研究背景與目的：大學生睡眠型態呈現睡眠時相延遲、睡眠不足、睡眠品質不佳的狀況，造成身心健康與學業問題。此種睡眠型態，一方面受到生理發展的影響因素，形成內在日夜節律型態偏向夜貓型的情形，二方面為社會與心理的影響因素，隨著年齡增加，家長對於孩子生活監控程度降低，特別是邁入大學以後，生活自主權增加，大學生有更多的自由安排自己的生活與睡眠時間，而大學生生活時間的安排與規劃，影響著夜晚的睡眠。現今科技可日新月異，科技產品的使用，包括看電視、打電腦與使用手機，成為大學生生活中不可或缺的活動之一。其中，電腦與上網為休閒活動時重要的角色。過去研究發現大學生一天使用電腦約3至5小時以上，國外調查睡前活動的研究發現約42.4％的大學生睡前使用電腦，而睡前使用電腦使得就寢時間延遲，形成總睡眠時數減少，睡眠不足造成白天的疲倦感增加，除此之外也有可能影響入睡時間與睡眠品質，因此本研究目的希望找出電腦使用對於睡眠影響的因素，減少電腦使用對大學生睡眠作息造成的影響。本研究根據訪談的結果及過去的文獻彙整，假設電腦使用使得沈浸狀態（flow）與激發狀態（arousal）較高，進而影響睡眠，包括就寢時間較晚、入睡時間較長、睡眠品質不佳、總睡眠時數不足、週末較晚起床補眠的狀況。 研究方法：本研究為瞭解個體電腦使用的沈浸與激發狀態變化對睡眠的影響，採受試者內設計，以重複測量的方式進行研究，測量受試者一週使用電腦的型態與睡眠之關係。受試者需符合睡前4小時內使用電腦1小時以上的習慣，排除任何生理、心理、睡眠疾患與極端日夜型態者（circadian type），並排除使用非法或影響睡眠的藥物。研究共募集國立與私立大學共76名學生，研究一週間請受試者於睡前填寫電腦使用型態問卷與與沈浸量表、激發狀態量表與睡眠日誌。資料回收後進行階層線性分析。階層一分析個人內每天電腦使用的沈浸程度、生理激發程度與認知激發程度是否可預測各睡眠變項，階層二分析個人間的日夜節律型態與焦慮特質調節沉浸、生理激發與認知激發程度與睡眠變項的關係。 研究結果：本研究發現每人每天睡前4小時電腦使用的內容，包括遊戲類、人際互動類與娛樂活動類的沈浸程度皆比文書作業的沈浸程度來得高，就受試者內的比較而言，當晚上電腦使用的沈浸程度越高，當晚的就寢時間提早、入睡時間減少、總睡眠時數增加與提升睡眠品質。而睡前4小時電腦使用時間長度可預測認知激發程度，但認知激發並無法預測睡眠變項；另外，不論睡前電腦使用內容或總時間無法預測生理激發，但晚上電腦使用後的生理激發程度越高，當晚的就寢時間越晚且總睡眠時數越少。此外，認知激發與生理激發的關係為正相關。在階層二個人間調節變項的分析，由於沈浸程度對睡眠變項的預測，以及生理激發程度對就寢時間與總睡眠時數的預測，皆未有尚未解釋的部分，因此在研究模型中無需再加入調節變項。 研究討論：研究結果發現沈浸程度在睡前電腦使用對睡眠影響的過程中扮演正向角色，但若睡前從事虛擬角色的線上遊戲，雖然沈浸程度偏高，但就寢時間偏晚且總睡眠時數較少；此外睡前的電腦使用時間越長，認知激發越高，而認知激發與生理激發呈現正相關，因此有可能認知激發程度提高，使生理激發程度也越高，而生理激發程度越高，導致就寢時間較晚，總睡眠時數較少。建議睡前選擇電腦使用內容並控制使用時間，以減少電腦使用對睡眠的不良影響。 / OBJECTIVE: College students tend to delay their sleep phase and have high prevalence of sleep problems, such as poor sleep quality and insufficient sleep. Many factors may be associated with the sleep patterns. First, delay sleep phase in college students may be affected by a natural tendency of delayed endogenous circadian phase in during puberty. Second, psychosocial and behavioral factors, such as late evening social events and computer use, may also contribute to these sleep patterns. Among these, computer use has been shown to be associated with poor sleep in previous studies. However, it’s unclear that what mechanisms through which computer use has an impact on sleep in college students. The goal of this study is to identify the underlying factors that mediate the effect of computer use to sleep. According to our pilot study in which college students were interviewed for their computer-use habits and sleep pattern, we hypothesize that mental flow, physical arousal and cognitive arousal are the factors mediating the impacts of computer use to sleep patterns characterize college students, including delayed sleep phase, longer sleep onset latency, insufficient sleep and poor sleep quality. METHOD: Seventy-six college students who are habitual computer users (using computer at least one hour before sleep every day) participated in the study. They were required to complete a set of questionnaires everyday for one week, including the computer-use questionnaire, the Flow Scale, and the Pre-Sleep Arousal Scale. Hieratical Linear Model was conducted to analyze within-individual level (level one) and between- individual level (level two). In our study, within-individual levels were mental flow, physical arousal and cognitive arousal that mediated the impacts of computer use to sleep patterns when college students used computer before sleep every night. In addition, between- individual levels in our study were various circadian types and anxious trait between college students. They may moderate the impacts of mental flow, physical arousal and cognitive arousal to sleep patterns in college students. RESULT: The results showed within-individual