孕期相關睡眠障礙的非藥物處置

Non-Pharmacological Interventions for Pregnancy-Related Sleep Disturbances

10.6224/JN.000015

洪瑄曼(Hsuan-Man Hung)；江曉菁(Hsiao-Ching Chiang)

懷孕婦女 ； 睡眠障礙 ； 非藥物處置 ； pregnant women ； sleep disturbance ； non-pharmacological interventions

護理雜誌

64卷1期（2017 / 02 / 01）

112 - 119

繁體中文

婦女生命期中睡眠品質較差的為孕期和產褥期，雖然懷孕在女性的一生週期可能只有短暫的幾年，但加總懷孕這段期間，其影響女性的睡眠已足夠對健康造成深遠的衝擊。約有78–80%的孕期婦女，經歷睡眠障礙包含：深沉睡眠期減少、總睡眠時數減少、白天嗜睡、自覺睡眠品質降低、頻繁夜間醒來、睡眠效率降低。孕期睡眠障礙始於第一孕期而盛行於第三孕期，相關因素包含：生理、心理社會及生活型態。70%–80%的失眠病人，可藉由非藥物的處置而得到改善睡眠的效果。故非藥物的輔助介入措施，儼然已成為護理措施的主軸。孕期睡眠障礙的相關非藥物處置包含：音樂療法、有氧運動、按摩、漸進式放鬆、複合方法及托腹帶使用等。然運用在改善一般成人睡眠障礙的其他非藥物處置如：耳穴按壓、認知療法、太極拳、芳香療法等，是否能有效改善孕期睡眠障礙及其相關的應用禁忌，仍需要未來實證研究加以多方探討。再者，非藥物處置仍有其限制，並非所有孕婦的睡眠障礙，皆能經由非藥物處置來改善。

Most women experience the worse sleep quality of their life during pregnancy and the early postpartum period. Although pregnancy typically accounts for a relatively short part of a woman's life, the related sleep disturbances may have a significant and negative impact on her long-term health. Approximately 78-80% of pregnant women experience sleep disturbances, including interruptions in deep sleep, decreased total sleep time, poor subjective sleep quality, frequent night waking, and reduced sleep efficacy. Sleep disturbances during pregnancy start during the first trimester and become prevalent during the third trimester. Related factors include physiological and psychosocial changes and an unhealthy lifestyle. As non-pharmacological interventions have the potential to improve sleep quality in 70% to 80% of patients with insomnia, this is the main approached that is currently used to treat pregnancy-related sleep disturbances. Examples of these non-pharmacological interventions include music therapy, aerobic exercise, massage, progressive muscle relaxation, multi-modal interventions, and the use of a maternity support belt. The efficacy and safety of other related non-pharmacological interventions such as auricular acupressure, cognitive therapy, tai chi, and aromatherapy remain uncertain, with more empirical research required. Additionally, non-pharmacological interventions do not effectively treat sleep disturbances in all pregnant women.

