門診慢性阻塞性肺部疾病患者之睡眠品質 與其相關因素的系統性文獻回顧

Sleep Quality in Outpatients with Chronic Obstructive Pulmonary Disease and its Correlates: A Systematic Review

許多研究顯示慢性阻塞性肺部疾病的患者容易出現睡眠障礙，並對患者的疾病及生活影響很大，但少有研究針對COPD患者睡眠障礙的相關性研究做系統性地彙整及評析。本篇系統性回顧的目的旨在統整與分析影響COPD患者睡眠品質之相關研究，以瞭解COPD患者睡眠障礙及其 相關因素之全貌，並找出相對重要或是高度相關的因素，作為日後COPD患者臨床照護或睡眠 介入處置之參考。本研究利用CINAHL、MEDLINE、Cochrane library、PubMed、台灣期刊論文索引、台灣碩博士論文加值系統、華藝以及GOOGLE學術搜尋網等資料庫，以關鍵字“COPD （chronic obstructive pulmonary disease）” 及 “insomnia”、“sleeplessness”、“sleep quality”、“sleep disturbance”、“sleep deprivation”、“REM”，搜尋2014年12月22日以前的中英文文獻。篩選後共 有14篇COPD睡眠相關性研究納入分析，查核文獻以比較研究之完整性與品質。並以STROBE checklist查核文獻，以比較研究之完整性與品質。回顧COPD患者的睡眠相關性研究，結果發現 患者多達半數以上有睡眠品質不佳的現象，顯示睡眠問題對於COPD患者的生活影響甚大，是個需要被重視及解決的問題。而和COPD患者睡眠品質顯著相關的因素有年齡、COPD嚴重程度、 呼吸困難、急性發作次數、肺功能、憂鬱、焦慮與生活品質等，其中以年齡、疾病嚴重度、憂鬱、 焦慮及生活品質篇數居多，是日後在COPD患者的臨床照護及實證研究中亟需重視的參考依據。

Many studies have demonstrated that sleep disturbance is common among patients with Chronic Obstructive Pulmonary Disease (COPD) and can severely affect the nature of the COPD and the associated quality of life. Many studies also have explored these correlates of sleep disturbance; however, few studies have integrated and analyzed these correlates through using a systematic review. This paper reports a systematic review the objective of which was to review, synthesize, and evaluate studies about sleep disturbance in patients with COPD to identify factors important for sleep quality and serve as a reference for the clinical care and intervention of sleep disturbance in these patients. This study searched for literature in CINAHL, MEDLINE, the Cochrane Library, PubMed, the Index to Taiwan Periodical Literature System of the National Central Library, the National Digital Library of Theses and Dissertations in Taiwan, the Airiti Library, and Google Scholar. In these electronic databases, we sought published articles in Chinese and English prior to Dec 22, 2014 using the keywords of “COPD with insomnia,” “sleep quality,” “sleep disturbance,” “sleep deprivation,” “REM,” and “sleep quality improvement.” Fourteen studies met the inclusion criteria and were subjected to further analysis. The quality of each retrieved article was assessed using the STROBE checklist to examine the completeness and adequacy of the studies. This review found that over half of the patients with COPD in the selected studies had sleep disturbance, revealing that sleep quality might seriously affect daily life and need to be emphasized and improved. Significant correlates of sleep quality in patients with COPD included age, COPD severity, dyspnea, the number of acute exacerbation, lung function, depression, anxiety, and quality of life. In particular, among the above correlates, age, COPD severity, depression, anxiety, and quality of life were indicated in the majority of the selected studies. In summary, this review can serve as a reference for the clinical care of sleep disturbance in patients with COPD and provide direction for future empirical research in this field.