혈액투석 환자의 수면의 질에 영향을 주는 신체적, 심리적, 생리적 요인
Physical, Physiological, and Psychological Factors Determing Sleep Quality in Patients on Maintenance Hemodialysis
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초록
본 연구의 목적은 혈액투석을 받는 대상자들의 수면의 질을 파악하고 신체적 특성, 심리적 특성, 생리적 특성이 수면장애에 주는 영향력을 확인하는 것이다. 대학병원의 혈액투석실에 내원한 환자 중 165명을 대상으로 2015년 7월에서 10월까지 자료수집을 하였으며, SPSSWIN 20.0 프로그램으로 자료를 분석하였다. 수면의 질과 관련요인은 표준화된 설문지와 신체계측, 혈액검사로 측정하였다. 자료수집 전 대상자로부터 서면동의를 받았다. 연구결과 대상자는 평균 63세로 평균 5년정도 혈액투석을 받고 있었다. 대상자의 67%는 ‘30분이내에 잠들 수 없다’, ‘밤에 자주깬다’ 등의 수면장애를 호소하였다. 대상자를 수면장애군과 비장애군으로 분류하여 증상을 비교한 결과 통증(t=-3.29, p=.007)과 우울정도 (t=-6.028, p<.001)가 두 군간 유의하게 달랐다. 다중회귀분석 결과 일반적 특성 (연령, 다인실, 낮잠), 신체적 특성 (통증, 증상)과 생리적 특성(우울, 기질 및 상태불안)이 혈액투석환자 수면의 질 변인의 20%를 설명하는 것으로 나타났다. 결론적으로 수면장애는 혈액투석환자에게 흔히 나타나는 건강문제이므로 수면증진을 위한 간호중재는 수면환경조정, 통증과 우울관리에 초점을 두어야 하는 것으로 나타났다. 추후 연구로 질병특성과 관련된 생리적 특성들이 혈액투석환자의 수면의 질에 미치는 영향을 탐구할 필요성이 제언되었다.
Abstract
Purpose: The study aimed to examine quality of sleep in hemodialysis patients and explore physical, physiological, and psychological factors determining sleep quality. Methods: The survey was conducted among 165 patients on maintenance hemodialysis at a university hospital. Data were collected from July to October in 2015. The sleep quality and its related factors were assessed by standardized questionnaires, anthropometric measures, and lab tests after obtaining a written consent from the participant. Results: The mean age of the participants was 62.58 years old, and 67.9% of the participants experienced sleep disorders such as ‘not falling asleep within 30 minutes’ or ‘frequently waking up at night’. Pain (t=-3.29, p=.007) and depression (t=-6.028, p<.001) were significantly different between the group with sleep disorder and the other without. The demographic factors (age, shared room, sleep during the day), physical factors (pain and symptom), and psychological factors (depression and trait and status anxiety) together explained 20.0% of variance in sleep quality. Conclusion: Sleep disorder was frequently experienced among the patients on maintenance hemodialysis. The effective nursing strategies should focus on sleep environment, pain and depression management. Further study is warranted to explore the effect of physiological factors related to the disease on sleep disorder in this population.
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