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題名 睡眠延長時間與糖尿病患者血糖代謝提升之關聯研究
The association between sleep extension and plasma glucose metabolism in diabetes patient作者 陳詠寧
Tan, Yong-Ning貢獻者 楊建銘
Yang, Chien-Ming
陳詠寧
Tan, Yong-Ning關鍵詞 睡眠延長
糖尿病
糖化白蛋白日期 2019 上傳時間 2-May-2019 14:43:32 (UTC+8) 摘要 研 究 目 的 ：近幾十年罹患糖尿病的比例逐漸攀升，與此同時人們自陳的睡眠時間卻越來越 少，台灣睡眠醫學會於 2017 提出國人平均一天只睡 6.8 小時;睡眠不足可直接影響葡萄糖 代謝失功能，進而使體內血糖過高、胰島素敏感性下降，導致胰島素阻抗的情形，因而有研 究提出增加睡眠時數有助於促進血糖代謝。過去研究在睡眠時數小於 7 小時的健康者中發 現，成功增加 1 小時的睡眠有助於降低空腹胰島素的濃度，提高胰島素敏感性(Leproult et al., 2015);由於尚未有研究探討延長睡眠對於較短睡眠的糖尿病患者血糖的影響，因此本 研究納入睡眠時數小於 7 小時的糖尿病患者，探討增加 1 小時的躺床時數後與血糖變化的關 聯。研究方法：本研究納入 19 名糖尿病患者(男:女 = 12:7;年齡:58.95 歲 ± 9.61)。研究 流程分為三階段，在篩檢期納入符合研究條件的受試者後，首先進行睡眠基準期 3 週，依據 習慣的睡眠時間作息，之後進行血糖檢測;在睡眠延長期時依據其生活型態增加 1 小時的睡 眠時間亦為期 3 週，之後再進行血糖檢測。研究期間受試者每日需填寫睡眠日誌睡眠日誌作 為主觀睡眠量測，配戴睡眠活動腕錶(actigraph)為客觀睡眠量測，血糖檢測部分使用空腹 血糖(fasting plasma glucose, FPG)、糖化白蛋白(glycated albumin, GA)及糖化血色素 (glycated hemoglobin, HbA1C)進行量測。 研究結果:總躺床時數在基準期(主觀:440.06 分鐘;客觀:413.18 分鐘)與延長期(主 觀:473.18 分鐘;客觀:440.60 分鐘)達顯著差異(t = -3.298, p = 0.004;t = -3.932 p = 0.001)。研究將在睡眠延長期所增加的客觀總躺床時數分為增加最少組(≤ 15.72 分鐘)、 增加中等組(16 至 37 分鐘)及增加最多組(≥ 37.25 分鐘)，使用二因子混合設計探討三組 在增加躺床時數後的血糖變化，研究發現相較於客觀躺床時數增加最少組(基準期:延長期 = 15.32:16.20)，躺床時數增加中等(16.19:15.86)與最多組(14.84:14.76)在延長睡 眠後 GA 值下降的幅度較大(F(2,1) = 5.038, p = .02)，然而在 FPG 與 HbA1c 的血糖指標上並 未有顯著差異。研究結論：本研究結果支持原先的假設，顯示在年齡較長、平均睡眠時數小於 7 小時的糖 尿病患者中，延長睡眠可以降低 GA 值，然而此一現象並未呈現在其他血糖指標。由於本研 究睡眠延長為期 3 週，因此相較於 FPG 與 HbA1c，GA 所得結果應更能顯示研究睡眠時數操弄的影響。然而，研究操弄延長一小時的躺床時間並未完全成功，平均躺床時間增加約半 小時，因此在臨床實務上增加 30 分鐘的躺床時數是可行的。此外，研究結果顯示在客觀躺 床時數增加 16 分鐘以上後，GA 值即呈下降的趨勢，因此建議睡眠時數較短的糖尿病患者 增加其躺床時數至充足的時間(以增加 30 分鐘的躺床時間為目標)，有利於後續血糖代謝的調控。 參考文獻 參考文獻中文部分黃筱珮（2017年3月24日） 。睡不夠啊！台灣人平均一天只睡6.8小時。【新聞群組】。取自http://www.peoplenews.tw/news/f4852b6e-2cdc-4935-b007-c4a81230452c黃漢華（2018年1月2日）。世台灣227萬糖尿病友 照護為何輸日韓、新加坡？。【新聞群組】。取自https://www.gvm.com.tw/article.html?id=41746衛生福利部中央健康保險署（2007年11月9日）。追蹤腎功能、血糖與血壓，三不可缺一 控制好慢性疾病。【新聞群組】。取自https://www.nhi.gov.tw/Content_List.aspx?n=09 400E3903354254&topn=874605F03B8FDFBA衛生福利部國民健康署（2010年12月8日）。洗腎數載情彌堅 執手護腎立範典。【新聞群組】。