探討醫療環境夜晚光線對於住院老人睡眠之影響

醫療院所住院的老人常出現睡眠時數減少及睡眠剝奪的問題，睡眠障礙對於住院病人的健康有很大的傷害，增加心血管疾病的機會、跌倒的風險及延長病人住院的時間等。住院老人睡眠障礙與醫療環境有關，而醫療環境的夜晚光線(Light)可能是導致住院患者睡眠品質不良的因素之一。本研究為橫斷式調查研究法，研究目的為了解住院中的老人其夜晚睡眠期間，接受光線暴露情形及主客觀睡眠品質，並且探究夜晚睡眠期間光線與主客觀睡眠品質之關係。研究工具包括匹茲堡睡眠品質量表、睡眠日誌等，以及睡眠活動記錄器(Actigraphy)，以便利取樣方式於台中市兩間醫學中心復健科病房之60歲以上住院年長者進行收案，55位完成研究，資料以SPSS 20 統計軟體進行資料分析。本研究夜晚睡眠期間光線平均值為9.9Lux(Median)，而整體光線分布情況以光線＜5Lux的時間為最多共403分鐘佔整體86.4%(Median)。本研究結果顯示住院年長者其主觀睡眠品質不佳(PSQI score：6.2±3.7分)、睡眠日誌之主觀睡眠潛伏期(SL):39.4分鐘(標準差58.5)、主觀入睡後甦醒時間(WASO)為40分鐘(標準差42.9)；客觀睡眠指標之睡眠效率(SE)：69.1%(標準差23.1)、睡眠總時數(TST)：366.1分鐘(標準差140.4)及睡眠總甦醒時間(WASO)：153分鐘(標準差120.3)，皆呈現客觀睡眠品質不佳狀態。夜晚睡眠期間光線與睡眠日誌之主觀入睡後甦醒時間(WASO)及自覺睡眠中斷情形有顯著的關係，住院老人的主觀入睡後甦醒時間及自覺睡眠中斷次數多者，其夜晚光線≧5Lux的分鐘數或≧5Lux的百分比較高，顯示夜晚睡眠期間光線亮的時間增加會影響夜晚睡眠中斷的時間及次數。藉由本研究了解住院年長者的睡眠品質現況，以及醫療環境夜晚光線之分布情形，以作為醫護人員在照顧年長住院者及醫療院所設置病房環境之參考。

The elder inpatients often suffer from reduced sleep times and sleep deprivation. Sleep disturbance in the older inpatients may have adverse effects, increasing chances of cardiovascular disease, risk of falls and length of hospital stay. Sleep disturbance may be related to the medical care environment of light at night. This was a cross-sectional study to investigate the relationship between light exposures at night and sleep in hospitalized older patients. The research instruments used in this study included the Pittsburgh Sleep Quality Index (PSQI), Sleep Dairy, and Actigraphy. A total of 55 older patients with a mean age of 71.5 ± 7.5 years were recruited from the rehabilitation wards of two medical centers in Taichung City. SPSS 20 statistical software was used for statistical analysis. Results show that the average light intensity during nighttime sleep was 9.9Lux (Median), whereas the duration of light <5Lux during sleep were 403 minutes, accounting for 86.4% of total sleep time (Median). The subjective sleep quality of hospitalized older patients was poor (PSQI score：6.2±3.7), with a subjective sleep latency (SL) of 39.4 minutes and subjective wake after sleep onset (WASO) of 40 minutes. For objective sleep indicators, their sleep efficiency (SE) was 69.1%, with a total sleep time (TST) of 366.1 minutes, and WASO of 153 minutes. Light intensity during nighttime sleep was found to have significant relationships with subjective WASO (p=0.037) and self-perceived interrupted sleep (p=0.037) in the sleep diary. Hospitalized older patients who experienced higher duration or percentage of nighttime light intensity ≥5Lux had frequent episodes of subjective WASO and self-perceived interrupted sleep. It is showing that increased illumination during nighttime sleep will affect the duration and number of sleep interruptions. Result of this study provides an understanding of the sleep quality and illumination distribution at night in hospitalized older patients in a medical environment and can be used as a reference for setting ward environment in medical institutions.