Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator

Moon Sook Hwang; Mi Kyung Lee; Jong Rye Song

doi:10.7469/kjan.2016.28.5.595

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Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator

Moon Sook Hwang, Ph.D., APN¹, Mi Kyung Lee, Ph.D., APN², Jong Rye Song, Ph.D., APN³

Korean Journal of Adult Nursing 2016;28(5):595-606.
Published online: October 31, 2016

DOI: https://doi.org/10.7469/kjan.2016.28.5.595

¹Associate Professor, Department of Nursing Science, School of Oriental Medicine, WooSuk University, Wanju

²Clinical Assistant Professor, Department of Clinical Nursing Science, Samsung Medical Center, Seoul

³Head Nurse, Department of Home Health Nursing, Aju University Hospital, Suwon, Korea

Corresponding author: Hwang, Moon Sook Department of Nursing Science, School of Oriental Medicine in WooSuk University, 443 Samyre-Ro, Samyre-up, Wanju 55338, Korea. Tel: +82-63-291-1989, Fax: +82-63-291-1547, E-mail: msyellow45@hanmail.net

• Received: September 2, 2016 • Accepted: October 27, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
This study aimed to investigate the influencing factors on self care, respiratory difficulty, sleep impediment, anxiety and depression among patients with neuromuscular disease who are dependent on Home Mechanical Ventilator (HMV).
Methods
157 patients were recruited through hospital based home nursing care departments and HMV rental centers. Data were collected by questionnaires. The analytic methods were n (%) / M±SD, x² / t-test or ANOVA and multiple linear regression.
Results
Patients with Amyotrophic lateral sclerosis were more likely to utilize HMV, had shorter periods of morbidity and the most extended daily use of HMV. As for medical equipment, they had ambu-bag (87.2%) and oxygenator (15.4%). Reports of respiratory difficulty and sleep impediment were low. There were no significant difference. In contrast, reported anxiety and depression were high and showed significant difference between non invasive HMV and invasive HMV. Anxiety contributes to respiratory difficulty (t=3.62, p=.002), sleep impediment (t=2.06, p=.042), and depression (t=7.24, p<.001). However, home nursing care exerts a positive influence in reducing anxiety (t=-2.73, p=.008).
Conclusion
Anxiety contributes to respiratory difficulty, sleep impediment, and depression. However, those who use home nursing care reported less anxiety. Home nursing care positively impacts patients dependent on HMV as a practical service and available resource.
Key Words: Ventilator; Respiration; Sleep; Anxiety; Depression

Table 1.

Comparisons of General Characteristics by Applied Method of HMV (N=157)

Variables	Categories	Total (N=157)	Non IHMV (n=55)	IHMV (n=102)	x² or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	101 (64.3)	42 (76.4)	59 (57.8)	5.34	.021
Gender	Female	56 (35.7)	13 (23.6)	43 (42.2)	5.34	.021
Age (year)	＜45	68 (43.6)	41 (75.9)	27 (26.5)		＜.001^†
	45~＜65	61 (39.1)	10 (18.5)	51 (50.0)
	≥65	27 (17.3)	3 (5.6)	24 (23.5)
		43.46±21.71	30.87±17.46	51.12±20.82	-5.80	＜.001
Religion	No	50 (31.8)	18 (32.7)	32 (31.4)	0.03	.862
Religion	Yes	107 (68.2)	37 (67.3)	70 (68.6)	0.03	.862
Family member	Couple	24 (15.4)	5 (9.1)	19 (18.8)	3.10	.212
	Couple & offspring	97 (62.2)	35 (63.6)	62 (61.4)
	Parent & others	35 (22.4)	15 (28.3)	20 (19.8)
Number of caring person		1.75±0.80	1.63±0.77	1.81±0.82	-1.25	.215

Missing data be excluded; IHMV=invasive home mechanical ventilator;

^†Fisher's exact test.

Table 2.

