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研究生:林建明
研究生(外文):Chien-Ming Lin
論文名稱:糖尿病患者睡眠品質及其相關因素之流行病學研究:以醫院為基礎之病例對照研究
論文名稱(外文):Status of Associated Factors for the Quality of Sleep in Patients with Diabetes Mellitus an Epidemiological Assessment: Hospital-based case-control study
指導教授:周雨青周雨青引用關係
指導教授(外文):Yu-Ching Chou
口試委員:孫建安楊燦周雨青
口試委員(外文):Chien-An SunTsan YangYu-Ching Chou
口試日期:2014-05-09
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:117
中文關鍵詞:病例對照研究法睡眠品質睡眠障礙糖尿病
外文關鍵詞:Case-control StudyQuality of SleepSleep DisordersDiabetes Mellitus
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本研究目的在於瞭解糖尿病患者睡眠品質情況及其影響因素,以提供相關醫護人員瞭解糖尿病患者睡眠品質的現況,進而協助患者改善或提昇其生活品質。研究設計為一病例對照研究法(Case-control Study),病例組以彰濱秀傳醫院睡眠中心20歲以上參與糖尿病照護網的患者為對象,樣本收案數為265位。對照組以回溯性方式蒐整彰濱秀傳醫院睡眠中心既有各式睡眠評估量表及個案例行醫療,依病例組性別、年齡(±5歲)以1:4進行配對,計有1,025位,總收案數為1,290位。
本研究發現,男性族群中在ESS量表及PSQI量表顯示嗜睡的人和睡眠品質差的人比正常的人有較高罹患糖尿病的危險(OR=1.06,95%信賴區間=0.72-1.57、OR=1.14,95%信賴區間=0.23-5.65),而低通氣指數越嚴重則糖尿病危險性越高(OR=1.15、1.32、1.69;95%信賴區間=0.70-1.88、0.74-4.23、0.96-3.01);女性族群在ESS量表及FSS量表顯示嗜睡的人和睡眠品質差的人比正常的人有較高罹患糖尿病的危險(OR=1.10,95%信賴區間=0.67-1.76、OR=1.20,95%信賴區間=0.62-2.31),而入快速動眼期時間越長則糖尿病危險性越高(OR=1.69、1.70,95%信賴區間=0.65-4.42、0.71-4.07)
睡眠品質與糖尿病可能沒有直接影響關係,但睡眠品質會因為其他影響因素而誘發糖尿病高發生率。

This study aimed to understand the risk of diabetes in patients with sleep quality and the relative factors, to provide health care workers to understand the current situation of the diabetic patient correlated to their sleep quality, and thus help patients to improve or enhance their quality of life. The study was designed as a case-control study. Study participants were recruited from outpatient patient department of Chang-Bing Show-Chwan Memorial Hospital aged over 20 years old in the Diabetes Shared Care Program. Definition of diabetes determined by physician examination, physical examination and questionnaire assessment methodology selected qualifying groups, and then conditionally remove potential problems with abnormal glucose metabolism in patients. Further collect basic demographic, sleep quality questionnaire, nutritional assessment and clinical biochemistry values, the number of 265 enrolled. For control group, a retrospective way from Chang-Bing Show-Chwan Memorial Hospital Sleep Center to obtain all kinds of sleep routine medical assessment scales and case (or usual care) medical records, the doctor diagnosed non-diabetic and further by the case group sex, age (± 5 years) and 1:4 matching selected target number of enrolled 1,025, with a total number of 1,290 people enrolled.
The study showed that the participants with poor sleep quality and the male population were tend to have a higher risk than normal people with diabetes (OR = 1.06, 95% CI = 0.72-1.57, OR = 1.14, 95% CI = 0.23-5.65) in the ESS and PSQI scale display sleepiness scales; the more serious hypopnea index has higher risk of diabetes (OR = 1.15,1.32,1.69; 95% confidence interval = 0.70-1.88,0.74-4.23,0.96 - 3.01). The higher risk of diabetes was found in female groups and the participants with poor sleep quality sleepiness than participants with normal sleep status (OR = 1.10, 95% CI = 0.67-1.76, OR = 1.20, 95% CI = 0.62-2.31) in the ESS scale and FSS scale, longer period of rapid eye movement with higher risk of diabetes (OR = 1.69,1.70, 95% CI = 0.65-4.42,0.71-4.07).
The association between sleep quality and the risk of diabetes are not directly affected in this study, but the incident of diabetes would be induced by other related risk factors.

表目錄……………………………………………….………………….III

圖目錄………………………………………………………………….IV

附錄目錄……………………………………………………………….. V

中文摘要…………………………………………………………….….VI

英文摘要……………………………………………..…………………VII

第一章 緒論………………………………………….…………………...1

第一節 研究背景及重要性…………………………..………………..1

第二節 研究動機……………………………………..………………..3

第三節 研究目的…………………………………..…..………………3

第二章 文獻探討…………………………………….……..…………….4

第一節 糖尿病………………………………….……………..……….4

一、糖尿病流行病學…………………………...………………..…...4

二、糖尿病的分類與病理學…………………………………..……..5

三、影響糖尿病的危險因子…………………………..……………..7

第二節 睡眠品質……………………………..………………………10

一、睡眠障礙現況…………………………………………………..10

二、睡眠障礙定義…………………………………………………..10

三、常見睡眠品質評估工具………………………………………..13

四、影響睡眠品質的危險因子……………………………………..26

五、睡眠障礙相關共病症…………………………………………..26

第三節 糖尿病與睡眠品質之相關性..………..………......................26

一、糖尿病患睡眠狀況………………….…………………...…….26

二、糖尿病與阻塞性睡眠呼吸中止症…………………..….......…28

三、糖尿病與睡眠時間………………………………………….....30

第三章 材料與方法……………………………......................................32

第一節 研究架構……………….………………...……………......…32

第二節 研究對象與資料來源..……………......................................32

第三節 研究工具……………………………......................................34

第四節 資料處理與分析方法…………..............................................36

第五節 研究流程……………………………………….……….........37

第四章 研究結果………………………………......................................38

第一節 研究對象基本特性、生活型態及睡眠品質情形……...…….38

第二節 性別分層其基本特性、生活型態及睡眠品質情形………....39

第三節 性別分層其睡眠品質與糖尿病之危險性分析……………..41

第四節 共病症分層其睡眠品質與糖尿病之危險性分析…………..46

第五章 討論………..…………………....................................................69

第一節 影響糖尿病之危險因素……………………………………69

第二節 睡眠品質與糖尿病之關係…………………………………..70

第三節 研究限制…………………………………………………….76

第六章 結論……………………………………………………………..78

參考文獻……………………………………………………....….…....80

附錄………………………………………………………..……………..93

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