Excessive Daytime Sleepiness in Taiwanese People with Heart Failure

台灣心臟衰竭病患之白天過度嗜睡

陳幸眉(Hsing-Mei Chen) ； Angela P. Clark ； 蔡良敏(Liang-Miin Tsai) ； 劉怡(Yi Liu) ； 吳麗敏(Li-Min Wu) ； 吳世忠(Shyh-Jong Wu)

《The Journal of Nursing Research》 21卷1期 (2013/03) Pp. 39-48

https://doi.org/10.1097/JNR.0b013e3182828f2f

摘要

背景：過度的白天嗜睡會增加心臟衰竭病患的死亡率，導致服藥堅持度不佳及降低生活品質。辨識白天過度嗜睡對心臟衰竭處置成效可能有所助益。目的：找出台灣心臟衰竭病患的白天過度嗜睡的決定因子。方法：採橫斷性、相關性研究，以非隨機抽樣法，在一所醫學中心的心臟內科門診召募133位定期於門診追蹤的病患參與研究。研究工具包括：白天過度嗜睡量表、堪薩斯市心肌病變症狀次量表、及匹茲堡睡眠品質指標。結果：約有23.3%研究參與者有白天過度嗜睡問題，重要的白天嗜睡決定因子為白天功能缺失、身體質量指數、及心臟衰竭症狀頻率。使用血管收縮素轉化酶抑制劑雖與白天過度嗜睡有關，但並非其重要決定因子。結論／臨床應用：將近四分之一研究參與者，有主觀的白天過度嗜睡問題，此研究結果建議，應將該症狀的辨認納入心臟衰竭的處置中。介入性措施，如改善白天功能缺失、降低身體質量指數、及緩解心臟衰竭症狀等，有助於改善白天過度嗜睡。白天午睡習慣，可能可幫助台灣心臟衰竭病患在克服夜間的睡眠不佳及重新儲存能量。然而，在罹患心臟衰竭的病程中，過多的白天睡眠及午睡的時間與型態改變，都應早期發現以維持白天的功能。醫療雖有助於控制心臟衰竭症狀，但應將藥物調整至病患最合適的狀況，以降低藥物副作用，並能維持病患對治療的堅持度。

關鍵字

心臟衰竭 ； 白天嗜睡 ； 夜間睡眠品質 ； 午睡

並列摘要

Background: Excessive daytime sleepiness can increase heart failure (HF) mortality, cause poor medication adherence, and worsen quality of life in people with HF. Recognition of excessive daytime sleepiness can help improve HF management outcomes. Purpose: This study was designed to identify the determinants of daytime sleepiness in patients with HF in Taiwan. Methods: A cross-sectional and correlational study design was employed. We used nonprobability sampling to recruit 133 participants during their regular visits to a cardiovascular outpatient department of a medical center. Instruments used included the Epworth Sleepiness Scale, Symptom Subscale of Kansas City Cardiomyopathy Questionnaire, and Pittsburgh Sleep Quality Index. Results: Excessive daytime sleepiness occurred in 23.3% of study participants. Significant determinants of excessive daytime sleepiness were daytime dysfunction, body mass index, and HF symptom frequency. Use of angiotensin-converting enzyme inhibitors was correlated with excessive daytime sleepiness but was not identified as a determinant. Conclusions/Implications for Practice: Approximately one quarter of participants reported subjective excessive daytime sleepiness, suggesting that recognition of this symptom should be incorporated into HF management. Interventions for improving daytime dysfunction, decreasing body mass index, and ameliorating HF symptoms may help improve excessive daytime sleepiness. Habitual daytime napping may assist Taiwanese patients with chronic HF to overcome poor nocturnal sleep and restore energy. However, extra daytime sleep and changes in the duration and pattern of daytime napping during the HF trajectory should be recognized early to maintain daytime functioning. Medical treatments may help control HF symptoms. Optimizing medications to minimize adverse effects may help patients maintain better treatment adherence.

並列關鍵字

heart failure ； daytime sleepiness ； nocturnal sleep quality ； daytime napping

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