京都大学 / 新制・課程博士 / 博士(薬学) / 甲第23849号 / 薬博第856号 / 新制||薬||242(附属図書館) / 京都大学大学院薬学研究科薬学専攻 / (主査)教授 寺田 智祐, 教授 金子 周司, 教授 土居 雅夫 / 学位規則第4条第1項該当 / Doctor of Pharmaceutical Sciences / Kyoto University / DFAM

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.

研究目的：以酒助眠是許多人認為可幫助睡眠的一種方式，但許多研究發現，飲酒後雖然在睡眠初期似有鎮靜鬆弛、縮短入睡時間的效果，但在入睡後的睡眠品質卻不一定良好，出現淺眠易醒的現象。但人體對酒精的反應存有明顯的個別差異，部分會對酒精產生敏感反應，出現頭暈、臉紅、心悸、噁心和嘔吐等不舒服的症狀，研究認為造成此種酒精敏感性（alcohol sensitivity）差異的原因主要來自一種乙醛脫氫酶（ALDH2）的基因型變異，導致個體在酒精代謝的過程中形成不同程度的乙醛堆積，進而影響到酒精攝取行為上的差異。然而不同個體對酒精敏感反應上的差異，是否也會影響到酒精造成睡眠狀況的變化，進而影響到個體對於酒精助眠效果的主觀感受的個別差異。因此，本研究的目的在於比較不同ALDH2基因型者，在飲酒和未飲酒的情境下，對睡眠的主觀知覺和實質睡眠參數測量的改變程度是否有差異，以了解ALDH2基因型對於酒精作用於睡眠歷程的影響。 研究方法：本研究共募集20位受試者，經基因型鑑定排除對酒精過於敏感的ALDH2*2/*2者和睡眠品質不佳者後，共14位納入正式分析。分別在睡前飲用中低劑量酒精（每公斤體重0.3克酒精）和非酒精飲料的情境下，採用多頻道睡眠記錄儀等儀器測量客觀的各項生理和睡眠指標，以及使用自填式量表評估睡前和早晨主觀的生理與心理感受。 研究結果：研究發現ALDH2*1/*1者飲酒後有入睡耗時、醒覺指數增加，以及Stage 2 睡眠潛伏期縮短的現象；ALDH2*1/*2者則有REM睡眠潛伏期延後的現象。在主觀感受上，飲酒後兩者皆在睡前誘發了明顯的生理負向感覺，早晨醒後則僅ALDH2*1/*2者有較高的生理激發程度。 結論：在給予中低劑量的酒精後，不同ALDH2基因型者其睡眠型態呈現不同的特性，也產生了生理心理反應上的差異，未來可再與睡眠相關的神經系統測量結合，釐清酒精和乙醛在影響人體睡眠中的角色，進一步了解酒精代謝對中樞神經的影響。 / Background: The effects of alcohol on sleep have been well documented. While alcohol consumption may decrease sleep onset latency, it may also lower sleep quality. Sleep problems, including prolonged sleep latency and decreased total sleep time, are more common among alcoholics than among nonalcoholics. But the effect of alcohol consumption has individual difference in the sensitivity of physiological reaction to alcohol, as reflected in facial flushing, palpitation, nausea, and other uncomfortable symptoms. The degree of physiological reaction was found to be associated with the efficiency in ethanol metabolism. Aldehyde dehydrogenase (ALDH) is the major enzymes involved in ethanol metabolism in humans. Homozygosity of the variant ALDH2*2 allele almost fully protects East Asian populations against the development of alcoholism. However, how the individual difference of alcohol sensitivity influence sleep pattern after alcohol consumption remains unknown. In this study, we aim to compare the changes of subjective report and objective measure of sleep following alcohol ingestion on variant ALDH2 genotypes. Methods: Fourteen nonalcohol-dependent subjects were recruited. After passing screening tests for ALDH2*2/*2 genotype and poor-sleep quality on PSG, subjects were required to complete two nights of PSG recording under the controlled condition (nonalcoholic beverage) and experimental condition (alcoholic beverage). Questionnaires were also used to evaluate subjective feelings before sleep and in the morning. Results: Decreased sleep onset latency and stage 2 latency as well as higher arousal index were observed in ALDH2*1/*1 subjects after challenge with a moderate dose of ethanol (0.3 g/kg of body weight), while only longer REM latency was showed in ALDH2*1/*2 individuals. As for subjective feelings, both genotypes showed more intense negative physiological responses before sleep, while only ALDH2*1/*2 individuals showed increased physical arousal the next morning. Conclusions: The variation of ALDH2*2 allele contributes to individual differences of alcohol sensitivity. The results indicate that sleep patterns and subjective perceptions following by alcohol administration were also affected by ALDH2 genotypes. This study suggests that sleep-related psychological factors may be crucial for the development of alcoholism.

