氣喘學齡兒童睡眠品質及其相關性因素之研究

A Study of Sleep Quality and Related Factors of Asthmatic Children

葉曉萍(Hsiao-Ping Yeh)

指導教授 ： 高碧霞

國立臺灣大學/醫學院/護理學研究所/碩士(2006年)

https://doi.org/10.6342/NTU.2006.01954

摘要

氣喘對兒童而言是常見的慢性病，其反覆性的咳嗽、喘鳴、胸悶、呼吸急促和呼吸困難的症狀，尤其是在夜晚或是清晨的時候，症狀往往加劇，常常導致兒童從睡眠中覺醒，造成氣喘兒童有睡眠的困擾，因此本研究採橫斷式之調查研究方法，以立意取樣方式在台北市某醫院及某國民小學做研究場所，運用結構式問卷及生理測量儀器作為研究工具，以探討氣喘與非氣喘兒童睡眠品質及其相關因素，結果共得130位研究對象(38位氣喘兒童，92位一般兒童)，所蒐集資料以SPSS/Window12.0套裝軟體進行進行描述性和推論性的統計分析，研究結果如下：
一、 主觀睡眠品質方面，氣喘兒童主觀睡眠品質得分(11.26±6.51)比一般兒童(8.95±5.68)高，即氣喘兒童主觀睡眠品質比一般兒童差。
二、 客觀睡眠品質方面，10位氣喘學齡兒童睡眠活動紀錄器測出之總睡眠時數約7.19~9.89小時/天、夜間清醒時間約32.07±19.18分鐘/天、睡眠潛伏期約7.76±5.86分/天及睡眠效率為95.92±2.74%；而一週睡眠日誌測出之總睡眠時數約7.22~10小時/天、夜間清醒次數約0.33±0.58次/天、睡眠潛伏期約16.41±12.18分/天及睡眠效率為95.32±2.97%。
三、 影響學齡兒童主觀睡眠品質的因素包括：有、無氣喘診斷、年級、氣喘嚴重度、生活壓力、睡眠衛生及夜間過敏症狀；而影響氣喘學齡兒童客觀睡眠品質的因素包括：年齡與夜間清醒次數有顯著負相關（r=-0.67, p ＜0.05）；另外，主觀睡眠品質與總睡眠時數、夜間清醒次數及睡眠潛伏期皆有顯著相關。
四、 生活壓力與主觀睡眠品質有中度正相關（r=0.45, p＜0.01），即生活壓力愈大其睡眠品質愈差，個人主觀睡眠感受愈差，睡眠困擾愈嚴重。
五、 睡眠衛生與主觀睡眠品質有顯著負相關（r=-0.23, p＜0.01），其中學齡兒童「睡覺有無需要布偶、玩具或小毯子陪伴」與「睡覺時是否被其他人、事、物吵到」對其主觀睡眠品質有顯著差異。
六、 夜間過敏症狀與主觀睡眠品質有顯著正相關（r=0.34，p＜0.01），即夜間過敏症狀出現愈頻繁其睡眠品質愈差，個人主觀睡眠感受愈差，睡眠困擾愈嚴重。
七、 預測睡眠品質相關變項，多元迴歸分析結果顯示：「年級（二年級、六年級）」、「生活壓力」及「夜間過敏症狀」三個變項對主觀睡眠品質有36.9%的解釋量（F=26.53, p＜0.01）。
根據本研究結果，強烈建議臨床護理人員應重視氣喘兒童住院期間之睡眠評估及居家睡眠情形，且護理人員更應該加強家屬及氣喘兒童對氣喘知識、居家氣喘照護效能的提升，以改善病情的控制。另外門診、臨床及學校護理人員也需加強家屬對學齡兒童睡眠品質之重視，並協助家長讓學齡兒童養成良好的睡眠衛生習慣，以促進兒童擁有良好的睡眠品質。

