目的：本研究欲利用中文版之PSQI匹茲堡睡眠品質量表及FRAX骨折風險評估工具此兩通用量表及工具，針對睡眠品質與未來十年內發生主要骨鬆性骨折與髖骨骨折的機率百分比及相關因子作討論，並且進一步了解睡眠品質與骨質疏鬆症的關聯。
方法：以中老年人為主要研究對象，收案地點則為南部某醫學中心之榮民之家，問卷內容以PSQI匹茲堡睡眠品質量表及FRAX骨折風險評估工具之內容為主，發放的問卷共回收357份，排除4份無效問卷後，獲得有效問卷353份，並以STATA14.0進行多元迴歸分析。
結果：睡眠品質總分越高(即睡眠品質越差)，未來十年內主要骨鬆性骨折機率百分比增加0.31%（p<0.01），未來十年內髖骨骨折機率百分比增加0.25%（p<0.01）；與睡眠品質好者相比，中重度睡眠障礙者在未來十年內主要骨鬆性骨折機率百分比增加3.39%（p<0.01），未來十年內髖骨骨折機率百分比增加了2.82%（p<0.01）。另外，在未來十年內主要骨鬆性骨折風險方面，睡眠品質總分每增加1分有1.16倍的機會增加骨折風險，中重度睡眠障礙者也有5.65倍的機會增加骨折風險（p<0.01），但在未來十年內髖骨骨折方面並沒有達到統計上顯著意義。未來十年內主要骨鬆性骨折與髖骨骨折的機率百分比越高，表示中老年人罹患骨質疏鬆症的可能性越大，根據本研究之結果發現睡眠品質總分越高，未來十年內主要骨鬆性骨折與髖骨骨折的機率百分比皆增加，表示睡眠品質會進一步影響骨質疏鬆症。
結論：睡眠品質會影響未來十年內骨鬆性骨折機率，睡眠品質總分越高，未來十年內主要骨鬆性骨折與髖骨骨折風險機率百分比就越高。而根據FRAX骨折風險評估工具測量結果，未來十年內主要骨鬆性骨折或髖骨骨折機率越高，罹患骨質疏鬆症的可能性就越大，因此也要多加留意睡眠品質與骨質疏鬆症間的關聯性。

Objective: The study used Pittsburgh Sleep Quality Index (PSQI) and FRAX Fracture Risk Assessment Tool, two general scales and tools, to discuss sleep quality and osteoporotic fracture in the next decade, and to further understand the relationship between sleep quality and osteoporosis.
Method: Middle-aged and elderly people are the main research objects, and the receiving site is the Veterans Home of a medical center in southern Taiwan. The content of the questionnaire is mainly based on the PSQI and the FRAX Tool. And STATA14.0 was used for multiple regression analysis.
Result: The higher the total score of sleep quality, increasing the 0.31% (p<0.01) the probability of major osteoporotic fractures and 0.25% (p<0.01) of hip fractures in the next decade. People with severe sleep disturbance had a 3.39%(p<0.01) increase in the risk of major osteoporotic fractures and a 2.82% (p<0.01) of hip fractures in the next decade. In addition, in terms of the risk of major osteoporotic fractures in the next decade, the total sleep quality score had a 1.16-fold chance (p<0.01) of increasing the risk of fracture, and those with severe sleep disturbance also had a 5.65-fold chance (p<0.01) of increasing the risk of fracture. But hip fracture did not reach statistical significance.
Conclusion: The worse the sleep quality, the higher the risk of major osteoporotic fracture and hip fracture, so it is known that sleep quality will affect the probability of osteoporotic fractures in the next decade. And according to the measurement results of the FRAX assessment tool, the higher the probability of major osteoporotic fracture or hip fracture in the next decade, the more likely to suffer from osteoporosis. Therefore, we should pay more attention to the relationship between sleep quality and osteoporosis.

論文審定書i
誌謝ii
摘要iii
ABSTRACTiv
第一章緒論1
第一節研究背景動機以及重要性1
第二節研究目的3
第二章文獻探討4
第一節骨質疏鬆症與骨鬆性骨折4
第二節睡眠障礙13
第三節骨質疏鬆與睡眠障礙18
第四節文獻探討小結21
第三章研究方法22
第一節研究架構22
第二節研究問題23
第三節研究假設23
第四節研究對象與資料來源24
第五節研究變項操作型定義25
第六節研究工具27
第七節資料處理分析32
第四章研究結果34
第一節描述性統計分析34
第二節推論性統計40
第三節假設驗證56
第五章研究討論57
第一節FRAX預測未來十年內主要骨鬆性骨折與髖骨骨折機率百分比57
第二節睡眠品質與主要骨鬆性骨折、髖骨骨折及骨質疏鬆症的關聯性57
第三節個人基本屬性相關探討60
第六章研究結論與建議62
第一節研究結論62
第二節研究限制63
第三節研究建議63
第四節研究貢獻64
參考文獻65
中文文獻65
英文文獻67
附錄73
圖次
圖3-1 研究架構圖22
圖3-2 FRAX骨折風險評估危險因子與其計算方式29
表次
表2-1 骨鬆與骨鬆性骨折的定義相關文獻整理5
表2-2 骨鬆與骨鬆性骨折之流行病學相關文獻整理8
表2-3 骨鬆及骨折的預防相關文獻整理11
表2-4 睡眠障礙的定義及流行病學相關文獻整理14
表2-5 老年人的睡眠品質相關文獻整理16
表2-6 骨鬆與睡眠障礙的關聯相關文獻整理19
表3-1 自變項操作型定義25
表3-2 控制變項操作型定義25
表3-3 依變項操作型定義26
表3-4 FRAX骨折風險評估工具內容28
表3-5 PSQI匹茲堡睡眠品質量表內容31
表4-1個人基本資料分析37
表4-2量表總分現況分析39
表4-3睡眠品質總分與未來十年內主要骨鬆性骨折機率&人口學資料的關係40
表4-4 睡眠品質總分與未來十年內髖骨骨折機率&人口學資料的關係42
表4-5 睡眠品質分3組與未來十年內主要骨鬆性骨折機率&人口學資料的關係44
表4-6 睡眠品質分3組與未來十年內髖骨骨折機率&人口學資料的關係46
表4-7睡眠品質總分與未來十年內主要骨鬆性骨折風險&人口學資料的關係48
表4-8睡眠品質總分與未來十年內髖骨骨折風險&人口學資料的關係50
表4-9睡眠品質分3組與未來十年內主要骨鬆性骨折風險&人口學資料的關係52
表4-10睡眠品質分3組與未來十年內髖骨骨折風險&人口學資料的關係54
附錄
附錄一 人體研究計畫同意函73

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