摘要
隨著台灣人口的老化，阿茲海默症的盛行率也不斷增加。過去研究顯示阿茲海默症患者常合併睡眠障礙，此將進一步惡化其已受損之生活功能與生活品質；併有睡眠障礙之阿茲海默症患者常會帶給照顧者相當程度的壓力，且常導致患者被轉介至長期機構。了解阿茲海默症的睡眠問題本質，將有助於改善阿茲海默症患者的睡眠問題。 影響阿茲海默症患者合併睡眠障礙的原因，除了調節睡眠的神經迴路受損之外，尚有：(1)大腦老化之生理變化；(2)併發身體或精神疾患所產生之睡眠障礙；(3)併發原發性睡眠問題，如睡眠呼吸中止症；(4)不良的睡眠衛生；(5)環境因素，例如：噪音、白天日照不足與生活壓力事件等；(6)藥物與影響中樞神經之物質；(7)併發上述多種狀況等。另外，阿茲海默症患者之睡眠障礙與其行為精神症狀有關，阿茲海默症合併睡眠障礙常與患者激動、攻擊、妄想與焦慮有關。但其睡眠障礙嚴重度與失智嚴重程度之關係，目前尚無定論。 阿茲海默症睡眠障礙的治療首重完整地評估與睡眠障礙相關的精神、行為與身體因素，並探討合併之環境因素；非藥物治療如認知行為治療、睡眠衛生的改善與光照治療等應優先考慮。藥物治療應針對其情緒或行為精神症狀給以治療。不當地使用安眠鎮靜藥物可能無助於長期改善其睡眠品質，且會帶給患者額外的健康風險。
並列摘要
The prevalence of Alzheimer's disease has increased in Taiwan as the population has aged. Previous studies have shown that many Alzheimer's disease patients suffer from sleep disturbances. For patients with Alzheimer's disease, sleep problems add further burden to the patients' compromised functioning and quality of life. In addition, disrupted sleep in patients with Alzheimer's disease is a significant cause of stress for caregivers and frequently leads to the institutionalization of patients. In addition to the degenerative changes in the neuro-circuit pathway modulating sleep that are inherent in Alzheimer's disease, other factors that contribute to sleep disturbances in Alzheimer's disease include: (1) Physiological changes in the brain due to aging; (2) Comorbid physical or psychiatric conditions; (3) Comorbid primary sleep disorders; (4) Environmental factors and life events; (5) Polypharmacy and the side effects of medications; and (6) A combination of the above factors. Furthermore, sleep disturbances in Alzheimer's disease are frequently associated with agitation, aggression, delusion, and anxiety. The cornerstone of treatment is thorough assessment of the associated determinants of sleep problems in terms of physical, psychiatric, medication, and environmental factors. Non-pharmacological intervention such as behavior modification, sleep hygiene correction and light-therapy should be chosen first. Inappropriate use of sedative medications would not improve the sleep quality of Alzheimer's disease patients, and even worse, it might burden patients with extra health problems.
延伸閱讀
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- 黃柏皓（2015）。阿茲罕默症長者之睡眠腦波新特徵〔碩士論文，國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2015.01673
- 郭燕君、白明奇、汪翠瀅、馬慧英、林克忠（2013）。阿茲海默氏症患者之生活功能關聯因子。職能治療學會雜誌，31(1)，30-52。https://doi.org/10.6594/JTOTA.2013.31(1).02
- 張倪蓉、陳啟昌、蔡志文、陳政男、李宗原（2018）。阿茲海默症與其合併憂鬱症狀患者之擴散張量影像指標改變。中華放射線技術學雜誌，42(1)，9-14。https://www.airitilibrary.com/Article/Detail?DocID=16849418-201803-201806210015-201806210015-9-14
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