level that contents of computer using, including play on-line games, interpersonal interaction, and entertainment, could predict increased flow level. Higher flow level in turn predicted earlier bedtime, shorter sleep latency, more sleep duration and better sleep quality. In addition, physical arousal was not affected by computer use, but had a negative impact on sleep. Higher physical arousal level was able to predict later bedtime and shorter sleep duration. Computer-use time during the four hours prior to bedtime was associated with pre-sleep cognitive arousal. Cognitive arousal did not show significant association with any sleep variables, however. Furthermore, there was a positive relationship between cognitive arousal and physical arousal. In addition, because the results of between- individual levels showed that the mental flow, physical arousal and cognitive arousal completely explained sleep patterns, there was no need to add between- individual moderations. CONCLUSION: Our study showed that flow level while engaging in computer use may have positive effect on sleep. However, playing on-line games before sleep, although may lead to higher flow level, were associated with later bedtime and shorter sleep duration. Also, the more time spending on computer before sleep, the higher the cognitive arousal. Higher cognitive arousal level may be associated with higher physical arousal level. And, higher physical arousal level lead to later bedtime and shorter sleep duration. The results suggested that in order to prevent the negative impacts of computer-use among college students, they should reduce computer using time and avoid on-line games before sleep. Future study can develop intervention program based on current findings to prevent college students from the negative impacts of computer.

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.

睡眠失功能信念在慢性失眠的病理上扮演重要的角色，可能讓個體產生不良睡眠行為與過度睡前激發狀態，進而造成失眠。而癌症相關失眠患者由於其病理的獨特性也可能出現其獨特的睡眠失功能信念，本研究探討在癌症相關失眠的病理機轉中加入癌症相關睡眠失功能信念，是否可較單純一般慢性失眠之睡眠失功能信念對癌症相關失眠有更全面的了解。而癌症相關失眠具有許多不同於一般慢性失眠的要素，其中除了與疾病相關的特殊睡眠失功能信念外，尚有可能與睡眠困擾相關的癌因性疲憊干擾存在。因此，本研究的目的在探討：1）加入癌症相關的睡眠信念之整合睡眠失功能信念與失眠症狀的關聯性是否與單純一般的睡眠失功能信念有所不同；2）其影響路徑是否透過不良睡眠行為與睡前激發狀態影響失眠嚴重度；3）疲憊嚴重度是否使整合睡眠失功能信念對不良睡眠行為的預測力增加。本研究使用問卷調查對混合癌症患者進行各因素的測量後 (N=148)，運用結構方程模型進行路徑與因果分析，研究結果顯示，在疲憊嚴重度較高時，加入癌症相關睡眠失功能信念的整合睡眠失功能信念，其中「對失眠之負向影響預期與擔憂」向度會透過睡前生理激發狀態對「失眠對白天功能影響」程度有正向預測力、而「安眠藥物對疾病影響」向度對「失眠對白天功能影響」程度有負向預測力、不良睡眠行為對「失眠對白天功能影響」程度有正向預測力、一般睡眠失功能信念之預測路徑則多透過認知激發狀態影響；在疲憊嚴重度較低時，「對失眠之負向影響預期與擔憂」向度對「失眠對白天功能影響」程度有正向預測力、「睡眠與健康及病後修復關聯性的信念」向度對「失眠對白天功能影響」程度有負向預測力、「安眠藥物對疾病影響」向度對「睡眠困難」與「主觀痛苦」程度有正向預測力、一般睡眠失功能信念可預測之細項有所減少。研究結果顯示一般睡眠失功能信念會透過睡前認知激發影響失眠嚴重度，而加入癌症睡眠失功能信念後的整合睡眠失功能信念會透過睡前生理激發影響失眠嚴重度，疲憊嚴重度在其中扮演調節變項的角色，疲憊程度高低會使癌症睡眠失功能信念透過不同路徑影響失眠嚴重度。 / Dysfunctional beliefs about sleep play an important role in the pathological mechanism of chronic insomnia. Sleep-related behaviors and presleep arousal may mediate the relationship between the dysfunctional beliefs and severity of insomnia. Since cancer-related insomnia is associated with specific physiological and psychological conditions, there are specific dysfunctional beliefs that might have different influence to patients' sleep. Also, cancer-related fatigue could be closely related to sleep disturbance in cancer patients and demands to be explored. Therefore, the primary purpose of the current study is to explore: 1) whether adding cancer-related dysfunctional sleep beliefs to general dysfunctional sleep beliefs would show different pattern of association with severity of insomnia, comparing to the pattern