癲癇兒童及青少年睡眠自助策略之初探

Abstract

癲癇是兒童及青少年常見且嚴重的慢性神經系統疾病，全球約有0.5%至1%的兒童與青少年受其影響。相較於同年齡的健康兒童及青少年，癲癇兒童及青少年更容易出現睡眠問題。長期無法解決的睡眠問題除了對兒童及青少年的生長發展及生活品質造成負面影響，更與較差的癲癇預後有關。根據過去研究結果，多數癲癇兒童及青少年父母報導病童有睡眠問題，然而鮮少有研究探討癲癇病童的父母對於主動改善病童睡眠所採取之方式及成效。故本研究目的為探討睡眠自助策略於癲癇兒童及青少年之使用現況以及此策略與癲癇兒童及青少年睡眠型態之相關性。本研究採橫斷式相關性設計，共111位1-18歲癲癇兒童及青少年參與研究並配戴活動記錄腕錶，由其父母完成基本資料表、兒童睡眠習慣問卷（Children’s Sleep Habits Questionnaire, CSHQ），由病童本人或其父母完成睡眠活動日誌。 本研究病童的平均年齡為9.53±4.57歲，男童佔53.2%，睡眠自助策略的使用人數為51人（45.9%），其中以故事或閱讀（18.9%）及音樂（18.0%）的使用比例最高。病童夜間睡眠效率<85%達90人（81.1%）且CSHQ總分平均值為51.59 ± 7.93，顯示本研究病童有中至重度睡眠問題。經多元線性迴歸分析，在控制可能影響病童睡眠的干擾因素後，睡眠自助策略之使用與較高的CSHQ總分(β= .35, p = .03)及夜間睡眠時數(β= 22.24, p =.04)呈顯著正相關。根據本研究結果，近半數癲癇病童曾自行發起睡眠自助策略以改善睡眠，臨床上應將睡眠問題納入常規篩檢，並主動與病童及其家庭討論具個別化的助眠策略。

Epilepsy is one of the most common chronic neurological disorders in childhood, affecting 0.5% to 1% of the child and adolescent population globally. Children and adolescents with epilepsy experience more sleep problems compared to their healthy peers. These sleep problems not only negatively impact development and quality of life but also pose challenges in managing epilepsy effectively. According to previous research, most parents of children and adolescents with epilepsy report their child as having sleep problems. However, there is a lack of research exploring the methods adopted by parents of children with epilepsy to improve their child's sleep. Therefore, this study aims to explore the use of self-help strategies for sleep among children and adolescents with epilepsy and examine the association between these strategies and sleep. A cross-sectional, correlational study was conducted involving 111 children and adolescents with epilepsy. Participants wore an actigraph for seven days, while their parents or children and adolescents themselves concurrently completed a sleep diary during the same period. Additional data were collected using a health information datasheet and the Children's Sleep Habits Questionnaire (CSHQ). The mean age of participants was 9.53 ± 4.57 years, and 53.2% were male. A total of 51 participants (45.9%) reported using self-help strategies to improve their sleep. The most commonly used self-help strategies were stories/reading(18.9%) and music (18.0%). Additionally, 90 participants (81.1%) had nighttime sleep efficiency below 85% and the overall Children’s Sleep Habits Questionnaire (CSHQ) score (51.59 ± 7.93) indicated the presence of moderate to severe sleep problems. After controlling for potential confounders, analyses revealed a significant positive association between the use of self-help strategies for sleep and the CSHQ total score (β = .35, p = .03). Regarding objective sleep parameters, the use of self-help strategies was significantly positively associated with nighttime sleep duration (β = 22.24, p = .04). Given that nearly half of the participants adopted self-help strategies to improve sleep, routine screening for sleep problems and individualized discussions with families are recommended as part of clinical care in pediatric epilepsy.