關鍵字

氣喘兒童 ； 睡眠品質 ； 生活壓力 ； 睡眠衛生 ； 夜間過敏症狀

並列摘要

Asthma including frequently cough, wheeze, tachypnoea and dyspnea symptoms is a common chronic disease for children. Particularly at night or in early morning, it becomes worse and leads children waked accompanying the problem of sleep interruption. Therefore, this study was a cross-sectional survey research aimed to investigate sleep quality and related factors of asthma and non-asthma children by the instrument of a self-administered structural questionnaire and physiological monitors. 130 children (38 asthmatic children and 92 health children) in an elementary school and hospital in Taipei City were enrolled in the study by purposive sampling. The data were analyzed with descriptive and inference statistics by SPSS/Windows 12.0 software. The findings of study as follow:
1. In subjective sleep quality aspect, asthmatic children of subjective sleep quality score (11.26±6.51) worse than health children score (8.95±5.68). It means that asthmatic children of subjective sleep quality worse than health children.
2. In objective sleeping quality aspect, 10 school-age asthmatic children of total sleep time by actigraphy average 7.19~9.89 hours/day, night awakening time 32.07±19.18 minutes/day, sleep latency 7.76±5.86 minutes/day and sleep efficiency 95.92±2.74%; total sleep time by sleep diary average 7.22~10 hours/day, night awakening times 0.33±0.58 times/day, sleep latency 16.41±12.18minutes/day and sleep efficiency 95.32±2.97%.
3. The factors effected school-age children subjective sleep quality were asthma diagnosis, the grade, the severe level of asthma, life stress, sleep hygiene and nocturnal allergy symptoms. And the factors effected school-age children objective sleep quality were significant negative relationship between age and night awakening times( r=-0.67, p＜0.05). Besides, the objective sleep quality was significantly related to total sleep time, night awakening times and sleep latency.
4. There was a significant moderate positive relationship between life stress and subjective sleep quality; it means that more life stress children have worse subjective sleep quality, worse subjective self-sleep feeling and more severe sleep disturbance.
5. There was a significant negative relationship between sleep hygiene and subjective sleep quality( r=-0.23, p＜0.01). Besides, there were significant differences between school-age children of subjective sleep quality and “need of dolls, toys and blankets or not”, “be sounded by others or not”.
6. There was a significant positive relationship between nocturnal allergy symptoms and subjective sleep quality( r=0.34，p＜0.01); it means that children had more frequent nocturnal allergy symptoms have worse subjective sleep quality, worse subjective self-sleep feeling and more severe sleep disturbance.
7. Three independent variables of the second and sixth grade, life stress, nocturnal allergy symptoms were significant predicators of subjective sleep quality. The variables explained 36.9% of the variances in children’s subjective sleep quality.
According to the research findings, clinical nurses are highly recommended to pay more attention to asthmatic children of sleep assessment in the hospital and sleep condition at home. In order to control asthmatic condition, nurses are suggested to enhance asthma knowledge and home care efficacy of children with asthma and their family. In addition, nurses of out patient department, wards and schools should enhance family to regard for school-age child sleep quality, and help family with school-age child having good sleep hygiene. So, school-age children will have good sleep quality.

並列關鍵字

sthma children ； sleeping quality ； life stress ； sleep hygiene ； nocturnal allergy symptom

參考文獻

吳家興、林瑞雄、謝貴雄、邱文達、陳麗美、邱淑媞等（1998）•臺灣北部國中學生氣喘盛行率調查•中華公共衛生雜誌，17（3），214-225。

李孟峰（2002）•淺談夜間性氣喘（Nocturnal asthma）•台灣兒童過敏氣喘及免疫學會會訊，3（3），7-8。

葉世彬（2003）•孩童的睡眠問題•台灣醫界，46（5），14-18。

行政院衛生署（2005）•氣喘診療指引•台北: 行政院衛生署。

熊得志、謝文斌（2003）•氣喘及慢性阻塞性肺疾病患者的睡眠•當代醫學，8（21），624-629。