國內職場孕婦睡眠品質的相關研究－以中文版匹茲堡睡眠品質量表作評估

An Investigation on the Sleep Quality among Working Pregnant Women in Taiwan Using Chinese Version of the Pittsburgh Sleep Quality Index

湯振青(Chen-Ching Tang) ； 王建楠(Jian-Nan Wang) ； 林鏡川(Ching-Chuang Lin) ； 蘇世斌(Shih-Bin Su) ； 林佳淑(Chia-Shu Lin) ； 李明昕(Ming-Hsin Lee)

《中華職業醫學雜誌》 21卷4期 (2014/10) Pp. 181-192

摘要

研究目的：根據國際睡眠基金會於1998年的調查，78%的婦女在懷孕期間出現睡眠障礙的問題，尤其是在第一與第三懷孕期。懷孕時荷爾蒙的變化如黃體激素的大量分泌，造成孕婦在白天的嗜睡與疲倦，而孕婦的打鼾、夜間頻尿等症狀也和荷爾蒙的改變有關。其他如睡眠呼吸中止症、不寧腿症候群等相關因子也會影響孕婦的睡眠品質。國外的研究指出，嚴重睡眠呼吸中止症的孕婦，易併發妊娠糖尿病、懷孕高血壓、子癇前症、低體重兒等問題而影響母子安全。因此，懷孕時期的睡眠問題應更加被注意與探討。國內職場孕婦發生睡眠障礙的情況也很普遍，然而相關的研究並不多。因此，本研究的目的在分析探討國內職場孕婦的睡眠品質與影響睡眠品質的相關危險因子，建立流行病學資料，進而能早期介入防範，減少睡眠障礙及其併發症的發生。研究方法：本研究收集2010年至2011間於南部某醫學中心婦產科接受規律產檢的孕婦，於產檢門診前進行訪視，採孕婦自填式問卷，內容包括個人基本資料、過去病史、懷孕史、用藥紀錄、工作狀況等及中文版匹茲堡睡眠品質量表、中文版打鼾問卷、中文版國際不寧腿症候群診斷問卷。以回溯性資料分析，探討國內職場孕婦的睡眠品質與影響睡眠品質的相關危險因子。研究結果：自2010年至2011年間，共訪問了101位孕婦，平均年齡為31.77歲；其中第一懷孕期的孕婦有2位（2%），第二懷孕期的孕婦有17位（16.8%），第三懷孕期的孕婦有82位（81.2%）。懷孕期間有工作的孕婦有77位（76.2%），沒有工作的孕婦有24位（23.8%）。若以PSQI分數大於6分定義為睡眠品質不佳，發現職場孕婦睡眠品質不佳的盛行率為64.9%，高於非職場孕婦的50% ；職場孕婦的平均PSQI分數為8.32±4.12分，高於非職場孕婦的7.75±3.81分，但未達顯著意義；職場孕婦每晚平均睡眠時數明顯較非職場孕婦減少（6.79±1.72小時vs 7.67±2.19小時，p＜0.05）；職場孕婦平均入睡所需時間較非職場孕婦增加（27.42±24.26分鐘vs 23.75±19.19分鐘），但未達顯著意義。分析職場孕婦懷孕前後的睡眠指標，發現懷孕後睡眠品質不佳的盛行率為64.9%，高於懷孕前的45.5%；懷孕後的平均PSQI分數較高（8.32±4.12分vs 5.00±3.00分），但未達顯著意義。第三懷孕期的職場孕婦其PSQI分數高於第二懷孕期（8.89±4.31分vs 6.50±2.35分）的職場孕婦，但未達顯著意義。在影響職場孕婦睡眠的相關因素部分，職場孕婦打鼾的盛行率為71.4%，嚴重打鼾的盛行率為6.5%；夜間抽筋的盛行率為54.5%；不寧腿症候群的盛行率則為13%。結論：國內職場孕婦睡眠品質不佳的盛行率偏高，其中包括入睡所需時間、整體睡眠時數等睡眠品質指標，在懷孕後都呈全面惡化，尤其第三懷孕期的職場孕婦，其睡眠品質最差。臨床醫護人員在面對可能有睡眠問題之職場孕婦時應及早介入防範，以減少睡眠障礙及其併發症的發生。

