第二型糖尿病患者的睡眠品質與血糖控制之相關性探討

The association of the sleep quality on glycemic control in patients with type II Diabetes

羅琦(Chyi Lo) ； 黃建寧(Chien-Ning Huang) ； 郭青萍(Ching-Pyng Kuo) ； 黃秀梨(Shiow-Li Hwang) ； 廖玟君(Wen-Chun Liao)

《台灣公共衛生雜誌》 36卷5期 (2017/10) Pp. 497-510

https://doi.org/10.6288/TJPH201736106048

摘要

目標：第二型糖尿病與其所延伸健康問題威脅著台灣民眾的健康，本研究旨在探討第二型糖尿病病人之主客觀睡眠品質與血糖控制之間關係。方法：以立意取樣中部某醫學中心之第二型糖尿病患者共61位完成研究。主觀睡眠品質以匹茲堡睡眠品質指標量表（PSQI）測量，客觀睡眠品質以腕動計（wrist actigraphy）測量72小時（24小時*3天），並以病歷查閱方式追蹤病人收案後一年內的血糖控制生化值（HbA1c），資料以SPSS 17.0套裝軟體進行統計分析。結果：研究結果發現本研究族群血糖控制不佳，糖化血色素（HbA1c）平均為7.9±1.6%；飯前血糖值（AC sugar）平均為162.1±45.4 mg/dl，HbA1c＞7.0%佔72.2%。主觀睡眠品質之PSQI平均分數為6.6±4.1分，主觀睡眠品質不佳者（PSQI＞5分）佔57.4%；客觀睡眠時數平均為5.7小時，睡眠效率為75.3%，睡眠潛伏期為25.5分鐘、半夜醒來總時間為63.3分鐘。線性複迴歸分析結果發現，自覺睡眠效率（β=-0.040）、糖尿病罹病年數（β=0.07）、BMI（β=0.13）能預測糖化血色素值，解釋32.2%變異量。結論：主觀睡眠品質的好壞與第二型糖尿病患者的血糖控制具有相關性，本研究結果提供臨床照護者將睡眠品質評估納入糖尿病患者血糖控制的重要參考。

關鍵字

第二型糖尿病 ； 主客觀睡眠品質 ； 血糖控制

並列摘要

Objectives: Type 2 diabetes and the health problems associated with type 2 diabetes threaten the health of the people in Taiwan. The purpose of this study was to determine the relationship between subjective and objective sleep quality on glycemic control of patients with type 2 diabetes. Methods: This study used a purpose sampling and cross-sectional study design to recruit type 2 diabetes patients from an outpatient endocrinology and metabolism clinic at a medical center in central Taiwan. A total of 61 patients completed questionnaires and were followed for 1 year. The Pittsburgh Sleep Quality Index (PSQI) measurements and wrist actigraphy (Somnowatch) measures for 72 h (24 h * 3 days) were collected. Glycemic control was followed for 1 year by reviewing the glycated hemoglobin (HbA1c) data in medical records. The SPSS 17.0 software package was used for statistical analysis. Results: The results showed poor glycemic control in patients with type 2 diabetes, with an average HbA1c of 7.9±1.6% and a fasting glucose value (AC sugar) of 162.1±45.4 mg/dl. The majority of patients (72.2%) had poor glycemic control (HbA1c＞ 7.0%). The subjective sleep quality was poor, with a global PSQI score of 6.6±4.1; 57.4% of patients had a PSQI score ＞ 5. The objective sleep hours were inadequate, as follows: average total sleep time, 5.7 hours; sleep efficiency, 75.3%; sleep latency, 25.5 min; and awake time after sleep onset, 63.3 min. Linear multiple regression analysis showed that perceived sleep efficiency (β=-0.040), duration of diabetes (β=0.07), and BMI (β=0.13) predicted the value of HbA1c with 32.2% of variance. Conclusions: Subjective sleep quality was shown to be associated with glycemic control in patients with type 2 diabetes. The results of this study suggest the importance of assessing patient sleep quality on managing glycemia in patients with type 2 diabetes.

並列關鍵字

type 2 diabetes ； subjective and objective sleep quality ； glycemic control

參考文獻

Shaw, JE,Punjabi, NM,Wilding, JP,Alberti, KG,Zimmet, PZ,International Diabetes Federation Taskforce on Epidemiology and Prevention(2008).Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention.Diabetes Res Clin Pract.81,2-12.

衛生福利部國民健康署：2015年國人死因統計。台北：衛生福利部國民健康署，2016。Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Annual Report on the Cause of Death Statistics, 2015. Taipei: Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan), 2016. [In Chinese]

衛生福利部國民健康署：國民營養健康狀況變遷調查。台北：衛生福利部國民健康署，2016。Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Nutrition and Health Survey in Taiwan (NAHSIT). Taipei: Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan), 2016. [In Chinese]

Vigg, A(2003).Sleep in type 2 diabetes.J Assoc Physicians India.51,479-81.

Knutson, KL,Ryden, AM,Mander, BA,Van Cauter, E(2006).Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus.Arch Intern Med.166,1768-7.