第2型糖尿病患者之糖尿病控制、疾病適應、睡眠衛生習慣與其睡眠品質之相關性探討

The Relations of Diabetes Control, Disease Adaptation , Sleep Hygiene and Sleep Quality in Type 2 Diabetic Patients.

汪宜靜(I-Ching Wang)

指導教授 ： 胡益進

國立臺灣師範大學/教育學院/健康促進與衛生教育學系在職進修碩士班/碩士(2013年)

摘要

本研究目的在瞭解第2型糖尿病人的睡眠品質與其社會人口學特、糖尿病控制狀況、疾病調適狀況、睡眠衛生習慣之關係。研究方法為橫斷式相關設計，採用結構式問卷，對象為北部某醫學中心第2型糖尿病病人，共304位。本研究主要結果如下：
一、 睡眠品質平均得分7.80±2.97分，其中睡眠品質不佳（PSQI > 5）
有77.0%，睡眠干擾中頻率較高的項目依序為「半夜上廁所」，「半夜或清晨醒來後不易入睡」，「咳或打鼾」。整體睡眠效率平均83.3％±13.4%，有38.8%的病人睡眠效率低於85%；半夜或清晨醒來後不易入睡平均為每週1.87±1.14次，入睡所需時間平均為18.81±16.78分鐘，有9.9%的病人其入睡所需時間大於30分鐘；夜間睡眠時數平均6.21±1.20小時，夜間睡眠時數小於6小時者佔30.6％，有使用安眠藥物的病人只有13.8%，但主觀認為睡眠品質非常差的病人有4.3%，不好的有13.8%。
二、 血糖、血壓與血脂控制與睡眠品質無顯著相關。女性睡眠品質較差，退休者比就業中差，由自己及他人供養都有者比自給自足者差，自己單獨睡比只與配偶同睡者差，低血糖次數最近一個月2-3次或4次以上者比沒有及只有1次者睡眠品質差。疾病調適較差者或睡眠衛生習慣較差者，其睡眠品質較差。
三、疾病調適所有變項皆與睡眠品質顯著相關，其中以「擔心、害怕」相關性最高，其次為「緊張、焦慮」、「難過、沮喪」。睡眠衛生習慣變項中以「睡前擔心睡不著」相關性最高，其次為「寢具不舒服」、「臥室溫度不舒服」。
四、性別、年齡、職業、低血糖、疾病調適總分、睡眠衛生習慣總分可顯著預測夜間睡眠品質，可解釋睡眠品質的總變異量是26.7%，其中「疾病調適總分」最具解釋力。

結論：女性、已退休、經常擔心、害怕，緊張、焦慮，難過、沮喪或常低血糖的糖尿病患都是睡眠障礙的高危險群，將來可針對睡眠品質較差者進行相關之衛教活動或轉介睡眠中心處理其相關問題。

關鍵字

糖尿病 ； 睡眠品質 ； 疾病調適狀況 ； 睡眠衛生習慣

並列摘要

Purpose: To assess the association of sleep quality with the demographics, glycemic control, disease adaptation, and sleep hygiene in persons with type 2 diabetes.
Method: A total of 304 type 2 diabetics from a medical center in north Taiwan participated in this cross- sectional study. A structural questionnaire was designed to collect the information .
Results:
1. The mean PSQI score was 7.80±2.97, and 77.0% were poor sleepers (PSQI>5). The leading causes to disturb night sleep were “nocturia”, “difficulty in falling asleep after waking up”, and “cough or snoring”. The global sleep efficiency was 83.3%±13.4 and 38.8% with sleep efficiency less than 85%. The rate of difficulty in falling asleep after waking up in mid-night or early morning was 1.87±1.14 times per week. Mean sleep incubation time was 18.81±16.78 minutes and 9.9% of them with incubation time more than 30 minutes. The average sleeping hours in night time were 6.21±1.20 hours and 30.6% slept less than 6 hours at night. Only 13.8% of the participants took hypnotics. But very poor sleep quality was felt subjectively by 4.3% of them and poor sleep quality by 13.8%.
2. There was no correlation between hyperglycemia, hypertension, hyperlipidemia control and sleep quality. Female had poorer sleep quality than male. Retirees had poorer sleep quality than workers. Sleep quality was poorer in economic support from both self and others than from oneself only. Patients who slept alone had poorer quality than those slept with wife. In patients with hypoglycemic episodes more than two times a month had poorer sleep quality than those with no or just one episode of hypoglycemia. Sleep quality was poorer in those with poor disease adaptation or poor sleep hygiene.
3. All of the variants of disease adaptation were closely correlated with sleep quality, especially “worried, scared”, followed by “nervous, anxiety” and “sad, depression”. In variants of sleep hygiene, the most correlated one was “worried about poor sleep before sleep”, followed by “unpleasant bedding” and“unpleasant bedroom temperature”.
4. Sex, age, occupation, hypoglycemia, scores of disease adaptation and scores of sleep hygiene can predict significantly night time sleep quality. The total variance was 26.7% and the most significant one was “scores of disease adaptation”.

Conclusion:
Female, retired, emotion of“worried, scared”,“nervous, anxiety”,“sad, depression” and frequent hypoglycemic diabetic patients are high risk groups of sleep disorder. In the future, we can help these patients by promoting relevant educational activities or transferring them to sleep center.

並列關鍵字

diabetes ； sleep quality ； disease adaptation ； sleep hygiene

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