Kauffman Karen S, Doede Megan, Diaz-Abad Montserrat, Scharf Steven M, Bell-Farrell Wanda, Rogers Valerie E, Geiger-Brown Jeanne
Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD, USA.
Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD, USA.
Patient Prefer Adherence. 2014 Dec 10;8:1699-704. doi: 10.2147/PPA.S71666. eCollection 2014.
Persons with chronic obstructive pulmonary disease (COPD) are known to have poor sleep quality. Acceptance of and adherence to therapies for sleep problems may depend on how the person with COPD regards the source of his sleep problem, yet little is known about their attribution as to the cause of these sleep symptoms. The objective of this study was to describe the subjective sleep complaints of individuals with COPD along with their attributions as to the cause of these symptoms, and their treatment preferences for insomnia. Three focus groups were conducted (N=18) with participants who have moderate to severe COPD. Focus group data were transcribed, compared and contrasted to identify themes of attribution. Participants reported difficulty falling asleep, staying asleep, and daytime sleepiness. They attributed their sleep problems primarily to their pulmonary symptoms, but also poor air quality (thick humid air) and death anxiety when awake during the night. There was no clear preference for type of treatment to remedy this problem (medication, cognitive therapy), although they indicated that traveling to the clinic was difficult and should be avoided as much as possible. These data suggest that environmental manipulation to improve air quality (eg, air conditioning) and modifications to reduce death anxiety could be beneficial to persons with COPD. In-person multi-session therapy may not be acceptable to persons with moderate to severe COPD, however internet-based therapy might make treatment more accessible.
已知慢性阻塞性肺疾病（COPD）患者的睡眠质量较差。对睡眠问题治疗方法的接受程度和依从性可能取决于COPD患者对其睡眠问题根源的看法，然而，对于他们对这些睡眠症状成因的归因却知之甚少。本研究的目的是描述COPD患者的主观睡眠主诉、他们对这些症状成因的归因以及他们对失眠的治疗偏好。对18名中重度COPD患者进行了三个焦点小组访谈。对焦点小组的数据进行了转录、比较和对比，以确定归因主题。参与者报告了入睡困难、睡眠维持困难和日间嗜睡。他们将自己的睡眠问题主要归因于肺部症状，但也归因于空气质量差（空气浓稠潮湿）以及夜间清醒时的死亡焦虑。对于解决这个问题的治疗类型（药物治疗、认知疗法）没有明确的偏好，尽管他们表示去诊所看病困难，应尽可能避免。这些数据表明，改善空气质量的环境调节措施（如使用空调）以及减轻死亡焦虑的调整措施可能对COPD患者有益。面对面的多疗程治疗可能不为中重度COPD患者所接受，然而基于互联网的治疗可能会使治疗更容易获得。
