睡眠失功能信念在慢性失眠的病理上扮演重要的角色，可能讓個體產生不良睡眠行為與過度睡前激發狀態，進而造成失眠。而癌症相關失眠患者由於其病理的獨特性也可能出現其獨特的睡眠失功能信念，本研究探討在癌症相關失眠的病理機轉中加入癌症相關睡眠失功能信念，是否可較單純一般慢性失眠之睡眠失功能信念對癌症相關失眠有更全面的了解。而癌症相關失眠具有許多不同於一般慢性失眠的要素，其中除了與疾病相關的特殊睡眠失功能信念外，尚有可能與睡眠困擾相關的癌因性疲憊干擾存在。因此，本研究的目的在探討：1）加入癌症相關的睡眠信念之整合睡眠失功能信念與失眠症狀的關聯性是否與單純一般的睡眠失功能信念有所不同；2）其影響路徑是否透過不良睡眠行為與睡前激發狀態影響失眠嚴重度；3）疲憊嚴重度是否使整合睡眠失功能信念對不良睡眠行為的預測力增加。本研究使用問卷調查對混合癌症患者進行各因素的測量後 (N=148)，運用結構方程模型進行路徑與因果分析，研究結果顯示，在疲憊嚴重度較高時，加入癌症相關睡眠失功能信念的整合睡眠失功能信念，其中「對失眠之負向影響預期與擔憂」向度會透過睡前生理激發狀態對「失眠對白天功能影響」程度有正向預測力、而「安眠藥物對疾病影響」向度對「失眠對白天功能影響」程度有負向預測力、不良睡眠行為對「失眠對白天功能影響」程度有正向預測力、一般睡眠失功能信念之預測路徑則多透過認知激發狀態影響；在疲憊嚴重度較低時，「對失眠之負向影響預期與擔憂」向度對「失眠對白天功能影響」程度有正向預測力、「睡眠與健康及病後修復關聯性的信念」向度對「失眠對白天功能影響」程度有負向預測力、「安眠藥物對疾病影響」向度對「睡眠困難」與「主觀痛苦」程度有正向預測力、一般睡眠失功能信念可預測之細項有所減少。研究結果顯示一般睡眠失功能信念會透過睡前認知激發影響失眠嚴重度，而加入癌症睡眠失功能信念後的整合睡眠失功能信念會透過睡前生理激發影響失眠嚴重度，疲憊嚴重度在其中扮演調節變項的角色，疲憊程度高低會使癌症睡眠失功能信念透過不同路徑影響失眠嚴重度。 / Dysfunctional beliefs about sleep play an important role in the pathological mechanism of chronic insomnia. Sleep-related behaviors and presleep arousal may mediate the relationship between the dysfunctional beliefs and severity of insomnia. Since cancer-related insomnia is associated with specific physiological and psychological conditions, there are specific dysfunctional beliefs that might have different influence to patients' sleep. Also, cancer-related fatigue could be closely related to sleep disturbance in cancer patients and demands to be explored. Therefore, the primary purpose of the current study is to explore: 1) whether adding cancer-related dysfunctional sleep beliefs to general dysfunctional sleep beliefs would show different pattern of association with severity of insomnia, comparing to the pattern of general dysfunctional sleep beliefs alone; 2) whether the sleep behavior and presleep arousal mediate the relationship between the dysfunctional beliefs to severity of insomnia in this path of model or not; 3) whether the severity of fatigue is a moderator of the predictibility of combided dysfunctional sleep beliefs to sleep-related behavior. The study recruited 148 mixed cancer diagnosis patients. They were instructed to fill out a package of questionnaires to assess their dysfunctional sleep beliefs, insomnia severity, cancer-related fatigue, etc. Structural equation modeling (SEM) was conducted for path analysis and causality test. Accroding to the result of SEM, presleep arousal was found to be a mediator of the positive association between the beliefs about “expectation and worries of negative consequence of insomnia” and daytime difficulties among subjects with high level of fatigue. Also the beliefs about “harmfulness of hypnotic” have negative predictibility to “daytime difficulty” in these subjects. Sleep behavior, on the other hand, have positive prediction to the “daytime difficulty”. General sleep dysfunctional beliefs showed pathway through presleep cognitive arousal level. For subjects with lower level of fatigue, the beliefs about “expectation and worries of negative consequence of insomnia” have positive association with the “daytime difficulty”. The beliefs about “beliefs about association between sleep and health and recovery from illnesss” were shown to have negative prediction to the “daytime difficulty”. The belief about “hypnotic related to disease” showed positive association with the “sleep difficulty” and associated “distress”. General sleep dysfunctional beliefs had less predictive factors. Based on the results of this study, adding cancer-related dysfunctional sleep beliefs was shown to have different relationship with severity of insomnia compared to general sleep dysfunctional beliefs. General dysfunctional sleep beliefs showed a pathway to insomnia severity through the mediation presleep cognitive arousal level. On the other hand, combided sleep dysfunctional beliefs showed a pathway to insomnia severity through the mediation of presleep somatic arousal level. Furthermore, severity of fatigue is a moderator. Subjets differed in the level of fatigue showed different path from combided dysfunctional sleep beliefs to severity of insomnia.
| Identifer | oai:union.ndltd.org:CHENGCHI/G0102752018 |
| Creators | 蕭立瀛, Hsiao, Li-Ying |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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