Comparisons of Disease related Characteristics by Applied Method of HMV (N=157)

Variables	Categories	Total (N=157)	Non IHMV (n=55)	IHMV (n=102)	x² or t	p
Variables	Categories	n (%)/M±SD	n (%)/M±SD	n (%)/M±SD	x² or t	p
Physical functional status		0.82±.087	1.75±0.61	0.32±0.51	14.88	＜.001
Diagnosis	ALS	87 (55.1)	13 (23.6)	74 (75.2)	35.22	＜.001
	SMA & PMD	51 (32.9)	32 (58.2)	19 (18.6)
	Others	19 (12.0)	10 (6.4)	9 (8.8)
Morbidity duration of disease (month)		100.53±73.82	128.75±77.31	85.38±67.55	3.51	.001
Diagnosis	ALS^a	75.41±63.24	62.08±58.32	73.28±52.87
	SMA & PMD^b	141.26±69.69	151.93±66.60	125.00±75.01
	Others^c	109.00±82.65	141.50±86.11	72.89±65.12
	F (p)	13.92 (＜.001)	7.42 (.002)	5.23 (.007)
		b＞c＞a	b, c＞a	b＞a, c
Utility duration of HMV (month)		43.42±35.37	44.43±35.09	42.87±35.68	0.26	.795
Diagnosis	ALS	39.20±31.50	34.69±24.16	40.18±32.91
	SMA & PMD	52.00±38.53	47.97±36.70	57.29±42.31
	Others	40.37±42.11	45.10±42.45	34.00±41.11
	F (p)	1.78 (.154)	0.66 (.521)	1.90 (.155)
Applied hours of HMV (day)		18.77±7.17	11.79±6.08	22.46±4.47	-11.41	＜.001
Diagnosis	ALS^a	21.99±5.35	14.67±8.52	23.16±3.51
	SMA & PMD^b	14.40±6.95	10.77±4.67	20.33±5.88
	Others^c	15.89±7.78	11.60±6.22	20.67±6.63
	F (p)	26.04 (＜.001)	1.86 (.165)	3.89 (.024)
		a＞b, c		a＞b, c
Type of HMV	Volume	102 (65.0)	41 (74.5)	61 (59.8)	3.41	.065
Type of HMV	Pressure	55 (35.0)	14 (25.5)	41 (40.2)	3.41	.065
Parameter of HMV	In case of TV	636.76±273.88	840.24±209.77	561±209.77	7.22	＜.001
	In case of PIP	13.41±4.38	11.82±5.09	13.97±4.02	-1.60	.116
	Respiratory rate	15.43±4.41	14.69±3.13	15.85±4.94	-1.56	.120
Change of parameter (6 months)	No	103 (65.6)	35 (63.6)	68 (66.7)	0.14	.764
Change of parameter (6 months)	Yes	54 (34.4)	20 (36.4)	34 (33.3)	0.14	.764
Reason^† (yes only)	RD	23 (33.3)	5 (19.2)	18 (11.4)	1.67	.232
	Headache	23 (33.3)	10 (38.5)	13 (12.8)
	Problem of HMV	4 (5.8)	1 (3.8)	3 (2.0)
	After check up	6 (8.7)	0 (0.0)	6 (3.9)
	Others	13 (18.8)	10 (38.5)	3 (7.0)
Changer of parameter	Physician	74 (67.9)	35 (83.3)	39 (58.2)		.014*
	Home care nurse	13 (11.9)	4 (9.5)	9 (13.4)
	Employer of equipment	22 (20.2)	3 (7.1)	19 (28.4)
Home nursing care	No	60 (38.2)	48 (87.3)	12 (11.8)	86.28	＜.001
Home nursing care	Yes	97 (61.8)	7 (12.7)	90 (88.2)	86.28	＜.001

Missing data be excluded; IHMV=invasive home mechanical ventilator; ALS=amytrophic lateral sclerosis; SMA=spinal muscular atrophy; PMD=primary muscular disease; TV=tidal volume; PIP=peak inspiratory pressure; RD=respiratory difficulty;

^†Fisher's exact test.

Table 3.

