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博碩士論文 etd-0524111-133455 詳細資訊
Title page for etd-0524111-133455
論文名稱
Title
臺灣末期腎臟衰竭接受透析治療者睡眠障礙之盛行率及相關因素探討
The prevalence and risk factors in End-Stage Renal Disease (ESRD) dialysis patients with sleep disorder in Taiwan
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
78
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2011-05-19
繳交日期
Date of Submission
2011-05-24
關鍵字
Keywords
透析治療、睡眠障礙、末期腎臟衰竭、盛行率、共病性
sleep disorder, ESRD, prevelance, comorbidities, dialysis therapy
統計
Statistics
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中文摘要
背景:根據美國腎臟資料系統2010年的報告指出,臺灣在末期腎衰竭的發生率及盛行率皆高居世界排名第一位。其中睡眠障礙經常是透析病患的困擾,並影響病患的健康相關生活品質,因此逐漸成為備受重視的議題。
目的:本研究探討台灣末期腎衰竭患者發生睡眠障礙的盛行率,以及末期腎衰竭患者發生睡眠障礙之人口學特徵、共病程度、透析治療、醫療資源利用等概況,以探討發生睡眠障礙之影響因素。
方法:利用健保資料庫內2000年、2002年、2004年與2006年之『醫事機構基本資料檔』、『重大傷病證明明細檔』『醫事機構基本資料檔』進行次級資料分析。由『重大傷病證明明細檔』自內挑出末期腎臟衰竭病患,再以病患之身份證統一編號(已加密轉碼)將『重大傷病證明明細檔』與『門診處方及治療明細檔』進行串檔合併再由其診斷碼中挑選出發生睡眠障礙者,利用卡方檢定、獨立樣本t檢定與邏輯斯回歸進行資料分析。
結果:2000年、2002年、2004年與2006年末期腎臟衰竭病患發生睡眠障礙之年盛行率為2.1%、2.7%、6.4%與7.3%;其病患為女性比男性有較高風險(OR:1.150、1.162、1.110、1.101);而共病嚴重程度越高者風險越高(除2006年以外);採血液透析較腹膜透析風險較高(血液/腹膜透析OR:16.45、16.48、8.23與7.91);在醫療資源區域分布方面,北部較東部院所風險高(北部/東部OR:3.47、2.73、1.94、2.29);就醫醫院層級以基層院所為參考組時,除2006年外,皆以地區醫院發現較多病例;發生睡眠障礙患者並有較多的門診利用次數及門診就醫費用,皆呈現正向相關。
結論:末期腎臟衰竭發生睡眠障礙之危險因子包括性別、共病、透析治療。睡眠障礙雖然非常常見,但經常沒有被診斷出來,建議未來相關研究可使用主觀問卷填寫,並使用臨床診斷睡眠障礙之工具,可彌補使用資料庫之不足而造成研究上的偏差。
Abstract
Background: According to 2010 U.S. Renal Data System 2010Annual Data Report, the incidence and prevalence of End-Stage Renal Disease is the worst of the world in Taiwan. Sleep complaints are common in dialysis patients, and impacts negatively on health. It has become highly important issue.
Objectives: This study explored the prevalence of ESRD with sleep disorder. We focused on demography status, comorbidities, dialysis therapies and utilization of health care to define the risk factors of disease.
Methods: We conducted secondary data analysis with admnstrative data of National Health Insurance between 2000, 2002, 2004 and 2006. We firstly seleced the patients diagnosed as ESRD and Dyssomnia, and merged the data set and other related variables.The data was analyzed by Chi-square test, t-test and logistic regression.
Result: The prevalence of ESRD with sleep disorder for the four years were 2.1%、2.7%、6.4% and 7.3%, respectively. Female patient has higher risk than male .Higher comorbidity score also lead to higher risk, dialysis therapies in hemodialysis/peritoneal were 16.45、16.48、8.23 and 7.91 in OR. There were significant differences in regions of hospital organizations (northern compared with the eastern, OR were 3.47, 2.73, 1.94 and 2.29, class of hospital organizations (compared with Physician Clinics), there are more cases in Regional Hospitals, except 2006. Outpatient expenses and visits are both positive correlation in all years.
Conclusion: The risk factors of suffering sleep disorder in ESRD patients are sex, comorbidities and dialysis therapies. It is a relatively common but frequently unrecognized, therefore, we strongly suggested further study could be conducted by research questionnaires to make up the weakness of adminstatrative data.
目次 Table of Contents
目錄
第一章、緒論 2
第一節、研究背景 2
第二節、研究目的 3
第二章、文獻探討 4
第一節、腎臟衰竭疾病重大傷病證明認定、分級 4
第二節、末期腎臟衰竭之透析治療方式說明 6
第三節、睡眠障礙的臨床症狀及測量 7
第四節、末期腎臟衰竭病患睡眠障礙之情形 8
第五節、末期腎臟衰竭病患睡眠障礙人口學特性 10
第六節、與末期腎臟衰竭之共病症 11
第七節、小結 13
第三章、研究方法與進行步驟 14
第一節、研究架構及研究假設 14
第二節、研究樣本與資料來源 16
第三節、研究流程 16
第四節、測量變項 19
第五節、分析方法 21
第四章、結果 23
第一節、描述性統計分析 23
第二節、推論性統計分析 32
第五章、討論 55
第一節、末期腎臟衰竭者睡眠障礙之盛行率 55
第二節、末期腎臟衰竭者發生睡眠障礙之人口學特質 56
第三節、末期腎臟衰竭者發生睡眠障礙之共病 57
第四節、末期腎臟衰竭者發生睡眠障礙之透析治療與透析持續時間 58
第五節、末期腎臟衰竭者發生睡眠障礙之醫療資源利用 59
第六章、結論與建議 61
第一節、研究結論 61
第二節、研究限制 62
第三節、研究建議 63
參考文獻 64
參考文獻 References
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