感覺刺激活動於老年人睡眠表現之介入 -初探研究

背景：老人睡眠障礙診斷之盛行率高，以失最多。不論台灣約老人睡眠障礙診斷之盛行率高，以失最多。不論台灣約43%有使用至少一種安眠藥物，造成大量醫療負擔焦慮與憂鬱也常見於老年健康問題，其與睡眠品質間相關性高睡眠困擾影響老年健康與生活品質甚鉅，文獻建議以非藥物治療為優先睡前的音樂介入已證實可改善老人的主觀睡眠品質；而本體覺介入藉由不同神經傳輸路徑活化副交感神經，具鎮定、安撫的效果，對其他類型個案發現可顯著降低焦慮、過動或躁但尚未應用在老年睡眠困擾的改善，因此本研究目的為：探討感覺刺激介入對於改善有睡眠困擾的老年人之主觀睡眠品質感受和客表現可能性，並了解結合式介入是否可有加成作用，更效改善老年人的睡眠問題。方法：研究採單一個案研究法，連續單一個案研究法，連續九週不同的介入階段，除了基礎期與撤回期各一週，選擇方便老人於生活中自行操作之感覺刺激介入活動，探討音樂介入兩週(睡前聆聽音樂)、本體覺介入兩週 (關節擠壓運動)與結合式介入兩週(音樂介入+本體覺介入 )，探討不同階段間，介入方案對於改善老人睡眠困擾之效益，成效指標為主觀睡眠品質（匹茲堡問卷、失嚴重度量表)和客觀腕動儀紀錄之每日睡眠表現 (睡眠總時數、效率遲滯夜醒間與次數)，每週同時進行控制變項的評量，包含情緒 (老年焦慮量表、流行病學研究中心之憂鬱量表 )與主觀生活品質改變 (台灣簡明版生活品質問卷)，並要求個案書寫睡眠日誌，紀錄是否有影響情緒之生活事件發避免不良干擾因素。結果：共有三位受試者納入研究並完成分析。結果發現受試者納入研究並完成分析。結果發現在感覺刺激介入期 (音樂介入、本體覺與結合式)間，三位受試者都可以有較好的主觀睡眠品質感受，且主觀睡品質較佳時，其焦慮、憂鬱程度較低:在客觀睡眠表現，音樂介入可有對睡眠效率、遲滯夜醒時間正向的每週平均數改變，且在撤回期一週間有維持效果；本體覺介入對睡眠遲滯可正向的平均數改變，但對於夜醒時間的減少僅有階段正向改變趨勢，仍無法肯定其效益；結合式介入對於各項客觀睡眠表現的改善並無明顯變趨勢。結論：感覺刺激介入活動可改善有睡眠困擾之老年人的主觀品質，進而影感覺刺激介入活動可改善有睡眠困擾之老年人的主觀品質，進而影響其情緒及生活品質感受，在客觀睡眠表現的改善中音樂介入效果較明顯，且具維持效果，本體覺介入在階段間有正向改善的趨勢也維持正向趨勢，研究結果發現睡眠表具有明顯的不穩定性每日間變異大容易受許多因素影響，建議後續研究除增加樣本數外可延長基礎期至兩週並增加追蹤期兩週，以確定感覺刺激介入對於老年人睡眠品質改善之效益及維持效果。

關鍵字

老年人；睡眠；感覺刺激活動；睡眠品質；腕動儀

並列摘要

Background: Sleep disturbance severely impacts elderly’s health and quality of life. Non-pharmacological treatments are highly recommended by the National Sleep Foundation as the primary method for improving sleep quality. A sensory-based approach effective in affecting the sympathetic and parasympathetic nervous system can be a potential candidate. Music intervention and proprioceptive interventions can activate the different nervous systems to provide calming effects. However, the effects of these sensory-based interventions on insomnia in elderlies remain unclear. The study aims to investigate the effects of an auditory-based (e.g., listening to the music before sleeping) and a proprioception-based approach (e.g., joint compression exercises) on improving the sleep performance for elderlies. Both interventions can be easily accessed without interrupting their everyday life. Methods: In this single-case designs study, we recruited three volunteering elderly with primary insomnia and use A-B-A-C-A-D design for 9 weeks including the three periods of baseline phases for 1 week(A), the music intervention phase for 2 weeks(B), the proprioceptive intervention phase for 2 weeks(C) and the combination phase for 2 weeks(D). The main outcome measures include the objective sleeping quality measured everyday by the actigraphy recording the sleeping performance and physiological data during sleep, and the subjective sleeping quality measured every week via the Pittsburgh Sleep Quality Index and the Insomnia Severity. The control variables measures, including the Center for Epidemiologic Studies Depression Scale, Geriatric Anxiety Scale – Chinese Version and WHOQOL-BREF, will be assessed weekly. The above results will present in visually analyzing graphed data to compare the performance among different phases and to evaluate the impacts of different interventions. Results: Participants have better subjective sleeping quality during the different phase in the 9-weeks of stimulative activities intervention. The degree of self-conscious anxiety and depression are declined, and thus they experience a better quality of life. The music intervention had a positive feedback of sleep efficiency, sleep latency and awakening at night during the two-week intervention. The proprioceptive intervention might have a improvement of sleep latency and still requires comprehensive research to confirm the effect of proprioceptive intervention in improving the sleep efficiency and awakening at night. Conclusion: Sensory stimulative intervention can improve the subjective sleep quality of the elderly with sleep problems, and then affect their emotional and quality of life feelings. In the improvement of objective sleep performance, the effect of music intervention is more obvious, and may have a maintenance effect. The study found that the sleep performance has obvious instability, and the daily variability is large, which is easily affected by many factors. A large sample size will be needed to further validate the generalization of current results. The base period can be extended to two weeks, and the tracking period can be increased for two weeks to determine the benefit and maintenance effect of sensory stimulation intervention on the improvement of sleep quality in the elderly.

並列關鍵字

Elderly ； Sleep ； Sensory stimulative intervention ； Sleep quality ； Actigraphy.

參考文獻

王拔群、莊銘隆、黃玉書、陳彥宏、邱國樑、陳濘宏. (2003). 中文版Epworth嗜睡量表之信效度研究 Reliability and Validity of the Chinese Version of the Epworth Sleepiness Scale. 臺灣精神醫學 Taiwanese Journal of Psychiatry, 17(1), 14～22.