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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 張媚(Mei Yeh Chang) | |
dc.contributor.author | Chia-Ling Lin | en |
dc.contributor.author | 林嘉玲 | zh_TW |
dc.date.accessioned | 2021-05-13T06:39:38Z | - |
dc.date.available | 2019-09-12 | |
dc.date.available | 2021-05-13T06:39:38Z | - |
dc.date.copyright | 2017-09-12 | |
dc.date.issued | 2017 | |
dc.date.submitted | 2017-08-08 | |
dc.identifier.citation | 參考文獻
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/2383 | - |
dc.description.abstract | 目的: 本論文研究利用全民健保資料庫(Taiwan’s National Health Insurance Database, NHIRD)探討失眠研究族群第二型糖尿病(Type 2 Diabetes Mellitus, T2DM)之發生風險及累積效應,並與無失眠的參考族群進行各項特性的比較;另外,探討失眠族群使用不同類型安眠藥者第二型糖尿病發生風險之差異。
方法: 本研究資料來源為台灣全民健保資料庫2005年100萬人承保抽樣歸人檔。研究分析2000至2010年之申報資料;採回溯性世代研究設計(retrospective cohort study),先排除1999年12月31日之前已有失眠或第二型糖尿病病史,定義2000年1月1日至2005年12月31日期間新診斷的94,535位失眠個案為研究族群,後續追蹤至2010年12月31日,計算其糖尿病發生率。另外,採隨機抽樣法選取同時段無失眠診斷的個案,配對性別、年齡及診斷時間,以2倍的人數189,070位作為參考族群,比較兩個族群發生糖尿病的風險差異。另外,將安眠藥使用分成BZD類、Non-BZD類、zolpidem及Mixed 組分析其與第二型糖尿病發生風險相關性。利用Cox proportional-hazards regression model 分析兩個族群、四組安眠藥使用者第二型糖尿病發生風險,呈現hazard ratios (HR) and 95% confidence intervals (CI) 結果: 失眠研究族群T2DM的發生率明顯高於參考族群(78.78 vs 39.45, per 1,000 person-years),失眠族群T2DM的發生風險為參考族群的1.51倍 (95% CI 1.48-1.54),達顯著差異。每增加一年失眠暴露時間,其T2DM發生風險增加1.2%。若將暴露時間分層,以暴露1年為參考組,暴露時間為2-4年、5-8年及>8年,其發生T2DM風險分別是參考族群的1.29倍(95% CI 1.25-1.33)、1.76倍(95% CI 1.73-1.79)、1.82倍(95% CI 1.77-1.87)。若以無失眠無使用安眠藥為參考族群,僅用BZDs、僅用Non-BZD、僅用zolpidem、Mixed組相對於參考族群,發生T2DM相對風險分別是1.77倍(95% CI 1.42-1.98)、1.65倍(95% CI1.27-1.87)、1.60倍(95% CI 1.10-1.77)、2.69倍(95% CI 1.51-3.43);其中以同時使用zolpidem及使用BZDs者,其T2DM發生風險為無使用zolpidem且無使用BZD者1.62倍( 95% CI 1.29–1.87)。 結論: 失眠族群T2DM的發生風險相較於參考族群高,失眠暴露時間愈久,T2DM發生風險愈高。各種安眠藥使用者中,使用一種以上安眠藥者對T2DM發生風險的影響程度最大,其中同時使用zolpidem及BZDs者對T2DM發生風險具有加成協同(additively synergistic)。本研究結果可提供臨床照護者重新審視長期失眠與安眠藥使用與T2DM風險相關性,將有助於T2DM照護策略的擬定。 | zh_TW |
dc.description.abstract | Aim: The present study investigated the risk of type 2 diabetes mellitus (T2DM) in patients with and without insomnia and explored the risk of T2DM in patients with hypnotic use through the secondary analysis of the data from the Taiwan National Health Insurance Database.
