糖尿病周邊神經病變患者感覺不適症狀與睡眠品質及生活品質之相關性探討

Abstract

糖尿病周邊感覺神經病變所呈現的感覺症狀常以不同的型式表現，如疼痛、燒灼感、針刺感、麻木感或感覺異常等，且因症狀在夜間明顯加劇的特性，往往對病患的生活品質造成影響，症狀嚴重者甚至會出現睡眠障礙或焦慮、憂鬱等問題。本研究之目的期望探討糖尿病周邊神經病變患者感覺不適症狀的特質、感覺症狀對病患整體生活品質和睡眠品質的影響程度。研究採橫斷性相關性設計，以北部某醫學中心之新陳代謝科病房及門診之個案為研究母群體，採立意取樣，經EMG/NCS及Japanese Study Group on Diabetic Neuropathy 診斷標準確定診斷為周邊感覺神經病變之糖尿病患者進入收案，並以神經病變疼痛量表 (NPS) 進行分組，將糖尿病周邊神經病變患者分為「有」及「無」疼痛或其它感覺不適症狀兩組，於民國96年7月1日至97年4月30日，共取得61名個案資料。研究工具包括基本特質調查表、神經病變疼痛量表、生活品質量表、匹茲堡睡眠品質指標量表。研究結果顯示麻木感為最常見的一種糖尿病周邊神經病變感覺不適症狀，疼痛症狀以劇烈刀割痛最常見。在糖尿病周邊神經病變患者生活品質部分，本研究結果發現有周邊神經病變感覺不適症狀的糖尿病患者在生理相關生活品質及心理相關生活品質兩個部份的得分皆較有周邊神經病變但無感覺不適症狀的患者來得低 (p＜.01)。進一步分析發現劇烈刀割痛程度愈高及睡眠品質愈差者，生理相關生活品質愈差；睡眠品質愈差及麻木程度愈嚴重患者，心理相關生活品質愈差。 結論：糖尿病周邊神經病變感覺不適症狀，確實會導致患者睡眠品質及生活品質變差，因此，期望本研究結果提供臨床工作者對此議題有初步的了解，進而有更深入的研究。

Diabetic peripheral neuropathy is one of the most common complications of diabetes, which frequently represents different types of sensory symptoms. These problems might further influence patients’ daily function, such as sleep quality and mood function. However, lack of information about how these problems in Taiwanese patients. Therefore, the purpose of this cross-sectional survey study is to examine DM patients’ problems related to peripheral neuropathy and its relationship to patients’ function. A total of 61 eligible DM patients with diabetic peripheral neuropathy which diagnosed by EMG/NCS and the diagnostic standard were recruited from outpatient and inpatient wards in Metabolism and Endocrinology Departments in a medical center in Northern Taiwan. Data were analyzed by two groups with comparison of their results (symptomatic and asymptomatic groups). Major instruments used for data included (1) Neuropathic Pain Scale, (2) Short Form-36, and (3) Pittsburgh Sleep Quality Index. The major results showed that numbness is the most common symptoms and sharp pain is the second most distressful symptom. With regard to patients’ function, a positive correlation between the physical component summary (PCS) and mental component summary (MCS) of SF-36. It also showed significant differences in function between patients with and without peripheral neuropathy symptoms. A further regression analysis showed that patients with higher impaired sleep quality and severer sharp pain had lower physical function measured by PCS; Patients with higher impaired sleep quality and severer numbness had worse psychological function measured by MCS. In conclusion, DM patients had more symptoms from diabetic peripheral neuropathy had worse sleep and function than those without these symptoms. Further study and clinical care should prevent and assess these problems to provide a better quality of care to DM patients.