睡眠障礙患者睡眠與睡眠導因評估

Evaluation of Sleep and Sleep Related Factor in Patients with Sleep Diffculties

賴祈鳳(Chi-Fung Lai)

指導教授 ： 廖玟君

中山醫學大學/護理學院/護理研究所/碩士(2016年)

摘要

睡眠障礙是在台灣社會很常見的問題，其治療方法不能只依賴藥物，而必須進行完整的睡眠評估之後再給予適合的措施。雖然文獻已提供評估睡眠障礙的諸多方法，但大多都只評估睡眠本身，缺乏整體性系統性評估工具。本研究主要建構一份具有信、效度的「周全性睡眠導因評估量表」，並比較探討有無睡眠障礙主訴個案之睡眠相關因素之差異。
「周全性睡眠導因評估量表」經專家效度及二十名受試者預試，進行再測信度分析，而後修改成正式量表進行施測，量表包括個人因素、生理因素、心理因素、社會因素、環境因素五大面向。睡眠障礙族群（病人組, n=32）乃因睡眠障礙至睡眠門診求診之病患為收案標準、而非睡眠障礙族群（常人組, n=96）則以性別及年齡相對應為收案標準，另外，為求足夠代表性，非睡眠障礙族群人數設定為睡眠障礙族群之三倍。
研究結果顯示，周全性睡眠導因評估量表其八位專家之CVI 值範圍在0.81 到1.00 之間，平均值為0.94，預試部分全樣本之四週再測信度結果， Pearson相關係數均在0.996-1.000之間，呈現完全與高度相關。運用中文版匹茲堡睡眠品質量及Epworth嗜睡量表結果顯示病人組過去一個月內的主觀睡眠狀況皆為睡眠品質不良之個案且白天嗜睡狀況介於輕度及中度之間。其睡眠導因各構面評估結果顯示， 個人因素方面，每天工作平均工時過長 (χ2= 10.315, p=0.001)、需要輪班 (χ2= 8.964, p =0.003)、夜間工作 (χ2=9.395, p =0.004)及自覺工作壓力 (χ2=9.503, p =0.002)等會影響睡眠；生理因素方面，身體檢查評估項目病人組張口呼吸、低軟顎、高窄硬腭、安格氏分類法、舌肥大、磨損表面咬合之情形達顯著差異；心理因素方面，壓力知覺越高
(χ2=32.542, p =0.000)且焦慮與憂鬱程度越高(χ2=32.868, p =0.000)皆會影響睡眠；社會因素方面，病人組較常人組之休閒活動比例低 (χ2=39.857, p =0.000)、飲酒習慣多（χ2=1.798, p =0.018）、每日三餐時間和量不正常的頻率高 (χ2=5.086, p =0.024)、晚餐的量總是/經常吃到飽或吃多(χ2=21.511, p =0.000)、前一晚沒睡好隔天無法定時起床(χ2=4.444, p =0.035)等；環境因素方面病人組有燈光 (χ2=7.683, p =0.006)、噪音(χ2=5.086, p =0.024)、太冷或太熱醒來 (χ2=4.595, p=0.032)等干擾而影響睡眠。本研究結果顯示周全性睡眠導因評估量表是一份具有良好信度與效度之工具，研究結果提供睡眠門診睡眠障礙評估方法之參考。

關鍵字

周全性睡眠評估 ； 量表 ； 影響睡眠之因子

並列摘要

Sleep disorder is common in Taiwan’s society. The treatment of sleep disorder goes be-yond the use of medications; it requires a comprehensive sleep assessment and tailored inter-ventions. Though literature provided rich information about assessing and evaluating sleep disorder in the general population, formulating a comprehensive assessment of sleep disorder in a clinical setting is still a challenge. This study built a reliable and effective "Comprehensive sleep assessment scale" based on reliability and validation testing and investigated whether this scale differentiates between patients with sleep disorder and the control.
"Comprehensive sleep assessment scale" was evaluated by expert validity and by 20 par-ticipants with test-retest reliability. The scale is composed of five dimensions: "personal fac-tors", "physiological factors", "psychological factors", "social factors "and "environmental factors." Patients who visited sleep clinics with a sleep disorder were identified as the patients subjects (n=32). Age- and gender-matched subjects without any sleep disorder were random-ly selected at a ratio of 1:3 (sleep disorder vs. non- sleep disorder) and identified as the non- sleep disorder subjects (n=96). The Content Validity Index (CVI) of this scale was 0.94 and the alpha of the consistency reliability was 0.996-1.000. Results show that all patients with sleep disorder had poor sleep quality (PSQI>5) and mild to moderate daytime sleepiness (ESS >11). Personal factors of working long hours (χ2= 10.315, p=0.001), shift workers (χ2= 8.964, p=0.003), night shift (χ2=9.395, p=0.004) and perceived stress (χ2=9.503, p=0.002) can disrupt sleep. Physiological factors from physical examination including breath by mouth, low soft palate, high narrow palate, Edward Angle, tongue hypertrophy, and occlusion of the worn surface were present in patients. Psychological factors including higher perceived stress
(χ2=32.542, p=0.000), anxiety and depression (χ2=32.868, p=0.000); social factors including lack of leisure activities (χ2=39.857, p=0.000), more drinking habits（χ2=1.798, p=0.018),
irregular amount and frequency in meals (χ2=5.086, p=0.024), eating too much in dinner (χ2=21.511, p=0.000), cannot get up without a good night sleep (χ2=4.444, p=0.035); and en-vironmental factors including lighting (χ2=7.683, p=0.006), noise (χ2=5.086, p=0.024), too cold or too hot (χ2=4.595, p=0.032) can affect sleep.
The Comprehensive sleep assessment is a valid and reliable instrument for evaluating sleep related factors. Results of this study provide reference for assessing patients with sleep disorder.

並列關鍵字

comprehensive sleep assessment ； Associated factors with sleep

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