研究目的：過去的研究已經證實睡前的光照會影響後續的睡眠，包括增加入睡所需時間以及減少第一個睡眠週期或前半夜的深睡。然而這些研究使用數千勒克斯(lux)的強光或特定波長的單色光且照光時參與者需要維持不動的姿勢或是暴露同一光源下6小時以上的時間，因此實驗情境與現實生活有很大的不同，所以目前還不清楚這些研究結果是否可以類推至現實生活中。本研究將實驗情境貼近日常生活，探討現代化生活的光照是否會對睡眠產生影響。 研究方法：本研究採受試者內設計來進行實驗。以市售3000K和5000K兩種不同色溫的光源進行實驗，將亮度固定在300多勒克斯，並將結果與弱光(<10 lux)進行比較。九名21至31歲的正常參與者維持規律睡眠一星期後，前來實驗室三晚分別接受睡前三小時不同的光照以及整夜的睡眠記錄。在三小時的光照期間，每半小時測量一次參與者的腦波和心跳速率，並要求他們填寫卡羅連斯加嗜睡量表(The Karolinska Sleepiness Scale)。睡眠資料的部分，針對三個依變項進行分析，分別為入睡時間、前兩個睡眠週期的深睡期以及Delta波的頻譜功率。 結果：高色溫光源相較於低色溫光源更能降低主觀睡前嗜睡狀態，並影響後續的睡眠，包括入睡時間較長以及深睡期較短。高色溫情境與弱光相比，除了上述變項同樣有效果外，Theta-低頻Alpha波(5-9Hz)的頻譜功率在5000K的光照後，有出現下降的狀況，但其它腦波的頻譜功率並沒有出現光照效果。心跳速率和前兩個睡眠週期的Delta波頻譜功率在各比較上均不達顯著，此外3000K光照和弱光在所有依變項上的比較均沒有統計上的顯著差異。 結論：本研究將實驗情境貼近日常生活後，仍大致可看到與過去研究類似的結果，即睡前高色溫的光照相對於低色溫，會降低嗜睡程度並影響後續睡眠。另外，現代化生活的光照，與弱光相比，會增加參與者的入睡時間以及減少前半夜的深睡，但室內燈強度的低色溫光源並不會對參與者的睡眠產生這些影響。因此本研究結果建議睡前可選擇低色溫的光源，以避免光照對入睡時間及深睡的影響。 / Objective：Previous studies confirmed that light exposure before sleep has negative impacts on sleep, including increased sleep onset latency and decreased deep sleep in the first sleep cycle. However experimental manipulations in those studies, such as exposure to bright light or to monochromatic light of specific wavelength and participants keeping a constant posture or light exposure for more than 6 hours are very different from daily life situation. It was not clear that whether those results could be generalized to everyday life. In our study, experiment condition was designed to approximate everyday life in order to examine the effect of presleep light exposure on daily life situations. Methods：The present study adopted within-subjects design. We used fluorescent light of color temperature of 5000K or 3000K in the experiment and the results were compared with dim light. Nine normal subjects participated in the study. They kept a regular sleep schedule during week before experiment. They came to sleep lab on three experiment nights and exposed to different light for three hours before sleep. During light exposure, EEG power, heart rate and subjective sleepiness were assessed every 30 minutes. For the sleep after light exposure, we analysed sleep onset latency, slow-wave sleep (SWS) duration and delta power after light exposure. Results： Subjective sleepiness decreased, sleep onset latency increased and SWS significantly decreased under color temperature of 5000K compared with color temperature of 3000K and dim light. Theta/low-frequence alpha (5-9Hz) power was lower under the color temperature of 5000K than dim light, but there were no effects of light on other EEG power. Effects of light exposure on heart rate and delta power were not evident. When 3000K compared with dim light, there were no significant differences on all the variables. Conclusion： Compared with previous experiments, our study showed similar results when experiment condition was close to everyday life. Exposure to light of high color temperature decreases participants，sleepiness and influences their sleep by increasing sleep onset latency and decreasing SWS duration. When compared with dim light, exposure to light of low color temperature does not influence sleep. These findings implies that light of low color temperature should be used before sleep in order to avoid the detrimental effects of light on sleep.