Comparisons of Self Care by Applied Method of HMV (N=157)

Variables	Categories		Total (N=157)	Non IHMV (n=55)	IHMV (n=102)	x²	p
Variables	Categories		n (%)	n (%)	n (%)	x²	p
HMV related	Holding equipment^† (yes only)	Equipment for suction	109 (69.9)	14 (12.8)	95 (87.2)	75.77	＜.001
		Equipment for oxygen	24 (15.4)	4 (16.7)	20 (83.3)		.061
		Ambu bag	136 (87.2)	44 (32.4)	92 (67.6)	2.40	.121
		Pulse oxymetry	80 (51.3)	26 (32.5)	54 (67.5)	0.33	.569
		Assisted cough	84 (53.8)	49 (58.3)	35 (41.7)	4.00	.046
	Changing cycle of circuit	q 2 weeks	29 (23.4)	18 (37.5)	11 (14.3)	9.72	.008
	Changing cycle of circuit	q≥1 month	95 (76.6)	30 (62.5)	65 (85.7)	9.72	.008
	Changer of circuit	Family caregiver	44 (29.7)	18 (33.4)	26 (27.7)	4.45	.218
		Employer of company	80 (54.1)	24 (44.4)	56 (59.6)
		Home care nurse	24 (16.2)	12 (22.2)	12 (12.8)
	Changing cycle of filter	q 2 weeks	11 (15.1)	1 (4.8)	10 (19.2)		.272
	Changing cycle of filter	q 1 month and above	62 (74.9)	20 (95.5)	39 (75.0)		.272
	Changer of filter	Family caregiver	103 (76.5)	33 (58.9)	68 (69.4)		.073
		Employer of company	45 (29.0)	17 (30.4)	28 (28.6)
		Home care nurse	7 (4.5)	6 (10.7)	2 (2.0)
Life habit related	Respiratory exercise (yes only)^‡	Cough assisted coughing	90 (59.2)	35 (66.0)	55 (55.6)		.210
		Postural drainage	18 (11.3)	3 (6.8)	15 (18.3)		.109
		Chest vibration	10 (7.2)	3 (6.5)	7 (7.5)		1.000
		Exercise of accumulated air	55 (41.0)	25 (55.6)	30 (33.7)	5.90	.015
		Respiratory muscle exercise	29 (21.0)	15 (33.3)	14 (15.1)		.040
		Suction of airway	104 (74.3)	9 (21.4)	95 (96.9)		＜.001
	General exercise	No	61 (39.1)	23 (42.6)	38 (37.3)	0.42	.516
	General exercise	Yes	95 (60.9)	31 (57.4)	64 (62.7)
	Major type of meal	Oral diet	74 (47.1)	48 (87.3.)	26 (25.5)	54.74	＜.001
	Major type of meal	Tube feeding	83 (52.9)	7 (12.7)	76 (74.5)
	Elevated upper body during meal	No	32 (20.8)	20 (38.5)	12 (11.8)	14.91	＜.001
	Elevated upper body during meal	Yes	122 (79.2)	32 (61.5)	90 (88.2)
	Oral care	No	18 (11.7)	10 (18.9)	8 (7.9)	4.05	.045
	Oral care	Yes	136 (88.3)	43 (81.1)	93 (92.1)

Missing data be excluded; IHMV=invasive home mechanical ventilator;

^†Fisher's exact test;

^‡Multiple respondent.

Table 4.

Comparisons by Applied Method and Influencing Factors on Respiratory Difficulty, Sleep Impediment, Anxiety, and Depression (N=157)

Variables	Total (n=157)	Non IHMV (n=55)	IHMV (n=102)	t (p)	Variables (Constant)	B	β	t	p	R²	Adj. R²
Variables	M±SD	M±SD	M±SD	t (p)	Variables (Constant)	B	β	t	p	R²	Adj. R²
Respiratory difficulty	0.88±1.10	0.76±1.07	0.95±1.18	-0.94	(Constant)	3.55		3.61	＜.001	.16	.14
				(.347)	Anxiety	0.97	0.30	3.62	.002
					Utility duration of HMV	-0.02	-0.24	-2.57	.012
					Gender (male)	-1.31	-0.22	-2.31	.023
Sleep impediment	0.44±0.29	0.43±0.31	0.45±0.28	-0.41	(Constant)	1.30		5.88	＜.001	.32	.28
				(.681)	SMA & PMD(yes)	0.50	0.32	2.91	.004
					Duration of morbidity	-0.01	-0.20	-2.05	.043
					Applied method(IHMV)	-0.48	-0.31	-3.08	.003
					Changing cycle of circuit	0.31	0.19	2.13	.035
					Anxiety	0.18	0.21	2.06	.042
Anxiety	1.41±0.85	0.96±0.77	1.69±0.83	-5.27	(Constant)	0.23		1.30	.198
				(＜.001)	Depression	0.62	0.62	8.42	＜.001
					Sleep impediment	0.22	0.19	2.83	.006	.62	.60
					Physical functional status	-0.35	-0.33	-3.57	.001
					HNC(yes)	-0.43	-0.24	-2.73	.008
Depression	1.68±0.84	1.13±0.79	2.1±12	-6.60	(Constant)	0.53		3.02	.003	.66	.65
				(＜.001)	Anxiety	0.51	0.51	7.24	＜.001
					Age	0.02	0.46	5.30	＜.001
					Duration of morbidity	-0.01	-0.21	-2.70	.008

