徘徊欲睡復起行－探討血液透析病患的睡眠障礙及評估工具之比較

Wandering between Wakefulness and Sleep: A Study on Sleep Disturbances and Assessment Tools among Hemodialysis Patients

根據美國腎臟登錄系統（United States Renal Data System [USRDS]，2024）統計，2022年台灣的透析盛行率居全球第一（USRDS，2024）。血液透析患者因腎功能下降和代謝異常，常面臨慢性睡眠障礙，嚴重影響其生活品質與健康。這些睡眠障礙源於內分泌失調、慢性炎症、透析時間安排、生活型態變遷及老化等內外在因素的交互影響，常見類型包括失眠、晝夜節律睡醒障礙、睡眠相關呼吸障礙及異常動作障礙。本文將就常見的主客觀睡眠評估工具分析其優缺點與適用時機，提供醫護人員於評估透析病患睡眠問題之參考，包括主觀工具：匹茲堡睡眠品質指標量表（PSQI）、Epworth嗜睡量表（ESS）、睡眠日誌；與客觀工具：多頻道睡眠生理儀（PSG）、睡眠活動記錄圖（Autograph）。主客觀工具的整合能提高診斷準確性，幫助透析患者明確睡眠問題來源，制定個人化照護計畫，改善睡眠品質和生活健康。透析與睡眠的關係需更多臨床與研究關注，以優化診斷和介入策略。

According to 2022 U United States Renal Data System statistics, Taiwan maintains the highest global prevalence of dialysis, a population frequently afflicted by chronic sleep disturbances such as insomnia, circadian rhythm disorders, and sleep-related breathing or movement disorders. These disturbances stem from a complex interplay of endocrine dysregulation, chronic inflammation, and lifestyle factors, significantly compromising patient quality of life. This article evaluates the clinical applicability of subjective assessment tools, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and sleep diaries, alongside objective measures like polysomnography (PSG) and actigraphy. The integration of these diagnostic approaches enhances accuracy and facilitates individualized care plans aimed at improving sleep quality and overall well-being. Consequently, increased clinical and research attention is essential to optimize assessment strategies and therapeutic interventions for this high-risk population.