研究背景與目的：近年來，有不少研究指出阻塞性睡眠呼吸中止疾患（簡稱OSA）患者呈現出高比例的憂鬱情緒，但其盛行率結果分歧，回顧過往文獻也發現OSA與憂鬱情緒的關聯性之結果亦呈現分歧的結果。值得注意的是，OSA與憂鬱情緒之間存在著類似的症狀表現——白天嗜睡，OSA患者可能依據OSA伴隨的嗜睡症狀，回應憂鬱問卷或診斷中的問題，而使其受到誤診或是使盛行率受到高估。為探討此議題，本研究進行兩項研究，分別以橫斷及長期追蹤的資料，探討（一）OSA患者的憂鬱情緒是否聚焦於身體面向，且OSA與憂鬱情緒之間是否受到白天嗜睡中介，以及（二）OSA患者睡眠檢查長期追蹤資料中憂鬱情緒的改變，是否與白天嗜睡程度有關。 研究方法：研究一以台北醫學大學附設醫院睡眠中心資料庫中，2010至2015年到台北醫學大學附設醫院睡眠中心看診並進行PSG檢測時所收集的資料（AHI、醒覺指標、缺氧指標、平均血氧飽和度、最低血氧飽和度、BDI-IA、ESS）進行分析，在排除小於20歲與睡眠疾患共病之後，共有2140位OSA（364女、1776男）患者資料被納入分析。本研究針對OSA患者的憂鬱情緒（BDI-IA）分數進行探索性因素分析，並以此因素結構與Beck與Steer（1993）所得之憂鬱情緒面向結構進行模型競爭，以求更適配於OSA患者之因素結構。再者，本研究取具輕度以上憂鬱情緒的OSA患者資料，以線性迴歸分析了解OSA嚴重度（AHI）、嗜睡程度（ESS得分）與憂鬱情緒（BDI-IA、身體面向、認知面向）之間的關聯性，並以拔靴法進行中介模型的檢定。此外，欲探討OSA患者的憂鬱情緒可能聚焦於身體面向，本研究亦將OSA患者依症狀嚴重度分組，並比較不同症狀嚴重度OSA患者的認知面向與身體面向憂鬱分數。研究二則是以台北醫學大學附設醫院睡眠中心資料庫追蹤一年至兩年間的OSA患者的資料進行資料分析，由於女性人數過少，因此僅納入81位男性OSA患者資料進行統計分析。 研究結果：研究一探索性因素分析結果顯示，「體重減輕」與「煩躁易怒」在因素分析結果的負荷量相當低，無法歸類至其一面向，予以排除，且「不滿自我」、「社交退縮」、「優柔寡斷」三題（原認知面向題項）在OSA患者樣本中被歸類至身體面向。競爭模型結果顯示，本研究所得之因素結構AIC值較低，因此以本研究所得之因素結構進行後續分析中認知面向與身體面向憂鬱情緒之計分與分析。以具憂鬱情緒的OSA患者資料進行相關分析結果發現，AHI 、覺醒指標、 缺氧指標、平均血氧飽和度、最低血氧飽和度皆與ESS呈現顯著相關；且ESS與BDI、身體面向、認知面向憂鬱情緒皆呈現顯著正相關。值得注意的是，OSA症狀嚴重度AHI雖未與BDI呈現顯著關聯性，但與身體面向憂鬱情緒達顯著正相關，且OSA病理機轉——醒覺指標、缺氧指標、平均血氧飽和度亦與身體面向憂鬱情緒達顯著關聯性。拔靴法結果顯示，在控制年齡與BMI後，ESS僅中介於醒覺指標與身體面向憂鬱情緒間的關聯性。將男女性分組後，女性患者的ESS中介於AHI與身體面向憂鬱情緒、醒覺指標與身體面向憂鬱情緒、以及缺氧指標與身體面向憂鬱情緒之間的關聯性，但男性OSA患者則無此中介效果。將OSA患者依症狀嚴重度分組，針對不同症狀嚴重度OSA患者的認知面向與身體面向憂鬱分數進行重複量數檢定，發現不論AHI為輕、中、重度，身體面向憂鬱分數皆較認知面向來得高。研究二檢視OSA患者一年至兩年間追蹤的結果，發現AHI改變量與BMI改變量，無論對於ESS的改變量、BDI-IA總分的改變量、認知面向以及身體面向憂鬱情緒的改變量，皆無顯著相關性；而ESS改變量則與BDI-IA總分的改變量、認知面向憂鬱情緒的改變量、身體面向憂鬱情緒的改變量呈現顯著相關性。依ESS改變量分組後，進一步以單因子變異數分析對BDI-IA改變量、認知面向憂鬱情緒改變量、身體面向憂鬱情緒改變量進行檢定，結果顯示，無論在BDI-IA改變量、認知面向憂鬱情緒改變量、或身體面向憂鬱情緒改變量，皆達顯著差異；而事後檢定顯示，無論在BDI-IA改變量、認知面向、身體面向憂鬱情緒，ESS升高組與ESS無變化組、ESS降低組呈現顯著差異，而ESS無變化組則與ESS降低組無顯著差異。 結論：本研究OSA患者自評BDI-IA的結果發現有高達35%的患者至少有輕度以上的憂鬱情緒，且本研究發現在女性OSA患者身上，OSA嚴重度、睡眠片段化病理機轉，與憂鬱情緒間，受到白天嗜睡程度中介；且OSA患者的憂鬱情緒明顯聚焦於身體面向上，此結果說明OSA患者的憂鬱情緒可能受到白天嗜睡程度所影響，本研究在於提醒臨床工作者對OSA患者進行憂鬱症臨床診斷時，需注意與釐清OSA患者是否以白天嗜睡的情況，來回應憂鬱症狀相關的嗜睡表現，以降低誤判OSA患者憂鬱情緒的可能性。 / Aims: Recent years, researchers found high prevalence of depression occurred in OSA patients. However, the inconsistency was also found in depression prevalence and in the association between OSA and depressive mood. Notably, excessive daytime sleepiness is one of common symptoms of both OSA and depression. High prevalence of depression might be an overestimation due to excessive daytime sleepiness reported by OSA patients. Two studies (cross-sectional and longitudinal studies) were conducted to examine (1) whether the depressive symptoms in OSA patients are more somatic in nature and whether mediation effect between OSA and depression exist, and (2) whether the changes in depressive mood correlate with the changes in excessive daytime sleepiness showed in long term follow-up data. Methods: Sleep test data (including AHI, arousal index, desaturation index, mean SaO2, lowest SaO2, BDI-IA, ESS) retrieved from database of Taipei Medical University Hospital Sleep Center from year 2010 to 2015 was used in Study 1. 