可支援認知行為治療之行動睡眠日誌設計

On Designing Mobile Diary To Assist Cognitive Behavioral Therapy of Sleep Disorder

卜莉亞(Borade Pradnya Uttamrao)

指導教授 ： 洪一平

國立臺灣大學/電機資訊學院/資訊工程學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.01780

摘要

現今，與生活型態相關的健康問題快速成長，例如: 睡眠問題。而這些問題對於人們健康的危害日趨嚴重且應獲得重視。失眠 (Insomnia) 是指睡眠障礙，它將對人體的運作、健康狀態與生活品質帶來潛在的負面影響。通常，治療失眠著重於判定睡眠問題的因素。 認知行為治療法 (CBT: Cognitive-Behavioral Therapy) 已成為治療失眠的首選治療法，它是心理治療中最廣泛的形式之一。然而失眠的研究需要蒐集更多的資料，現有的睡眠品質回報工具被稱為睡眠日誌 (sleep diary)需要進一步研究。
睡眠品質 (Sleep quality) 這詞彙被普遍使用於睡眠醫學中，它是一種主觀評量睡眠優劣層級的方法。使用的問卷如: 雅典失眠自評量表 (AIS: Athens Insomnia Scale), 失眠嚴重度量表 (ISI: Insomnia Severity Index), 及匹茲堡睡眠品質量表 (PSQI: Pittsburg Sleep Quality Index)，這些量表被專門設計以量測睡眠品質，而匹茲堡睡眠品質量表是最能提供總體睡眠評估的工具。然而，睡眠品質問卷可能在格式、範圍、及其他屬性中有統計異質性 (statistical heterogeneity)。因此，本論文致力於消除上述量測法潛在的缺點，同時提供一個容易管理的有效性篩選工具。
透過與台大醫院合作，我們設計出基於認知行為治療法的睡眠日誌初期版本，並且使用為期一個月的時間來驗證睡眠日誌參數的一致性與有效性。分析後，我們發現這個初期的睡眠日誌項目尚不足用於計算睡眠品質。進一步評估後，我們更具體瞭解能用於輔助醫生進行睡眠品質評估的臨床篩查工具需具備更多資訊。因此，基於認知行為治療法的原理，我們設計出新的睡眠品質指標，稱為每日睡眠品質量表 (DSQI: Daily Sleep Quality Index)，正如字面上的意思一樣，每日睡眠品質量表是基於每天的睡眠品質給予分數。
近年來，資訊與通訊技術被廣泛應用於許多健康推廣計畫中。因為行動電話的普遍性及其運算力一日千里，在行動電話平台上提供健康管理的應用，將是大有可為的。因此，本論文同時提出一個行動版本的睡眠日誌應用以協助認知行為治療法進行。更進一步，我們也將每日睡眠品質量表的問卷轉換成為能被不同使用族群接受的行動版應用程式。

關鍵字

失眠 ； 認知行為治療法 ； 每日睡眠品質量表

並列摘要

Worldwide prevalence of life-style related health problems is increasing rapidly and this has culminated into serious health risks including sleep problems. Insomnia is a sleep disorder and potentially a serious condition that adversely affects the functioning, health status, and quality of lives of millions worldwide. In general, treating insomnia focuses on determining the cause of the sleeping problems. Cognitive-behavioral therapy (CBT) has emerged as a “treatment of choice” for managing the sleeping complains of insomnia. CBT is one of the most extensively researched forms of psychotherapy. However, more studies are required in insomnia research and existing self-reported instruments that are called as sleep diaries need further investigation.
“Sleep quality” term is commonly used in sleep medicine. It’s a degree of excellence in sleep and based on subjective measurement. Questionnaires such as Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), and Pittsburg Sleep Quality Index (PSQI) have been specifically designed to measure “sleep quality”, while PSQI stands as the only tool that provides global assessment of sleep. However, the available stock of “sleep quality” questionnaire has a statistical heterogeneity in their formats, scopes and other attributes. Therefore, in this thesis we aim to eliminate potential shortcomings of these measures and identify a valid screening tool as a self-reported instrument that can be easily administered
Preliminary sleep diary was designed and administered on the basis of CBT in collaboration with National Taiwan University Hospital for a period of 1 month to test the internal consistency and validity of preliminary sleep diary. After analysis it was found that preliminary sleep diary entries were not sufficient to calculate “sleep quality”. Hence the clear need of a tool or instrument to assist practitioners in the clinical screening of sleep disorder was identified. Consequently we designed a new sleep quality index called “Daily Sleep Quality Index” (DSQI) based on the philosophy of CBT. DSQI calculates “sleep quality” score on daily basis.
Lately, information and communication technologies have been harnessed for use in health promotion programs. Mobile phones provide a particularly promising platform for health management applications due to their central role in people’s lives as well as their technical capabilities. This thesis also presents a mobile based sleep diary application to assist CBT. Further DSQI sleep questionnaire was transformed into mobile based application tool that is acceptable to different group of users.

並列關鍵字

Insomnia ； Cognitive-Behavioral Therapy ； Daily Sleep Quality Index

參考文獻

1. A. G. Bray, “Epidemiology, risks and pathogenesis of obesity,” Meat Sci., vol. 71, pp. 2–7, 2005.

2. Stress at Work. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 99–101, 1999.

3. E. S. Tee, “Obesity in Asia: Prevalence and issues in assessment methodologies,” Asia Pac. J. Clin. Nutr., vol. 11, pp. S694–S701, 2002.

4. M. Partinen, “Sleep disorders and stress,” J. Psychosom. Res., vol. 38, suppl. 1, pp. 89–91, 1994.

5. M. G. Terzano, L. Parrino, F. Cirignotta, L. Ferini-Strambi, G. Gigli, G. Rudelli, S. Sommacal, Studio Morfeo Committee: “Studio morfeo: Insomnia in primary care, a survey conducted on the Italian population,” Sleep Med, vol. 5, pp. 67-75, 2004.