| 摘要: | 研究背景：失眠被定義為困難進入和維持睡眠進而影響日間功能，是現代人常見的問題，會影響認知功能、生活品質和情緒。簡易失眠行為療法是治療原發性和次發性失眠的新指引；但台灣尚未建立其治療模式。
研究目的：建立台灣版護理引導簡易失眠行為療法的模型，並探討護理引導簡易失眠行為療法對改善失眠之成效，與對日間功能狀態、生活品質與負面情緒的影響，以及探討失眠嚴重度改善程度與日間功能狀態、生活品質與負面情緒變化之相關性。
研究方法：本研究為施測者盲性的隨機對照試驗，採兩組平行設計。共計42名有失眠症狀的受試者，將依1：1的比例隨機分配到護理引導簡易失眠行為療法組或睡眠衛生控制組，進行為期4週，每週一次的治療。在治療前和治療後，將使用睡眠日誌評與中文版匹茲堡睡眠品質量表估睡眠狀況，使用中文版失眠嚴重程度量表評估失眠嚴重度，使用中文版艾沃氏嗜睡量表、台灣版簡明疲憊量表、RAND-36生活品質量表與簡短版憂鬱焦慮與壓力量表評估相關影響。統計方式使用廣義估計方程檢驗改善成效，與使用皮爾森績差相關分析相關性。
結果：本研究受試者之平均年齡33.19歲，66.70％為女性。與控制組相比，實驗組在接受四週完整的護理引導簡易失眠行為療法後，可顯著改善入睡潛伏期（p=0.001）、睡眠效率（p<0.001）、失眠嚴重程度（p=0.001）、睡眠品質（p<0.001）、日間嗜睡（p<0.001）與心理層面生活品質（p=0.009）。失眠嚴重程度的改變量與日間嗜睡情形、心理層面生活品質及壓力程度之改善具顯著相關性（p=0.01、0.02與0.04）。
結論：本研究已建立台灣版護理引導簡易失眠行為療法之模型，並證實護理引導簡易失眠行為療法能有效改善年輕失眠患者之失眠狀況，以及失眠嚴重度的改善程度與減緩日間嗜睡情形以及提升心理層面生活品質及壓力程度有關。護理人員應將此療法納入失眠的非藥物治療之一，從而改善有失眠症狀之年輕成年人的日間功能狀態與生活品質。
Background: Insomnia is defined as difficulty initiating and maintaining sleep, which further impacts daytime function. Insomnia is a common complaint among general population, affecting their cognitive function, quality of life, and mood. Brief behavioral treatment for insomnia (BBTI) is a new treatment direction for primary and secondary insomnia; however, its treatment model has not been established in Taiwan.
Purpose: To establish the treatment model of BBTI in Taiwan and to examine the effects of nurse-led BBTI on sleep status, daytime function, quality of life, and negative emotions of adults in Taiwan. We also explored the relationships of insomnia severity improvement with daytime function, quality of life, and negative emotions.
Methods: This was an assessor-blinded randomized controlled trial, with a two-arm parallel-group design. A total of 42 adults with insomnia were randomly allocated to the four-week nurse-led BBTI group or the sleep hygiene control group at an 1:1 ratio. Sleep status was evaluated by sleep diary and the Pittsburgh Sleep Quality Scale. Insomnia severity was measured by the Insomnia Severity Scale. Secondary outcomes were assessed using the Epworth Sleepiness Scale, Brief Fatigue Inventory- Taiwan Form, RAND-36 Health Status Inventory, and Depression, Anxiety and Stress Scale-21 Items. The measurement timepoints included pre- and post-treatment assessments. Generalized estimating equations (GEE) was used to evaluate the treatment effects of nurse-led BBTI and Pearson correlation was used to test the relationship between the change of insomnia severity with secondary outcomes.
Results: The mean age of participants was 33.19 years old and 66.70% of them were female. Compared with the sleep hygiene group, participants in the experimental group significantly improved sleep onset latency (p=0.001), sleep efficiency (p<0.001), insomnia severity (p=0.001), sleep quality (p<0.001), daytime sleepiness (p<0.001), and the mental components of quality of life (p=0.009) after completing the intervention. The change of insomnia severity significantly correlated with reduced daytime sleepiness, improved mental components of quality of life, and declined stress level (p=0.01, 0.02 and 0.04, respectively).
Conclusion: This study has established a Taiwanese version of nurse-led BBTI and confirmed its effectiveness in improving sleep status in young insomnia patients; the improvement in insomnia severity is linked to a decrease in daytime sleepiness, enhanced mental aspects of quality of life, and reduced levels of stress. Healthcare providers should incorporate the therapy into the treatment of insomnia to enhance daytime functioning and quality of life for young adults with insomnia symptoms. |
