体感振动音乐疗法改善睡眠障碍的研究

目的：探讨体感振动音乐疗法改善睡眠障碍的疗效。方法：164例经匹兹堡睡眠质量指数量表（PSOI）评定存在睡眠障碍者．同时使用症状自评量表（SCL-90）对身心状况进行评估．随机分为治疗组与对照组．治疗组除进行睡眠健康宣教外再给予音乐体感振动治疗．对照组则按照睡眠健康宣教．进行自我调节。治疗结束后进行睡眠质量及身心症状测评。结果：①治疗后治疗组PSOI总分、睡眠障碍因子、睡眠质量因子和日间功能障碍因子分低于对照组，差异有显著性意义（P〈0．05）；两组在入睡时间、睡眠时间、睡眠效率及安眠药物服用因子上差异无显著性意义。②治疗前两组在SCL-90各因子分上与国内常模比较，除人际关系障碍因子外其他因子均高于国内常模。治疗后治疗组在躯体化、强迫症状、抑郁、焦虑、敌对、偏执因子分低于对照组，差异有显著性意义（P〈0．05）；在人际关系、恐怖和精神病性这三个因子与对照组相比无明显的变化。结论：体感振动音乐疗法可以在一定程度上改善睡眠状况及身心症状。     

Effects of melatonin in elderly patients with sleep disturbance: a pilot study

This open-label, short-term pilot study was designed to assess the efficacy and tolerability of melatonin in the treatment of sleep disturbances in elderly patients. The 41 patients (28 women and 13 men; mean age [±SD], 74 ± 12 years) were separated into three groups: (1) patients with sleep disturbances alone (n = 22); (2) patients with sleep disturbances and signs of depression (n = 9); and (3) patients with sleep disturbances and dementia of the degenerative or vascular type (n = 10). All patients received 3-mg gelatin capsules of melatonin orally 30 minutes before expected sleep time for 21 days. Overall sleep quality and daytime alertness were assessed by means of structured clinical interviews and sleep logs completed by the patients (or their caregivers in the case of dementia patients). Starting from day 2 or 3 of treatment, melatonin significantly improved sleep quality and decreased the number of awakenings in patients with sleep disturbances with or without associated depression. Patients with dementia did not show significant improvement of sleep quality. Estimates of next-day function (ie, alertness in the morning and during the day) improved significantly only in patients exhibiting sleep disturbances alone. Clinical assessment indicated that symptoms improved in 16 (73%) of the patients with sleep disturbances alone and 4 (44%) of those with sleep disturbances associated with depression, and that agitated behavior at night (sundowning) decreased significantly in 7 (70%) of the patients with dementia. This was reflected by the coefficient of variation of bedtime, which averaged 58% in patients with dementia compared with 27% and 33% in nondepressed and depressed patients, respectively, on days 0 to 2 of treatment, and which decreased significantly only in dementia patients when reassessed on days 19 to 21. Four (31%) of the 13 patients with primary insomnia who were receiving benzodiazepines concomitantly reduced their benzodiazepine use (by 50% to 75% of initial doses) and 4 (31%) discontinued use of these agents; of the 7 patients with depression and 7 with dementia who were receiving benzodiazepines concomitantly, 2 (29%) in each group reduced benzodiazepine use by up to 50%. No side effects considered to be attributable to treatment were reported. The results of this trial suggest that melatonin may be useful for the treatment of primary sleep disturbances in elderly patients.     

Factors associated with perceived sleep quality of nurses working on rotating shifts

Aims. To explore nurses’ perceived sleep quality and examine factors that contribute to insufficient sleep quality. Background. Shift work is an important source of disturbances in the health and well‐being of nurses. However, nursing services must be available on a 24‐hour basis, making shift work a necessity. Sleep disorders tend to occur among nurses typically working on a rotating schedule. Although many studies related to nurses’ sleep quality have been carried out in the West, few have investigated factors linked to nurses’ sleep quality in Hong Kong. Design. A cross‐sectional study. Method. The study was conducted during the period November 2005–June 2006 in two local hospitals in Hong Kong. Nurses (n = 163) completed a self‐reported questionnaire. Demographic data and information on health status, strain and symptom levels and perceived sleep quality were collected. Results. More than 70% of the nurses reported having insufficient sleep and strain and symptom levels were higher in this group. Older age, perceived poor sleep status, gastrointestinal symptoms and higher strain and symptom levels were risk factors that contributed to insufficient sleep. Conclusions. Evaluation of internal stressors and modification of shift work schedules are important areas of future research; these should aim at finding the best compromise between productivity and employees’ sleep quality, health and performance. Relevance to clinical practice. Healthcare workers’ job task analysis, the evaluation of internal stressors and the modification of shift work schedules are important areas of future research and should result in the best compromise between productivity and employees’ sleep quality, health and performance.     