Methods: The present retrospective study used the data from the Longitudinal Health Insurance Database of the Taiwan National Health Research Institute, which consists of all original claims data of 1 million beneficiaries randomly selected from the original registry for beneficiaries in 2005. We excluded patients with a history of insomnia or T2DM before December 31, 1999. The study group included 94,535 patients who received a diagnosis of insomnia between January 1, 2000, and December 31, 2005, and had the onset of T2DM before December 31, 2010. The incidence of T2DM in the study group was estimated. The reference group of 189,070 individuals was obtained by randomly selecting insured individuals without insomnia and T2DM and by two-fold frequency matching by sex, age, and index year. According to the different hypnotics used, the study group was divided into four subgroups: benzodiazepine (BZD), non-BZD, zolpidem, and mixed hypnotic users and the risk of T2DM was analyzed in each subgroup. We conducted a Cox proportional hazard regression analysis to estimate the effects of insomnia and hypnotic use on the risk of T2DM. Results: During the follow-up period, the incidence of T2DM in the insomnia group was significantly higher than that in the reference group (78.78 vs 39.45, per 1,000 person-years). Overall, the insomnia group had a higher risk of T2DM than the reference group (adjusted hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.48–1.54). The risk of T2DM increased by 1.2% with each additional year of insomnia duration. The risk of T2DM increased 1.29 (95% CI, 1.25–1.33), 1.76 (95% CI, 1.73–1.79), and 1.82 (95% CI, 1.77–1.87) times for an insomnia duration of 2–4, 5–8, and >8 years, respectively, compared with an insomnia duration of up to 1 year. Furthermore, the risk of T2DM in BZD, non-BZD, zolpidem, and mixed hypnotic users increased 1.77 (95% CI, 1.42–1.98), 1.65 (95% CI, 1.27–1.87), 1.60 (95% CI, 1.10–1.77), and 2.69 (95% CI, 1.51–3.43) times, respectively, compared with non-hypnotic users. In addition, patients using both zolpidem and BZDs had a higher risk of T2DM than those not using zolpidem or BZDs (adjusted HR, 1.62, 95% CI, 1.29–1.87). Conclusion: Compared with the reference group, the insomnia group had a higher risk of T2DM, and the longer the insomnia duration, the higher the risk of T2DM. Patients using more than one type of hypnotics had a higher risk of T2DM. Furthermore, T2DM exerted a synergistic effect in patients using both zolpidem and BZDs compared with those without hypnotic use. The present results may help clinicians re-examine the relationship among chronic insomnia, hypnotic use, and the risk of T2DM and contribute to T2DM management. | en |
dc.description.provenance | Made available in DSpace on 2021-05-13T06:39:38Z (GMT). No. of bitstreams: 1 ntu-106-D99426005-1.pdf: 1180034 bytes, checksum: 4b101456a37b1f083b8a10fb9e95aef8 (MD5) Previous issue date: 2017 | en |
dc.description.tableofcontents | 目錄