1. 國家教育研究院（2012）．雙語辭彙、學術名詞暨辭書資訊網． 取自http://terms.naer.edu.tw/detail/1295248/[National Academy for Educational Research. (2012). Bilingual glossary, academic terms, and dictionary information network. Retrieved from http://terms.naer.edu.tw/detail/1295248/]
2. National Sleep Foundation. (n.d.). Pregnancy and sleep. Retrieved from http://sleepfoundation.org/sleep-topics/pregnancy-and-sleep
3. Akmeşe, Z. B.,Oran, N. T.(2014).Effects of progressive muscle relaxation exercises accompanied by music on low back pain and quality of life during pregnancy.Journal of Midwifery & Women's Health,59(5),503-509.
4. American Academy of Sleep Medicine(2014).International classification of sleep disorders.Darien, IL:Author.
5. Beddoe, A. E.,Lee, K. A.,Weiss, S. J.,Kennedy, H. P.,Yang, C. P.(2010).Effects of mindful yoga on sleep in pregnant women: A pilot study.Biological Research for Nursing,11(4),363-370.
6. Borodulin, K.,Evenson, K. R.,Monda, K.,Wen, F.,Herring, A. H.,Dole, N.(2010).Physical activity and sleep among pregnant women.Paediatric and Perinatal Epidemiology,24(1),45-52.
7. Carr, C. A.(2003).Use of a maternity support binder for relief of pregnancy-related back pain.Journal of Obstetric, Gynecologic, & Neonatal Nursing,32(4),495-502.
8. Chang, H. C.,Yu, C. H.,Chen, S. Y.,Chen, C. H.(2015).The effects of music listening on psychosocial stress and maternal-fetal attachment during pregnancy.Complementary Therapies in Medicine,23(4),509-515.
9. Chang, M. Y.,Chen, C. H.,Huang, K. F.(2008).Effects of music therapy on psychological health of women during pregnancy.Journal of Clinical Nursing,17(19),2580-2587.
10. Fernández-Alonso, A. M.,Trabalón-Pastor, M.,Chedraui, P.,Pérez-López, F. R.(2012).Factors related to insomnia and sleepiness in the late third trimester of pregnancy.Archives of Gynecology and Obstetrics,286(1),55-61.
11. Field, T.,Hernandez-Reif, M.,Hart, S.,Theakston, H.,Schanberg, S.,Kuhn, C.(1999).Pregnant women benefit from massage therapy.Journal of Psychosomatic Obstetrics and Gynaecology,20(1),31-38.
12. Hashmi, A. M.,Bhatia, S. K.,Bhatia, S. K.,Khawaja, I. S.(2016).Insomnia during pregnancy: Diagnosis and rational interventions.Journal of Psychosomatic Obstetrics and Gynaecology,32(4),1030-1037.
13. Hung, H. M.,Tsai, P. S.,Ko, S. H.,Chen, C. H.(2013).Patterns and predictors of sleep quality in Taiwanese pregnant women.The American Journal of Maternal/ Child Nursing,38(2),95-101.
14. Kamysheva, E.,Skouteris, H.,Wertheim, E. H.,Paxton, S. J.,Milgrom, J.(2010).A prospective investigation of the relationships among sleep quality, physical symptoms, and depressive symptoms during pregnancy.Journal of Affective Disorders,123(1-3),317-320.
15. Kaneita, Y.,Ohida, T.,Takemura, S.,Sone, T.,Suzuki, K.,Miyake, T.,Umeda, T.(2005).Relation of smoking and drinking to sleep disturbance among Japanese pregnant women.Preventive Medicine,41(5-6),877-882.
16. Ko, S. H.,Chang, S. C.,Chen, C. H.(2010).A comparative study of sleep quality between pregnant and nonpregnant Taiwanese women.Journal of Nursing Scholarship,42(1),23-30.
17. Lamberg, L.(2006).Sleeping poorly while pregnant may not be "normal".JAMA: Journal of the American Medical Association,295(12),1357-1361.
18. Larsson, L.,Lindqvist, P. G.(2005).Low-impact exercise during pregnancy: A study of safety.Acta Obstetricia et Gynecologica Scandinavica,84(1),34-38.
19. Liddle, S. D.,Pennick, V.(2015).Interventions for preventing and treating low-back and pelvic pain during pregnancy.Cochrane Database of Systematic Reviews,9,CD001139.
20. Liu, Y. H.,Lee, C. S.,Yu, C. H.,Chen, C. H.(2016).Effects of music listening on stress, anxiety and sleep quality for sleep disturbed pregnant women.Women & Health,56(3),296-311.
21. Mindell, J. A.,Cook, R. A.,Nikolovski, J.(2015).Sleep patterns and sleep disturbances across pregnancy.Sleep Medicine,16(4),483-488.
22. Moline, M. L.,Broch, L.,Zak, R.,Gross, V.(2003).Sleep in women across the life cycle from adulthood through menopause.Sleep Medicine Reviews,7(2),155-177.
23. Nascimento, S. L.,Surita, F. G.,Cecatti, J. G.(2012).Physical exercise during pregnancy: A systematic review.Current Opinion in Obstetrics and Gynecology,24(6),387-394.
24. Parry, B. L.,Martínez, L. F.,Maurer, E. L.,López, A. M.,Sorenson, D.,Meliska, C. J.(2006).Sleep, rhythms and women's mood. Part I. Menstrual cycle, pregnancy and postpartum.Sleep Medicine Reviews,10(2),129-144.
25. Pien, G. W.,Schwab, R. J.(2004).Sleep disorders during pregnancy.Sleep,27(7),1405-1417.
26. Santos, I. A.,Stein, R.,Fuchs, S. C.,Duncan, B. B.,Ribeiro, J. P.,Kroeff, L. R.,Schmidt, M. I.(2005).Aerobic exercise and submaximal functional capacity in overweight pregnant women: A randomized trial.Obstetrics & Gynecology,106(2),243-249.
27. Sarberg, M.,Josefsson, A.,Wiréhn, A. B.,Svanborg, E.(2012).Restless legs syndrome during and after pregnancy and its relation to snoring.Acta Obstetricia et Gynecologica Scandinavica,91(7),850-855.
28. Sloan, E. P.(2008).Sleep disruption during pregnancy.Sleep Medicine Clinics,3(1),73-80.
29. Soares, C. N.,Murray, B. J.(2006).Sleep disorders in women: Clinical evidence and treatment strategies.Psychiatric Clinics North America,29(4),1095-1113.
30. Tsai, S. Y.,Kuo, L. T.,Lai, Y. H.,Lee, C. N.(2011).Factors associated with sleep quality in pregnant women: A prospective observational study.Nursing Research,60(6),405-412.
31. Wang, S. M.,Dezinno, P.,Maranets, I.,Berman, M. R.,Caldwell-Andrews, A. A.,Kain, Z.(2004).Low back pain during pregnancy: Prevalence, risk factors, and outcomes.Obstetrics & Gynecology,104(1),65-70.
32. 朱哲生、陸悌(2011)。失眠之最新概況。臺灣醫界，54(6)，8-14。
33. 湯振青、王建楠、林鏡川、蘇世斌、林佳淑、李明昕(2014)。國內職場孕婦睡眠品質的相關研究─以中文版匹茲堡睡眠品質量表作評估。中華職業醫學雜誌，21(4)，181-192。

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2. 温玉瑩、林欣仕(2018)。瑜珈對懷孕婦女睡眠品質的影響。成大體育，50(2)，16-46。
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