關鍵字

職場孕婦 ； 睡眠品質 ； 打鼾 ； 不寧腿症候群 ； 匹茲堡睡眠品質量表

並列摘要

Objective: According to a study by the International Sleep Foundation in 1998, 78% of pregnant women have sleep problems during pregnancy, especially in their third trimester. The hormonal changes associated with pregnancy, such as secretion of luteinising hormone, can lead to daytime sleepiness and fatigue. Snoring, nocturnal urinary frequency and other symptoms are also linked with hormonal changes. Otherwise, pregnant woman's quality of sleep can be affected by factors such as sleep apnea and restless leg syndrome. Pregnant women with sleep apnea have been found to be more likely to have gestational diabetes, pregnancy induced hypertension, preeclampsia and low birth weight babies, affecting the health and safety of expectant mothers and their children. Thus, sleep problems during pregnancy should be taken seriously. Sleep disorders in working pregnant women in Taiwan are common, but there are few studies on it. The purpose of this study is to investigate quality of sleep and the risk factors for it in working pregnant women and to establish epidemiological data for early intervention to reduce sleep problems and complications. Methods: The self-administered questionnaires, containing questions about basic personal information, past medical history, pregnancy history, medication history and working conditions, the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) and the International Restless Legs Syndrome Scale (IRLSS) were distributed to and collected from pregnant woman at the antenatal clinics at a medical center in the southern Tainan from 2010 to 2011. We conducted a retrospective analysis to investigate quality of sleep and the risk factors for it in working pregnant women in Taiwan. Results: From 2010 to 2011, a total of 101 responses were collected and analyzed, with average age of 31.77 years. Among them, 2 (2%) were in first trimester, 17(16.8%) were in second trimester, and 82 (81.2%) were in third trimester. 77 (76.2%) of them were working during pregnancy and 24 (23.8%) were not. A global PSQI score greater than 6 was defined as poor sleep quality, and our study found that the prevalence of poor sleep quality in working pregnant women was 64.9%, which is higher than that (50%) in the non-working pregnant woman; There was no significant difference in mean PSQI scores were among the working pregnant women (8.32±4.12) and those in the non-working pregnant women (7.75±3.81). Women who worked during pregnancy had less hours of sleep per night (6.79 ± 1.72 hours), comparing with non-working pregnant women (7.67±2.19 hours) significantly, and they took longer time (27.42±24.26 minutes) to fall asleep than their counterparts (23.75±19.19 minutes), however, with no statistically significant difference. Using the PSQI to analyze sleep quality in the working women before and after their pregnancy, we found a significantly higher prevalence of poor sleep quality after pregnancy (64.9%) than before pregnancy (45.5%); pregnant working women had insignificantly higher mean PSQI scores (8.32±4.12) than non-working ones (5.00±3.00). Among working women, those in the third trimester had insignificantly higher PSQI scores (8.89±4.31) than those in the second trimester (6.50±2.35), and factors affecting the prevalence of poor sleep quality include snoring (71.4%), with severe snoring being 6.5%, nocturnal cramps (54.5%), and restless legs syndrome (13%). Conclusion: The results of our study show a high prevalence of poor sleep quality after pregnancy in the working women in Taiwan, such as the time it takes to fall asleep and hours of sleep, especially in their third trimester. Early intervention is recommended when doctors or nurses suspect sleep problems in the pregnant patients who work to reduce the problems and complications.

並列關鍵字

working pregnant women ； sleep quality ； snoring ； restless legs syndrome ； he Pittsburgh Sleep Quality Index