早期肺癌術後患者睡眠品質與相關因素探討

Abstract

早期肺癌患者主要治療方式為開刀，開完刀後多數患者只需定期返回醫院長期追蹤即可，但術後症狀可能會一直持續影響患者，其中最常見的症狀是睡眠品質不佳，睡眠是人類維持基本生活功能不可或缺的關鍵之一，長期的睡眠不足除了影響生活品質之外，甚至會造成健康上的不良影響，本研究目的為探討早期肺癌患者術後睡眠品質及個人特質（如性別、年齡、教育程度、工作狀況等）、疾病治療特質、生理、心理相關因素與睡眠品質之間的關係。 研究設計為描述相關性、縱貫式研究設計，針對接受手術之早期肺癌患者術前及術後一個月，以立意取樣使用結構試問卷進行資料收集，於台北某醫學中心之胸腔外科門診收案。包括：「背景資料量表」、「匹茲堡睡眠品質量表」、「睡眠干擾量表-身體緊繃及精神緊張次量表」、「歐洲癌症治療與研究組織之生活品質量表之症狀量表及肺癌模組」、「Godin休閒時運動量表」、「醫院焦慮及憂鬱量表-憂鬱次量表」、「Mishel疾病不確定感量表」。 總共收案67人，研究結果發現 (1) 超過一半的患者匹茲堡睡眠品質量表得分超過5分（大於五分表示睡眠品質不佳），34.3%的人每週3次以上需躺超過30分鐘才能入睡，39.8%的人睡眠效率小於85%，睡眠困擾為得分最高之構面，感到中度困擾以上的有43.3%， 31%的患者對自身的睡眠品質感到不滿意或是非常不滿意，平均睡眠時數6.8±1.5小時，有2成左右的人每週需服用安眠藥三次以上，而將近半數的人感到自己睡眠不足；(2) 不同教育程度之睡眠品質有顯著差異；(3) 患者之身體活動度及症狀嚴重度等皆與睡眠品質無關；(4) 心理相關因素方面，憂鬱情形與睡眠品質無相關，但不確定感及焦慮與睡眠品質成顯著相關。(5) 術後精神越緊張、術前睡眠品質越差以及教育程度越低可有預測患者術後睡眠品質越差，其解釋變異量為46.3%。 睡眠問題非常重要，臨床醫療人員卻較少重視，臨床醫療人員應了解患者的睡眠情形及了解其相關因素。本研究可做為臨床評估及處置早期肺癌患者睡眠狀態之參考，達促進睡眠品質之目的。

Sleep is an important health and daily life issue. Disease and related treatments may influence lung cancer patients’ sleep, unfortunately, relatively few studies have emphasized on early staged lung cancer patients’ sleep after surgery. The purposes of this study were to (1) examine sleep quality during the first month post-surgery in early stage lung cancer patient; and (2) identify factors related to sleep quality. This study is part of a major project with a longitudinal panel research design. Primary lung cancer patients with stage I, II, and IIIa who received surgery would be eligible for the study. A total of 67 patients from a medical center in North Taiwan were recruited. Data were collected at 2 time-points: pre-operation and 1 month after surgery. Patients were assessed by trained nurses with structured interview using several instruments, including (1) Background & Disease Related Information Form, (2) Pittsburgh Sleep Quality Index (PSQI), (3) Sleep Disturbance Questionnaire- Physical Tension and Mental Anxiety subscale, (4) Godin Leisure-Time Exercise Questionnaire (GLTEQ), (5) EORTC Core Quality of Life Questionnaire (QLQ-C30) - Symptom Scales and 13-item Lung Cancer-Specific Questionnaire Module ( LC-13), (6) Hospital Anxiety and Depression Scale, the Depression subscale (HADS-D), and (7) Mishel’s Uncertainty in Illness Scale Chinese Version (MUIS). The results showed that (1) more than half of subjects (53.7%) reported poor sleep quality (global PSQI score > 5), about 31% reported “fairly bad” or “very bad” sleep quality, 39.8% reported sleep efficiency less than 85%, The mean of sleep hour were 6.8 hours, and 34.3% of subjects reported to have sleep disturbances three or more times per week; (2) patients with high school/collage education levels reported to have worse sleep quality than with university education levels; (3) patients with worse sleep quality before operation, higher uncertainty and mental anxiety reported to have worse sleep quality analyzed by bi-variate correlation; (4) Overall, patients’ poor sleep quality was significantly predicted by more mental anxiety, sleep quality of pre-operation and less education level and these factors accounted for 46.3% of the variance of sleep quality analyzed by regression. Sleep disturbance is still a problem among the early stage lung cancer patients post-operation. Our results can provide the information to develop evidence-based services to help early stage lung cancer patients to improve their sleep quality.