高血壓病患合併失眠的盛行率與治療現況：台灣地區某綜合醫院家庭醫學科門診之研究結果

The Prevalence of Insomnia and Its Treatment in Hypertension Patients by Primary Care Clinic of a General Hospital in Taiwan

林育靖(Yu-Ching Lin) ； 黃麗卿(Lee-Ching Hwang)

《台灣家庭醫學雜誌》 15卷4期 (2005/12) Pp. 202-210

https://doi.org/10.7023/TJFM.200512.0202

摘要

高血壓是家庭醫學科門診常見的診斷，2003年台灣地區因高血壓性疾病就診患者達218萬人，且逐年上升。文獻回顧發現門診高血壓病患合併失眠盛行率高且有慢性化趨勢，但台灣沒有相關文獻報告，本研究欲探討門診高血壓病患合併失眠盛行率與相關危險因子。收集在2004年6月至2004年9月之間至家庭醫學科門診追蹤高血壓個案共618人，以問卷填寫方式，登錄基本資料和病患情緒與睡眠狀況評估，並由病歷記載登錄處方藥物與精神相關疾病記載。睡眠狀況評估則採用世界衛生組織的睡眠與健康全球專案計畫中的失眠症自我評估表。結果顯示，門診高血壓病患有任一型夜間睡眠障礙者佔46.6%，其失眠型態以「入睡困難」（24.1%）與「難以維持睡眠」(25.2%)較明顯，早醒者20.2%，混合型失眠（具備上述任兩種以上睡眠障礙者）佔18.5%，無法藉由睡眠充分恢復精神體力者佔28.2%，日間嗜睡白天疲乏者32.4%。年齡較大、有憂鬱或焦慮情緒者失眠盛行率較高，有喝茶、喝咖啡習慣者較少失眠，性別、身體質量指數、合併糖尿病與否、飲酒、抽菸、運動習慣的有無、乙型交感神經阻斷劑或利尿劑的使用，則與失眠情形無顯著相關。此外，門診醫師對高血壓病患的失眠及情緒問題有警覺度不足及治療不足的現象，家庭醫學科醫師長期追蹤慢性疾病病患時，應重視病患的睡眠狀況及情緒問題。

並列摘要

Hypertension is a common disease cared in primary care clinics. In Taiwan, the number of patients who visit clinics for hypertensive disease reached 2,180,000 in 2003 and is still on the increase. Article reviews provide that hypertensive patients are highly prone to insomnia and are at risk of chronicity, but there was no available data in Taiwan. Our study focused on the prevalence and associated risk factors of insomnia in hypertension patients in our clinic cared. In the study, a total of 618 hypertensive patients were collected and were followed up their treatments in a period from June to September in 2004. We got basic personal information and their mood and sleep conditions through questionnaires, and recorded the blood pressures, the prescriptions, and a psychiatric diagnoses if available. The self-reporting questionnaire for insomnia from WHO Worldwide Project on Sleep and Health was adopted to evaluate the condition of sleep. The results showed 46.6% of hypertensive patients in clinic had sleeping disorders at night, among which ”difficulty falling asleep”(24.1%) and ”difficulty maintaining sleep”(25.2%) were two common types. 20.2% of the patients had the problem of ”early awakening”, 18.5% had ”mixed type insomnia” (i.e., combination of two or more types of the sleeping disorders mentioned above), 28.2% had unrefreshed sleep, and 32.4% had excessive daytime sleepiness. The prevalence of insomnia was higher in patients with aging, depressed or anxious mood, and was lower in those who drank tea or coffee habitually. Sexes, body mass index (BMI), the presence of DM, drinking, smoking, exercise habit, and the use of β-blocker or diuretics had no significant correlation with insomnia. Another finding was that insomnia and mood disorders of these hypertensive patients were under-diagnosed and under-treated in clinic. Family physicians should emphasize on the sleep and mood problems of chronic ill patients in long-term follow-up.

並列關鍵字

hypertension ； insomnia ； prevalence

參考文獻

郭斐然、陳慶餘(1994)。家庭醫業疾病當斷分佈之探討。中華家醫誌。4，1-12。

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).(The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)).,未出版.

台灣地區高血壓、高血糖、高血脂盛行率調查報告

Accessed online

Katz DA,McHorney CA(1998).Clinical Correlates of Insomnia in Patient with Chronic Illness.Arch Intern Med.158,1099-107.