臺灣博碩士論文加值系統

睡眠障礙普遍且嚴重地影響了肺癌患者的生活，欲改善其睡眠問題之首要步驟有賴於審慎的睡眠評估與監測。本研究目的為探討不同睡眠測量工具所測得肺癌病患睡眠品質各層面所代表之參數值 (parameter) 的一致性程度，及影響其一致性之因素。採重複測試性研究設計，立意取樣第Ⅲ期或第Ⅳ期接受化學治療的肺癌病患，連續施測7天。正式分析共24位病患，研究結果發現腕動計與睡眠日誌一致性較佳的參數為睡眠潛伏期與總睡眠時間，ICC= .478 ~ .605；而睡眠效率、睡眠中斷時間與次數、白天小睡時間與次數之ICC為.003至.274。腕動計與匹茲堡睡眠品質量表一致性較佳之參數為躺床時間、總睡眠時間與睡眠效率，ICC= .492 ~ .724；睡眠潛伏期之ICC則僅.064。以Bland & Altman plot 發現，睡眠潛伏期、睡眠中斷時間及白天小睡時間愈長，主客觀工具間的一致性愈差(即兩工具差值的變異性愈大)；而睡眠中斷次數及白天小睡次數愈多，主客觀工具間的差距值愈大。病患佩戴腕動計的類型、睡眠地點、是否獨睡、有無睡眠困擾、有無焦慮或憂鬱情形皆會影響主客觀工具間的一致性。因此建議未來運用腕動計評估病患之睡眠情形時，對於本研究所發現影響主客觀測量工具一致性之因素能夠加以控制，並在腕動計的選擇上應採用具Event Marker者為佳。

Sleep disturbance is the most common problem experienced by lung cancer patients. The purposes of that study were to (1) examine the consistency of sleep parameters measured by wrist actigraphy, sleep diary, and Pittsburgh Sleep Quality Index (PSQI); and (2) evaluate the related factors. Based on 7 day’s data from 24 patients with lung cancer under chemotherapy, this study found that there was a good agreement between actigraphy and sleep diary in determining sleep latency and total sleep time (ICC = .478 - .605). However, poor agreement were found in sleep efficiency, wake after sleep onset (WASO) time, WASO bouts, nap time and nap bouts (ICC = .003 - .274). For consistency between actigraphy and PSQI, good agreement was found in bed time, total sleep time and sleep latency (ICC = .492 - .724), but poor agreement in sleep latency (ICC = .064). The Bland & Altman plot showed worse agreement between different assessment methods was associated with the longer of sleep latency, WASO time, WASO bouts, nap time and nap bouts. Actigraphy type, sleeping location, sleeping alone, sleep disturbances, anxiety or depression were factors that influenced the agreement between the methods. The findings of this study suggest that using actigraphy to assess the sleep parameters may need to control for the related factors, and use of build-in event marker of actigraphy may help reducing inconsistency.

目錄
第一章 緒論……………………………………………………………………………1
第一節 研究背景與重要性……………………………………………………………1
第二節 研究動機………………………………………………………………………3
第三節 研究目的………………………………………………………………………5
第四節 研究問題………………………………………………………………………5
第二章 文獻查證………………………………………………………………………6
第一節 肺癌相關概念…………………………………………………………………6
第二節 睡眠之相關概念及其測量……………………………………………………9
第三節 比較兩睡眠測量工具所得睡眠數值一致性之相關研究……………………20
第三章 研究方法………………………………………………………………………34
第一節 研究設計………………………………………………………………………34
第二節 研究對象與場所………………………………………………………………35
第三節 資料收集方法…………………………………………………………………36
第四節 研究工具………………………………………………………………………38
第五節 資料分析方法…………………………………………………………………51
第四章 研究結果與分析………………………………………………………………54
第一節 肺癌病人基本資料……………………………………………………………54
第二節 各睡眠測量工具所得睡眠參數值……………………………………………60
第三節 各睡眠測量工具所得睡眠參數值之一致性…………………………………63
第四節 有無使用Event Marker在各睡眠參數中之一致性…………………………69
第五章 討論……………………………………………………………………………87
第一節 不同睡眠測量工具所得肺癌病患睡眠品質各參數值………………………87
第二節 腕動計與睡眠日誌在各睡眠參數中之一致性………………………………94
第三節 腕動計、睡眠日誌與匹茲堡睡眠品質量表在各睡眠參數中之一致性……100
第四節 影響主客觀睡眠測量工具一致性之因素……………………………………101
第六章 結論與建議……………………………………………………………………105
第一節 結論……………………………………………………………………………105
第二節 研究限制………………………………………………………………………107
第三節 建議……………………………………………………………………………109
參考資料………………………………………………………………………………111

