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  • 學位論文

睡眠與外傷之系列研究

A series of studies on sleep and injury

指導教授 : 蔡佩珊

摘要


目的: 本系列研究旨在:(1)調查不同輪班工作型態者其失眠與日間嗜睡症狀之盛行率與輪班型態對工作或休閒時小意外發生的預測能力(子研究1)、(2)探討急性頭部外傷後睡眠型態之變化軌跡及頭部外傷急性期睡眠型態變化之預測因子(子研究2)以及(3)檢視輕、中、重急性頭部外傷病患睡眠障礙之盛行率並探討與睡眠在頭部外傷急性期嚴重度與認知功能恢復之關係中扮演的中介角色(子研究3)。 方法: 子研究1為橫斷式研究設計。係使用2005年臺灣社會發展趨勢調查之資料庫(n= 18, 794)。失眠症狀、日間嗜睡與工作或休閒時小意外的資料由該資料庫取得並進行分析。子研究2與子研究3為前瞻性觀察性研究。共收取52位首次發生頭部外傷,並於24小時內入住神經外科病房的急性頭部外傷病患。睡眠變項係利用七天活動腕表(actigraphy)與睡眠日誌取得。頭部外傷嚴重度由急診昏迷指數量表所測得。Rancho Los Amigos Levels of Cognitive Functioning (RLA)則為入院後第一天與第七天的認知功能測量工具。 結果: 延長工時的班別如:小夜加大夜班(day-to-evening group)與白班加小夜班(evening-to-night group)。子研究1結果顯示小夜加大夜班的輪班人員有較高失眠症狀之盛行率;小夜加大夜班與白班加小夜班的輪班人員有較高過度嗜睡之盛行率。在校正干擾因子後,白班加小夜班的輪班人員有較高小意外發生的風險。子研究2結果顯示72% 急性頭部外傷病患有延長24小時睡眠時間。日間與24小時睡眠時間會隨著時間呈現減少的趨勢。昏迷指數< 11為顯著預測日間睡眠時間改變之斜率的因子。無喪失意識與年齡< 40則為顯著預測24小時睡眠時間改變之斜率的因子。子研究3顯示輕(n = 35)、中(n = 7)、重(n = 10)度急性頭部外傷病患出現日間與24小時睡眠時間延長的現象。中重度個案較輕度個案有較長的日間睡眠時間。重度頭部外傷病患較輕度個案有較長的24小時睡眠時間。日間睡眠時間為頭部外傷嚴重度與認知功能恢復之中介因子。 結論:延長工時之輪班工作易發生工作或休閒時之小意外。急性頭部外傷會出現睡眠效能差與睡眠時間延長的現象。頭部外傷嚴重度與年齡為預測急性頭部外傷病患日間與24小時睡眠時間變化之重要預測因子。日間睡眠時間為頭部外傷嚴重度與認知功能恢復之中介因子。本系列研究結果提供睡眠相關因子對外傷的影響、頭部外傷後睡眠型態的改變以及睡眠對急性期頭部外傷認知功能恢復影響之證據,可做為未來研究之根基與臨床護理實務措施之參考。

關鍵字

睡眠 外傷

並列摘要


Purpose: A series of studies were conducted to (1) examine the prevalence of insomnia and daytime sleepiness among various work schedules and the relationship between work schedules and non-fatal accidents during work or leisure time (Study I), (2) investigate different trajectories of change in sleep parameters during the acute phase of traumatic brain injury (TBI) and whether specific demographic and disease characteristics predicted the initial levels of sleep and the trajectories of change in sleep parameters (Study II), and (3) examine the prevalence of sleep disturbance among patients with mild, moderate and severe TBI and whether the relationship between brain injury severity and cognitive function recovery is mediated by sleep (Study III). Methods: Study I was a cross-sectional study using the data of Taiwan Social Development Trend Survey in 2005 (n = 18, 794). Insomnia symptoms, daytime sleepiness and non-fatal accidents were derived from the survey. Study II and Study III were prospective observational studies. Fifty-two patients with first-ever TBI were enrolled within 24 hours of admission to the neurosurgical ward. Each participant wore an actigraph for 7 consecutive days to gather sleep data. Head injury severity was determined by Glasgow Coma Scale at emergency department (initial GCS). Cognitive function was assessed by the Rancho Los Amigos Levels of Cognitive Functioning (RLA) at the first and seventh days after admission. Results: Study I showed that the evening-to-night group had significantly higher prevalence rates of insomnia symptoms. Higher prevalence rate of severe daytime sleepiness was presented in both day-to-evening and evening-to-night groups. Adjusting for confounders, the day-to-evening shift had a higher odds ratio of non-fatal accidents (p<0.05). Study II showed that 72% of the TBI participants experienced prolonged 24-hour sleep duration. Both daytime and 24-hour sleep duration showed a significant downward trend across the study period. An initial GCS score < 11 significantly predicted the slope of change of daytime sleep duration over time. Without initial loss of consciousness and age < 40 years were independent predictors of the change pattern of 24-hour sleep duration over time. Study III revealed that longer daytime total sleep time (TST) and 24-hr TST were exhibited in the mild (n = 35), moderate (n = 7) and severe TBI groups (n=10). The severe and moderate TBI groups had longer daytime TST than those of the mild TBI group and the severe TBI group had longer 24-hr TST than the mild TBI group. The relationship between severity of brain injury and cognition function recovery was mediated by daytime TST. Conclusions: Extended shift work predicted the occurrence of non-fatal accidents. Poor sleep efficiency and prolonged sleep duration are common symptoms in acute TBI patients. Both head injury severity and age significantly predicted the trajectories of daytime and 24-hour TST during acute phase of TBI. Daytime TST mediates the relationship between severity of brain injury and cognition function recovery. The findings from these studies regarding the influence of work schedule on non-fatal accidents, the effect of brain injury on changes of sleep pattern, and role played by sleep in cognitive function recovery provide fundamental knowledge for future international studies and serves the reference sources for clinical nursing practices.

並列關鍵字

sleep injury

參考文獻


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