Missing data be excluded; Gender: Male (1) vs Female (0); Diagnosis: ALS (no) 0 vs SMA & PMD (yes)1; Applied method: non Invasive (0) vs Invasive (1); HNC (Home nursing care): No (0) vs Yes (1); IHMV=invasive home mechanical ventilator, SMA=spinal muscular atrophy; PMD=primary muscular disease; Adj. R

²=Adjusted R

².

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Research Paper: Anxiety, Depression, and Their Related Factors in Patients Admitted to Intensive Care Units
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Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator

Korean J Adult Nurs. 2016;28(5):595-606. Published online October 31, 2016

DOI: https://doi.org/10.7475/kjan.2016.28.5.595

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Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator

Korean J Adult Nurs. 2016;28(5):595-606. Published online October 31, 2016

DOI: https://doi.org/10.7475/kjan.2016.28.5.595

Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator

Table 1.

Comparisons of General Characteristics by Applied Method of HMV (N=157)

Variables	Categories	Total (N=157)	Non IHMV (n=55)	IHMV (n=102)	x² or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	101 (64.3)	42 (76.4)	59 (57.8)	5.34	.021
Gender	Female	56 (35.7)	13 (23.6)	43 (42.2)	5.34	.021
Age (year)	＜45	68 (43.6)	41 (75.9)	27 (26.5)		＜.001^†
	45~＜65	61 (39.1)	10 (18.5)	51 (50.0)
	≥65	27 (17.3)	3 (5.6)	24 (23.5)
		43.46±21.71	30.87±17.46	51.12±20.82	-5.80	＜.001
Religion	No	50 (31.8)	18 (32.7)	32 (31.4)	0.03	.862
Religion	Yes	107 (68.2)	37 (67.3)	70 (68.6)	0.03	.862
Family member	Couple	24 (15.4)	5 (9.1)	19 (18.8)	3.10	.212
	Couple & offspring	97 (62.2)	35 (63.6)	62 (61.4)
	Parent & others	35 (22.4)	15 (28.3)	20 (19.8)
Number of caring person		1.75±0.80	1.63±0.77	1.81±0.82	-1.25	.215

Missing data be excluded; IHMV=invasive home mechanical ventilator;

^†Fisher's exact test.

Table 2.

Comparisons of Disease related Characteristics by Applied Method of HMV (N=157)

