臺灣博碩士論文加值系統

中文摘要
失眠為慢性阻塞性肺部疾病病患的重要困擾，睡眠障礙不僅造成病患身心不適、干擾日常活動，更降低了病患的生活品質。目前慢性阻塞性肺部疾病的研究多著重在呼吸困難、疲憊、身體功能狀態方面，對於睡眠品質方面的研究則是闕如。因此本研究之目的在探討慢性阻塞性肺部疾病病患的睡眠品質現況，影響睡眠品質的相關因素。
本研究採橫斷性、描述相關性研究(cross-sectional descriptive correlational study)，以台北地區某醫學中心胸腔內科門診為研究場所，以慢性阻塞性肺部疾病病患為研究對象，採立意取樣之方式選取符合收案條件個案共77名。研究採取微型活動計錄器(Mini- Motionlogger Actigraph)及匹茲堡睡眠品質問卷(PSQI)及雙重測量，所收集資料以次數分配、百分比、卡方檢定(chi-square)、曼-惠特尼U檢定(Mann-Whitney U test)及邏輯式迴歸(logistic regression)分析等方法進行資料分析。
研究結果發現：( 1 )慢性阻塞性肺部疾病病患的匹茲堡睡眠品質量表平均得分8.74 ± 4.12，睡眠品質良好者(PSQI≦5分)有19人(24.7 %)，睡眠品質不良者(PSQI＞5分)有58人(75.3 %)；( 2 )慢性阻塞性肺部疾病病患之肺功能值、GOLD疾病分期、慢性疾病總數、服用藥物總數、身體症狀、焦慮、憂鬱與問卷評量之睡眠品質有顯著相關；即慢性阻塞性肺部疾病病患的肺功能愈差、GOLD疾病分期愈嚴重、慢性疾病總數愈多、服用藥物總數愈多、身體症狀愈嚴重、焦慮程度愈高、憂鬱程度愈高，則睡眠品質愈差；( 3 )將睡眠品質以邏輯式迴歸(logistic regression)分析顯示：服用藥物總數與第一秒用力肺活量預測值(FEV1 % pred)為慢性阻塞性肺部疾病病患問卷評量睡眠品質的最重要預測因子；( 4 )在儀器測量睡眠品質方面，慢性阻塞性肺部疾病病患夜眠平均活動度為34.72 ± 19.05 counts/10sec，客觀睡眠時間平均值為282.68 ± 91.98分，客觀睡眠效率平均值為82.72 ± 13.90 %，客觀睡眠潛伏期平均值為82.72 ± 13.90分，睡眠醒覺次數平均值為7.86 ± 4.88 次/天，最長連續睡眠時間平均值為82.53 ± 46.43分；( 5 ) 客觀睡眠效率85 %以上為睡眠品質良好，未滿85 %為睡眠品質不良，經由邏輯式迴歸(logistic regression)分析顯示儀器測量睡眠品質的最佳預測因子為：年齡、第一秒用力肺活量預測值(FEV1 % pred)、運動習慣。研究結果可提供臨床護理人員，在照顧慢性阻塞性肺部疾病病患瞭解其可能面臨之睡眠問題及其相關因素，發展適當及以研究為基礎之護理措施，進而提昇照護品質。

Insomnia causes severe distress in patients with chronic obstructive pulmonary disease (COPD). Sleep disturbance not only make patients uncomfortable and interfere their daily activities, but also decrease their quality of life. Studies relating to patients with COPD have focus on dyspnea, fatigue, health status than sleep disturbance. There is no related sleep quality research in patients with COPD in Taiwan. Hence, the purpose of this study was investigated the sleep quality and related factors in patients with COPD.
The cross-sectional and descriptive designed was used in the study. Seventy-seven patients were recruited from the chest outpatient department in teaching hospitals in Taipei City. The inventory included PSQI and Mini- Motionlogger Actigraph. The frequency, percentage, chi-square, Mann-Whitney U test, and logistic regression were used to analyze data.
The results demonstrated that the average PQSI global score of the total subjects was 8.74 ± 4.12 , there were nineteen (24.7 %) patients in good sleep quality(PSQI ≤ 5), and fifty-eight(75.3 %) patients in poor sleep quality(PSQI > 5). The pulmonary function, stages of Global Initiative for Chronic Obstructive Lung Disease (GOLD), overall category of chronic diseases, overall category of drugs, physical symptoms, anxiety, depression, and sleep quality measured by questionnaire revealed significant differences. The patients who had lower pulmonary function, more serious disease stage, more kinds of chronic diseases, more kinds of drugs used, more serious physical symptoms, and higher score of anxiety and depression had poor sleep quality. The researchers further analyzed sleep quality with logistic regression analysis. The results indicated that overall category of drugs and FEV1 % were the significant predictors of sleep quality measured by questionnaires. The mean of night activity was 34.72 ± 19.05 counts/ 10sec; the objective sleep time was 282.68 ± 91.98 minutes/ day; the objective sleep efficiency was 82.72 ± 13.90 %; the objective night awakening was 7.86 ± 4.88 times/ day; and the longest sleep time was 82.53 ± 46.43 minutes. In this study, objective sleep efficiency up 85 % was defined as good sleep quality and below 85 % as poor sleep quality. Data was analyzed with logistic regression analysis. The result showed that age, FEV1 %, and exercise were the significant predictors of sleep quality measured by Mini- Motionlogger Actigraph. Bases on this study, we suggest that a awareness of the importance of understanding sleep problem and related factors in patients with COPD will be necessary to enable future testing of research-based interventions and increase the quality of COPD care.

