探討男男性行為愛滋病毒感染者睡眠障礙現況及影響因素

Abstract

背景：隨著抗高效能抗愛滋病毒治療，感染愛滋病毒被視為一種慢性病，此族群睡眠障礙盛行率偏高，且睡眠障礙會影響感染者的免疫功能，是不可忽視之議題。然而過去研究較少針對男男性行為愛滋病毒感染者睡眠障礙之現況進行調查，探討身體和社會心理因素對睡眠障礙影響的研究也較缺乏，故本研究進行此議題的探討。 目的：探討1.男男性行為愛滋病毒感染者睡眠障礙現況。2.影響男男性行為愛滋病毒感染者睡眠障礙的主要影響因素與下列因素之相關，包含:人口學特性、疾病及治療(CD4、診斷時間長短、病毒量、抗反轉錄病毒用藥)、HIV相關症狀困擾程度、危險健康行為（酒精飲用、娛樂性藥物使用情形）、心理社會因素(憂鬱、自我負向同志感受及親密關係的依附型態)。 方法：本研究採橫斷式研究設計，以立意取樣方式於北部某醫學中心感染科門診進行收案。收案條件為年齡大於20歲，過去或現在曾有男男性行為或認定自己為男同志，同意參與本研究，距離診斷感染愛滋病毒大於1年，且現行無伺機性感染或惡性腫瘤之愛滋病毒感染者。使用結構式問卷進行資料收集包含人口學及危險健康行為基本屬性問卷、中文版匹茲堡睡眠量表、貝氏憂鬱量表第二版、HIV症狀困擾量表，親密關係量表簡版、內化恐同量表中文版。 結果:本研究結果發現穩定治療追蹤的愛滋病毒感染者有62.6%的感染者有睡眠障礙情形，於多元迴歸的模式中，在控制人口學、疾病等因素後，生理症狀的疲倦、咳嗽或喘不過氣、體重減輕或消瘦，以及心理因素的憂鬱程度為主要影響睡眠障礙的因素。身心因素(疲倦與憂鬱)對於睡眠障礙的影響，彼此互為中介因子。進一步分析探討何者為影響憂鬱的因素，生理症狀的記憶困難、咳嗽或喘不過氣、掉髮或頭髮外觀改變及親密關係的焦慮依附型態為主要影響因子。自我負向同志感受於焦慮依附和憂鬱程度間扮演著調節因子的角色，當有較高的自我同志負向觀感會使高焦慮依附的感染者產生較高的憂鬱程度。 結論：雖然男男性行為愛滋病毒感染者於治療後病情穩定，但是睡眠障礙情形仍普遍困擾此族群病患。除了生理症狀外，疲倦和憂鬱是主要影響睡眠障礙的因素。未來發展此族群睡眠障礙的護理措施時，除了疲倦相關的處置外，需同時對導致憂鬱原因的自我負向同志感受和焦慮依附型態的親密關係發展心理介入措施，以有效改善男男性行為愛滋病毒感染者之睡眠障礙。

Background: Although the antiretroviral therapy effectively increase the survival rates among the patients with HIV, it is common for them to experience sleep disturbance. It is important to understand sleep disturbance among the HIV infected patient because of the impacts of sleep disturbance on their immune functions.However, there is a lack of study examining the sleep disturbance and its main associated factors for HIV infected men who have sex with men. Purpose/Objectives: This study aimed to investigate sleep disturbance among HIV Infected Men Who Have Sex With Men(MSM) and to explore the main associated factors among the following factors: demographic variables, disease and treatment variables (CD4,viral load, time of diagnosis,antiretroviral drug), HIV symptom distress scale, health-risk behaviors (alcohol drinking, recreational drug), and psychosocial factors (depression, personal homonegativity, attachment styles in close relationship). Method: This study adopted the cross-sectional design. The purposive sampling method was used to recruit the participants from the outpatient department of infectious diseases at the general hospital. Inclusion criteria was aged above 20 year-old, having been diagnosed as HIV diagnosis for at least one year without malignancy and opportunistic infection,self-reporting having sex with man.Data were collected by using the structured questionnaires including Chinese version of the Pittsburgh Sleep Quality Index(CPSQI), Beck Depression Inventory-II(BDI-II), HIV symptom distress scale(HIV SDS), Experiences in Close Relationships-Revised (ECR-R), Internalized Homonegativity Inventory for Gay Men(IHNI). Result: The result indicated that 62.2% of the participants appeared to have sleep disturbance. In mulitiple regression model analysis, after controlling the demographic, disease and treatment factors, physical symptoms (fatigue, cough or trouble catching your breath,problems with weight loss or wasting ) and psychological factor of depression were significantly associated with sleep disturbance. Moreover, fatigue and depression were the mediators for each other to sleep disturbance. To develop the sleep program, we further analyzed what was the main factor associated with depression. The result showed that depression was associated with the physical factors (trouble remembering,cough or trouble catching your breath,hair loss or changes in the way your hair looks) and psychological factor of anxiety attachment in close relationship. The personal homonegativity was the moderator between anxiety attachment and depression. The higher personal homonegativity significantly amplified the relationship between anxiety attachment and depression. Conclusion: Although the disease condition remains stable after treatments, it is common for MSM living with HIV to suffer from sleep disturbance. In addition to HIV-related symptoms, fatigue and depression were significantly associated with sleep disturbance. In the future, to develop sleep program needs not only to target at fatigue distress but to manage the depression and its related factors of the patients’ personal homonegativity and anxiety attachment in close relationship.