Kyoto University (京都大学) / 0048 / 新制・課程博士 / 博士(工学) / 甲第14271号 / 工博第3022号 / 新制||工||1449(附属図書館) / 26598 / UT51-2008-T31 / 京都大学大学院工学研究科建築学専攻 / (主査)教授 鉾井 修一, 教授 宗本 順三, 教授 髙橋 大弐 / 学位規則第4条第1項該当

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.

研究目的 對於慢性腎臟病患者而言，睡眠困擾是十分常見的問題。過去相關研究中，研究對象較偏重於已進入透析治療的患者，且大多著重於探討人口學及臨床變項，而忽略了心理及行為因素（例如睡前激發狀態、睡眠衛生行為）的影響。本研究試圖改善過去研究之不足，釐清心理及行為因子在慢性腎臟病患者的睡眠問題中所扮演之角色。 研究方法 本研究採橫斷性調查研究，於腎臟科門診及血液透析室招募第三期到第五期（eGFR＜60 ml/min/1.73m2）的慢性腎臟病患者。最終納入分析的個案共有152人，其中77人為未達尿毒症的慢性腎臟病患者，75人為穩定接受血液透析治療（3個月以上）的尿毒症患者。受試者需完成匹茲堡睡眠品質量表、失眠嚴重度量表、睡眠衛生行為量表、睡前激發狀態量表、醫院焦慮與憂鬱量表，並且回答和不寧腿症候群、疼痛及皮膚癢程度相關的問題，此外，本研究亦從病歷紀錄中抄錄相關的檢驗數値以及共病情形。 研究結果 未透析患者約有29.9%睡眠品質不佳、23.4%有失眠問題；而血液透析患者約有57.3%睡眠品質不佳、28.0%有失眠的問題。血液透析患者和未透析患者相比，其睡眠品質顯著較差，且失眠較為嚴重。迴歸分析結果顯示，MMSE得分較低、共病較多、疼痛程度較高、和焦慮相關行為較多可預測較差的睡眠品質，而焦慮與憂鬱情緒較高、焦慮相關行為較多、和認知激發程度較高可預測較嚴重的失眠。未透析患者的睡眠問題主要是受到和激發相關的行為或認知活動的影響，而血液透析患者的睡眠則較容易受到疾病和症狀相關因素的影響。 結論 疾病與臨床因素、身體症狀、以及睡眠心理及行為相關因素對於慢性腎臟病患者的睡眠有所影響，但對於未透析和已透析的患者，其影響因素和影響程度可能不同。

