하지불안증후군 환자의 불면증 인지행동중재 프로그램 개발 및 효과

Other Titles
Development and effects of cognitive behavioral therapy for insomnia on patients with restless legs syndrome
Authors
송미령
Abstract
The purpose of this study was to investigate the effects of cognitive behavioral therapy for insomnia (CBT-I) on patients with restless legs syndrome (RLS). This study was conducted using a nonequivalent control groups pretest-posttest design, and there were 12 patients in the experimental group and 13 patients in the control group. The data collection was done from May 2, 2016 to July 20, 2017 with patients who visited the department of neurology at the tertiary medical center in D-city. In this study, the experimental group received 4 sessions of the CBT-I, with one session per week, and the control group only received one sleep hygiene education session. Data analysis was performed using the SPSS/WIN 18.0 program. The qualitative data was analyzed using Fisher's exact test, and the quantitative data was analyzed using the Mann Whitney U-test. The results of this study were as follows: 1) The first hypothesis, "The experimental group that received the CBT-I will have a lower score of sleep-related dysfunctional cognitions than the control group," was supported. There was a significant difference in dysfunctional cognition of the two groups (Z=-2.83, p=.005). 2) The second hypothesis, "The experimental group that received the CBT-I will have a lower score of sleep-related maladaptive habits than the control group," was supported. There were significant differences in the maladaptive habits of the two groups (Z=-2.92, p=.004). 3) The third hypothesis, "The experimental group that received the CBT-I will show greater improvement in subjective and objective sleep-related variables than the control group," was partially supported. There were significant differences in severity of insomnia (Z=-4.19, p<0.001), subjective sleep efficiency (Z=-3.16, p=.002), subjective total sleep time (Z=-2.04, p=.041), subjective sleep latency to onset (Z=-3.05, p=.002), and objective sleep latency to onset (Z=-2.77, p=.006). 4) The fourth hypothesis, "The experimental group that received the CBT-I will show greater improvement in psychiatric-related variables than the control group," was partially supported. There was no significant difference in the depression scores of the two groups (Z=-0.49, p=.623); however, there was a significant difference in the anxiety scores (Z=-2.09, p=.037). 5) The fifth hypothesis, "The experimental group that received the CBT-I will have a lower score in severity of RLS than the control group," was not supported. There was no significant difference in the severity of RLS (Z=-0.93, p=.353). In conclusion, the CBT-I for RLS patients was effective for improving sleep quality and anxiety symptoms. Therefore, it is necessary to perform CBT-I for RLS patients with insomnia in clinical practice.
본 연구는 하지불안증후군(restless legs syndrome, RLS) 환자를 대상으 로 불면증 인지행동중재 프로그램을 시행하여 그 효과를 검증하기 위한 목 적으로 실시되었다. 연구설계는 비동등성 대조군 전후설계로 실험군 12명, 대조군 13명이었다. 대상자는 D광역시 소재 1개 대학병원 신경과 외래로 방문하는 환자로 하였으며, 자료수집 기간은 2016년 5월 2일부터 2017년 7 월 20일까지 이루어졌다. 본 연구에서 실험군은 불면증 인지행동중재 프로 그램을 주 1회 총 4주 적용하였고, 대조군은 수면위생 교육만 1회 적용하였 다. 자료분석은 SPSS/WIN 18.0 프로그램을 이용하여, 질적 자료는 Fisher's exact test, 양적자료는 Mann whitney U-test를 통하여 분석하였다. 본 연구에 대한 결과는 다음과 같다. 1) 제1가설: “불면증 인지행동중재 프로그램을 받은 실험군은 대조군보다 수면에 대한 역기능적 인지가 낮아질 것이다.”를 검증한 결과 프로그램 실 시 후 실험군과 대조군의 수면에 대한 역기능적 인지는 유의한 차이가 있 었다(Z=-2.83, p=.005). 따라서 제1가설이 지지되었다. 2) 제2가설: “불면증 인지행동중재 프로그램을 받은 실험군은 대조군보다 수면에 대한 비적응적 대처행동이 낮아질 것이다.”를 검증한 결과 프로그램 실시 후 실험군과 대조군의 수면에 대한 비적응적 대처행동은 유의한 차이 가 있었다(Z=-2.92, p=.004). 따라서 제2가설은 지지되었다. 3) 제3가설: “불면증 인지행동중재 프로그램을 받은 실험군은 대조군보다 주관적 객관적 수면관련 변수가 좋아질 것이다.”를 검증한 결과 실험군과 대조군의 불면증 심각도(Z=-4.19, p<.001), 주관적 수면효율(Z=-3.16, p=.002), 주관적 총 수면시간(Z=-2.04, p=.041), 주관적 입면시간(Z=-3.05, p=.002), 객관적 입면시간(Z=-2.77, p=.006)에서 유이한 차이가 있었다. 따라 서 제3가설은 일부 지지되었다. 4) 제4가설: “불면증 인지행동중재 프로그램을 받은 실험군은 대조군보다 정서적 상태가 개선될 것이다.”를 검정한 결과 우울 점수는 유의한 차이가 없었고(Z=-0.49, p=.623), 불안 점수는 유의한 차이가 있었다(Z=-2.09, p=.037). 따라서 제4가설은 일부 지지되었다.
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http://kumel.medlib.dsmc.or.kr/handle/2015.oak/30037
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3. Thesis (학위논문) > 2. College of Nursing (간호대학) > 박사
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