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研究生: 汪宜靜
I-Ching Wang
論文名稱: 第2型糖尿病患者之糖尿病控制、疾病適應、睡眠衛生習慣與其睡眠品質之相關性探討
The Relations of Diabetes Control, Disease Adaptation , Sleep Hygiene and Sleep Quality in Type 2 Diabetic Patients.
指導教授: 胡益進
Hu, Yih-Jin
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2013
畢業學年度: 101
語文別: 中文
論文頁數: 86
中文關鍵詞: 糖尿病睡眠品質疾病調適狀況睡眠衛生習慣
英文關鍵詞: diabetes, sleep quality, disease adaptation, sleep hygiene
論文種類: 學術論文
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本研究目的在瞭解第2型糖尿病人的睡眠品質與其社會人口學特、糖尿病控制狀況、疾病調適狀況、睡眠衛生習慣之關係。研究方法為橫斷式相關設計,採用結構式問卷,對象為北部某醫學中心第2型糖尿病病人,共304位。本研究主要結果如下:
一、 睡眠品質平均得分7.80±2.97分,其中睡眠品質不佳(PSQI > 5)
有77.0%,睡眠干擾中頻率較高的項目依序為「半夜上廁所」,「半夜或清晨醒來後不易入睡」,「咳或打鼾」。整體睡眠效率平均83.3%±13.4%,有38.8%的病人睡眠效率低於85%;半夜或清晨醒來後不易入睡平均為每週1.87±1.14次,入睡所需時間平均為18.81±16.78分鐘,有9.9%的病人其入睡所需時間大於30分鐘;夜間睡眠時數平均6.21±1.20小時,夜間睡眠時數小於6小時者佔30.6%,有使用安眠藥物的病人只有13.8%,但主觀認為睡眠品質非常差的病人有4.3%,不好的有13.8%。
二、 血糖、血壓與血脂控制與睡眠品質無顯著相關。女性睡眠品質較差,退休者比就業中差,由自己及他人供養都有者比自給自足者差,自己單獨睡比只與配偶同睡者差,低血糖次數最近一個月2-3次或4次以上者比沒有及只有1次者睡眠品質差。疾病調適較差者或睡眠衛生習慣較差者,其睡眠品質較差。
三、疾病調適所有變項皆與睡眠品質顯著相關,其中以「擔心、害怕」相關性最高,其次為「緊張、焦慮」、「難過、沮喪」。睡眠衛生習慣變項中以「睡前擔心睡不著」相關性最高,其次為「寢具不舒服」、「臥室溫度不舒服」。
四、性別、年齡、職業、低血糖、疾病調適總分、睡眠衛生習慣總分可顯著預測夜間睡眠品質,可解釋睡眠品質的總變異量是26.7%,其中「疾病調適總分」最具解釋力。

結論:女性、已退休、經常擔心、害怕,緊張、焦慮,難過、沮喪或常低血糖的糖尿病患都是睡眠障礙的高危險群,將來可針對睡眠品質較差者進行相關之衛教活動或轉介睡眠中心處理其相關問題。

Purpose: To assess the association of sleep quality with the demographics, glycemic control, disease adaptation, and sleep hygiene in persons with type 2 diabetes.
Method: A total of 304 type 2 diabetics from a medical center in north Taiwan participated in this cross- sectional study. A structural questionnaire was designed to collect the information .
Results:
1. The mean PSQI score was 7.80±2.97, and 77.0% were poor sleepers (PSQI>5). The leading causes to disturb night sleep were “nocturia”, “difficulty in falling asleep after waking up”, and “cough or snoring”. The global sleep efficiency was 83.3%±13.4 and 38.8% with sleep efficiency less than 85%. The rate of difficulty in falling asleep after waking up in mid-night or early morning was 1.87±1.14 times per week. Mean sleep incubation time was 18.81±16.78 minutes and 9.9% of them with incubation time more than 30 minutes. The average sleeping hours in night time were 6.21±1.20 hours and 30.6% slept less than 6 hours at night. Only 13.8% of the participants took hypnotics. But very poor sleep quality was felt subjectively by 4.3% of them and poor sleep quality by 13.8%.
2. There was no correlation between hyperglycemia, hypertension, hyperlipidemia control and sleep quality. Female had poorer sleep quality than male. Retirees had poorer sleep quality than workers. Sleep quality was poorer in economic support from both self and others than from oneself only. Patients who slept alone had poorer quality than those slept with wife. In patients with hypoglycemic episodes more than two times a month had poorer sleep quality than those with no or just one episode of hypoglycemia. Sleep quality was poorer in those with poor disease adaptation or poor sleep hygiene.
3. All of the variants of disease adaptation were closely correlated with sleep quality, especially “worried, scared”, followed by “nervous, anxiety” and “sad, depression”. In variants of sleep hygiene, the most correlated one was “worried about poor sleep before sleep”, followed by “unpleasant bedding” and“unpleasant bedroom temperature”.
4. Sex, age, occupation, hypoglycemia, scores of disease adaptation and scores of sleep hygiene can predict significantly night time sleep quality. The total variance was 26.7% and the most significant one was “scores of disease adaptation”.

Conclusion:
Female, retired, emotion of“worried, scared”,“nervous, anxiety”,“sad, depression” and frequent hypoglycemic diabetic patients are high risk groups of sleep disorder. In the future, we can help these patients by promoting relevant educational activities or transferring them to sleep center.

第一章 緒論 第一節 研究動機與重要性……………………………… 1 第二節 研究目的………………………………………… 3 第三節 研究問題………………………………………… 4 第四節 研究假設 ………………………………………… 5 第五節 名詞操作型定義………………………………… 6 第二章 文獻探討 第一節 糖尿病與睡眠問題的關係……………………… 9 第二節 睡眠品質之影響因素 12 第三節 睡眠品質評估 18 第三章 研究方法 第一節 研究架構 ………………………………………… 20 第二節 研究對象 ………………………………………… 21 第三節 研究工具 ………………………………………… 22 第四節 研究步驟 ………………………………………… 24 第五節 資料處理與分析 ……………………………… 25 第四章 結果及討論 第一節 研究對象的社會人口學特性、糖尿病控制、疾病調適、睡眠衛生習慣分佈之狀況……………… 27 第二節 研究對象之睡眠品質…………………………… 40 第三節 研究對象之睡眠品質與研究變項間之關係…… 45 第五章 結論與建議 第一節 結論……………………………………………… 64 第二節 應用及建議……………………………………… 66 參考文獻 中文部份…………………………………………………… 68 英文部份…………………………………………………… 71 附錄 受試者同意書………………………………………… 76 問卷…………………………………………………… 80 倫理委員會同意函………………………………………… 85

一、 中文部份
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游凱宇(2009)。台灣地區老人自評睡眠品質與跌倒之相關研究。未出版之碩士論文,亞洲大學健康暨醫務管理研究所,台中。
程淑珠(2011)。眩暈患者的生活壓力、社會支持和睡眠品質之探討。未出版之碩士論文,國立臺北教育大學生命教育與健康促進研究所,台北。
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廖柏夷(2011)。第二型糖尿病個案睡眠品質及其相關因素探討。未出版之碩士論文,中山醫學大學護理研究所,台中。
劉惠瑚、陳玉敏與李月萍(2005)。糖尿病人睡眠問題之探討 。長庚護理,16(4),408-413。
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謝文順(2001)。身體活動與睡眠品質的關係。中華體育,14(4),97-106。
蘇東平(2000)。障礙症之診斷分類及臨床評估。台灣醫學,4(6),665-672。

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