睡眠是否能鞏固陳述性記憶目前尚無定論。過去研究一致較支持睡眠能增進相關字詞配對的學習，但睡眠是否能增進無關字詞配對的學習，目前仍存在不一致的發現。造成該差異的原因可能是：過去研究多採用的行為測量指標，或許無法充分反映出睡眠促進記憶新聯結（new association）產生的效果。事件關聯電位（Event-related potential, ERP）的N400反映出語意記憶系統內每個字詞彼此的相關程度，因此本研究使用N400來探討睡眠強化無關字詞配對形成新聯結的電生理歷程。30名健康受試者（15位男性與15位女性，平均年齡為20.7歲） 隨機分派至睡眠組或清醒組，第一晚在學習80組無關字詞配對後，接受第一次再認記憶測驗，同時進行ERP的記錄。隨後睡眠組接受睡眠記錄（PSG），清醒組則接受整晚的睡眠剝奪，兩組受試者皆在第二晚給予8小時的躺床時間，使他們有機會充足睡眠以恢復精神，於第三天早上接受第二次再認記憶測驗及ERP記錄。在記憶測驗時，無關字詞配對分別組成促發字（prime）與目標字（target）先後出現，受試者需判斷先後出現的字詞是否為先前學過的完整配對，在測試階段同時記錄腦電波訊號。行為測量結果顯示睡眠過後，再認表現的正確率顯著提高且反應時間明顯縮短，但在睡眠剝奪後則顯示相反的結果。電生理測量發現睡眠組的N400振幅在睡眠過後較清醒組明顯降低。另外，睡眠組較清醒組有較高的正確率與較短的反應時間。睡眠組再認測驗的進步量與慢波睡眠呈現負相關，而慢波睡眠與第一次再認測驗的正確率呈現正相關，根據二階段睡眠記憶鞏固理論，慢波睡眠涉及重新組織記憶的歷程（系統性固化），因此學習表現較佳的受試者出現較多的深度睡眠，可能反應其經歷系統性固化。本研究結果顯示睡眠對於產生新聯結有明顯的增強效果，而且慢波睡眠可能參與了記憶表徵重新分配的歷程。 / The effect of sleep on declarative memory remains contradictory. Prior studies show that sleep benefits the learning of related word pairs consistently, while the learning of unrelated word pairs, however, show mixed results. It is possible that the behavioral measures used in previous studies are not sensitive enough to reveal subtle effects of sleep on new associations. N400, an event-related potential (ERP) component reflecting relatedness among words in semantic memory, was used in the present study to investigate the effect of sleep on the physiological process underlying new associations of unrelated word pairs. Participants were randomly assigned to either a Sleep group or a Wakefulness group. In the learning phase, participants were asked to memorize 80 visually presented unrelated word-pairs, followed by a pre-test phase with a recognition task. The participants then underwent either a night of nocturnal sleep (Sleep group) or sleep deprivation (Wakefulness group). A post-test was conducted after subjects had one night of recovery sleep. During both pre-test and post-test sessions, prime and target words were presented successively for the subjects to judge whether they were among the original pairs or new pairs. ERPs were recorded during both test phases. The behavioral data show that differences in improvement of recognition and decreases in reaction time from pre-test to post-test are significant between Sleep and Wakefulness groups. N400 peak amplitude attenuated significantly after sleep but not after wakefulness. The improvement of recognition negatively correlates with slow wave sleep (SWS). The number of word-pairs acquired in the learning phase, however, correlates positively with SWS. According to the two-stage memory consolidation theory of sleep, SWS involves in redistribution of memory (systematic consolidation). Therefore, that the participants with high performance showed more SWS may reflect the process of systematic consolidation. These results suggest that the sleep has an enhancing effect on the formation of novel association, and SWS may be involved in the process of redistributing memory representations.

