唾液皮質醇、心理與身體健康及婚姻狀況：影響血液透析患者睡眠健康的關鍵因素

Salivary Cortisol, Mental and Physical Health, and Marital Status: Key Determinants of Sleep Health in Hemodialysis Patients

背景：血液透析病人普遍存在睡眠障礙，可能導致免疫功能受損、炎症反應增加、死亡風險上升及生活品質下降。然而，身心健康與個人因素對睡眠障礙的影響尚不明確。本研究旨在探討這些因素對血液透析病人睡眠障礙的影響。方法：本研究於2020年11月至2021年1月招募138名血液透析病人，並透過結構式問卷評估其基本屬性、臨床特徵、心理困擾（BSRS-5）及睡眠品質（CPSQI）。此外，測量唾液皮質醇水平以評估生理壓力反應，並透過羅吉斯迴歸分析探討影響睡眠障礙的關鍵因素。結果：81.2%的受試者有睡眠障礙。心理困擾（BSRS-5）平均得分為4.1±3.8，其中29.0%的病人經歷顯著的心理困擾。羅吉斯迴歸分析顯示，心理困擾（OR = 2.07, 95% CI = 1.36–3.15, p = .001）與婚姻狀態（OR = 0.22,95% CI = 0.67–0.74, p = .014）為影響睡眠障礙的關鍵因素。結論：心理困擾與婚姻狀態對血液透析病人的睡眠障礙影響大於生理健康因素。本研究結果強調，應加強心理健康支持並考量社會因素，以改善此族群的睡眠品質與整體健康。未來研究應進一步探討長期介入策略，以減少透析病人的睡眠障礙。

Background: Sleep disturbances are highly prevalent among hemodialysis patients, leading to severe health consequences such as impaired immunity, increased inflammation, higher mortality risk, and reduced quality of life. However, the interplay between physical health, psychological distress, and personal factors in sleep disturbances remains unclear. This study examines the impact of these factors on sleep disturbances in hemodialysis patients. Methods: From November 2020 to January 2021, 138 hemodialysis patients were recruited. A structured questionnaire assessed basic attributes, clinical characteristics, psychological distress (BSRS-5), and sleep quality (CPSQI). Salivary cortisol levels were measured to evaluate physiological stress responses. Logistic regression analysis was performed to identify factors associated with sleep disturbances. Results: Among participants, 81.2% reported sleep disturbances. Psychological distress (BSRS-5 mean: 4.1±3.8) was prevalent, with 29.0% experiencing significant distress. Logistic regression analysis identified psychological distress (OR = 2.07, 95% CI = 1.36–3.15, p = .001) and marital status (OR = 0.22, 95% CI = 0.67–0.74, p = .014) as key factors influencing sleep disturbances. Conclusion: Psychological distress and marital status play a more significant role than physical health in sleep disturbances among hemodialysis patients. These findings emphasize the need for psychological support and social interventions to improve sleep quality and overall well-being in this population. Future research should explore long-term strategies to mitigate sleep disturbances in hemodialysis care.