研究背景與目的：2008年美國睡眠醫學會(American Academy of Sleep Medicine)對於失眠患者在助眠劑的臨床使用原則中(clinical guideline)，建議初次藥物治療的時間以2至4週較為適宜，後續是否繼續用藥則須專業醫師的重新評估，以降低身體對於藥物的依賴性及副作用的風險，但實際上許多失眠患者因擔心停用助眠劑就無法入眠，因此仍長期使用助眠劑。目前臨床上大都採用逐步減藥的方式協助患者降低助眠劑的使用，除了藥物因素會影響減藥成效之外，從心理因素來看，在過去研究指出自我效能會影響健康行為的改變，因此本研究將比較逐步減藥計畫加上提升減藥自我效能策略與單獨逐步減藥計畫對於原發性失眠患者在減藥上的成效。
研究方法：本研究的原發型失眠患者共48人(男17人，女31人，平均年齡46.8歲，平均使用助眠劑66.7個月)，被分為兩組進行10週的減藥介入計畫，一組為自我效能提升組(n=24)，受試者減藥前先接受為期兩週的提升減藥自我效能策略，再進行8週的逐步減藥計畫，另一組為單純減藥組(n=24)，受試者只進行8週的逐步減藥計畫。受試者每週均需填寫睡眠日誌、單題減藥自我效能量尺，以瞭解睡眠參數、減藥自我效能及助眠劑使用之情況。
研究結果：減藥成效方面，自我效能提升組在減少劑量的百分比顯著高於單純減藥組(自我效能提升組=78.62%；單純減藥組=64.10%)，且自我效能提升組在減藥前後劑量的改變也顯著高於單純減藥組(自我效能提升組=4.35顆/週；單純減藥組=3.22顆/週)，自我效能提升組在停藥人數的百分比上雖未顯著高於單純停藥組(自我效能提升組=29.2%；單純減藥組=16.7%)，但就整體結果來看均較為支持自我效能提升組在減藥的成效上是優於單純減藥組。減藥自我效能方面，在控制住第1週的減藥自我效能後，提升減藥自我效能策略造成的減藥自我效能改變量仍可以有效解釋21.9%的減藥百分比。
研究結論：自我效能提升組增加的提升減藥自我效能策略能有助於個案在執行逐步減藥計畫的成效，另外，提升減藥自我效能策略造成的減藥自我效能改變量是減藥百分比有效的預測因子。因此，減藥自我效能對於減藥成效來說，確實是一個可以著力的部分。 / Introduction：According to the 2008 clinical guidelines for insomnia by the American Academy of Sleep Medicine proposed, hypnotic use is recommended for short-term use for 2 to 4 weeks. However, many insomnia patients have difficulty to stop hypnotic use. In clinic practices, gradual tapering is usually applied in helping patients to reduce the hypnotic use. Previous studies have shown that self-efficacy of the patients are associated with medication tapering. The present study examine the effect of the institution of a self-efficacy enhancement strategy prior to gradual tapering plan on hypnotic tapering in patients with primary insomnia.
Methods：Forty-eight patients with primary insomnia (17 men, 31 women；mean age of 46.8 years；mean duration of hypnotics use of 66.7 months) were assigned to two groups: a self-efficacy enhancement group and a tapering group. Patients in the self-efficacy enhancement group (n=24) underwent a two-week self-efficacy enhancement strategy prior to an eight-week gradual tapering plan. Patients in the tapering group (n=24) participated in the eight-week gradual tapering plan only. The main outcome measures were sleep parameters from sleep diary, a single-item tapering self-efficacy rating scale, number of pills taken per week, and percentage of dosage reduction.
Results：The percentage of dosage reduction of patients in the self-efficacy enhancement group was significantly more than those in the tapering group (the self-efficacy enhancement group = 78.62%；the tapering group = 64.10%). The number of pills taken per week also showed significantly more reduction for patients in the self-efficacy enhancement group than those in the tapering group (the self-efficacy enhancement group = 4.35 pills per week；the tapering group = 3.22 pills per week). However, the percentage of drug-free patients at the end of the programs in the self-efficacy enhancement group was not significant different from those in the tapering group (the self-efficacy enhancement group = 29.2%；the tapering group = 16.7%). Overall, the effect of hypnotic tapering in the self-efficacy enhancement group was better than those in the tapering group. In addition, linear regression showed that the tapering self-efficacy data showed that, after controlling baseline tapering self-efficacy, the change of tapering self-efficacy following the first two weeks of self-efficacy enhancement strategy can explain the variation of percentage of dosage reduction up to 21.9%.
Conclusions：The institution of self-efficacy enhancement strategy can increase the efficacy of gradual tapering plan for hypnotics. In addition, the level of tapering self-efficacy enhanced by the self-efficacy enhancement strategy is a good predictor for dosage reduction. This is a useful strategy that can be applied in clinical settings.
| Identifer | oai:union.ndltd.org:CHENGCHI/G0095752016 |
| Creators | 曾承翔 |
| 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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