使用（由0.0616，P=0.005）。观察到阿片类药物相关的PUAL下降，但统计显著性因模型而异。在健康的受试者中，根据接受阿片类药物输注的健康受试者以前的数据,PUAL值没有落在表明阿片类药物毒性可能性高的范围内.
结论：PUAL在高年龄组有所下降，糖尿病和β受体阻滞剂的使用，与自主神经功能受损相关的疾病，和阿片类药物的使用，但意义取决于所选择的模型。
