嬰兒照顧模式與睡眠型態之相關性研究

The Relation between Infant Care Mode and Sleep Patterns

王湘雲(Hsiang-Yun Wang)

指導教授 ： 蔡劭瑜

國立臺灣大學/醫學院/護理學研究所/碩士(2018年)

https://doi.org/10.6342/NTU201800394

摘要

睡眠對於人類相當重要，特別是嬰兒族群，該階段是人類成長最為快速的時期。過去的調查顯示臺灣嬰兒睡眠時數偏短且半數以上的父母認為其嬰兒有睡眠問題，相較於歐美與亞洲其它國家其比例是高的。然而，照顧者提供之照顧模式是否可幫助嬰兒睡眠型態的調節，目前國內外研究尚無定論。有鑒於此，本橫斷性研究探討嬰兒照顧模式與其睡眠型態的相關性。本研究目的為：（1）描述6個月嬰兒的日夜睡眠型態；（2）分析母乳哺餵與6個月嬰兒睡眠型態之相關性；（3）分析照顧者壓力與6個月嬰兒睡眠型態之相關性；（4）分析6個月嬰兒日間戶外時數與其睡眠型態之相關性；（5）分析親子同床共眠與6個月嬰兒睡眠型態之相關性。
本研究於北部某醫學中心門診收案，共78位6個月健康嬰兒完成本研究，包含嬰兒配戴活動記錄器7天，照顧者填寫嬰兒之健康基本資料、嬰兒睡眠活動日誌、長版簡易嬰兒睡眠問卷和母親填寫壓力知覺量表。本研究結果顯示，照顧者74.4%認為其嬰兒有睡眠問題，與嬰兒無睡眠問題者相比，父母認為有睡眠問題之嬰兒其夜間睡眠潛伏期較長（p<0.01）、夜間睡眠效率較低（p=0.03）、整日睡眠時數較短（p<0.05），照顧者主觀認為嬰兒夜間清醒次數較多（p<0.01），及母親壓力知覺量表分數較高（p<0.01）。母乳哺餵的各項睡眠參數無不同於配方奶哺餵之嬰兒（p>0.05），純母乳哺餵之嬰兒比混餵或純配方奶哺餵之嬰兒較傾向使用喝奶安撫入睡（p=0.02），仍有親餵比純瓶餵的嬰兒有較多夜間清醒次數（p=0.04）、較高比率父母覺得嬰兒有睡眠問題（p=0.01）、較高比率使用喝奶安撫入睡（p=0.02）及在嬰兒夜間清醒時較高比率使用喝奶安撫再度入睡（p=0.02）
。母親壓力指數部分，仍有親餵母親壓力指數較瓶餵者高（p<0.01），且嬰兒有睡眠問題者較無問題者高（p<0.01）。嬰兒日間戶外時數與嬰兒各項睡眠參數均無顯著相關。親子同床共眠與各項嬰兒睡眠時數無顯著相關，但與嬰兒以喝奶方式安撫入睡或夜醒以喝奶方式安撫再入睡有關（p<0.01）。
根據以上研究結果，建議對於認為喝母乳的嬰兒睡眠會較差之照顧者，可衛教母乳哺餵不會影響嬰兒睡眠型態，並給予母乳哺餵的母親更多支持與協助，以減少其壓力。當照顧者有外出會影響嬰兒睡眠的疑慮時，可澄清嬰兒日間戶外時數增加並不會減少嬰兒睡眠時數，親子同床共眠也與嬰兒睡眠時數多寡無關。

關鍵字

嬰兒 ； 照顧模式 ； 睡眠型態

並列摘要

Sleep is essential for human beings, especially during infancy which is the most rapid and significant growth period of life. Past investigations have indicated that Taiwanese infants obtain less sleep, and more than half of Taiwanese caregivers have reported that their infants have sleep problems. This is a much higher proportion than that reported for Western countries or for the rest of Asia.
However, whether infant care mode is associated with infant sleep patterns is unclear. To help address these research gaps, this study recruited six-month old infants from a medical center in Taipei and aimed to (1) describe sleep patterns in infants, (2) analyze the relationship between breastfeeding and sleep patterns in infants, (3) analyze the relationship between caregivers’ level of stress and sleep patterns in infants, (4) analyze the relationship between the amount of time spent outdoors and sleep patterns infants, and (5) analyze the relationship between bed-sharing and sleep patterns in infants.
Study subjects included 78 healthy 6-month-old infants who wore actigraphs for 7 consecutive days. The caregivers of these infants completed a demographic background survey, a sleep diary, the Extended version of the Brief Infant Sleep Questionnaire. Mothers completed the Perceived Stress Scale (PSS).
According to results reported by caregivers, 74.4% of infants had sleep problems. Actigtaphy results indicated that infants with parentally reported sleep problems had longer sleep latency (p<0.01), lower sleep efficiency (p=0.03), and shorter total sleep durations (p<0.05) than did infants who did not have sleep problems. Moreover, parents of infants with a sleep problem reported more nocturnal awakenings (p<0.01), and mothers of these infants reported higher PSS scores (p<0.01). Conversely, no significant differences in sleep patterns were identified between infants who were breastfed and infants who were exclusively bottle-fed (p>0.05). Feeding was more commonly used as a sleep aid method among infants who were exclusively breastfed than among infants who were fed with a combination of breast milk and formula or among infants who were fed with formula alone (p= 0.02). In addition, compared to infants who were exclusively bottle-fed, infants who were breastfed had increased nocturnal awakenings (p=0.04), prone to feed for sleep (p=0.02) and prone to feed for sleep during nocturnal awakening (p=0.02). Parents of breastfed infants were also more concerned their infants having sleep problems than were parents of infants who were fed with formula alone (p=0.01). The PPS scores of mothers who breastfed their infants were significantly higher than those that were bottle-fed (p<0.01), and those who considered their infants’s sleep a problem were significantly higher in comparison to those who didn’t (p<0.01).
Results of this study suggest that it is important to educate caregivers that breastfeeding is not associated with poor sleep in infants and that bed-sharing and time spent outdoors also do not reduce infant sleep. Healthcare professionals should provide more support for breastfeeding mothers in order to reduce their stress.

並列關鍵字

infant ； care mode ； sleep patterns

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