全身性紅斑性狼瘡女性睡眠與晝夜血壓相關性及預測因子之初探

Association Between Sleep Patterns and Diurnal Blood Pressure Variation and Its Predictors in Women With Systemic Lupus Erythematosus

背景：全身性紅斑性狼瘡（systemic lupus erythematosus, SLE）病患常主訴有睡眠困擾及合併高血壓，但缺乏客觀睡眠型態評估及探討SLE晝夜血壓變化的情形，也尚未有研究探討SLE睡眠型態與晝夜血壓的關係。目的：探討SLE女性主、客觀睡眠型態與晝夜血壓變動之相關性，並找出預測晝夜血壓變動之因素。方法：採橫斷式描述相關性設計，共納入42位SLE女性，受試者完成匹茲堡睡眠品質量表、醫院焦慮憂鬱量表、疼痛量表，並由風濕科醫師評估疾病活動度；另佩戴腕動計連續7日及24小時血壓計1日。結果：匹茲堡睡眠品質量表平均總分為7.74±3.21，主觀睡眠品質不良佔69%，佩戴腕動計測得睡眠效率85.29±5.95%，42.9%為客觀睡眠品質不良。夜間睡眠總時數與舒張壓晝夜下降幅度（r=.315, p<.05）呈正相關，疼痛指數則與收縮壓（r=-.430, p<.01）及舒張壓（r=-.371, p<.05）之晝夜下降幅度呈負相關，以多元迴歸分析後疼痛亦分別為收縮壓（β=-0.397, p<.01）及舒張壓（β=-0.325, p<.05）之晝夜下降幅度之顯著預測因子。結論：實務應用根據研究結果，建議醫護人員常規評估SLE病患的睡眠及疼痛，除了改善睡眠欠佳的情形，也可協助擬定減緩疼痛之計畫。未來可對於疼痛改善與晝夜血壓下降幅度之關係進一步探討。

Background: Sleep disturbances and hypertension are common health issues in patients with systemic lupus erythematosus (SLE). Limited information is available regarding the objective sleep quality and the variation of diurnal blood pressure (BP) in patients with SLE. Moreover, the relationship between sleep patterns and diurnal BP variation in SLE patients is not clear. Purpose: To explore the subjective/objective sleep patterns and the diurnal BP variation in women with SLE, to identify the factors associated with diurnal BP variation, and to identify the predictors of this variation. Methods: A cross-sectional, descriptive, correlational study was conducted and 42 women with SLE were recruited. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, and Brief Pain Inventory. Rheumatologists rated current lupus disease activity. Additionally, the participants wore a wrist actigraph for 7 consecutive days and underwent 24h ambulatory BP monitoring for one day. Results: The mean Global PSQI score was 7.74 ± 3.21; 69% of the participants reported poor subjective sleep quality; the actigraphy-measured sleep efficiency was 85.29 ± 5.95%; and 42.9% had poor objective sleep quality. Total sleep time at night was positively associated with diurnal change in diastolic BP (r = .315. p < .05) and pain severity was negatively associated with diurnal change in systolic BP (r = -.430, p < .01) and diastolic BP (r = -.371, p < .05). Multiple linear regression analysis was used to predict diurnal BP variation. Moreover, pain was a significant predictor of diurnal change in systolic BP (β = -0.397, p < .01) and diurnal change in diastolic BP (β = -0.325, p < .05). Conclusions/Implications for Practice: The findings of the present study suggest that healthcare professionals should routinely evaluate sleep quality and pain in SLE patients. Improving both the poor sleep and pain management of these patients is clinically important. Further studies of the association between pain management and diurnal BP variation are needed.