失智症家庭照顧者睡眠障礙及其相關因素

Sleep Disturbance and Associated Factors Amongst Family Caregivers of Dementia Patients

背景：在台灣，有85%失智症患者是由家庭成員擔任照顧者，家庭照顧者表示失眠為常見的健康問題。
目的：旨在探討失智症家庭照顧者睡眠障礙發生頻率及相關因素。
方法：本研究採相關性研究，立意取樣180對北部六家神經內科或記憶門診之失智症患者及其照顧者，使用患者中文版神經精神病徵量表（the Chinese version of the Neuropsychiatric Inventory, CNPI）與其家庭照顧者壓力負向感受量表（CNPI-caregiver distress scale）、美國國家衛生機構流行病學研究中心所發展憂鬱量表之簡短版（Center for Epidemiological Studies -Depression Scales 10, CESD-10）及照顧者一般睡眠障礙量表（General Sleep Disturbance Scale, GSDS），測量患者非認知症狀、家庭照顧者自覺壓力負向感受、照顧者憂鬱程度與其睡眠障礙。
結果：本研究發現有13.3%失智症家庭照顧者表示睡眠障礙已干擾到日常生活。照顧者與失智症患者的關係與照顧者憂鬱程度共可解釋照顧者睡眠障礙45.8%的變異量；而照顧者憂鬱程度是其睡眠障礙的最佳預測因子，貢獻31%的變異量。
結論：實務應用　研究結果有助於護理人員在面對失智症家庭照護時，評估失智症患者非認知症狀及照顧者照顧壓力負向感受。可針對不同的家庭照顧者關係所感受到的負向壓力及需求，提供不同的資源與社會支持。亦可引導不同關係的家庭照顧者採正向思考，檢視其照顧過程中的獲得，以改善憂鬱程度及睡眠障礙。

Background: In Taiwan, eighty-five percent of dementia patients are cared for by family caregivers (FCGs), who have indicated insomnia to be a prevalent personal health problem.
Purpose: The aim of this study was to explore sleep disturbance and associated factors among FCGs caring for dementia patients.
Methods: A purposive sample of 180 dementia patient dyads and their FCGs was recruited from northern Taiwan. Dementia patients neuropsychiatric symptoms were assessed using the Chinese Neuropsychological Inventory (CNPI). FCG distress, depressive symptoms, and sleep disturbance were assessed using the CNPI Caregiver Distress Scale, Center for Epidemiological Studies-Depression Scales, and Lee’s General Sleep Disturbance Scale, respectively.
Results: Sleep disturbance was reported as interfering with the daily lives of 13.3% of FCGs. The hierarchical regression model indicated (1) relationships between patients and FCGs and (2) FCG depressive symptoms as two significant predictors of sleep disturbance in FCGs, explaining 45.8% of variance. FCG depressive symptoms represented the most significant single predictor - contributing 31% of variance.
Conclusions: Sleep disturbance in FCGs is predicted by the patient-FCG relationship and FCG depressive symptoms. To better care for FCGs of dementia patients, nurses should assess patients behavioral problems, FCG distress, and FCG depressive symptoms. Nurses may also better allocate social resources based on the specific relationships between FCGs and their dementia patients. In addition, nurses should redirect FCG attention toward positive thinking in order to alleviate depressive symptoms and decrease sleep disturbance (235 words)