2140 OSA patients (364 F、1776 M) were included after rule out patients who is under 20 year-old or comorbid with other sleep disorders. Exploratory factor analysis was conducted to extract the dimensions of depressive mood in OSA patients and the dimensions obtained were further compared with those of Beck and Steer (1993) through competing models. Furthermore, correlations between OSA severity, OSA pathological mechanism, excessive daytime sleepiness, and depressive mood were analyzed in the data of OSA patients with depressive mood, and boostrapping method was conducted to test mediation effect. For examining whether the depressive symptoms in OSA patients are more somatic in nature, cognitive dimension and somatic dimension were compared within different OSA severity. One to two year follow-up sleep test data retrieved from database of Taipei Medical University Hospital Sleep Center was analyzed in Study 2. There were only 81 male OSA patient data included due to the small numbers of female patients. Results: Exploratory factor analysis in Study 1 showed that “weight loss” and “irritability” should be excluded due to low factor loading in depressive mood of OSA patients. “Dissatisfaction”, “social withdrawal” and “indecisiveness” were categorized into somatic dimension in OSA patients. Competing models indicated the factors obtained in exploratory factor analysis were preferred due to lower AIC value, which suggested the model was better fit to OSA patients. Correlation analysis showed that AHI, arousal index, desaturation index, mean SaO2, lowest SaO2, BDI-IA score, somatic dimension and cognitive dimension significantly correlated with ESS. Notably, although the correlation between AHI and BDI-IA was non-significant, AHI positively correlated with somatic dimension. OSA pathological mechanism (arousal index, desaturation index, mean SaO2) also significantly correlated with somatic dimension on BDI-IA. After controlling age and BMI, mediation effects of excessive daytime sleepiness were only found on the relation of arousal index and somatic dimension. Mediation effects were also found on the relation of AHI and somatic dimension, on the relation of desaturation index and somatic dimension, and on the relation of arousal index and somatic dimension in female OSA patients, but the mediation effect was not found in male OSA patients. Furthermore, 3 X 2 ANOVA repeated measurement showed somatic dimension was significantly higher than cognitive dimension on BDI-IA in different AHI severity group. Follow-up data in Study 2 showed the change of AHI and BMI were not correlated with the change of ESS, BDI-IA, cognitive dimension and somatic dimension on BDI-IA. However, the change of ESS was significantly correlated with the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA. Furthermore, the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA were tested in different ESS change group. Results showed that the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA were significant in different ESS change group. Post-hoc analysis indicated the change of BDI-IA, cognitive dimension and somatic dimension in ESS elevated group were significantly different from ESS maintained group and ESS descend group but the difference between ESS maintained group and ESS descend group was non-significant. Conclusion: 35% of OSA patients were classified as co-occurring depressive mood using BDI-IA. However, mediation effect of excessive daytime sleepiness was found in female patients on the relation of OSA severity and depressive mood, and also on the relation of sleep fragmentation and depressive mood. Furthermore, depressive symptoms in OSA patients are more somatic in nature. The results showed depressive mood in OSA patients was probably affected by the excessive daytime sleepiness. The findings suggested the need to clarify the effect of excessive daytime sleepiness to prevent the overestimation of depressive mood in OSA patients.

