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. 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. 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, < 0.001), with diabetes (by 0.0481, = 0.025), and with beta-blocker use (by 0.0616, = 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. 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.

中文翻译：

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环境光下瞳孔不安的人群研究


环境光下的瞳孔不安（PUAL）描述了在典型的室内光水平下正常、清醒的受试者观察到的瞳孔直径的波动。在阿片类药物中毒期间，年轻健康受试者的 PUAL 会降低甚至消失。我们试图确定流动参与者随机样本中 PUAL 值与年龄相关的分布。招募年龄≥18岁的受试者。所有患者均按年龄范围（18-29、30-49、50-69 和 ≥70 岁）进行识别，并接受了糖尿病、β 受体阻滞剂使用情况以及既往 24 小时阿片类药物使用情况的调查。通过 Kruskal Wallis 检验和 PUAL 检查平均 PUAL、年龄组、合并症和阿片类药物使用之间的关系，并使用逐步多级线性回归进行建模，包括糖尿病、β 受体阻滞剂使用、既往 24 小时阿片类药物使用、自主神经功能障碍和瞳孔直径作为固定效应，主题作为随机效应。在 150 名受试者中，17 名报告患有糖尿病，12 名报告使用 β 受体阻滞剂，14 名报告之前 24 小时使用阿片类药物，120 名报告没有合并症。 PUAL 在较高年龄组（下降 0.0307，< 0.001）、糖尿病（下降 0.0481，= 0.025）和使用 β 受体阻滞剂（下降 0.0616，= 0.005）中下降。观察到阿片类药物相关的 PUAL 下降，但统计显着性因模型而异。在健康受试者中，根据接受阿片类药物输注的健康受试者的先前数据，没有 PUAL 值落在表明阿片类药物毒性的可能性很高的范围内。 PUAL 在较高年龄组、糖尿病和 β 受体阻滞剂使用、与自主神经功能受损相关的疾病以及阿片类药物使用中下降，但显着性因所选模型而异。