口試委員會審定書 I 致謝 II 中文摘要 III 英文摘要 V 目錄 VIII 圖目錄 IX 表目錄 X 第一章 緒論 1 第一節 研究重要性 1 第二節 研究動機 3 第三節 研究目的 6 第四節 研究假設 6 第二章 文獻探討 7 第一節 健保資料庫研究對失眠族群的界定 7 第二節 失眠與健康衝擊 9 第三節 健保資料庫研究對T2DM族群的界定 9 第四節 睡眠問題與T2DM可能之致病機轉 11 第五節 睡眠時數、睡眠品質及失眠與T2DM相關性之研究 13 第六節 安眠藥與T2DM風險相關性 19 第七節 影響睡眠問題及T2DM兩者關係之干擾因子 20 第三章 研究方法 25 第一節 研究資料來源 25 第二節 研究設計 27 第三節 研究族群與參考族群定義 28 第四節 結果變項定義 30 第五節 其他變項因素定義 30 第六節 研究資料庫信、效度 34 第七節 資料分析方法 35 第四章 結果 38 第一節 研究族群失眠的發生率與盛行率 38 第二節 失眠與T2DM相關性 42 第三節 失眠族群使用不同類安眠藥與T2DM相關性 50 第五章 討論 55 第一節 研究族群之失眠盛行率與發生率 55 第二節 失眠與T2DM相關性 57 第三節 失眠族群使用不同類安眠藥與T2DM相關性 61 第六章 結論與建議 66 第一節 結論 66 第二節 建議 67 第三節 研究限制 69 參考文獻 72 附錄 87 附錄一 睡眠時數、睡眠品質、失眠與T2DM相關性之橫斷式研究一覽表 87 附錄二 睡眠時數、睡眠品質、失眠與T2DM相關性之世代研究一覽表 90 附錄三 台大醫院研究倫理委員會(IRB編號201412130W) 93 附錄四 藥品代碼、英文名稱、成份名稱 94 圖目錄 Figure 3-1健康保險資料庫各檔案明細 26 Figure 3-2回溯性世代研究(Retrospective cohort study) 27 Figure 3-3 The flowchart of study sample selection from National Health Insurance Research Database in Taiwan 33 Figure 4-1. Overall 10-year prevalence trend of insomnia in female and male 39 Figure 4-2. Overall 10-year incidence trend of insomnia in female and male 40 Figure 4-3. Age- and gender-specific prevalence of insomnia (%) 41 Figure 4-4. Age- and gender-specific incidence of insomnia (%) 41 Figure 4-5. Kaplan-Meier for cumulative risk of T2DM among aged 20 and over stratified by insomnia with log-rank test 46 表目錄 Table3-1 Comorbidities in ICD-9-CM 32 Table3-2 Variables attributes and statistical methods 37 Table4-1. Overall 10-year prevalence of insomnia among study group (%) 39 Table4-2. Overall 10-year incidence of insomnia among study group( %) 40 Table4-3. Demographic data for the study subjects with and without insomnia (baseline) 44 Table4-4. Incidence rates and adjusted HR of T2DM by age, gender, urbanization level and comorbidities 45 Table4-5. Numbers of T2DM in different follow-up time 47 Table4-6. Adjusted HR of T2DM patients among groups with different duration of insomnia 48 Table4-7. Incidence rate ratio and HR of T2DM patients with different type of insomnia 49 Table4-8. Distribution of medication among insomnia patients 51 Table4-9. Comparison of demographics and comorbidities between with and without insomnia patients 52 Table4-10. Comparison of incidence rates and adjusted HR of T2DM in study subjects 53 Table4-11. Cox proportional model measured adjusted HR in insomnia patients with Zolpidem treatment-associated T2DM with interaction of comorbidities and BZDs 54 | |
dc.language.iso | zh-TW | |
dc.title | 失眠與第二型糖尿病風險之觀察性研究 | zh_TW |
dc.title | Insomnia and the Risk of Type 2 Diabetes Mellitus: An Observation Study | en |
dc.type | Thesis | |
dc.date.schoolyear | 105-2 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 張念慈(Nien-Tzu Chang),高嘉鴻(Chia-Hung Kao),莊立民(Lee-Ming Chuang),胡朝榮(Chaur-Jong Hu),簡戊鑑(Wu-Chien Chien) | |
dc.subject.keyword | 失眠,安眠藥,第二型糖尿病,回溯性世代研究,全民健保資料庫, | zh_TW |
dc.subject.keyword | Insomnia,Hypnotics,Type 2 diabetes mellitus,Retrospective cohort study, | en |
dc.relation.page | 112 | |
dc.identifier.doi | 10.6342/NTU201702699 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2017-08-08 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 護理學研究所 | zh_TW |
顯示於系所單位: | 護理學系所 |
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