Variables	Categories	Total (N=157)	Non IHMV (n=55)	IHMV (n=102)	x² or t	p
Variables	Categories	n (%)/M±SD	n (%)/M±SD	n (%)/M±SD	x² or t	p
Physical functional status		0.82±.087	1.75±0.61	0.32±0.51	14.88	＜.001
Diagnosis	ALS	87 (55.1)	13 (23.6)	74 (75.2)	35.22	＜.001
	SMA & PMD	51 (32.9)	32 (58.2)	19 (18.6)
	Others	19 (12.0)	10 (6.4)	9 (8.8)
Morbidity duration of disease (month)		100.53±73.82	128.75±77.31	85.38±67.55	3.51	.001
Diagnosis	ALS^a	75.41±63.24	62.08±58.32	73.28±52.87
	SMA & PMD^b	141.26±69.69	151.93±66.60	125.00±75.01
	Others^c	109.00±82.65	141.50±86.11	72.89±65.12
	F (p)	13.92 (＜.001)	7.42 (.002)	5.23 (.007)
		b＞c＞a	b, c＞a	b＞a, c
Utility duration of HMV (month)		43.42±35.37	44.43±35.09	42.87±35.68	0.26	.795
Diagnosis	ALS	39.20±31.50	34.69±24.16	40.18±32.91
	SMA & PMD	52.00±38.53	47.97±36.70	57.29±42.31
	Others	40.37±42.11	45.10±42.45	34.00±41.11
	F (p)	1.78 (.154)	0.66 (.521)	1.90 (.155)
Applied hours of HMV (day)		18.77±7.17	11.79±6.08	22.46±4.47	-11.41	＜.001
Diagnosis	ALS^a	21.99±5.35	14.67±8.52	23.16±3.51
	SMA & PMD^b	14.40±6.95	10.77±4.67	20.33±5.88
	Others^c	15.89±7.78	11.60±6.22	20.67±6.63
	F (p)	26.04 (＜.001)	1.86 (.165)	3.89 (.024)
		a＞b, c		a＞b, c
Type of HMV	Volume	102 (65.0)	41 (74.5)	61 (59.8)	3.41	.065
Type of HMV	Pressure	55 (35.0)	14 (25.5)	41 (40.2)	3.41	.065
Parameter of HMV	In case of TV	636.76±273.88	840.24±209.77	561±209.77	7.22	＜.001
	In case of PIP	13.41±4.38	11.82±5.09	13.97±4.02	-1.60	.116
	Respiratory rate	15.43±4.41	14.69±3.13	15.85±4.94	-1.56	.120
Change of parameter (6 months)	No	103 (65.6)	35 (63.6)	68 (66.7)	0.14	.764
Change of parameter (6 months)	Yes	54 (34.4)	20 (36.4)	34 (33.3)	0.14	.764
Reason^† (yes only)	RD	23 (33.3)	5 (19.2)	18 (11.4)	1.67	.232
	Headache	23 (33.3)	10 (38.5)	13 (12.8)
	Problem of HMV	4 (5.8)	1 (3.8)	3 (2.0)
	After check up	6 (8.7)	0 (0.0)	6 (3.9)
	Others	13 (18.8)	10 (38.5)	3 (7.0)
Changer of parameter	Physician	74 (67.9)	35 (83.3)	39 (58.2)		.014*
	Home care nurse	13 (11.9)	4 (9.5)	9 (13.4)
	Employer of equipment	22 (20.2)	3 (7.1)	19 (28.4)
Home nursing care	No	60 (38.2)	48 (87.3)	12 (11.8)	86.28	＜.001
Home nursing care	Yes	97 (61.8)	7 (12.7)	90 (88.2)	86.28	＜.001

^†Fisher's exact test.

Table 3.

Comparisons of Self Care by Applied Method of HMV (N=157)

Variables	Categories		Total (N=157)	Non IHMV (n=55)	IHMV (n=102)	x²	p
Variables	Categories		n (%)	n (%)	n (%)	x²	p
HMV related	Holding equipment^† (yes only)	Equipment for suction	109 (69.9)	14 (12.8)	95 (87.2)	75.77	＜.001
		Equipment for oxygen	24 (15.4)	4 (16.7)	20 (83.3)		.061
		Ambu bag	136 (87.2)	44 (32.4)	92 (67.6)	2.40	.121
		Pulse oxymetry	80 (51.3)	26 (32.5)	54 (67.5)	0.33	.569
		Assisted cough	84 (53.8)	49 (58.3)	35 (41.7)	4.00	.046
	Changing cycle of circuit	q 2 weeks	29 (23.4)	18 (37.5)	11 (14.3)	9.72	.008
	Changing cycle of circuit	q≥1 month	95 (76.6)	30 (62.5)	65 (85.7)	9.72	.008
	Changer of circuit	Family caregiver	44 (29.7)	18 (33.4)	26 (27.7)	4.45	.218
		Employer of company	80 (54.1)	24 (44.4)	56 (59.6)
		Home care nurse	24 (16.2)	12 (22.2)	12 (12.8)
	Changing cycle of filter	q 2 weeks	11 (15.1)	1 (4.8)	10 (19.2)		.272
	Changing cycle of filter	q 1 month and above	62 (74.9)	20 (95.5)	39 (75.0)		.272
	Changer of filter	Family caregiver	103 (76.5)	33 (58.9)	68 (69.4)		.073
		Employer of company	45 (29.0)	17 (30.4)	28 (28.6)
		Home care nurse	7 (4.5)	6 (10.7)	2 (2.0)
Life habit related	Respiratory exercise (yes only)^‡	Cough assisted coughing	90 (59.2)	35 (66.0)	55 (55.6)		.210
		Postural drainage	18 (11.3)	3 (6.8)	15 (18.3)		.109
		Chest vibration	10 (7.2)	3 (6.5)	7 (7.5)		1.000
		Exercise of accumulated air	55 (41.0)	25 (55.6)	30 (33.7)	5.90	.015
		Respiratory muscle exercise	29 (21.0)	15 (33.3)	14 (15.1)		.040
		Suction of airway	104 (74.3)	9 (21.4)	95 (96.9)		＜.001
	General exercise	No	61 (39.1)	23 (42.6)	38 (37.3)	0.42	.516
	General exercise	Yes	95 (60.9)	31 (57.4)	64 (62.7)
	Major type of meal	Oral diet	74 (47.1)	48 (87.3.)	26 (25.5)	54.74	＜.001
	Major type of meal	Tube feeding	83 (52.9)	7 (12.7)	76 (74.5)
	Elevated upper body during meal	No	32 (20.8)	20 (38.5)	12 (11.8)	14.91	＜.001
	Elevated upper body during meal	Yes	122 (79.2)	32 (61.5)	90 (88.2)
	Oral care	No	18 (11.7)	10 (18.9)	8 (7.9)	4.05	.045
	Oral care	Yes	136 (88.3)	43 (81.1)	93 (92.1)

