睡眠衛生行為量表之信效度探討

目的：不適當的睡眠衛生行為經常被視為干擾睡眠及持續慢性失眠的重要因素，國外研究亦對不適當的睡眠衛生行為是否影響睡眠品質常有不一致的研究結果。本研究認為，不一致的結果可能是由於睡眠衛生行為的本質是多因素建構的概念或過去測量睡眠衛生行為之量表信效度不佳導致，故研究目的為發展多因素建構的睡眠衛生行為量表，對正常睡眠者與失眠者族群進行此量表之信效度考驗。方法：本研究由睡眠中心／精神科門診招募106位失眠患者，根據其教育程度、性別、年齡分佈配對89位正常睡眠者，填答中文匹茲堡睡眠品質量表、失眠嚴重度量表、睡眠衛生行為量表等問卷。結果：顯示睡眠衛生行為量表於兩組樣本中有類似的因素建構，分為「睡眠規律性」、「焦慮相關行為」、「睡前飲食習慣」及「睡眠環境」等四個面向。此四因素有可接受的內部一致性信度及因素效度。於正常睡眠族群中，四因素有良好的效標關聯效度；在失眠族群，只有「焦慮相關行為」此因素與睡眠品質及失眠嚴重度有顯著相關。此外，「焦慮相關行為」此因素可以有效區辨正常睡眠族群與失眠族群的差異。結論：睡眠衛生行為量表顯示此量表信效度比過去測量睡眠衛生行為之量表完整且穩定，多因素的測量概念可更細緻的描述不同睡眠衛生行為對睡眠的干擾程度，有利於未來研究瞭解睡眠衛生行為對睡眠的影響，亦可整體且有結構的提供臨床工作者做為睡眠衛生教育或失眠治療介入之參考。

關鍵字

睡眠衛生；睡眠習慣；失眠；睡眠品質

並列摘要

Objective: Poor sleep hygiene practices can interfere with sleep and may be a contributing factor for insomnia. Only few instruments have been developed to assess sleep hygiene practices. Most of them had only fair internal consistency, limited construct validity, and/or were tested only in non-clinical population. The aim of the study was to evaluate the psychometric properties of the Sleep Hygiene Practice Scale (SHPS) that we developed for the measurement of poor sleep hygiene practices.Method: A total of 89 normal sleepers and 106 insomniacs participated in the study. SHPS, Chinese Pittsburgh Sleep Quality Index (CPSQI) and Insomnia Severity Index (ISI) were administered.Result: The finding showed that normal sleepers and insomniacs showed similar factor structure in the SHPS. The SHPS contained four factors: (1) sleep schedule and timing, (2) arousal-related behaviors, (3) poor eating/drinking habits prior to sleep, and (4) poor sleep environment. Internal consistency and Goodness of Fit indexes were acceptable. The SHPS demonstrated good criterion-related validity for all factors in related to measures of sleep quality in normal sleepers; however ”arousal-related behaviors” was the only factor that was correlated with sleep quality in insomniacs. Finally, the result showed ”arousal-related behaviors” could differentiate insomniacs from normal sleepers.Conclusion: The SHPS contained four factors. The psychometric properties of the SHPS were found to be superior to previously published sleep hygiene instruments. It can be a useful measure to be applied for both research and clinical purposes.