本研究旨在探討猝睡症患者生活品質受症狀變化及神經認知功能改變的影響情況，以及不同層次影響因素對患者生活品質的初始狀態及後續變化軌跡的影響效果。 本研究於北部一所醫學中心睡眠障礙科及兒童心智科募集確診為猝睡症之患者，經同意後進行為期五年的長期研究，募集總人數168人，完成五年資料收集人數85人。本研究使用睡眠多項檢驗（polysomnography, PSG）、多段入睡測試（multiple sleep latency test, MSLT）、人類白血球抗原檢驗（human leukocyte antigen, HLA）為基本檢驗工具，以電腦化第二版康氏持續注意力測驗（Continuous Performance Test- II）及威斯康辛卡片分類測驗（Wisconsin Card Sorting Test, WCST）為檢測神經認知功能之工具，以自填艾普渥斯嗜睡程度量表（Epworth sleepiness scale, ESS）、史丹佛睡眠問卷（Stanford sleep inventory, SSI）及簡式生活品質量表（short from-36 items of health related quality of life, SF-36）做為症狀嚴重度及生活品質的依據。資料分析以描述統計及階層線性模式（hierarchical linear models , HLM）統計方法進行。主要結果如下： 一、 猝睡症患者生活品質分為生理與心理兩個層面，患者生理層面在五年期間維持相對穩定沒有顯著變化；心理層面中之不同向度則有不同變化趨勢，心理健康與活力向度隨時間有逐漸提高的趨勢，患者此二向度生活品質接受治療後有穩定上升的趨勢，而社會功能及情緒角色限制則呈現二次方曲線變化，以及呈現先增後減的發展軌跡，患者此二向度接受治療後顯著上升，第三年後有逐年下降的趨勢。 二、 患者嗜睡程度及猝倒嚴重度變化隨時間有顯著成長軌跡，呈二次方曲線發展，轉折點在第三年，接受治療前三年症狀呈現穩定降低的軌跡，但自第三年起逐年增加，此結果與藥物治療初期症狀獲得顯著改善，後期改善幅度相對減少，及藥物效果具有關聯。 三、 個體間層次變項僅疾病持續時間、HLA對患者生活品質具顯著解釋力，其中疾病持續時間越長，患者可能發展因應症狀之策略，從而降低疾病對生活品質之衝擊。而HLA則對症狀有不同影響，HLA陽性患者初始嗜睡程度較陰性者為低，且接受治療後改善效果較陰性者顯著，猝倒嚴重度起始值較陰性者高，且接受治療後的趕善幅度較陰性者小。 四、 疾病嚴重度變化對生活品質具顯著影響，完整模式分析中，時間主效應未達顯著，但可由症狀變化及神經認知功能改變進行更佳的解釋。嗜睡程度變化僅對身體疼痛向度變化不具有解釋力外，對其餘七個向度均具顯著影響；猝倒影響層面不及嗜睡程度，但亦可解釋生理量表、生理角色限制、心理量表、心理健康、情緒角色限制、活力等向度上的變化。 五、 神經認知功能改變與否對患者生活品質具有加成效果，分析顯示患者神經認知功能改善時，其生活品質提升速率較未改善者高，影響較顯著的包括注意力、警覺度及概念反應，此結果與下視丘泌素參與的維持注意力及前額葉功能有關。 本研究依據分析結果提出猝睡症患者生活品質受嗜睡症狀及猝倒嚴重度改變直接影響，同時受人類白血球抗原屬性及神經認知功能改變調節之假設模型，作為未來研究參考依據。並根據研究結果與限制，提出對臨床實務的應用與心理介入的建議，並對未來提升猝睡症患者生活品質相關研究提供建議。 / The current study aims to: (1) examine the change of eight domains of quality of life in narcoleptics within five years, (2) investigate the impact of the change of symptom severity on different dimension of quality of life, as well as the influence associated with the change of neuro-cognitive function. There were 168 participants recruited from a medical center in northern Taiwan. 85 of them completed the 5-year annual follow-up data collection. During the follow-ups, polysomnography (PSG), multiple sleep latency test (MSLT) and human leukocyte antigen (HLA) test were conducted. Computerized neuropsychological tests of Conners’ Continuous Performance Test- II (CPT-II) and Wisconsin Card Sorting Test (WCST) were also administered to obtain attention and executive function data. The short from-36 items of health related quality of life (SF-36), Stanford sleep inventory (SSI) and Epworth sleepiness scale were applied to assess quality of life and symptom severity. Descriptive statistics and hierarchical linear models were applied for data analysis. The main results were: 1. The quality of life was divided into physical and psychological domains. The physical domain kept relatively stable during the 5-year follow up as opposed to the psychological domain. In psychological domain, the vitality and psychological health showed increasing tendency overtime. However, the social function and role functioning-emotion increased during the first 3 years then declined afterward. 