阻塞性睡眠呼吸暂停低通气综合征与脂代谢紊乱的关系

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与脂代谢紊乱的关系。方法检测55例OSAHS男性患者(OSAHS组)与52名男性体检者(对照组)血脂水平差异比较。对OSAHS组内身高体重指数(BMI)、呼吸紊乱指数(RDI)与血脂指标进行相关分析。结果OSAHS组空腹时总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)显著高于对照组(P<0.05),而高密度脂蛋白胆固醇(HDL-C)显著低于对照组(P<0.05)。OSAHS组中重度患者的TC与RDI呈正相关(P<0.05)。结论OSAHS并发脂代谢紊乱,重度OSAHS是引起胆固醇升高的重要因素。     

阻塞性睡眠呼吸暂停低通气综合征与脂代谢紊乱的关系

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与脂代谢紊乱的关系。方法检测55例OSAHS男性患者（OSAHS组）与52名男性体检者（对照组）血脂水平差异比较。对OSAHS组内身高体重指数（BMI）、呼吸紊乱指数（RDI）与血脂指标进行相关分析。结果OSAHS组空腹时总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）显著高于对照组（P〈0.05）,而高密度脂蛋白胆固醇（HDL-C）显著低于对照组（P〈0.05）。OSAHS组中重度患者的TC与RDI呈正相关（P〈0.05）。结论OSAHS并发脂代谢紊乱,重度OSAHS是引起胆固醇升高的重要因素。     

Self-care management of sleep disturbances and risk factors for poor sleep among older residents of Taiwanese nursing homes

Aims. To explore self-care management strategies for sleep disturbances and risk factors for poor sleep among older residents of nursing homes in Taiwan. Background. With the deterioration of health that accompanies ageing, sleep quality becomes poorer, making it a significant issue in geriatric care. However, little is known about self-care strategies for management of sleep disturbances among elders worldwide. Design. A cross-sectional design was used. Methods. Residents (n = 196) were recruited from nine nursing homes chosen by stratified sampling across Taiwan. The Pittsburgh Sleep Quality Index, a self-care management of sleep disturbance questionnaire and a demographic form were used to collect data. Results. The prevalence of poor sleep in these older nursing home residents was 46·4%. Only 48·5% of participants used self-care strategies to manage sleep disturbances. The most frequently used strategy was ‘take prescribed medicines’. Self-learning was the main information source for self-care strategies. Logistic regression analysis indicated that having no spouse and a low educational level significantly predicted poor sleep. Conclusions. This study revealed a high prevalence of poor sleep quality among older residents of nursing homes in Taiwan. Older residents’ inability to get relief from sleep disturbances may have been because of their limited use of strategies to manage sleep disturbances. Relevance to clinical practice. As health care providers play an important role in helping older people to manage sleep disturbances in nursing homes, it is crucial to train nursing home staff to perform sleep assessments and provide current knowledge about sleep disturbance management. It is also necessary to pay more attention to the sleep problems of elders without spouses and with little education.     

A warm footbath before bedtime and sleep in older Taiwanese with sleep disturbance

A single-group crossover design was used to examine the effects of a warm footbath on body temperatures, distal-proximal skin temperature gradient (DPG), and sleep outcomes in 15 Taiwanese elders with self-reported sleep disturbance. Body temperatures and polysomnography were recorded for three consecutive nights. Participants were assigned randomly to receive a 41 degrees C footbath for 40 minutes before sleep onset on night 2 or night 3. Mean DPG before lights off was significantly elevated on the bathing night. There were no significant differences in sleep outcomes between the two nights. However, when the first two non-rapid eye movement (NREM) sleep periods were examined, the amount of wakefulness was decreased in the second NREM period on the bathing night.     

