醫學中心高齡門診病患其睡眠品質及各項構面之性別差異研究

Sex differences in sleep quality and various dimensions among elderly outpatients at a medical hospital

本研究以醫學中心門診老年人為研究對象，探討及分析影響老年人睡眠品質及各項構面之性別差異及修飾作用。方法：本研究採橫斷式研究設計。於台灣南部某醫學中心之高齡醫學科、神經內科與精神科之門診個案，進行人口學特質、生活型態、代謝症候群臨床檢驗值、匹茲堡睡眠品質問卷、愛普沃斯嗜睡量表、老年憂鬱量表、睡眠呼吸障礙與日常生活活動功能等量表進行資料收集。結果：結果顯示女性有較多睡眠品質不佳的問題。而女性無規律運動、BMI≧27、憂鬱評估異常、有代謝性症候群及睡眠呼吸障礙中／高風險者有較差的睡眠品質|男性中憂鬱評估異常及睡眠呼吸障礙中／高風險者有較差的睡眠品質。以睡眠品質的各構面分析中發現，女性在主觀性睡眠品質、睡眠潛伏期時間、睡眠效率、服用藥物幫助入睡及日間功能上都較男性差。以邏輯斯迴歸分析睡眠品質各項構面之性別修飾作用，結果顯示男性女性老年憂鬱評估異常者在主觀式睡眠品質、服用安眠藥物與日間功能失調構面上較憂鬱評估正常者有較高風險。男女性在睡眠呼吸障礙中／高風險者的睡眠困擾與日間功能障礙構面上較低風險者有較高風險，女性更多了睡眠潛伏期及睡眠總時間兩構面。結論：男性當中有較多睡眠困擾的問題及睡眠潛伏期較長，女性為睡眠潛伏期較長及使用睡眠藥物，男女皆有較多的主觀睡眠品質不佳。憂鬱評估異常為男性及女性的主觀睡眠品質、使用睡眠相關藥物及日間功能障礙之影響因素|睡眠呼吸障礙為男性睡眠困擾及日間功能及女性睡眠潛伏期長、睡眠時間短、睡眠困擾及日間功能的影響因素。

Objectives: This study takes the elderly outpatients of a medical hospital as subjects, analyzes the effects of various dimensions on their sleep quality, and examines how such effects differ by sex and modification. Methods: By employing a cross-sectional design, this study collected data by obtaining clinical measurements related to metabolic syndrome in patients attending outpatient geriatrics, neurology, and psychiatry departments at a medical center in Southern Taiwan. Data were collected using a questionnaire containing a demographic scale, a lifestyle scale, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Geriatric Depression Scale, a sleep-disordered breathing scale, and an activities of daily living functional assessment scale. Results: Women had more problems with low sleep quality. Women with irregular exercise, BMI ≥ 27 kg/m^2, an abnormal depression evaluation, metabolic syndrome, and moderate-to-high risk of sleep-disordered breathing had low sleep quality, as were men with an abnormal depression assessment and moderate-to-high risk of sleep-disordered breathing. In the analysis of all dimensions of sleep quality, women had significantly poorer scores than did men in subjective sleep quality, sleep latency, habitual sleep efficiency, sleeping medication use, and daytime dysfunction. In a logistic regression analysis on sex modification in various aspects of sleep quality, men and women with abnormal geriatric depression results had higher risks of poor subjective sleep quality, sleeping medication use, and daytime dysfunction than did those with normal depression results. Men and women with moderate-to-high risks of sleep-disordered breathing and daytime dysfunction, respectively, had higher risks of sleep disturbance than did their counterparts with low risks. Conclusions: The most common sleep problems in men were sleep disturbance and longer sleep latency, whereas those in women were longer sleep latency and sleeping medication use. Both men and women frequently experienced low subjective sleep quality. Abnormal depression assessment was the major factor influencing the subjective sleep quality of men and women, as indicated by their use of sleeping medication and daytime dysfunction. Sleep-disordered breathing among men and long sleep latency and short sleep time among women were the major factors affecting sleep distress and daytime functioning.