研究目的：失眠為國人常見的健康問題，造成患者夜間睡眠的痛苦，對白天生活品質也有明顯的影響，站在預防失眠慢性化的角度切入，找出情境性失眠高危險群的心理病理特性，應可為防治失眠疾患提供更積極的建議。本研究目的一即是想透過與好眠組的比較，討論壓力因應風格、持續失眠相關病因(對睡眠不適當認知、睡眠相關安全行為、身心激發程度)在失眠高危險族群及慢性失眠者的特性為何。第二個目的則想驗證失眠持續因素對失眠的影響路徑，並探討壓力因應風格在失眠持續模式中的影響性為何。 研究方法：本研究以橫斷式問卷調查法收集資料，蒐集有效問卷情境性失眠高風險群組74份、好眠組75份、與慢性失眠組62份，總共211份有效問卷。統計方法則根據不同研究目的分別採用單因子變異數分析及結構方程模型的路徑分析進行資料處理。 研究結果：慢性失眠者比好眠者與慢性失眠者有更高的睡眠不適當認知、更多睡眠相關安全行為更高的睡前激發程度。慢性失眠者與情境性失眠高危險族群在面對壓力時，也比好眠者使用較多的「社會支持、情緒調節與發洩的調解」、「逃避」、「問題解決、重釋與接受」等因應策略。此外，情境性失眠高危險族群也比好眠者用更多的睡眠相關安全行為來因應疲憊或睡不好的狀況。另外，本研究路徑分析結果發現睡眠不適當認知會透過安全行為及激發程度而影響失眠，且在考驗各個壓力因應風格對失眠持續模式之影響時，發現較一致的結果是逃避因應可能會增加個體使用更多睡眠相關安全行為而惡化失眠 研究討論：研究結果支持過去理論認為睡眠不適當認知、睡眠相關安全行為及睡前激發程度為失眠的持續因子。為預防情境性失眠高危險族群其失眠症狀慢性化，建議重點應放在睡眠的衛生教育，並且不只是教導適當因應失眠的行為，重要的是需包括增強對失眠處理的控制感、建立適當合理的藥物使用概念、矯正對失眠後果的災難化想法。最後，過去少有其他研究討論逃避因應風格與失眠的關係，建議對此有興趣的研究者可對逃避因應風格與失眠的關係做進一步的重覆驗證與探討。 / OBJECTIVE: The goals of the study are to examine (1) the differences of coping, dysfunctional beliefs and attitudes about sleep, sleep related safety behaviors and pre-sleep arousals among chronic insomniacs, normal sleepers vulnerable to stress-related sleep disturbance and good sleepers (2) the interactions of coping with other etiological factors in the model of persistent insomnia. METHOD: The sample was composed of 211 participants. Participants were asked to complete a set of questionnaires, including the Ford Insomnia Response to Stress Test (FIRST), the Insomnia Severity Index, the Pre-Sleep Arousal Scale, the Sleep-Related Behaviour Questionnaire, the Dysfunctional beliefs and attitudes about sleep questionnaire, COPE, the Center for Epidemiologic Studies Depression Scale, the Beck Anxiety Inventory and the Pittsburgh Sleep Quality Inventory. The participants were categorized into three subgroups, 75 good sleepers, 74 normal sleepers vulnerable to stress-related sleep disturbance, and 62 chronic insomniacs, according to clinical interview and/or their scores on the FIRST. RESULT: The results showed that chronic insomniacs reported more dysfunctional beliefs and attitudes about sleep, sleep related safety behaviors and pre-sleep arousals than the other groups. In addition, chronic insomniacs and normal sleepers vulnerable to stress-related sleep disturbance used more coping styles of “problem solving, positive reinterpretation and acceptance”, “social support, focus on and venting of emotions”, and “avoidance” than good sleepers. Also, normal sleepers vulnerable to stress-related sleep disturbance reported more safety behaviors to cope insomnia than good sleepers. Furthermore, the path analysis showed that the safety behaviors and arousal play an important mediating role between dysfunctional beliefs and attitudes about sleep and insomnia in chronic insomniacs. Finally, data showed that avoidance coping could predict the frequency of sleep related safety behaviors. CONCLUSION: The results imply that in order to prevent normal sleepers vulnerable to stress-related sleep disturbance from becoming chronic insomniacs, sleep hygiene education program should incorporate methods that are designed to reduce maladaptive sleep beliefs and sleep related safety behaviors. The relationship found between avoidance coping and insomnia is also of interest and require replication in future researches.