Missing data be excluded; IHMV=invasive home mechanical ventilator;

^†Fisher's exact test;

^‡Multiple respondent.

Table 4.

Comparisons by Applied Method and Influencing Factors on Respiratory Difficulty, Sleep Impediment, Anxiety, and Depression (N=157)

Variables	Total (n=157)	Non IHMV (n=55)	IHMV (n=102)	t (p)	Variables (Constant)	B	β	t	p	R²	Adj. R²
Variables	M±SD	M±SD	M±SD	t (p)	Variables (Constant)	B	β	t	p	R²	Adj. R²
Respiratory difficulty	0.88±1.10	0.76±1.07	0.95±1.18	-0.94	(Constant)	3.55		3.61	＜.001	.16	.14
				(.347)	Anxiety	0.97	0.30	3.62	.002
					Utility duration of HMV	-0.02	-0.24	-2.57	.012
					Gender (male)	-1.31	-0.22	-2.31	.023
Sleep impediment	0.44±0.29	0.43±0.31	0.45±0.28	-0.41	(Constant)	1.30		5.88	＜.001	.32	.28
				(.681)	SMA & PMD(yes)	0.50	0.32	2.91	.004
					Duration of morbidity	-0.01	-0.20	-2.05	.043
					Applied method(IHMV)	-0.48	-0.31	-3.08	.003
					Changing cycle of circuit	0.31	0.19	2.13	.035
					Anxiety	0.18	0.21	2.06	.042
Anxiety	1.41±0.85	0.96±0.77	1.69±0.83	-5.27	(Constant)	0.23		1.30	.198
				(＜.001)	Depression	0.62	0.62	8.42	＜.001
					Sleep impediment	0.22	0.19	2.83	.006	.62	.60
					Physical functional status	-0.35	-0.33	-3.57	.001
					HNC(yes)	-0.43	-0.24	-2.73	.008
Depression	1.68±0.84	1.13±0.79	2.1±12	-6.60	(Constant)	0.53		3.02	.003	.66	.65
				(＜.001)	Anxiety	0.51	0.51	7.24	＜.001
					Age	0.02	0.46	5.30	＜.001
					Duration of morbidity	-0.01	-0.21	-2.70	.008

²=Adjusted R

².

Table 1. Comparisons of General Characteristics by Applied Method of HMV (N=157)

Missing data be excluded; IHMV=invasive home mechanical ventilator;

†

Fisher's exact test.

Table 2. Comparisons of Disease related Characteristics by Applied Method of HMV (N=157)

†

Fisher's exact test.

Table 3. Comparisons of Self Care by Applied Method of HMV (N=157)

Missing data be excluded; IHMV=invasive home mechanical ventilator;

†

Fisher's exact test;

‡

Multiple respondent.

Table 4. Comparisons by Applied Method and Influencing Factors on Respiratory Difficulty, Sleep Impediment, Anxiety, and Depression (N=157)

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