產後婦女睡眠品質之探討：質量交叉研究

產後期是女性在人生過程中的一個重要的角色轉變階段，產後睡眠品質則是產後婦女身心狀況的重要指標，也是婦女健康的重要議題之一，但在台灣鮮少被探討。本研究採質量交叉研究法，量性研究的目的是探討台灣產後婦女睡眠品質的現況，以及產後睡眠品質的影響因素；質性研究的目的在了解婦女產後睡眠形態改變的主觀經驗與感受。量性研究採橫斷性問卷調查，方便取樣327位在台灣某醫學中心接受產後檢查的產後六週婦女為對象，以匹茲堡睡眠指標、生理症狀量表、壓力知覺量表、和產後社會支持量表測量依變項。質性研究則採深度訪談法，深入訪談11位產婦。所得資料以卡方檢定、t考驗、皮爾森相關分析、單因子變異數分析、和逐步迴歸分析量性資料，以內容分析法分析質性資料。研究結果顯示，286位（87.5％）產婦的睡眠品質不佳（匹茲堡睡眠指標總分＞5分），產後睡眠品質與知覺壓力、產後生理症狀、及社會支持有顯著性的相關。逐步迴歸分析顯示，產後睡眠品質的顯著預測因子包括產後生理症狀、寶寶夜醒次數、同睡干擾程度、知覺壓力、孕前睡眠狀況和年齡等六項，共可解釋29.7％的總變異量。經由產後婦女的述說，發現產後睡眠形態改變之經驗主軸，乃在自身睡眠需求和照顧嬰兒上尋求平衡點，共可歸納出「產後睡眠型態改變的主觀因素」及「睡眠的調適策略」兩個類別，產後睡眠型態改變的主觀因素可歸納出：夜間配合新生兒的生理時鐘、因應夜間脹奶必須起來擠奶、不確定感與預期性掛慮、多重角色的壓力白天無法補眠及夜間的環境干擾。而產後睡眠品質的調適策略則有調整自己的作息、尋求他人協助、改善嬰兒夜間的睡眠、和尋找時間補眠。總之，產後睡眠品質和母職任務、產婦身心狀況、及社會支持有關，產婦積極採取調適策略，在本身和新生兒的基本需要上努力尋求平衡點。這些實證資料可做為未來設計產後支持團體方案或其他產後婦女睡眠紊亂介入措施的參考。

關鍵字

產後睡眠品質；產後生理症狀；知覺壓力；社會支持；質量交叉研究

並列摘要

Postpartum period is a critical stage of role transition in women’s life. Postpartum sleep quality is an important indicator of women's physical and mental health, therefore is one of the important issues of women health, but has rarely been explored in Taiwan. A quantitative and qualitative mixed method was conducted. The purposes of the quantitative study were to explore the postnatal women’s sleep quality and its affecting factors during their sixth postpartum period. Qualitative study was concurrently used to understand their subjective experiences of those altered sleep patterns. In this cross-sectional quantitative study, a total of 327 postpartum women were recruited by convenience sampling during their postnatal check-ups in a medical center in Taiwan. The dependent variables were measured by Pittsburgh Sleep Quality Index (PSQI), Physical Symptoms Checklist, Perceived Stress Scale, and Postpartum Social Support Scale. Concurrently, 11 postpartum women were interviewed in depth. Chi-square test, two-sample t test, Pearson’s correlation, one-way ANOVA, and stepwise regression were used to analyze quantitative data, and content analysis was performed to analyze qualitative data. The results showed that 286 participants (87.5%) reported poor sleep quality (PSQI＞5), and postpartum sleep quality significantly correlated with perceived stress, physical symptoms and social support. Stepwise multiple regression analysis showed that the best subsets to predict postpartum sleep quality included postpartum physical symptoms, the frequencies of baby wake at night, disturbances of co-sleepers, pre-pregnancy sleep quality, perceived stress, and age explained 29.7% of the total variances. Based on the postnatal women’s narratives, the experience axis of altered postpartum sleep pattern was seeking the balance point between their sleep needs and taking care of babies. Two themes were inductively categorized “Subjective factors of altered sleep pattern during postpartum” and “Coping strategies”. The subjective factors of altered sleep pattern during postpartum included dancing with the biological clock of newborn at night, getting up to milking the breast due to breast engorgement, feeling uncertainty and expected worries, the strain of multiple roles that no time to catch up on sleep during daytime, and environmental disturbance during the night. The copying strategies of poor postpartum sleep quality were to adjust their own daily routines, seek assistance, try their best to improve infant sleep at night, and find time to catch up their own sleep. Obviously, postpartum sleep quality was associated with maternal tasks, women’s physical-psychological status, and social support. Postnatal women actively adapt coping strategies, and seek the balance between their own sleep needs and taking care of babies. This study provides the evidence for designing postpartum support group and other intervention protocols for disturbed postpartum sleep in further studies.