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    政大機構典藏 > 理學院 > 心理學系 > 學位論文 >  Item 140.119/58969


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    Title: 療效回饋對阻塞型睡眠呼吸中止症患者正壓呼吸器接受度之影響
    The Effect of Treatment Efficacy Feedback on the Acceptance and Compliance of CPAP Usage in Patients with Obstructive Sleep Apnea Syndrome
    Authors: 蔡明潔
    Contributors: 楊建銘
    蔡明潔
    Keywords: 睡眠呼吸中止症
    正壓呼吸器接受度
    療效回饋
    Date: 2012
    Issue Date: 2013-07-22 17:16:38 (UTC+8)
    Abstract: 研究背景與目的：阻塞性睡眠呼吸中止症（obstructive sleep apnea；簡稱OSA）患者因夜間睡眠時上呼吸道反覆阻塞，導致呼吸中止、睡眠片段化、及血中氧氣飽和度下降的情形。配戴正壓呼吸器（continuous positive airway pressure, 簡稱CPAP）是最為有效的第一線治療策略之一，但過去研究發現OSAS患者在使用CPAP的接受度普遍不高，持續使用CPAP的比例更低。過去除了透過技術層面解決使用上的困難外，也從教育層面、心理層面等策略來提升患者的接受度。根據跨領域行為模式，在運思期的患者會試圖找尋改變行為的利弊，而常陷入於有意願卻無法行動的狀態，若能在這個階段提供患者使用CPAP的好處，減少使用CPAP的困難，使患者發現改變能獲得的好處並協助他們解決所遭受的困難時，患者會重新評估繼續使用CPAP的可能，其動機亦會隨之提升；而根據動機式會談的理論，動機的增進可以透過瞭解患者所關心及感知的部分，探討關於行為改變的矛盾處，以協助病患建立改變的內在動機。由於過去研究發現患者主觀感知睡眠呼吸中止症的影響與客觀測量可能不一致，可能使患者無法感知到使用CPAP所獲得的助益，因此本研究希望透過給予患者使用CPAP後主觀及客觀療效改善狀況的回饋，以提升OSAS患者使用CPAP的動機，進而增加OSAS患者對配戴CPAP的接受度。

    研究方法：本研究共篩選出42名符合收案標準的OSAS重度患者，隨機分派至有回饋組及無回饋組二組各21人，所有受試者均接受多頻道睡眠記錄（Polysmnographic；PSG）檢測以確定OSAS診斷之後給予CPAP治療，在患者接受CPAP治療前安排進行PVT（Psychomotor Vigilance Test）及心跳變異率（Heart rate variability；HRV）的測量，並填寫主觀自評問卷匹茲堡睡眠品質問卷（Pittsburgh Sleep Quality Index，簡稱PSQI）及艾普沃茲嗜睡量表（Epworth Sleepoiness Scale，簡稱：ESS），二組受試者皆於接受CPAP治療後一個月再次進行相同的測量，並蒐集CPAP使用資料，有回饋組會依測量結果給予回饋，無回饋組則僅有測量不給予回饋，於CPAP治療後二個月後，再次填寫PSQI及ESS，並蒐集CPAP使用資料。

    研究結果：本研究結果顯示有客觀回饋組16人（男性15名，女性1名；平均年齡為47.19歲）完成研究，流失率為23.8％；無客觀回饋組11人（男性11名，女性0名；平均年齡為43.82歲）完成研究，流失率為47.6％。在治療前的年齡、AHI、BMI、PSG相關參數、PSQI、ESS及HRV兩組間無差異，PVT參數僅在漏失次數（lapse）上有回饋組明顯較高（F=5.716，p=.025）。在CPAP使用資料分析結果發現，只有在使用天數中治療階段有顯著差異（F(1,24)=4.96，p<.05），治療後使用CPAP的行為改變階段亦有顯著改善（F(2,48)=216.169，p<.05），主觀對CPAP接受程度有顯著的改善（F(2,48)=3.302，p<.05），但兩組間皆無顯著差異，亦無交互作用，其餘CPAP使用各項指標在組間或組內皆未達顯著差異，亦無交互作用。

    結論：本研究結果指出無論有無給予療效回饋，OSAS患者在治療前後對CPAP的接受度皆有提升，使用的天數也有顯著增加，但兩組間CPAP使用情形未能有顯著差異，原因之一可能因留下來完成研究流程的受試者原先對於CPAP使用的動機就較高，而造成兩組在後續CPAP使用情形沒有顯著差異。此外，在有回饋組中流失率較無回饋組少，顯示給予回饋可能可提升OSAS患者接受CPAP治療的持續度。若從跨領域行為模式中行為改變的處理過程來看，本研究在患者行為改變的初期（運思期及準備期）增加療效回饋，亦是企圖使患者能更穩定的進入行動期，而結果也顯示有給予療效回饋的患者比沒有療效回饋的患者更能夠進入下個行為改變的階段，因此在臨床應用上，若是能篩選在使用CPAP有意願但仍有猶豫的患者，提供患者更多使用CPAP的效果的回饋，能使患者更願意持續使用CPAP。
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    Description: 碩士
    國立政治大學
    心理學研究所
    96752007
    101
    Source URI: http://thesis.lib.nccu.edu.tw/record/#G0096752007
    Data Type: thesis
    Appears in Collections:[心理學系] 學位論文

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