取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1130&pid=2193衛生福利部國民健康署（2016年11月1日）。世界糖尿病日由來與國內宣導響應。【新聞群組】。取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1090&pid=6426衛生福利部（2017年6月19日）。105年國人死因統計結果。【新聞群組】。取自https://www.mohw.gov.tw/cp-16-33598-1.html英文部分AASM. 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國立政治大學
心理學系
103752022資料來源 http://thesis.lib.nccu.edu.tw/record/#G0103752022 資料類型 thesis dc.contributor.advisor 楊建銘 zh_TW dc.contributor.advisor Yang, Chien-Ming en_US dc.contributor.author (Authors) 陳詠寧 zh_TW dc.contributor.author (Authors) Tan, Yong-Ning en_US dc.creator (作者) 陳詠寧 zh_TW dc.creator (作者) Tan, Yong-Ning en_US dc.date (日期) 2019 en_US dc.date.accessioned 2-May-2019 14:43:32 (UTC+8) - dc.date.available 2-May-2019 14:43:32 (UTC+8) - dc.date.issued (上傳時間) 2-May-2019 14:43:32 (UTC+8) - dc.identifier (Other Identifiers) G0103752022 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/123229 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學系 zh_TW dc.description (描述) 103752022 zh_TW dc.description.abstract (摘要) 研 究 目 的 ：近幾十年罹患糖尿病的比例逐漸攀升，與此同時人們自陳的睡眠時間卻越來越 少，台灣睡眠醫學會於 2017 提出國人平均一天只睡 6.8 小時;睡眠不足可直接影響葡萄糖 代謝失功能，進而使體內血糖過高、胰島素敏感性下降，導致胰島素阻抗的情形，因而有研 究提出增加睡眠時數有助於促進血糖代謝。過去研究在睡眠時數小於 7 小時的健康者中發 現，成功增加 1 小時的睡眠有助於降低空腹胰島素的濃度，提高胰島素敏感性(Leproult et al., 2015);由於尚未有研究探討延長睡眠對於較短睡眠的糖尿病患者血糖的影響，因此本 研究納入睡眠時數小於 7 小時的糖尿病患者，探討增加 1 小時的躺床時數後與血糖變化的關 聯。研究方法：本研究納入 19 名糖尿病患者(男:女 = 12:7;年齡:58.95 歲 ± 9.61)。研究 流程分為三階段，在篩檢期納入符合研究條件的受試者後，首先進行睡眠基準期 3 週，依據 習慣的睡眠時間作息，之後進行血糖檢測;在睡眠延長期時依據其生活型態增加 1 小時的睡 眠時間亦為期 3 週，之後再進行血糖檢測。研究期間受試者每日需填寫睡眠日誌睡眠日誌作 為主觀睡眠量測，配戴睡眠活動腕錶(actigraph)為客觀睡眠量測，血糖檢測部分使用空腹 血糖(fasting plasma glucose, FPG)、糖化白蛋白(glycated albumin, GA)及糖化血色素 (glycated hemoglobin, HbA1C)進行量測。 研究結果:總躺床時數在基準期(主觀:440.06 分鐘;客觀:413.18 分鐘)與延長期(主 觀:473.18 分鐘;客觀:440.60 分鐘)達顯著差異(t = -3.298, p = 0.004;t = -3.932 p = 0.001)。研究將在睡眠延長期所增加的客觀總躺床時數分為增加最少組(≤ 15.72 分鐘)、 增加中等組(16 至 37 分鐘)及增加最多組(≥ 37.25 分鐘)，使用二因子混合設計探討三組 在增加躺床時數後的血糖變化，研究發現相較於客觀躺床時數增加最少組(基準期:延長期 = 15.32:16.20)，躺床時數增加中等(16.19:15.86)與最多組(14.84:14.76)在延長睡 眠後 GA 值下降的幅度較大(F(2,1) = 5.038, p = .02)，然而在 FPG 與 HbA1c 的血糖指標上並 未有顯著差異。