圖表目錄
圖3-1 研究概念架構…………………………………………………………………34
表2-1 各睡眠測量工具之特點………………………………………………………19
表2-2 比較主、客觀測量睡眠品質工具之相關研究………………………………24
表3-1 資料收集時間點………………………………………………………………37
表3-2 各項睡眠數值於不同工具之測量方法………………………………………41
表3-3 各睡眠測量工具所測得之睡眠參數…………………………………………53
表4-1 肺癌病人人口學特性…………………………………………………………55
表4-2 肺癌病人疾病特性……………………………………………………………57
表4-3 肺癌病人治療特性……………………………………………………………58
表4-4 肺癌病人測量特性……………………………………………………………59
表4-5 腕動計、睡眠日誌與匹茲堡睡眠品質量表所得各睡眠參數值……………62
表4-6 腕動計與睡眠日誌所得各睡眠參數值之一致性……………………………64
表4-7 腕動計與匹茲堡睡眠品質量表之一致性……………………………………66
表4-8 睡眠日誌與匹茲堡睡眠品質量表之一致性…………………………………68
表4-9 以Event Marker或睡眠日誌設定之躺床時間所得各睡眠參數………………70
表4-10 以Event Marker或睡眠日誌設定之躺床時間所得各睡眠參數之一致性…71
表4-11 影響腕動計與日誌一致性因素之單變量分析………………………………76
表4-12 影響腕動計與匹茲堡睡眠品質量表一致性因素之單變量分析……………82
表5-1 以睡眠日誌測得之睡眠參數與過去相關研究之比較………………………90
表5-2 以腕動計測得之睡眠參數與過去相關研究之比較…………………………91
表5-3 腕動計與睡眠日誌之差值與過去相關研究之比較…………………………97

附件目錄
附件一 單因子與雙因子隨機效果模式及雙因子固定模式之變異數分析………126
附件二 「活動記錄手錶」使用注意事項…………………………………………127
附件三 睡眠日誌……………………………………………………………………128
附件四 匹茲堡睡眠品質量表………………………………………………………130
附件五 匹茲堡睡眠品質量表計分標準……………………………………………131
附件六 肺癌病人化療日、住院與回家時間一覽表………………………………136
附錄七 不同天數睡眠日誌所得躺床時間…………………………………………137
附圖1 腕動計、睡眠日誌與匹茲堡睡眠品質量表所得睡眠參數(單位：分鐘)…139
附圖2 腕動計與睡眠日誌所得睡眠參數(單位：次數)……………………………139
附圖3 腕動計、睡眠日誌與匹茲堡睡眠品質量表所得睡眠效率………………140
附圖4 腕動計與睡眠日誌所得睡眠潛伏期之一致性……………………………140
附圖5 腕動計與睡眠日誌所得總睡眠時間之一致性……………………………141
附圖6 腕動計與睡眠日誌所得睡眠中斷時間之一致性…………………………141
附圖7 腕動計與睡眠日誌所得睡眠中斷次數之一致性…………………………142
附圖8 腕動計與睡眠日誌所得睡眠效率之一致性………………………………142
附圖9 腕動計與睡眠日誌所得白天小睡時間之一致性…………………………143
附圖10 腕動計與睡眠日誌所得白天小睡次數之一致性…………………………143
附圖11 腕動計與睡眠日誌所得各項參數之ICC…………………………………144
附圖12 腕動計與匹茲堡睡眠品質量表所得躺床時間之一致性…………………145
附圖13 腕動計與匹茲堡睡眠品質量表所得睡眠潛伏期之一致性………………145
附圖14 腕動計與匹茲堡睡眠品質量表所得總睡眠時間之一致性………………146
附圖15 腕動計與匹茲堡睡眠品質量表所得睡眠效率之一致性…………………146
附圖16 腕動計與匹茲堡睡眠品質量表所得各參數之ICC………………………147
附圖17 睡眠日誌與匹茲堡睡眠品質量表所得躺床時間之一致性………………147
附圖18 睡眠日誌與匹茲堡睡眠品質量表所得睡眠潛伏期之一致性……………148
附圖19 睡眠日誌與匹茲堡睡眠品質量表所得總睡眠時間之一致性……………149
附圖20 睡眠日誌與匹茲堡睡眠品質量表所得睡眠效率之一致性………………149
附圖21 睡眠日誌與匹茲堡睡眠品質量表所得各參數之ICC……………………150
附圖22 腕動計 (以Event Marker設定) 與睡眠日誌躺床時間之一致性…………151
附圖23 腕動計 (以Event Marker設定) 與睡眠日誌睡眠潛伏期之一致性………151
附圖24 腕動計 (以Event Marker設定) 與睡眠日誌總睡眠時間之一致性………152
附圖25 腕動計 (以Event Marker設定) 與睡眠日誌睡眠中斷時間之一致性……152
附圖26 腕動計 (以Event Marker設定) 與睡眠日誌睡眠中斷次數之一致性……153
附圖27 腕動計 (以Event Marker設定) 與睡眠日誌睡眠效率之一致性…………153
附圖28 腕動計 (以睡眠日誌設定) 與睡眠日誌睡眠潛伏期之一致性…………154
附圖29 腕動計 (以睡眠日誌設定) 與睡眠日誌總睡眠時間之一致性…………154
附圖30 腕動計 (以睡眠日誌設定) 與睡眠日誌睡眠中斷時間之一致性………155
附圖31 腕動計 (以睡眠日誌設定) 與睡眠日誌睡眠中斷次數之一致性………155
附圖32 腕動計 (以睡眠日誌設定) 與睡眠日誌睡眠效率之一致性……………156

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