台灣青少年睡眠品質不良之危險因子分析及對身體質量指數之影響

Abstract

背景：睡眠與肥胖均為影響青少年健康的重要公共衛生問題，兩者之間的關係近年來已逐漸成為研究的焦點，已有不少研究發現青少年的睡眠時間不足與肥胖間存在正相關，然而對於睡眠品質與肥胖間的關係目前仍舊缺乏一致的結果，且國內尚未有針對該議題所進行的研究。本研究的目的在應用傾向分數配對法分析具代表性的台灣青少年資料，以得到睡眠品質不良影響身體質量指數的推估。 方法：本研究採用行政院主計處2001年收集的社會發展趨勢調查資料庫，分析以家戶為單位收集的資料。自變項睡眠品質的測量是採用睡眠品質自我評估表，並區分為睡眠起始困難、睡眠維持困難以及睡眠恢復感不佳三個不同的構面分開進行分析。依變項身體質量指數則是根據自訴的身高體重計算所得。以可能影響青少年睡眠品質的個人屬性與家庭背景因子對三種不同性質的睡眠品質不良及具任一種睡眠問題者分別進行邏輯斯迴歸分析，取得每個樣本的傾向分數後，再進行配對，估算各種睡眠品質不良對身體質量指數所造成的效應。 結果：在此研究樣本中，有任何一種睡眠品質不良的盛行率為20.9%，肥胖的盛行率依衛生署標準，過重為8.0%，肥胖為7.4%。邏輯斯迴歸分析下各種睡眠品質不良的顯著危險因子分別為：（1）睡眠起始困難：青少年目前有抽菸習慣（勝算比：4.346；95%信賴區間：1.980 – 9.539）；（2）睡眠維持困難：戶長有工作且在夜間工作（勝算比：2.335；95%信賴區間：1.070 – 5.095）；（3）睡眠恢復感不佳：青少年目前有抽菸習慣（勝算比：2.913；95%信賴區間：1.864 – 4.552）。經過傾向分數配對法分析的結果，在三種睡眠品質不良中，只有睡眠起始困難會對有該種睡眠問題的青少年造成顯著較高的身體質量指數，而三種睡眠問題對於整個母群體造成的效應則均未達統計顯著。 結論：本研究發現不同性質的睡眠品質不良不但有不同的危險因子，對於青少年身體質量指數的效應亦有所不同，而有睡眠起始困難的青少年如果改善了睡眠起始的問題，可望能顯著地減少他們的身體質量指數，雖然這仍不足以降低全體青少年肥胖的趨勢，對於預防特殊族群的肥胖仍甚具意義。

Background: Sleep and obesity are both major issues in public health which affect wellness of adolescence. The association between them had drawn much attention in recent years. Many previous studies had demonstrated a positive association between short sleep duration and adolescent overweight. However, the relationship between sleep quality and adolescent overweight is inconsistent. Besides, no domestic study had ever been conducted about this issue. Therefore we analyze the representative data from Taiwanese teenagers by employing propensity score matching （PSM）to estimate the effect of sleep disturbance on body mass index (BMI). Methods: We adopted the database of the 2001 Survey of Social Development Trends–Health Security in Taiwan which was collected with each household as a unit. Poor sleep quality was categorized into difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and non-restorative sleep (NRS) according to the results of different items of the Insomnia Self-Assessment Inventory. The BMIs were calculated from self-reported body heights and weights. We first employed multivariate logistic regression analysis with each of the 3 types of disturbed sleep and their aggregate as outcome variable separately to obtain the propensity scores. Then we estimate the average treatment effects of different types of sleep disturbance by applying propensity score matching. Methods: The prevalence of overall sleep disturbance was 20.9% within this population. The prevalence of overweight and obesity was 8.0% and 7.4% respectively according to the criteria proposed by Department of Health in Taiwan. Under multivariate logistic regression, the significant risk factors of disturbed sleep were: (1) DIS: current habitual smoker (odds ratio: 4.346; 95% confidence interval: 1.980 – 9.539); (2) DMS: chief of household who works at night (OR: 2.335; 95%CI: 1.070 – 5.095); (3) NRS: current habitual smoker (OR: 2.913；95%CI: 1.864 – 4.552). After propensity score matching analysis, only DIS had significant average treatment effect on higher BMIs for those teenagers who suffered from DIS among the 3 types of disturbed sleep. None of the 3 kinds of sleep disturbance had significant average treatment effect for the whole population. Conclusion: The study revealed that different types of sleep disturbance may have different risk factors and cause unequal effect on BMIs of the adolescence. For those teenagers who have difficulty initiating sleep, improving their sleep initiation may significantly lower their BMIs. This result implies that improving sleep quality may be a novel way to prevent adolescent overweight, at least for those who have disturbed sleep initiation.