癌症病人之疼痛、生物節律與睡眠障礙之相關性探討 Relationships Among Circadian Rhythm, Pain, and Sleep Disturbance in Cancer Patients
中文摘要
研究旨在探討癌症住院病人的疼痛、生物節律和睡眠障礙之關係。採立意取樣方 式，以橫斷性研究法針對某治癌中心醫院進行為期一年三個月收案期，共收集 68 位住院癌症疼痛病人。使用人口學調查表、簡明疼痛量表、匹茲堡睡眠品質指 標量表來瞭解研究對象之基本屬性、疼痛程度和睡眠品質指標。並以活動記錄器
（actigraphy）記錄病患連續三天的睡眠及活動量。收集資料以描述性統計、皮爾 森積差相關分析、多元迴歸及階層迴歸等方法進行處理。研究所得重要結果如下 病人最劇烈疼痛平均得分為5.47 （SD=2.70）（量表計分範圍為 1-10）。病人之 匹茲堡睡眠品質指標量表總和平均得分為11.19 分（SD=4.05）（量表計分範圍 為0-21）。生物節律 r24 指標平均為 .19（SD=0.16）；生物節律 I<O 指標平均為 85.29%（SD=0.13）。分別以癌症病人疼痛程度、睡眠障礙情形、生物節律 r24 指 標及 I<O 指標作相關性分析，發現疼痛程度與睡眠障礙間呈正相關（r=.69, p<.01）；疼痛程度與 r24 指標間有統計上之顯著負相關（r=-.51, p<.01）；疼痛 程度與I<O 指標間也有統計上之顯著負相關（r=-.42, p<.01）；而生物節律 r24 指標、I<O 指標，也皆與睡眠障礙間有顯著負相關，其中 r24 指標
r=-.43、p<.01；I<O 指標 r=-.44、p<.01。在嘗試將病人疼痛分類為輕度疼痛（BPI 得分1-3）、中度疼痛（BPI 得分 4-6）、重度疼痛（BPI 得分 7-10），分別取其 三天中所有休息及活動時間片段出現之機率點，結果發現短時間的休息或活動，
在不同程度癌症疼痛病人出現的機率次數相近；然而愈疼痛的病人，愈無法維 持較長時間的休息及活動。疼痛程度對睡眠障礙有顯著預測力，對睡眠障礙的解
釋變異量為47.1%。而睡眠障礙為疼痛程度最重要的預測因子，可解釋變異量為
47.1%；其次為生物節律 r24 指標，可解釋變異量為 5.0%。進一步以階層迴歸分 析，發現生物節律指標 r24、I<O 為疼痛程度與睡眠障礙之間的中介變項
（mediator variable），即疼痛程度透過生物節律指標 r24、I<O 對睡眠障礙有部 份中介效果。本研究結果使得護理人員更加了解癌症住院病人的疼痛、生物節律 和睡眠障礙情況，以期針對癌症病人提供適時個別性的照護，進而增進其生活 品質。
英文摘要
In this thesis, we explore the relationships among pain, sleep disturbance, and circadian rhythm of cancer inpatients. Sixty-eight cancer inpatients were recruited during a time span of 15 months. Study participants completed the Demographic form, Pittsburgh Sleep Quality Index (PSQI), and Brief Pain Inventory (BPI-C). Wrist actigraphy worn for 3 consecutive days, were used to measure the patient’s activity,
sleep quality, and circadian rhythms. Data were analyzed using descriptive statistics, pearson’s correlation, multiple regression and hierarchical regression.
The major findings of this study were as follows: Pain severity scores ranged from 1 to 10. The mean score of pain severity was 5.47 ± 2.70 for worst pain, Mean Global sleep Quality score was 11.19 ± 4.05. The mean values of the autocorrelation coefficient (r24) was .19 ± 0.16, and the mean values of the dichotomy index (I<O) was 85.29 % ± 0.13. Cancer patients with higher pain levels had higher degrees of sleep disturbance, and worse circadian rhythms, as shown by r24 and I<O. Pain levels could explain up 47.1% of variance in sleep disturbance. Sleep disturbance degrees could explain up 47.1% of variance in pain, and also mean r24 could explain up 5.0%
of variance in pain. With further hierarchical regression, we found that r24 and I<O function as a mediator variables between pain levels and sleep disturbance. The correlation between pain level and sleep disturbance varied at different level of r24 and I<O.
Results from this study allow us a better understanding of the relationships among pain, sleep disturbance and circadian rhythms.