研究結論：本研究結果支持原先的假設，顯示在年齡較長、平均睡眠時數小於 7 小時的糖 尿病患者中，延長睡眠可以降低 GA 值，然而此一現象並未呈現在其他血糖指標。由於本研 究睡眠延長為期 3 週，因此相較於 FPG 與 HbA1c，GA 所得結果應更能顯示研究睡眠時數操弄的影響。然而，研究操弄延長一小時的躺床時間並未完全成功，平均躺床時間增加約半 小時，因此在臨床實務上增加 30 分鐘的躺床時數是可行的。此外，研究結果顯示在客觀躺 床時數增加 16 分鐘以上後，GA 值即呈下降的趨勢，因此建議睡眠時數較短的糖尿病患者 增加其躺床時數至充足的時間(以增加 30 分鐘的躺床時間為目標)，有利於後續血糖代謝的調控。 zh_TW dc.description.tableofcontents 謝誌 I摘要 II第一章 研究動機 1第二章 文獻探討 3第一節 糖尿病的死亡與盛行率 3第二節 糖尿病的定義與診斷標準 4第三節 睡眠與糖尿病的關係 6一、 長睡眠時數與糖尿病的關係 8二、 短睡眠時數與糖尿病的關係 9第四節 睡眠不足的影響 12一、 睡眠不足與肥胖的關係 13二、 睡眠剝奪對肥胖的影響 15三、 睡眠不足與葡萄糖代謝的關係 15四、 睡眠剝奪對血糖代謝的影響 17五、 睡眠延長的療效 19第五節 研究目的與假設 20第三章 研究方法 21第一節 研究對象 21第二節 研究設計與程序 21第三節測量工具 23一、 睡眠檢測 23二、 血糖檢測 24第四章 研究結果 25第一節 人口學變項 25第二節 睡眠指標 26第三節 睡眠時數與血糖指標分析 28第四節 睡眠穩定度與血糖指標分析 33第五節 睡眠呼吸中止與睡眠時數及血糖指標分析 34第五章 討論 37第一節 睡眠延長的影響 38一、 主觀與客觀的睡眠指標 38二、 糖尿病患者的睡眠型態 38三、延長睡眠時數對血糖的影響 39四、睡眠指標穩定度與血糖的關聯 41第二節 睡眠呼吸中止與血糖的關係 41第三節 研究限制與未來方向 44第四節 臨床應用 45參考文獻 46附錄一、 睡眠日誌基準期版二、睡眠日誌睡眠延長期版 zh_TW dc.format.extent 2817911 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0103752022 en_US dc.subject (關鍵詞) 睡眠延長 zh_TW dc.subject (關鍵詞) 糖尿病 zh_TW dc.subject (關鍵詞) 糖化白蛋白 zh_TW dc.title (題名) 睡眠延長時間與糖尿病患者血糖代謝提升之關聯研究 zh_TW dc.title (題名) The association between sleep extension and plasma glucose metabolism in diabetes patient en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 參考文獻中文部分黃筱珮（2017年3月24日） 。睡不夠啊！台灣人平均一天只睡6.8小時。【新聞群組】。取自http://www.peoplenews.tw/news/f4852b6e-2cdc-4935-b007-c4a81230452c黃漢華（2018年1月2日）。世台灣227萬糖尿病友 照護為何輸日韓、新加坡？。【新聞群組】。取自https://www.gvm.com.tw/article.html?id=41746衛生福利部中央健康保險署（2007年11月9日）。追蹤腎功能、血糖與血壓，三不可缺一 控制好慢性疾病。【新聞群組】。取自https://www.nhi.gov.tw/Content_List.aspx?n=09 400E3903354254&topn=874605F03B8FDFBA衛生福利部國民健康署（2010年12月8日）。洗腎數載情彌堅 執手護腎立範典。【新聞群組】。取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1130&pid=2193衛生福利部國民健康署（2016年11月1日）。世界糖尿病日由來與國內宣導響應。【新聞群組】。取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1090&pid=6426衛生福利部（2017年6月19日）。105年國人死因統計結果。【新聞群組】。取自https://www.mohw.gov.tw/cp-16-33598-1.html英文部分AASM. 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