臺灣博碩士論文加值系統

目的：
睡眠障礙在青少年族群之盛行率高且影響重大。然而，一套有效率且完整的篩檢工具仍相對闕如。本研究旨在建立一套睡眠相關障礙快速篩檢題組(Quick Screening Items for Sleep-related Disturbance, QSISD)，評估青少年族群的失眠、日間嗜睡、及作息型態偏好。

方法：
一共有1784名青少年被納入本研究，以建立睡眠相關障礙快速篩檢題組的信度與效度。睡眠相關障礙快速篩檢題組有三個分題組，評估失眠、日間嗜睡、與作息型態偏好，分別源自簡式雅典失眠量表、Epworth嗜睡量表、及孩童睡眠型態偏好量表。本研究(1) 進行Epworth嗜睡量表、孩童睡眠型態偏好量表之題項縮減，並(2) 建立QSISD的三個分題組在青少年族群的信效度資料。進行題項縮減時，參酌因素分析與逐步邏輯迴歸分析的結果。使用ROC曲線分析決定QSISD的三個分題組之最佳切分點。

結果：
QSISD由三個分題組，共17個題目組成。五題的失眠分題組顯示為一個因素結構，七題的日間嗜睡分題組為Epworth嗜睡量表減去第八題，五題的作息型態偏好分題組則由十題之孩童睡眠型態偏好量表精減而來。這三個分題組應用在偵測失眠、日間嗜睡、夜型人作息偏好的個案上表現良好，三個分題組的最佳切分點分別為5、10、10。

結論：
QSISD是一個適用於快速篩檢青少年睡眠相關障礙的工具，其中的各分題組可單獨或合併使用。

Objectives:
Sleep disturbance is prevalent and has significant impact in adolescents. However, efficient and comprehensive screening tool is relatively lacking. This study aimed to establish the Quick Screening Items for Sleep-related Disturbance (QSISD), which evaluates insomnia, daytime sleepiness, and evening chronotypes in adolescents.

Methods:
A total of 1784 adolescent subjects were recruited to assess the reliability and validity of QSISD in adolescents. Five-item Athens Insomnia Scale (AIS-5), Epworth Sleepiness Scale (ESS), and Morningness- Eveningness Scale for Children (MESC), which measured insomnia, daytime sleepiness, and chronotypes accordingly, were used to compose the 3 main domains of the QSISD. Item reduction, reliability and validity test were performed to compose the components of QSISD. Factor analysis and sequential analysis of logistic regression were used for item reduction. ROC analysis was examined to decide the cutoffs for the QSISD.

Results:
The QSISD was composed by 3 dimensions and 17 items. AIS-5 revealed a parsimonious one-factor structure. In the reduced 7-item ESS, the item “taking a test” was removed without compromising the performance. The final simplified MESC had only 5 representative items. All 3 subscales had good performance to detect cases. The cutoff points for 3 subscales were also provided.

Conclusions:
QSISD is suggested to be used independently or in combination for rapid screening of sleep-related disturbance in adolescents.

目錄：
誌謝…………………………………………………………………. i
中文摘要…………………………………………………………… ii
英文摘要…………………………………………………………… iv
目錄………………………………………………………………… vi
表目錄……………………………………………………………… ix
圖目錄……………………………………………………………… x
第一章 緒論…………………………………………………....... 1
第一節 研究背景與動機…………………………………….. 1
第二節 研究目的…………………………………………….. 2
第三節 名詞定義……………………………………………... 3
第二章 文獻探討……………………………………………..... 5
第一節 青少年之睡眠障礙…………………………………. 5
一、青少年發育與睡眠調節……………………….. 5
二、睡眠障礙在青少年相當普遍…………………. 6
三、睡眠障礙對青少年的身心影響甚鉅……….. 7
第二節 現階段青少年睡眠障礙量表之發展……………12
一、綜合性睡眠障礙之篩檢量表……………………12
二、失眠篩檢量表………………………………………..12
三、日間嗜睡篩檢量表………………………………….13
四、作息型態偏好篩檢量表…………………………..14
第三章 研究方法…………………………………………………..16
第一節 研究設計與對象……………………………………....16
一、研究對象……………………………………………....16
二、研究工具……………………………………………....17
A、由簡式雅典失眠量表發展青少年睡眠相關障礙快篩題組中之失眠分題組………………………….. 17
B、由Epworth嗜睡量表發展青少年睡眠相關障礙快篩題組中之日間嗜睡分題組…………………….. 19
C、由孩童睡眠型態偏好量表發展青少年睡眠相關障礙快篩題組中之作息型態偏好分題組…………22
第二節 統計分析……………………………………………...... 24
第四章 研究結果……………………………………………………25
第一節 QSISD之失眠分題組………………………………... 25
第二節 QSISD之日間嗜睡分題組…………………………...25
第三節 QSISD之作息型態偏好分題組(偵測夜型人)….26
第五章 討論與研究限制………………………………............28
第一節 討論……………………………………………………..... 28
一、 國中生睡眠相關障礙的盛行率………………… 29
二、 QSISD之失眠分題組……………………………… 30
三、 QSIDS之日間嗜睡分題組……………………….. 30
四、 QSISD之作息型態偏好分題組………………… 33
五、 比較QSISD與其他評估青少年睡眠障礙的綜合量表34
第二節 研究限制………………………………………………......... 35
第六章 結論………………………………………………………….......37
結果表格………………………………………………………………........ 38
參考文獻………………………………………………………………........ 46
附錄（研究IRB）……………………………………………………....... 55
發表論文………………………………………………………………........ 57
 
表目錄
中文版簡式雅典失眠量表………………………………………...18
中文版Epworth嗜睡量表………………………………………...20
中文版孩童睡眠型態偏好量表………………………………….23

結果表格
表一 QSISD三個分題組的得分分佈………………………….........38
表二 QSISD三個分題組的因素結構……………………………......39
表三 QSISD的失眠與日間嗜睡兩分題組在不同切分點的敏感度與特異度 ………………………………………………………………….. 40
表四 不同題數之縮減版孩童睡眠型態偏好量表的效度比較..42
附錄 青少年睡眠相關障礙快篩題組………………………………... 43
 
圖目錄
Figure 1. QSISD三個分題組之ROC曲線分析………………….....41

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