睡眠困擾是癌症病人最常主訴的問題之一。患有睡眠困擾之癌症病人經常同時伴隨 疲憊、憂鬱等現象發生，形成症狀群集，影響生活品質。雖然目前對於癌症病人睡眠障 礙之量性研究已多有著墨，然而對於癌症病人經歷睡眠障礙之主觀經驗之瞭解，仍相當 有限。瞭解病人經歷睡眠障礙之主觀經驗，將有助於未來睡眠評估工具之修訂。另外， 在評估癌症病人睡眠品質時，若能以簡單工具評估，會更具效率及助益。阿森斯失眠量 表(Athens Insomnia Scale, AIS) 是一個簡單的8 題問卷，廣為使用在一般失眠的病人， 在癌症病人使用上，尚未有豐富的實證資料，若能建立其在癌症病人的信效度，將可作 為一簡單篩檢癌症病人失眠的工具。 睡眠遵行日夜節律規則，日夜節律又需要光作為矯正的線索，光在癌症病人睡眠的 角色，尚未有研究證實，過去研究顯示癌症病人睡眠品質不佳與生物節律有關係。光是 重要日夜節律的線索，光療法透過褪黑激素調節，調整日夜節律週期，可能可以改善睡 眠品質。另外，由於，睡眠障礙、憂鬱、疲憊經常形成一症狀群集，光療法於改善睡眠 障礙之同時，是否亦同時改善憂鬱、疲憊及生活品質。目前，光療法在癌症病人的運用 上，付之闕如，故建立光療法於癌症病人的有效性值得探究。 本研究為三年期研究計畫，目的包括有：1.瞭解癌症個案對於睡眠困擾的主觀經驗 （第一年）。2.建立阿森斯失眠量表中文版的信效度、敏感性、特異性（第一年）。3.瞭 解癌症病人光暴露與生物節率、睡眠障礙的關係（第二年）。4.瞭解光療法對於改善癌 症病人睡眠障礙及相關症狀群集、及生活品質之成效；以及瞭解光療法影響褪黑激素之 程度（第三年）。 本研究擬以癌症住院及門診病人為對象，研究工具包括基本資料、匹茲堡睡眠品質 問卷、阿森斯失眠問卷，簡明疲憊量表，貝克憂鬱量表度、SF-36 生活品質量表、腕動 力器等。資料處理分析方式包括：內容分析、描述性統計、t 檢定、皮爾森相關、GEE (generalized estimating equations)等。 本研究之結果將可瞭解光暴露與生物節率與睡眠障礙之間的關係，並可進一步瞭解 光療法作為改善癌症病人睡眠障礙之護理措施之成效，以期，最終能藉由改善癌症病人 之睡眠品質提昇病人之生活品質。

Clinical experience suggests that cancer as well as cancer treatments and associated symptoms result in sleep disturbances. Sleep disturbances can lead to impairment of daily functioning and quality of life. Depression and fatigue are most commonly co-occurred with sleep disturbances and form a symptom cluster in cancer patients. Despite the fact that there has been some amount of quantitative research on sleep disturbance in cancer patients, the subjective experience of sleep disturbance in cancer patients has not been studied and documented. Information on the subjective experience of sleep disturbance in cancer patients will help with verifying the instrument measuring sleep quality in cancer patients in future research. It is important to have a valid and brief instrument of assessing sleep disturbance when we examine the effect of an intervention on sleep quality, especially in cancer patients, who are usually with limited energy. Athens Insomnia Scale is a simple and brief instrument, which has a great potential to be used in cancer patients for measuring sleep disturbance. Light plays a primary role in circadian physiology and promoting sleep. Humans are diurnal animals and their biological clock synchronizes their physiological functions such that those associated with activity happen in the daytime while those associated with rest occur at night. Light is the main environmental cue used by the circadian clock to achieve this synchronization with the day-night cycle. It has been suggested that bright light therapy can be a potential strategy to manage sleep disturbance. It has been shown the bright light therapy is effective in improving sleep quality in a very small sample of elders. There has been no study examining the effect of bright light therapy on sleep disturbance in cancer patients. The purposes of this 3-year proposal are to (a) explore the subjective experience of sleep disturbance in cancer patients, (b) validate the Taiwanese version of the Athens Insomnia Scale, (c) explore the relationships among light exposure, circadian rhythms, and sleep quality, and (d) investigate the effect of bright light therapy on improving sleep disturbance, its related symptom cluster, and quality of life. Results from this study will have a great potential to develop effective nursing interventions to improve sleep quality and quality of life in cancer patients.