海洛因成癮者睡眠障礙及相關因子之研究

Sleep Disturbance and Related Factors among Heroin-dependent Patients

吳孟寰(Meng-Huan Wu)

指導教授 ： 丁化

中山醫學大學/醫學院/醫學研究所/碩士(2017年)

摘要

研究目的：睡眠障礙(sleep disturbance)為海洛因成癮(heroin dependence)者一常見共病，也對其治療預後、身心健康、及生活品質有重大的影響。過去研究對象多侷限於正在接受美沙酮治療的個案，關於治療前的海洛因成癮者之研究相對缺乏。目前為止尚未有研究在探討海洛因成癮者之睡眠障礙與成癮嚴重度(severity of dependence)的關係。本研究旨在探討治療前的海洛因成癮者之睡眠障礙盛行率，以及研究睡眠障礙與人口統計學特性、物質相關特性、物質成癮嚴重度、憂鬱症狀嚴重程度及生活品質等的關係。
研究方法及資料：本研究以西元2008年至2014年參與衛生福利部草屯療養院美沙酮維持療法計畫(methadone maintenance treatment, MMT)以及治療性社區(therapeutic community, TC)的海洛因成癮者為研究對象。運用匹茲堡睡眠品質量表(Pittsburgh Sleep Quality Index, PSQI)作為評估睡眠之工具。睡眠障礙(sleep disturbance)的定義為PSQI總分超過5分。本研究經資料蒐集完成之後，以t-test、chi-square tests以及multivariate logistic regression分析上述變項與睡眠障礙之相關性。
研究結果：514位海洛因成癮者之睡眠障礙(sleep disturbance)盛行率為76.3%。與無睡眠障礙者相比，有睡眠障礙(sleep disturbance)的海洛因成癮者有較多的生活重大事件、無業、吸菸量、注射者和物質相關犯罪史、較長的海洛因使用時間、較嚴重的物質成癮和憂鬱、以及較差的生活品質。在控制其他變項後，物質成癮嚴重度、憂鬱嚴重度、及生活品質仍與睡眠障礙有顯著相關。
結論與建議：本研究發現海洛因成癮者有很高的睡眠障礙盛行率。睡眠障礙與較高的物質成癮嚴重度、較嚴重的憂鬱症狀以及較差的生活品質顯著相關。因此，建議針對海洛因成癮者提供睡眠品質的早期評估與治療。

關鍵字

海洛因成癮 ； 睡眠障礙 ； 憂鬱 ； 生活品質

並列摘要

Background/Objectives: Sleep disturbance is common and may adversely affect treatment outcome, mental health, and quality of life in heroin-dependent patients.
Participants in previous studies have focused upon patients receiving treatment. Less is known about patients before treatment, and the association between sleep disturbance and severity of dependence. We conducted a cross-sectional descriptive study and explored the 1-month prevalence of sleep disturbance and its associations with socio-demographic, substance-related characteristics, severity of dependence, depression, and quality of life.
Methods: The sample (n=514) comprised individuals with heroin dependence attending the methadone maintenance treatment program and the therapeutic community at a psychiatric center in Nantou, Taiwan between 2008 and 2014. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) with a global score greater than 5 indicating sleep disturbance. Centre for Epidemiologic Studies Depression Scale, Severity of Dependence Scale, and World Health Organization Quality of Life-BREF were also approached. T-test, chi-square tests, and multivariate logistic regression were performed to measure associations between variables and sleep disturbance.
Results: The 1-month prevalence of sleep disturbance (PSQI>5) was 76.3% among 514 subjects with heroin dependence. Heroin users with sleep disturbance had significantly more life events in the previous year, higher rate of unemployment, greater cigarette consumption, longer length of heroin use, higher rate of injectors, greater severity of dependence, greater severity of depression, and lower quality of life compared to those without sleep disturbance. Severity of dependence, severity of depression, and physical health domain of quality of life remained significantly associated with sleep disturbance after adjusting for other variables.
Conclusion: Heroin-dependent patients had a high 1-month prevalence of sleep disturbance, and which was associated with greater severity of dependence, depression, and poorer physical health-related quality of life. Early assessments and interventions for sleep disturbance among patients with heroin dependence are recommended.

並列關鍵字

Heroin dependence ； Sleep disturbance ； Depression ； Quality of life

參考文獻

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