1. 腫瘤病患睡眠障礙及評估工具介紹 市立萬芳醫院 湯梅芬護理長

2. Introduction Sleep is an inevitable part of human existence and a part of the dynamic of quality of life.

3. Introduction Promotes health and comfort through its effects on Tissue restoration The immune system Psychological functioning

4. Introduction Sleep deprivation leads to Increased fatigability, mood changes Lowered the threshold for experiencing negative stimuli and feelings : pain tolerance

5. Normal Sleep The sleep –wake cycle follows a circadian rhythm Sensitive to the light-dark cycle and the pineal hormone melatonin

6. Factors Contributing to Sleep Disturbance Environmental factors Noise bright lights frequent nocturnal disturbances hospital admission

7. Factors Contributing to Sleep Disturbance Physical factors Pain Fatigue medication Respiratory disorders Gastrointestinal disorders

8. Factors Contributing to Sleep Disturbance Psychological factors Depression Anxiety cognitive impairment disorders

9. Evaluation of Sleep Disturbance 1. Identify the primary complaint : insomnia, Excessive sleepiness, sleep-wake schedule disturbance 2. Characterize the complaint : chronic drowsiness, difficult initiating sleep, insufficient total sleep 3. Document the sleep-wake cycle : sleep logs, naps, activities, medications

10. Evaluation of Sleep Disturbance 4. Identify possible precipitants of disturbance information from patient and family members 5. Consider the particular sleep requirements of the patient : Variation in sleep habits with age and situation 6. Medical and neuropychiatric history : 7. Substance use : medication, alcohol, drugs, caffeine, nicotine

11. Measurements Physiologic sleep assessment tools 1. Polysomnography : EEG, EOG, ECG, EMG 2. Multiple Sleep Latency Test (MSLT) : EEG, EOG, EMG 3. Maintenance of Wakefulness Test (MWT) : EEG, EOG, EMG

12. Measurements 4. Actigraphy : long-term movement detection(up to 2 weeks) 5. PSQI : 7 components, global PSQI score: 0-21 6. Epworth Sleepiness Scale(ESS) : 8 items,range from 0-3