台灣學齡期兒童睡眠狀況與相關因素探討

Sleep and related factors of school-age children in Taiwan

莊小玲(Hsiao-ling Chuang)

指導教授 ： 廖玟君

中山醫學大學/醫學院/醫學研究所/博士(2016年)

摘要

研究背景及目的：台灣社會型態的轉變，加上少子化與贏在起跑點的觀念，使得學童過著成人般早出晚歸的生活，睡眠不足的問題時有所聞，但相關研究卻不足，本研究主要的目的為探討學齡期兒童整體的睡眠狀況，以及生活型態與壓力對學童睡眠品質的影響。
研究方法及資料：本研究為橫斷性問卷調查，採分層隨機抽樣的方式，選取362位國小三~四年級學童(男生172位、女生190位)及其父母參與本研究；研究工具為結構式問卷，包括基本資料、生活壓力量表及兒童睡眠評估量表；資料分析方法以IBM SPSS 20.0版套裝軟體進行，採描述性統計呈現學童睡眠狀況的分布情形，以Pearson correlation分析學童之睡眠品質與睡眠困擾的相關因素，以迴歸分析探討學童睡眠品質與睡眠困擾的預測因子。
研究結果：前驅研究結果發現兒童睡眠評估量表包括睡眠衛生、睡眠品質及睡眠困擾三部分，睡眠衛生於學童與父母間的評分者信度（intra-class correlation coefficient, ICC）為0.37–0.66。探索式因素分析顯示：睡眠品質包括睡眠中斷、白天嗜睡、量性睡眠型態及早晨起床情形等四個因素，此四個因素可以解釋64.9%的變異量；睡眠困擾包括異睡症及睡眠呼吸疾症等兩個因素，此兩個因素可以解釋57.7%的變異量。
正式研究結果顯示：學童平均睡眠時間為8小時36分，有高達67.9%的學童每天夜晚睡眠時間不到9小時，81.9%的學童有睡眠中斷的情形、48.6%的學童白天會嗜睡，86.5%的學童有異睡症或睡眠呼吸疾症的困擾，而僅8.2％的學童早晨起床時精神狀況良好。迴歸分析結果發現：可顯著預測學童之整體睡眠品質的變項依次為「生活壓力」、「睡眠衛生」及「睡眠困擾」，當睡眠衛生（含生活型態與睡眠環境）越差、生活壓力越大及睡眠困擾越嚴重時學童的睡眠品質也會越差，此三變項共可解釋31%的變異量。
結論與建議：台灣學齡期兒童睡眠問題普遍存在，而學童的睡眠衛生、生活壓力與睡眠困擾將影響其睡眠品質。父母平時可依據學童早晨起床情形初步判斷其睡眠狀況，其他健康照護者懷疑學童有睡眠問題時則可運用兒童睡眠評估量表進行評估，以了解學童的睡眠狀況，作為是否需進一步就醫的參考；教育單位可規劃睡眠衛生相關課程，教導學童、家長及教師認識睡眠相關知識，以協助學童建立良好的睡眠衛生、提升睡眠品質。

關鍵字

學齡期兒童 ； 睡眠品質 ； 睡眠困擾 ； 睡眠衛生 ； 生活壓力

並列摘要

Objective: Insufficient sleep is popular in school-aged children due to transformative lifestyles, low birth rate, and the desire to win at the start point in Taiwan’s society. This made the school-aged children leave home early and return late as adults do. Studies exploring sleep related problems in school-aged children are insufficient in Taiwan. The purpose of this study was to explore the overall sleep problems in school-aged children, and to examine the influence of lifestyle and life stress on their sleep quality.
Methods and Materials: A cross-sectional study design with a stratified random sampling was used in this study. Participants were recruited from three civil elementary schools. There are 362 pairs of third- and fourth-grade students (172 boys, 190 girls) and their parents enrolled. The instruments used in this study including the Demographic Data Form, the Life Stress Questionnaire (LSQ), and the Children’ Sleep Assessment Questionnaire (CSAQ). IBM SPSS statistics version 20.0 was used to analyze the data. Descriptive statistics was used to analyze the distribution of sleep problem. Pearson correlation was used to analyze the relationships between the related factors and sleep; and multiple regressions were used to analyze the predictors on children’s sleep quality and sleep disturbances.
Results: The pilot study showed that the CSAQ comprised three parts: sleep hygiene, sleep quality, and sleep disturbance. Sleep hygiene showed a moderate intra-class correlation coefficient (0.37–0.66) between children and parents. Results of exploratory factor analysis suggested that four factors including nighttime weaking, daytime sleepiness, quantitative sleep pattern, and waking in the morning were extracted and explained 64.9% of variance in sleep quality. Two factors including parasomnias and sleep-disordered breathing were extracted and explained 57.7% of variance in sleep disturbance.
The formal study showed that the mean sleep duration was 8 hours 36 minutes. About 67.9% of children slept less than 9 hours per day. The prevalence of nighttime waking, daytime sleepiness, and sleep disturbance were 81.9%, 48.6%, and 86.5%, respectively. Only 8.2% of children waked up with restoration perception in the morning. Regression analysis showed that the children’s life stress, sleep hygiene, and sleep disturbance could independently predict 31% of the variances of the children’s sleep quality. The children who had worse sleep hygiene including lifestyle and sleep environment, and who had more life stress and severer sleep disturbance had poorer sleep quality.
Conclusion and suggestion: Sleep problems in school-aged children are prevalent in Taiwan. Children’s sleep hygiene and life stress have impact on children’s sleep quality and sleep disturbance. Parent could assess children’s sleep quality while their waking up in the morning. Health providers could use the CSAQ to assess children’s sleep problems in children with high risk. Outcomes of the CSAQ will help health providers to understand children’s sleep condition, and to be the reference for seeking medical advice. Otherwise, sleep hygiene-related courses are needed to assist children, parent, and teachers in understanding sleep-related knowledge, and hence to improve children’s sleep hygienes and sleep quality.

並列關鍵字

school-aged children ； sleep quality ； sleep hygiene ； life stress

參考文獻

尹祚芊. 2000. 學校衛生護理. 臺灣醫學. 4, 215-222.

吳明隆. 2006. 國小學生學習壓力之研究. 正修通識教育學報. 3, 33-66.

吳敏華. 2008. 台灣兒童睡眠障礙與其行為及學習成績之研究. 碩士論文. 台北：中山醫學大學公共衛生學系研究所.

宋維村、高淑芬. 2000. 兒童及青少年之睡眠障礙症. 臺灣醫學. 4, 681-686.

施嫈瑜. 2005. 睡眠與成長. 中醫兒科醫學雜誌. 7, 1-5.