研究目的：睡眠遲惰（sleep inertia）指的是剛由睡眠中醒來的一種現象，在這段轉換期間內，個體的警覺力較低、心智較為遲緩，認知和行為表現都較差。過去針對睡眠遲惰的研究顯示，睡眠遲惰是從一個較低生理激發的狀態到較高生理激發的漸進式轉換過渡階段。若睡眠遲惰是與較低的生理激發狀態有關，則若能提高個體的激發狀態，應能減少睡眠遲惰的負面影響。從過去的文獻中可發現，快節奏的音樂可以提高個體的生理激發。因此，本研究針對音樂的節奏快慢做操弄，探討生理激發狀態在睡眠遲惰所扮演的角色，比較不同快慢節奏的音樂刺激對於睡眠遲惰效果的影響。 方法：12名年齡介於18到31歲之間的受試者參與此研究。受試者在20分鐘小睡被喚醒後，分次接受快節奏音樂、慢節奏音樂、以及無音樂控制情境等三種情境安排。睡醒後的實驗期間為1小時，受試者每10分鐘被要求進行加法作業及填寫卡羅連斯加睡意量表（Karolinska Sleepiness Scale）、視覺類比量表（visual analog scales）、以及情緒評估等主觀量表，總計六次。同時，他們的腦電波（electroencephalogram）、心率變異率（heart rate variability）、膚電反應（skin conductance responses）、指溫等生理反應亦被記錄。 結果：受試者在認知表現或主觀評量上的確顯現出睡眠遲惰的效果，其加法作業的完成題數隨著時間增加，而主觀睡意則隨著時間減少。快節奏音樂情境比慢節奏音樂情境有顯著較高的主觀激發程度，並有較清醒的評量。在生理測量部分，受試者在快節奏音樂情境中有顯著較高的非特定刺激引起之膚電反應（Non-specific skin conductance responses）和腦電波較多beta波的趨勢。然而，儘管受試者的主觀評量會受到音樂刺激的影響而有不同，其認知表現並沒有出現類似的效果。 結論：本研究發現藉由音樂提高激發狀態，可使主觀睡意評量降低，但認知表現並不受到影響。此分離的現象顯示睡眠遲惰的消散不能以單一的生理激發狀態來解釋，而必須考慮多種歷程機制同時運作的可能性。 / Objective：Sleep inertia (SI) is a transitional state occurring immediately after awakening from sleep that are associated with sleepiness, decreased alertness and decrement in cognitive performance. It has been suggested that SI may be due to a decline in arousal level. Therefore, it was hypothesized that factors likely increasing arousal would reduce the effects of SI. Previous studies showed that fast-tempo music may enhance the level of arousal. The present study was conducted to clarify the role of arousal in SI by exposure to music with different tempos. Methods：Twelve healthy young adults, aged 18 to 31 years, participated in the study. All subjects went through three conditions: a fast-tempo music, a slow-tempo music, and a control (no music) conditions. Music stimuli were applied to subjects awaked from a 20-mins nap, and the subjects were given an addition task and asked to rate their level of subjective sleepiness and arousal on the Karolinska Sleepiness Scale (KSS), visual analog scales (VAS) and emotional rating scales 6 times over an hour. During the test period, their physiological arousal state was recorded, including electroencephalogram (EEG), heart rate variability (HRV), skin conductance responses (SCR), finger temperature. Results：The effects of SI on cognitive throughput and subjective ratings were evident. Their performance on the addition task increased and sleepiness decreased over time. Subjective sleepiness was significantly reduced and physiological arousal level measured by non-specific skin conductance responses (NS-SCRs) and EEG beta power were elevated when the participants were exposed to fast-tempo music. However, cognitive performance was not influenced by music exposure. Conclusion：The present findings suggest that increased arousal level during SI by manipulating music stimuli may decrease subjective sleepiness but have no impact on cognitive performance. This dissociative effect suggests that the dissipation of sleep inertia may not be a function of a general arousal level. Rather, there may be multiple processes that are responsible for different aspects of SI.

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.