臺灣博碩士論文加值系統

此為十二個月前瞻性、隨機、控制研究，主要目的在探討登階運動訓練對阻塞型睡眠呼吸中止症候群患者心肺耐力與睡眠狀況之成效。本研究的病人收案標準為經用多項式睡眠生理檢查(Polysomnography)診斷其呼吸中止/呼吸不全指數(AHI)＞15/hr，氧氣低飽和指數(oxygen desaturation index, ODI)＞10/hr，願意参與本研究計畫，年齡19歲以上者。共收27位在長庚紀念醫院林口醫學中心胸腔科門診阻塞型睡眠呼吸中止症候群患者，每位病人的研究期間為九週。將研究對象隨機分派至實驗組與對照組。兩組個案皆接受內科治療與阻塞型睡眠呼吸中止症候群護理指導，實驗組個案另外在家施行登階運動八週。結果測量包括睡眠狀況參數: 多項式睡眠生理檢查、Epworth日間嗜睡量表、匹茲堡睡眠品質量表；心肺耐力參數:心肺體適能指數、自覺用力係數、六分鐘走路距離；症狀量表及細胞激素檢測包含IL-6、HS-CRP、TNF-α及BNP；於第一週、第五週及第九週至門診回診，接受三次成果測量。研究資料將使用以描述性統計及Generalized Estimating Equation (GEE)等推論性統計方法進行分析。
研究結果顯示，在調整了年齡、性別及BMI等干擾因素效應將以GEE方法之多項式線性迴歸(Multiple Linear Regression)加以控制。在時間效應下與組別的交互作用，達統計上顯著性差異的參數包括：AHI指數 (p=0.02) 、Epworth日間嗜睡量表(p=0.01) 、心肺體適能指數 (p=0.004)、自覺用力係數(p=0.007)及症狀量表之打鼾及睡眠中斷(p=.<001)。其他參數未達統計上顯著性差異。結論為規律運動訓練對改善阻塞型睡眠呼吸中止症候群患者的心肺耐力和睡眠狀況是扮演重要的角色。

This twelve months prospective randomized control study is aimed to study the effect of stair stepping exercise training on cardiopulmonary endurance and sleep condition in patients with obstructive sleep apnea syndrome (OSAS). Patients meet the following criteria will be invited to participate in this study: being diagnosed with AHI (Apnea-hyponea index)＞15/hr and ODI (oxygen desaturation index)＞10/hr by Polysomnography, aged 19 or older. In this study, 27 patients with OSAS from the outpatient department of Chang Gung Medical Center were recruited over a period of 9 weeks. Patients were randomly assigned to receive stair stepping in addition to nursing education and standard care, or nursing education and standard care alone. Stair stepping exercises performed at home daily for eight weeks. Outcome measures include sleep condition: Polysomnography, daytime sleepiness measured by Epworth sleepiness scale, Pittsburgh sleep quality index ,
cardiopulmonary endurance condition: cardiorespiratory fitness index, rating of perceived exertion, six-minute walking distance test, rate of perceived exertion; symptom scale and cytokines examination. Data were analyzed using descriptive statistics and Multiple Linear Regression of Generalized Estimating Equation (GEE).
Results of this study showed that after adjustment for the effect of sex, age and body mass, AHI (p=0.02), Epworth Sleepiness Scale (p=0.01), cardiorespiratory fitness index (p=0.004), rating of perceived exertion(p=0.007), and snoring and sleep deprivation of symptoms scale (p< .001) were significantly improved. Differences in the effect of stair stepping exercise for other outcome variables were either minimal or not statistically significant. Eight weeks of stair stepping exercise training could be useful in improving sleep condition and increasing cardiopulmonary endurance on patients with OSAS.

目 錄
中文摘要-iv-
英文摘要-v-
第一章 緒論
第一節 研究動機與重要性-1-
第二節 研究目的-2-
第三節 研究假設-3-
第四節 名詞解釋-3-
第五節 研究限制-7-

第二章 文獻查證
第一節 OSAS概述-8-
第二節 OSAS生理病理機轉-15-
第三節 OSAS與有氧運動之相關性-19-

第三章 研究方法與步驟
第一節 研究架構-25-
第二節 研究設計-25-
第三節 研究對象與場所-27-
第四節 登階運動-28-
第五節 OSAS之護理指導-31-
第六節 研究結果之測量-32-
第七節 研究測量工具之信效度-38-
第八節 資料收集過程-40-
第九節 資料處理與統計分析-43-

第四章 研究結果
第一節 研究對象基本資料-44-
第二節 兩組間有無登階運動訓練前後睡眠的狀況-47-
第三節 兩組間有無登階運動訓練前後的心肺耐力狀況-52-
第四節 兩組間有無登階運動訓練前後的症狀結果-54-
第五節 兩組間有無登階運動訓練前後的細胞激素結果-57-
第六節 兩組間睡眠狀況差異與登階運動訓練成效--57
第七節 兩組間心肺耐力差異與登階運動訓練成效-60-
第八節 兩組間症狀差異與登階運動訓練成效-61-
第九節 兩組間細胞激素差異與登階運動訓練成效-63-

第五章 討論
第一節 病患之特性-65-
第二節 登階運動訓練對OSAS患者的睡眠狀況影響-66-
第三節 登階運動訓練對OSAS患者的心肺耐力影響-69-
第四節 登階運動訓練對OSAS症患者的症狀影響-70-
第五節 登階運動訓練對OSAS患者的細胞激素影響-71-

第六章 結論與建議
第一節 結論-73-
第二節 研究限制與建議-74-
第三節 護理應用-75-
參考資料

圖目錄
圖一：OSAS生理病理機轉-18-
圖二：研究架構圖-25-
圖三：研究設計圖-26-
圖四：研究步驟與資料收集之流程圖-42-
圖五：兩組各參與人數圖表-44-
圖六：兩組間AHI指數隨時間增加變化圖-49-
圖七：兩組間夜間最低血氧濃度隨時間增加變化圖-50-
圖八：兩組間非快速動眼期第四期隨時間增加變化圖-50-
圖九：兩組間Epworth日間嗜睡量表隨時間增加變化圖-51-
圖十：兩組間心肺體適能指數驗隨時間增加變化圖-53-
圖十一：兩組間自覺用力係數隨時間增加變化圖-54-
圖十二：兩組間症狀量表之打鼾隨時間增加變化圖-55-
圖十三：兩組間症狀量表之睡眠中斷隨時間增加變化圖-56-
圖十四：兩組間BMI隨時間變化圖-67-

表目錄
表一：心肺耐力指數男女參考數值-23-
表二：登階運動訓練進度表-31-
表三：人口學特徵一-46-
表四：人口學特徵二-47-
表五：AHI嚴重度兩組人數分配表-48-
表六：兩組間有無登階運動訓練前後睡眠狀況狀況-51-
表七：兩組間有無登階運動訓練前後心肺耐力狀況-54-
表八：兩組間有無登階運動訓練前後症狀結果-56-
表九：兩組間有無登階運動訓練前後細胞激素結果-57-
表十：GEE分析兩組間有無運動訓練前後睡眠狀況成效差異-59-
表十一：GEE分析兩組間有無運動訓練前後心肺耐力成效差異-61-
表十二：GEE分析兩組間有無運動訓練前後症狀成效差異-62-
表十三：GEE分析兩組間有無運動訓練前後細胞激素成效差異-64-

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