臺灣博碩士論文加值系統

因全球老年人口比例逐年增加，現今醫療技術快速發展，但老年人有睡眠障礙的比例卻居高不下且逐年上升。若能找出影響老年人睡眠障礙的因素，或許可減少使用的藥物，避免醫療資源濫用。
本篇論文研究採用衛生署國民健康局「2009國民健康訪問調查」問卷資料，調查期間為2009年6月至2010年2月底，有效問卷2904份，剔除問卷遺失值與干擾因素 (失智症) 後，完整資料計2703筆。 本研究以二種方式討論影響老年人睡眠障礙的因素，先運用因素分析將「困難入睡」、「維持睡眠困難，頻繁的醒來或醒來後困難再進入睡眠等特點」、「清晨很早醒來，無法再睡覺」 等三個變數整合成自覺睡眠障礙應變數、而使用「藥物治療」為另一個應變數。藉由卡方獨立性檢定與兩樣本獨立T檢定以及變異數分析 (ANOVA) 檢定來檢定與睡眠障礙有相關的自變數。再利用邏輯斯迴歸與多項式邏輯斯迴歸分別找出影響的因子，並比較兩變數之影響因素。
本研究結果發現性別、曾罹患心臟疾病或曾被醫師診斷過失眠對於使用藥物幫助入睡與自覺睡眠障礙有顯著的影響。女性老年人覺得有睡眠障礙的困擾比使用藥物治療高
(勝算比分別為1.86 與1.40)；曾經罹患過心臟疾病的老年人比較有睡眠障礙, 二個模型結果一致 (勝算比約為 1.4)；曾經被醫師診斷過失眠的老年人有睡眠障礙的勝算亦比較高 (使用藥物治療的勝算比為自覺睡眠障礙的 3 倍)。
二個模型有一致的結果，但女性卻有較高自覺睡眠障礙，而有被醫師診斷過失眠，較不會覺得有睡眠障礙，希望本研究的研究結果可以提供民眾做為提升生活品質的參考。

The percent of elderly is increasing each year globally. Although the medical technics make great strides nowadays, the percent of having sleep disorder in elderly increases every year. It is then important to understand influential factors associated with sleep disorders in elderly. In turn, the elderly can avoid taking too many drugs and it might result in reducing a waste of the medical resource.
This research used data collected by Health Promotion Administration in 2009 National Health Interview Survey. 2703 eligible respondents who were aged 65 years old and over, had no missing data and didn’t have Alzheimer disease were included in this study. Two dependent variables were considered. The first variables used factor analysis to combine three questions “Difficulty with initiating sleep?”, “Difficulty with maintaining sleep?”, “Early morning awakening” and was used to measure self-reported sleep disorder and is treated as a subjective measure. The second variable used “Use any medication for sleep night?” and is treated an objective measure of sleep disorder. The chi-square test, two sample t-test and analysis of variance were used to assess the relationship between the response variables and potential influential factors. The overall association between the response variables and explanatory variables were examined through the logistic regression and proportional odds model.
The result of the study shows that the potential influential factors for the subjective and objective measures are the same. They are gender, cardiovascular disease and diagnosed of insomnia. The result indicated that the odds of having sleep disorder based on subjective and objective measures for female are 1.403 and 1.857 higher than those for male. The odds of having sleep disorder for respondents who had cardiovascular disease are about the same for both measures. However, the odds of having sleep disorder for respondents who diagnosed of insomnia is 3 times higher when using a direct measure (OR=22.756) as compared to an indirect measure (OR=7.404).
Although the findings from the subjective and objective measures are consistent, female elderly tends to feel they have sleep disorders but does not take sleeping pill and for those who were diagnosed with insomnia, they do not feel they have sleep disorder when respondents take sleeping pills. The finding of this research may provide some guidance for the publics to improve their quality of life.

目錄
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究架構 2
第二章 文獻探討 3
第一節 睡眠障礙的定義與盛行率 3
第二節 睡眠障礙之相關因素 4
第三章 研究流程、範圍及資料變項 6
第一節 研究流程 6
第二節 研究範圍 7
第三節 資料變項 8
第四章 研究方法 12
第一節 因素分析 12
第二節 皮爾森卡方檢定 13
第三節 COCHRAN MANTEL HAENSZEL檢定 15
第四節 兩個獨立樣本之T檢定 16
第五節 單因子變異數分析 18
第六節 二元邏輯斯迴歸 20
第七節 多項式邏輯斯迴歸模型 24
第五章 實證研究 27
第一節 定義變數 27
第二節 因素分析 31
第三節 關聯性分析 34
第四節 建立藥物之邏輯斯迴歸模型 40
4.1 選擇變數 40
4.2 參數估計與係數檢定 41
4.3 模型適合度檢定 43
4.4 模型診斷 44
4.5 參數勝算比 48
第五節 建立多項式邏輯斯迴歸模型 50
5.1 選擇變數 50
5.2 參數估計與係數檢定 52
5.3 模型適合度檢定 54
5.4 模型診斷 55
5.5 參數勝算比 56
第六節 COCHRAN MANTEL HAENSZEL檢定 58
第六章 結論與建議 60
第一節 結論 60
第二節 建議 63
參考文獻－中文部分 65
參考文獻－英文部分 66
附錄一 藥物治療與自變數相關分析 (共計2703筆) 68
附錄二 自覺睡眠障礙與類別自變數相關分析 (共計2703筆) 71
附錄三 自變數之設計變數 (藥物治療建立邏輯斯迴歸模型) 74
附錄四 控制干擾因素下，與藥物治療的CMH結果 75
附錄五 控制干擾因素下，顯著變數與藥物治療無相關的列聯表 78
附錄六 控制干擾因素下，無齊一的勝算比與列聯表 79
附錄七 藥物治療與干擾因素之模型 81
附錄八 控制干擾因素下，與自覺睡眠障礙的CMH結果 83
附錄九 控制干擾因素下，顯著變數與自覺有無眠障礙無相關的列聯表 85
附錄十 自覺睡眠障礙之迴歸模型，標準化後之殘差診斷圖 88
附錄十一 控制是否曾被醫師診斷過失眠下藥物治療與自覺睡眠障礙之關係 89

表目錄
表 1 失眠症狀的診斷標準 3
表 2 ANOVA表 19
表 3 變數說明 28
表 4 自覺睡眠障礙的相關分析 31
表 5因素分析之相關特徵值 32
表 6因素分析之因素的相關係數 32
表 7 加總分數的常態檢定 32
表 8 藥物治療逐步排除挑選的迴歸模型結果 40
表 9 藥物治療的模型參數估計與係數檢定 41
表 10適合度檢定結果 43
表 11 藥物治療的模型未剔除與剔除離群值參數估計 46
表 12 藥物治療的模型參數估計值、勝算比及信賴區間 48
表 13 自覺睡眠障礙逐步排除挑選的迴歸模型結果 51
表 14 自覺睡眠障礙的模型參數估計與係數檢定 52
表 15 自覺睡眠障礙的模型皮爾森及偏差檢定適合度檢定結果 54
表 16 自覺睡眠障礙的模型參數估計值、勝算比及信賴區間 56

圖目錄
圖 1 Y之累積分配函數圖 25
圖 2 Y之機率質量圖 25
圖 3 因素分析之陡坡圖 32
圖 4 自覺睡眠障礙的平均分數的直方圖 33
圖 5 模型影響診斷圖 44
圖 6 模型預測機率診斷圖 45
圖 7 ROC曲線圖 47

參考文獻－中文部分
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7.鐘威昇 (2013). 失眠的分類及治療. 台灣醫學 56(12), 19-22.

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