臨床醫療人員睡眠品質與頭痛失能之相關性探討

Abstract

背景：頭痛是最常見的神經系統疾患，發作時疼痛的不適可導致生活上的失能，症狀嚴重者需服用止痛藥物緩減不適，頭痛失能可能影響著工作、社交活動、日常活動及生活品質的優劣。多數臨床人員需輪值夜班，不規律的工作型態及日夜顛倒，可能影響睡眠品質造成頭痛失能的情形。研究目的：(1)調查臨床醫療人員的睡眠品質；(2)探討臨床醫療人員的睡眠品質與頭痛失能的相關性，並分析影響頭痛失能的可能因子。研究方法：橫斷性研究設計，以北部某醫學中心之臨床醫療人員為母群體，採方便取樣，符合輪班定義的醫療人員進入收案，並以國際頭痛學會(International Headache Society, IHS)的診斷標準進行分組，依頭痛情形做分類。本研究採個案自填問卷進行資料收集，研究工具包括基本社會人口學特性調查表、頭痛診斷評估表、頭痛失能量表(HDI)、偏頭痛失能評估表(MIDAS)、中文版匹茲堡睡眠品質指標量表(CPSQI)、職場疲勞量表(C-CBI)、高汀休閒時運動量表(GLTEQ)、壓力知覺量表(Chinese 14-item PSS)等，以SPSS 22.0電腦軟體進行鍵入與分析。研究結果：在292位臨床醫療人員中，頭痛者佔57%(n = 165)，其中偏頭痛佔51%，緊縮型頭痛佔29%，其他頭痛類型佔12%，無法歸類佔8%；睡眠品質方面，整體睡眠品質CPSQI得分為6.8(SD = 3.50)分，顯示平均睡眠品質差。有頭痛之臨床醫療人員的CPSQI平均得分顯著較無頭痛者高1.0分(t = 2.55, p = .011)，顯示有頭痛者睡眠品質較差。在睡眠品質與頭痛失能的關係，當控制了藥物使用習慣(β = 8.70, p = .035)、職業類別(β = 11.73, p = .004)、個人疲勞程度(β = 0.25, p = .037)、工作過度投入(β = 0.23, p = .020)、頭痛型態(β = 7.61, p = .017)與頭痛強度(β = 2.82, p <.001)，對頭痛失能的影響，發現睡眠品質越差(β = 1.28, p = .004)，頭痛相關失能程度越強。結論：本研究顯示臨床醫療人員睡眠品質普遍不佳，頭痛症狀者有顯著睡眠品質差的情形；在控制相關變數後，睡眠品質不良者頭痛失能情況較為嚴重。整體而言，本研究結果支持臨床醫療人員睡眠品質與頭痛失能之間的相關性，呼籲醫院應重視臨床醫療人員的睡眠與頭痛情形，未來研究應釐清睡眠與頭痛失能之間的因果關係，以進一步提供改善措施。

Background: Headaches are the most common disorders of the nervous system. Headache attacks may disable patients’ daily life. Headache disability may impact on the work, social activity, daily activity and quality of life. Many clinical health professionals have to work by day-and-night shifting rotation. The shifting work pattern, including reversed biological clock, may impact the quality of sleep and headache disability severity. Objectives: The purposes of this study were (1) to investigate the sleep quality among clinical health professionals with shifting work, and (2) to examine associations between sleep quality and headache-related disability. Method: The study adopted a cross-sectional design. Participants were recruited in a medical center in northern Taiwan. The diagnostic questionnaire was in accordance with the diagnostic criteria from the International Headache Society (IHS). Data were collected by self-administration questionnaires, including basic demographic characteristics and work shift, headache symptoms assessment scale, Headache Disability Inventory (HDI), Migraine Disability Assessment (MIDAS), the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), the Chinese version of Copenhagen Burnout Inventory (C-CBI), Godin Leisure Time Exercise Questionnaire (GLTEQ), and the Chinese version of Perceived Stress Scale 14-item (PSS-14). Data were analyzed by the SPSS version 22.0. Results: Among 292 participants, 165 (57%) clinical health professionals reported headache disorders, including migraine (51%), tension-type headache (29%), other headache types (12%), and the other undiagnosis (8%). Regarding the sleep quality, the overall CPSQI score were 6.8 (SD = 3.50), indicating the poor sleep quality among the clinical health professionals. Comparing to clinical health professionals with/without headache, indicated the positive association between headache disorders and sleep quality(mean differences = 1.0, t = 2.55, p = .011). Regarding the association between sleep quality and headache-related disability, when controlling the habits of medicine-taking(β = 8.70, p = .035), position as nurses (β = 11.73, p = .004), higher “personal burnout” (β = 0.25, p = .037), higher “over-commitment to work” (β = 0.23, p = .020), headache types(β = 7.61, p = .017) and headache intensity(β = 2.82, p <.001) clinical health professionals with worse sleep quality(β = 1.28, p = .004) had more severe headache-related disability. Conclusions: The research findings demonstrated that the sleep quality in clinical health professionals was poor generally, and that those with headache symptoms had the association with poor sleep quality. Related variable controlled, the research findings demonstrated those with poor sleep quality had wosre headache-related disability. In conclusion, the research findings supported the association between headache-related disability and sleep quality in the clinical health professionals. And to provide the improvement strategies based on the manpower planning for institution in the future.