癌症兒童住院期間與返家後睡眠品質及相關因素之研究

Quality of Sleep and Related Factors in Children with Cancer During and After Hospitalization

藍湘勻(Hsiang-Yun Lan)

指導教授 ： 李雅玲

國立臺灣大學/醫學院/護理學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.02101

摘要

睡眠型態改變是癌症病童住院期間非常普遍的問題，是否影響癌症病童及主要照顧者住院期間的身心狀況，是值得探討的問題。因此，本研究主要目的為探討癌症病童住院期間之睡眠品質及相關因素，比較住院期間與出院後的睡眠品質差異，並探討影響睡眠品質的預測因子。
本研究採縱貫式及相關性之研究調查，以立意取樣方式於台北市某醫學中心之癌症兒童病房調查年齡為7-18歲住院中癌症病童，運用結構式問卷(包括「病童基本屬性資料表」、「睡眠衛生量表」、「兒童多向度疲憊量表」、「記憶症狀評估量表」、「睡眠品質量表」及睡眠日誌)、24小時活動監測器（腕動計）及病歷查閱來進行資料收集。分三個時間點進行資料收集，分別收集研究參與者住院接受化學治療中的第一天及第五天兩次資料及返家後五天的ㄧ次資料。
研究結果：本研究共收得20位研究參與者、總計60次的資料，其年齡分布7-17歲，平均年齡12±0.67歲，75％為男童，此次住院天數平均35.8±6.9天，疾病診斷以白血病（35％）及神經母細胞瘤（35％）居多。相關性分析結果，有使用止痛藥的研究參與者在住院第五天及返家，睡眠品質是顯著較差的(住院第五天F=5.88，p=0.03；返家F=4.24，p=0.05)，有使用安眠藥的研究參與者睡眠品質也是顯著較差的(F=5.09，p=0.04)；在身心健康部分，住院第五天與返家期間，疲憊總分皆與睡眠品質總分呈顯著正相關，表示疲憊情形越高，睡眠品質越差（r=0.44-0.46，p=0.04-0.05）；在記憶症狀部分，無論在住院第一天、第五天或返家，記憶症狀總分皆與睡眠品質總分呈顯著正相關（r=0.53-0.62，p=0.00-0.02），表示症狀發生的頻率、嚴重度及困擾程度越高，睡眠品質越差；而在睡眠衛生部分，無論在住院期間或返家後，睡眠衛生和睡眠品質之間並無明顯的相關性。
在住院期間與返家後睡眠品質的比較上，返家後的主觀睡眠品質比住院期間的主觀睡眠品質為佳(t=4.76，p<0.01)；在睡眠日誌部分及腕動計的部份，研究參與者住院期間平均夜間醒來次數明顯高於返家期間夜間醒來次數，且在每日主觀的睡眠品質及精神上，也顯示返家期間的睡眠品質及精神皆比住院期間好。經由線性混合分析模式(mixed model)檢定，記憶症狀及有無使用止痛藥是預測睡眠品質的重要因子。
期能以此研究結果作為臨床照護之依據，加強醫護人員對癌症兒童住院期間睡眠問題的重視，進而提升照護品質並改善癌症病童及家屬住院品質。

關鍵字

癌症兒童 ； 睡眠品質 ； 睡眠衛生 ； 腕動計

並列摘要

Changes in sleep patterns in children with cancer may be a very common problem during hospitalization. The quality of sleep in cancer children during hospitalization thus warrants detailed investigation. The purposes of current research were: (1) to investigate the quality of sleep and related factors, (2) to compare the differences in quality of sleep between hospitalization and after discharge, and (3) to explore predictors of quality of sleep in children with cancer.
A longitudinal and correlation design was used. Children with cancer aged 7-18 years old were enrolled from a medical center in Taipei. Data collection used a set of questionnaires including a Personal Information Form, the Adolescent Sleep Hygiene Scale, the PedsQL Multidimensional Fatigue Scale, the Memorial Symptom Assessment Scale, the Sleep Quality Index, a sleep log, and a 24-hour activity monitor (wrist actigraph) and chart review. Information was collected at three time points, the first day and fifth day of a cycle of hospitalization for chemotherapy and the fifth day after discharge.
A total of 20 participants (with 60 pieces of data) were recruited for the analysis. The average age of participants was 12 ± .67 years with a range of 7-17 years. Seventy five percent of the participants were boys. Most of the participants were diagnosed with leukemia (35%) and neuroblastoma (35%). The average of length of hospital stay was 35.8 ± 6.9 days. The use of pain medicine was correlated with significantly poorer quality of sleep at both day 5 and at home after discharge (F = 5.88, P =.03, F = 4.24, P = .05, respectively). Those participants who used sleep medicine had significantly poorer quality of sleep (F = 5.09, P = .04). With respect to psycho-somatic health, fatigue was significantly positively correlated with negative quality of sleep at both day 5 and at home after discharge (r = 0.44-0.46, P = 0.04-0.05). The severity, frequency, perplexity of symptom was significantly positively correlated with negative quality of sleep at all three time points (r = 0.53-0.62, P = 0.00-0.02). That is, the higher the scores of frequency, severity and suffering scores, the poorer of quality of sleep. With respect to sleep hygiene, there was no significant correlation between hospitalization and sleeping at home, and between sleep hygiene and quality of sleep.
Sleep at home was perceived to be of higher quality at home than that during hospitalization by participants (t = 4.76, P < 0.01). The results recorded by sleep log and wrist actigraph showed that the frequency of awakening at night was higher during hospitalization and subjects had better quality of sleep and mental health at home after discharge. Using the statistical method of Mixed model, the severity, frequency, perplexity of symptom and does use the pain-killer are the important variables to predict the sleep quality.
The findings of the current study provide evidence for clinical practice and increase feasibility of this issue for the health care providers. They may also improve the quality of care and life during hospitalization for both cancer children and their caregivers.

並列關鍵字

childhood cancer ； quality of sleep ； sleep hygiene ； actigraph

參考文獻

鄧錦榮（2003）．老年人規律運動與睡眠品質之相關研究．師大體育，47，185-192。

葉曉萍（2006b）．氣喘學齡兒童睡眠品質及其相關性因素之研究．未發表的碩士論文．台北：國立台灣大學護理研究所。

葉世彬 ( 2003)．孩童的睡眠問題．台灣醫學，46（5），14-18。

王秀禾、葉美玲、鍾律琳、楊千慧 ( 2008）．應用耳穴貼壓改善睡眠之成效．實證護理，4（3），243-250。

許琦珍、張文慧、施榮恩 ( 2008）．重症病人睡眠品質改善專案．澄清醫護管理雜誌，3（4），47-53。