[[alternative]]The Relations of Quality of Sleep and Glycemic Control in Type Ⅱ Diabetes Mellitus Elderly

[[abstract]]長期睡眠障礙影響糖尿病老年患者之血糖控制，甚至可能是造成糖尿病的元凶，並易導致糖尿病控制惡化，進而影響生活品質，因此引發研究者探究睡眠品質與血糖控制相關性之動機。本研究旨在探討第Ⅱ型糖尿病老年患者睡眠品質與血糖控制相關性，採橫斷性研究設計(Cross-sectional research design)，資料收集方式採用調查研究法(survey research method)，以結構性問卷及病歷查閱等方式進行資料收集，並於中部地區某醫院新陳代謝科與糖尿病衛教門診進行收案，採方便取樣，本研究共招募109位第Ⅱ型糖尿病老年患者參與本研究，問卷填寫不完整流失6人，因此有效樣本共103位，回收率94%。研究工具採用匹茲堡睡眠品質量表及流行病學研究中心憂鬱量表，資料統計分析方式包括描述性統計與皮爾森積差相關分析和一般線性迴歸分析。資料分析結果發現本研究對象普遍睡眠品質差，且老年女性睡眠品質差之比例較男性高。有27.2%的糖尿病老人主觀睡眠品質差，有34%的糖尿病老人過去一個月來上床後20分鐘以內入睡，但是有31.1%的老年糖尿病患者上床後躺著60分鐘以上才能入睡。有40.8%的老年糖尿病患者睡眠總時數大於7小時以上，但睡眠總時數小於5小時以內的糖尿病老人佔11.7%。習慣性睡眠效率≧85%的糖尿病老人佔67%，而有15.5%的受訪者習慣性睡眠效率小於65%。從未使用安眠藥的老年糖尿病患者居多，有82位(79.6%)。大多數的糖尿病老人沒有日間功能失調，有82位 (79.6%)。本研究對象的糖化血色素(A1C)平均值為7.42%，以一般線性迴歸分析研究對象的睡眠品質與血糖控制相關性，結果發現糖化血色素與睡眠品質總分無顯著相關(p = 0.5)。但採一般線性迴歸分析睡眠品質量表中主觀睡眠品質、睡眠潛伏期、睡眠總時數、習慣性睡眠效率、睡眠干擾、使用安眠藥、日間功能失調等七個構面與血糖控制的相關性，結果顯示其日間功能失調和糖化血色素有顯著相關性(B= .59, p = .03)。以皮爾森積差相關分析來檢視年齡、憂鬱狀態、血糖控制狀況與睡眠品質之相關程度，結果顯示憂鬱狀態與睡眠品質有顯著正相關(r = .44, p = .0)，憂鬱程度愈嚴重，其睡眠品質也越差。 第二型糖尿病老年病患常發生睡眠品質不佳情形，期待未來研究可對夜間低血糖、睡眠品質與情緒問題有進一步的了解，並給予相關之處置，讓病患獲得優質的生活品質與減少相關併發症之發生。[[abstract]]Long-term sleep disorders affect the glycemic control in diabetic elderly, it may even cause diabetes and leads to worsening diabetes control, thereby affecting the quality of life. This study was aimed to investigate the relations of quality of sleep and glycemic control in type II diabetic elderly. This was a cross- sectional study using survey research with structured questionnaires and review of medical records for data collection. Then recruit study subjects in outpatient department in a hospital in the central region of Taiwan. At the beginning, a total of 109 elderly with type II diabetes mellitus were recruited in this study. Later six persons did not finish the questionnaires. A total of 103 samples completed the survey, the completion rate of 94%. Pittsburgh Sleep Quality Index and CES-D were used in data collection. Statistical analysis methods included descriptive statistics and Pearson product moment correlation analysis and general linear regression analysis. The quality of sleep of the study subjects is even worse than general, and elderly women even worse than elderly men. Subjective quality of sleep are good accounted for 72.8%, but 27.2% of the diabetic elderly are poor in subjective quality of sleep. 27.2% of all diabetic elderly are poor in subjective quality of sleep, 34% of elderly people with diabetes are go to bed after 20 minutes to fall asleep over the past month, but 31.1% of elderly patients are hardly to fall asleep lying in bed after more than 60 minutes. 40.8% of the total hours of sleep in elderly diabetic patients are greater more than 7 hours, but less than the total number of sleeping hours are only five hours or less with diabetic elderly accounted for 11.7%. Habitual sleep efficiency ≧ 85% of elderly people with diabetes are accounted for 67%, and 15.5% respondents of habitual sleep efficiency are less than 65%. There are 82 elderly patients with diabetes express never use sleeping pills (79.6%). A total of 82 elderly with diabetes do not have daytime dysfunction. Glycated hemoglobin (A1C) in this study are the average of 7.42%, quality of sleep and the relevance of glycemic control in general linear regression analysis, the result showed there was no significant correlation between the HbA1c and the quality of sleep (p = 0.5). However, the relevance in subjective quality of sleep, sleep latency, the total sleep time assessed, habitual sleep efficiency, sleep disturbances, use of sleeping pills, daytime dysfunction and glycemic control in general linear model shows that there is a significant correlation between daytime dysfunction and glycated hemoglobin (B = .59, p = .03). In Pearson product moment correlation analysis to check the relevance of the age, state of depression, glycemic control and the quality of sleep, the results show that there is a significant positive correlation between depression and the quality of sleep (r = .44, p = .0). Diabetic elderly is more depressed than the average elderly. The more serious depressed elderly had the worse quality of sleep. Elderly with type II diabetes often occurs in the case of poor quality of sleep. Reserchers are looking forward to discover more about nocturnal hypoglycemia, quality of sleep and emotional problems, give the proper treatment that patients get high quality of life, and reduce the occurrence of complications