便携式睡眠呼吸监测仪诊断睡眠呼吸暂停综合征病人的护理

[目的]探讨便携式睡眠呼吸监测仪诊断睡眠呼吸暂停综合征(SAS)病人的护理体会。[方法]对2009年1月—2011年10月146例怀疑有SAS病人进行检测诊断有无睡眠呼吸暂停综合征,同时加强的护理。[结果]使用便携式睡眠呼吸监测仪诊断睡眠呼吸暂停综合征检测成功135例,检测失败11例,其中入睡差2例,监测到一半脱线6例,监测后无数据显示有3例。[结论]使用便携式睡眠呼吸监测仪,监测时护士加强宣教及做好导线连接和各项护理措施是提高检测成功率的重要环节。     

Sleep Inquiry: A Look with Fresh Eyes

A review of nursing research into the impairment of sleep in the critically ill is presented. The author asserts that in order to fully explicate the phenomena from a nursing perspective, research is needed that focuses upon the meaning of the phenomenon to the patient.     

综合睡眠干预在脑卒中睡眠障碍患者中的应用效果

目的探讨睡眠护理干预对脑卒中患者睡眠质量及生活质量的影响。方法选取60例脑卒中合并睡眠障碍的患者为研究对象,进行综合睡眠干预,包括睡眠指导、放松训练、足部穴位按摩等,比较患者干预前后睡眠质量及生活质量的变化。结果干预3个月后,患者在睡眠障碍、入睡时间、睡眠时间、睡眠效率等方面的睡眠质量评分均低于干预前,差异有统计学意义(P0.05),且患者在手功能、行动能力、记忆与思维、交流等方面的生活质量评分高于干预前,差异有统计学意义(P0.05)。结论综合睡眠干预能够改善脑卒中睡眠障碍患者的睡眠质量,提升患者的生活质量。     

中医护理临床路径对胆囊切除术患者术后疼痛与睡眠障碍的影响

目的探讨中医护理临床路径对胆囊切除术患者术后疼痛及睡眠障碍影响。方法选取2017年1月至2019年1月在本院行胆囊切除术的72例患者为研究对象,随机等分为干预组和对照组,干预组实施中医护理临床路径干预,对照组实施常规护理措施。术后1 d和实施干预措施后2周分别评估患者术后疼痛情况和睡眠质量。结果护理干预2周后,干预组术后疼痛评分低于对照组,差异具有统计学意义(P<0.05),对照组睡眠质量总分高于干预组,差异具有统计学意义(P<0.05)。结论中医护理临床路径方案可以调和肝胆功能,强健脾胃,祛湿安神,缓解患者术后疼痛和睡眠障碍,适宜在胆囊切除术临床护理工作中推广。     

Acute sleep deprivation is associated with increased electrocardiographic P-wave dispersion in healthy young men and women

Background: Sleep deprivation (SD) is associated with worse cardiovascular outcome including mortality. Prolonged P-wave duration and P-wave dispersion (Pd) are known to represent inhomogeneous conduction of sinus impulses and are known to be electrophysiologic predictors of atrial fibrillation. Pd in normal subjects has been reported to be influenced by the autonomic tone. Because autonomic tone is affected by sleep and sleep duration, we evaluated the effect of acute SD on P-wave duration and Pd in healthy young adults and whether the effect was gender selective.
Methods : We obtained electrocardiograms of 37 healthy young volunteers (age: 28.45 ± 7.97; 11 women) after a night of regular sleep and repeated after a night with sleep debt. We measured minimum and maximum P-wave durations (Pmin, Pmax) and Pd in milliseconds.
Results : Average sleep time of the subjects were 7.7 ± 0.8 hours during regular sleep and 1.7 ± 1.6 hours during a night of sleep debt (P < 0.001). Subjects had significantly lower values of Pmin in milliseconds after a night of sleep debt when compared to regular sleep (65.13 ± 8.03 vs 74.86 ± 10.95; P < 0.001), whereas they had significantly higher values of Pmax and Pd (102.16 ± 9.46 vs 95.13 ± 11.21; P < 0.001 and 37.02 ± 8.11 vs 20.27 ± 11.42; P < 0.001, respectively). In Pearson's correlation analysis Pmin was positively and Pmax and Pd were negatively correlated with sleep time (P < 0.001, r = 0.465; P = 0.003, r =−0.336 and P < 0.001, r =–0.698 respectively). Effect of SD on P-wave duration and Pd was similar for both men and women.
Conclusions : In conclusion, prolongation of Pmax and Pd in acute SD suggests that acute SD might contribute to development and/or recurrence of atrial fibrillation.