2. The symptom severity also showed a tendency corresponded to quadratic curve. The daytime sleepiness together with cataplexy severity reduced immediately after treatment but rose after the third year. 3. The variables of individual characteristics that showed significant impact on quality of life were disease duration and HLA type. The longer the duration, the better quality of life one had. Positive HLA typing seemed to be a protective factor on severity of sleepiness. It also predicted better treatment outcomes, but worsen the severity of cataplexy and treatment effects. 4. The symptom severity could be a good explanation as a variable of quality of life. The daytime sleepiness altered all domain of SF-36 expect body pain. Cataplexy affected only psychological domain of SF-36. 5. The neuro-cognitive function was also found to affect quality of life. Those who improved in attention and executive function test got greater improvement on SF-36 as well. The vigilance on CPT-II and conceptualized response on WCST had most significant impact. I proposed a model of change of quality of life in patients with narcolepsy based on the results obtained. Several suggestions were also proposed for clinical and psychological intervention for narcolepsy to improve their quality of life.

輪班工作者除了睡眠片段化、睡眠品質降低等困擾外，工作時間的嗜睡與警醒度下降亦是常見問題，這些影響都可能跟輪班造成的內在晝夜節律與輪班工作時間的不一致有關。根據Minors & Waterhouse (1983)提出的定錨睡眠的概念，每天若能有四個小時在固定時間的睡眠，會有穩定內在晝夜節律、減少位移的效果，然而過去研究未曾探討定錨睡眠應用在輪班工作者的效果。因此，本研究的目的在於以模擬輪班的方式，比較採用定錨睡眠者與非定錨睡眠者在模擬輪班工作中的主觀嗜睡度、心理動作警覺度，以及睡眠指標，以探討定錨睡眠對於輪班工作者的睡眠與警覺度的影響，以期有助於輪班工作中的適應。 本研究採混合實驗設計，招募睡眠品質良好的受試者，並排除極端夜貓型或極端早晨型晝夜節律型態者，共包含20名受試者、依據性別配對隨機分派至定錨睡眠與無定錨睡眠組（各7名女性、3名男性，平均年齡24歲）。受試者需進行11天的模擬輪班，進行白班與大夜班的輪班；班表為：2天白班-1天休假-2天大夜班-1天休假-2天白班-1天休假-2天大夜班，受試者在實驗期間均配合配戴活動記錄儀與填寫睡眠日誌，並在第二次輪值的工作時間測量心理動作警覺作業（psychomotor vigilance task，PVT）與史丹福嗜睡度量表（Stanford Sleepiness Scale，SSS）。研究結果以三因子及雙因子變異數分析進行統計考驗。 研究結果發現在PVT的反應時間中位數與疏漏次數上，採用定錨睡眠者在白班至大夜班所增加的反應時間與疏漏次數低於非採用定錨睡眠者，且採用定錨睡眠者在工作時有較低的主觀嗜睡度、持平的主觀警醒度；在睡眠指標上，定錨睡眠組入睡後醒覺時數較短、夜班的主觀睡眠品質較佳。整體來說，研究結果顯示採用定錨睡眠能增進在工作中的心理動作警覺度、降低主觀嗜睡度，並促進睡眠的穩定度及夜班主觀睡眠品質，提供定錨睡眠運用在實際的輪班工作場域的初步證據。 / Sleep fragmentation, poor sleep quality, as well as sleepiness and decreased alertness at work are all common problems in shift workers. It is assumed that these problems are associated with the dyssynchronization of endogenous circadian rhythms and shift-work schedule. According to the concept of anchor sleep proposed by Minors & Waterhouse (1983), consistent sleep for few consecutive days can stabilize endogenous circadian rhythm and prevent the phase shift. However, previous studies have not investigate the effect of anchor sleep in shift workers . The current study used an experiment-manipulated shift work schedule to explore the effects of anchor sleep on sleep, sleepiness and psychomotor vigilance at work in a simulated shift work, in order to evaluate the possibility of applying anchor sleep in the assistance of adaption to shift work. Twenty participants with good sleep quality, intermediate types of morning-eveningness, were divided according to gender and randomly assigned to an anchor-group and a non-anchor-sleep control group (7 females and 3 males in each group, mean age 24). They were required to follow an eleven-day schedule