正文目錄
正文目錄.................................................Ⅰ
「表」目錄...............................................Ⅲ
「圖」目錄...............................................Ⅳ
中文摘要.................................................Ⅴ
英文摘要.................................................Ⅶ
第壹章 緒論..............................................1
第一節 研究動機與重要性.........................................1
第二節 研究目的.................................................4
第貳章 文獻查證..........................................5
第一節 慢性阻塞性肺部疾病之相關概念.............................5
第二節 睡眠生理學..............................................10
第三節 睡眠品質的概念及評量....................................14
第四節 影響睡眠品質的因素及其相關研究..........................21
第參章 概念架構.........................................32
第一節 概念架構................................................32
第二節 名詞界定................................................33
第三節 研究問題................................................38
第肆章 研究方法與過程...................................39
第一節 研究設計................................................39
第二節 研究對象與場所..........................................40
第三節 研究工具................................................42
第四節 資料收集過程定..........................................49
第五節 研究倫理考量............................................50
第六節 資料處理與分析..........................................51
第伍章 研究結果.........................................52
第一節 慢性阻塞性肺部疾病病患基本資料..........................52
第二節 慢性阻塞性肺部疾病病患睡眠環境、疲憊、心理狀態之
描述....................................................55
第三節 慢性阻塞性肺部疾病病患睡眠品質之分佈....................56
第四節 慢性阻塞性肺部疾病病患睡眠品質與基本資料的關係..........64
第五節 慢性阻塞性肺部疾病病患睡眠品質與睡眠環境、疲憊、
心理狀態的關係..........................................73
第六節 慢性阻塞性肺部疾病病患睡眠品質的預測因子................75
第陸章 討論.............................................78
第一節 慢性阻塞性肺部疾病病患問卷評量睡眠品質及其影響因素.....78
第二節 慢性阻塞性肺部疾病病患儀器測量睡眠品質及其影響因素.....86
第三節 慢性阻塞性肺部疾病病患睡眠品質之重要預測變項...........92
第柒章 研究結論與建議...................................94
第一節 結論...................................................94
第二節 建議...................................................98
第三節 研究限制..............................................101
參考資料................................................103
中文部分......................................................103
英文部分......................................................107

「表」目錄
表一 慢性阻塞性肺部疾病病患之人口學特性..........................123
表二 慢性阻塞性肺部疾病病患之疾病嚴重度..........................124
表三 慢性阻塞性肺部疾病病患之疾病特性............................125
表四 慢性阻塞性肺部疾病病患之身體症狀............................126
表五 慢性阻塞性肺部疾病病患之生活型態............................127
表六 慢性阻塞性肺部疾病病患睡眠環境之分佈情形....................128
表七 慢性阻塞性肺部疾病病患之心理狀態............................129
表八 匹茲堡睡眠品質量表(PSQI)七個構成要素的得分..................130
表九 睡眠困擾之分佈情形..........................................131
表十 匹茲堡睡眠品質量表各因素之分佈情形..........................132
表十一 匹茲堡睡眠品質之史丕曼排序相關.............................133
表十二 客觀睡眠品質變項之分佈.....................................134
表十三 客觀睡眠品質變項之史丕曼排序相關...........................135
表十四 慢性阻塞性肺部疾病病患基本資料與問卷評量睡眠品質
之檢定.....................................................136
表十五 慢性阻塞性肺部疾病病患基本資料與儀器測量睡眠品質
的關係.....................................................137
表十六 慢性阻塞性肺部疾病病患睡眠環境、疲憊、心理狀態與
問卷評量睡眠品質之檢定....................................139
表十七 慢性阻塞性肺部疾病病患睡眠環境、疲憊、心理狀態與
儀器測量睡眠品質的關係...................................140
表十八 慢性阻塞性肺部疾病病患之疾病嚴重度分期、合併其它
慢性疾病與問卷評量睡眠品質之檢定.........................141
表十九 慢性阻塞性肺部疾病病患之疾病嚴重度分期、合併其它
慢性疾病與儀器測量睡眠品質之檢定.........................142
表二十 使用逐步邏輯式迴歸分析( logistic regression )預測問卷
評量睡眠品質.............................................144
表二十一 使用逐步邏輯式迴歸分析( logistic regression )預測儀
器測量睡眠品質...........................................144
「圖」目錄
圖一 研究架構.....................................................32

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