that simulate the schedule of shift work. The subjects were required to wear actigraphy and keep sleep logs throughout the experimental period and their psychomotor vigilance and subjective sleepiness at the second work shifts were measured with psychomotor vigilance task (PVT) and Stanford Sleepiness Scale (SSS). The data was analyzed using three-way and two-way ANOVA. The data showed that PVT median reaction time and the number of lapses increased less from day-shift to night-shift in anchor sleeper, the anchor sleeper also had lower sleepiness, and more steady subjective alertness during the working time. Also, they had better subjective sleep quality in night-shift and shorter wake after sleep onset time than the control subjects. The findings of the current study suggest that anchor sleep can reduce the deterioration of subjective sleepiness and vigilance at work in shift workers, and maintain the sleep quality in night-shift. It provides preliminary evidence that support the use of anchor sleep in the assistance of the adjustment of shift work.

本研究主要目的在探討高中生的睡眠型態與學業表現的關係，試圖分析睡眠時間量及睡眠的規律性與其課業表現以及睡眠相關現象(白天嗜睡程度及睡眠品質)的關係，並探討白天嗜睡及睡眠品質之中介效果及以日夜節律型態之調節效果。本研究以自填「青少年睡眠習慣問卷」，對台灣北區普通高中及綜合高中中學術學程的高中生進行調查，採群集抽樣的方式進行，共進行42個班級施測，發出1,650份問卷，取得有效問卷1,308份樣本分別以日夜節律型態類型及高低成就動機兩種分類方式進行分析，主要研究結果如下： 1.夜貓型高中生之週間週末規律性變項對於學業表現具有影響力。 2.白日型高中生之週間規律性變項對於學業表現具影響力。 3.以高低成就動機分組，兩組之睡眠型態變項對於學業影響力皆未達顯著性。 4.白天嗜睡及睡眠品質在兩種分類分析下，皆無中介效果。 本研究初步結果支持夜貓型高中生在維持週間週末某種程度睡眠規律性對於學業表現具有相當的影響性，而早晨型在週間內維持其規律性也是對於其學業表現是具有顯著影響性，也就是依其日夜節律型態在其睡眠型態維持自己生活作息的規律性，而不在時間點或睡眠量的多寡來作要求，也許對於正值課業壓力或生心理高度變化的青少年時期會是更合適的睡眠作息。 / The purposes of this study are to explore the relationship of the sleep pattern with academic performance, day time sleepiness and sleep quality in senior high school students. Data were collected by sleep pattern questionnaire of the adolescent. The participants included 1650 students form the 10th grade to 12th grade, recruited form senior high schools in Taipei. Using stratified cluster sampling method. There were 1308 of valid questionnaires obtained. The major results are as follow: (1) The variablity of the sleep-wake pattern between weekdays and weekends has significant influences on academic performace in the evening type students. (2) The variablity of the sleep-wake pattern during weekdays showed significant influences on academic performace in the morening type students. (3) In both the high and low achievement motivation groups, sleep pattern showed no significant associations with academic performance. (4) The mediation effect of daytime sleepiness and sleep quality were not proven in all the data analyses. In coclusion, the results indicate that in evening type students, maintaining regularity of sleep pattern between weekdays and weekends would be beneficial to their academic performance; and in the morning type students, keeping regular weekday sleep-wake schedules seem to be more important for better academic performance. Therefore, when considering the influences on academic performance, regularity of sleep seem to be more important than quantity of sleep in high schoolers.