of general dysfunctional sleep beliefs alone; 2) whether the sleep behavior and presleep arousal mediate the relationship between the dysfunctional beliefs to severity of insomnia in this path of model or not; 3) whether the severity of fatigue is a moderator of the predictibility of combided dysfunctional sleep beliefs to sleep-related behavior. The study recruited 148 mixed cancer diagnosis patients. They were instructed to fill out a package of questionnaires to assess their dysfunctional sleep beliefs, insomnia severity, cancer-related fatigue, etc. Structural equation modeling (SEM) was conducted for path analysis and causality test. Accroding to the result of SEM, presleep arousal was found to be a mediator of the positive association between the beliefs about “expectation and worries of negative consequence of insomnia” and daytime difficulties among subjects with high level of fatigue. Also the beliefs about “harmfulness of hypnotic” have negative predictibility to “daytime difficulty” in these subjects. Sleep behavior, on the other hand, have positive prediction to the “daytime difficulty”. General sleep dysfunctional beliefs showed pathway through presleep cognitive arousal level. For subjects with lower level of fatigue, the beliefs about “expectation and worries of negative consequence of insomnia” have positive association with the “daytime difficulty”. The beliefs about “beliefs about association between sleep and health and recovery from illnesss” were shown to have negative prediction to the “daytime difficulty”. The belief about “hypnotic related to disease” showed positive association with the “sleep difficulty” and associated “distress”. General sleep dysfunctional beliefs had less predictive factors. Based on the results of this study, adding cancer-related dysfunctional sleep beliefs was shown to have different relationship with severity of insomnia compared to general sleep dysfunctional beliefs. General dysfunctional sleep beliefs showed a pathway to insomnia severity through the mediation presleep cognitive arousal level. On the other hand, combided sleep dysfunctional beliefs showed a pathway to insomnia severity through the mediation of presleep somatic arousal level. Furthermore, severity of fatigue is a moderator. Subjets differed in the level of fatigue showed different path from combided dysfunctional sleep beliefs to severity of insomnia.

京都大学 / 0048 / 新制・論文博士 / 博士(工学) / 乙第13041号 / 論工博第4142号 / 新制||工||1652(附属図書館) / 33033 / (主査)教授 高野 裕久, 教授 伊藤 禎彦, 教授 米田 稔 / 学位規則第4条第2項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

我們提出的智慧型睡眠監測系統，是基於影像分析技術進行睡眠品質觀測，並利用所得到的數據來推斷最佳的喚醒時間。此系統命名為iWakeUp，利用非接觸式的方法來收集影像資料並進行後續處理，此裝置將被安裝在一般的臥室來幫助睡眠者，以期成為增進智慧家庭生活品質的一環。在此論文中，我們將會描述iWakeUp的各個模組包括測定動作量、推斷睡眠階段乃至於如何建立喚醒機制。更特別的是，我們考慮了喚醒時間與喚醒機制的關係，於較早的時間喚醒必須具有更高的信心度，否則將付出較大的代價，反之亦然。另外為了處理晨間臥室中的光影變化，不同的背景模型也已被整合測試，以期讓系統可以提升長時間觀測的準確度。最後，我們也進行了使用iWakeUp的臨床實驗，結果指出使用iWakeUp喚醒的睡眠者具有較低的嗜睡感與更好的活力。 / We present a video-based monitoring system to determine the sleep status and optimal wakeup time in this thesis. We envision a smart living space in which a data collection and processing module named iWakeUp is installed in the bedroom to record and monitor sleep in a non-invasive manner. We describe the overall structure of the iWakeUp system, including the procedure to measure amount of motion, the method for inferring wake/sleep status from the acquired video and the logics for deciding the optimal wakeup time. In particular, a time-dependent decision rule has been incorporated to account for unequal penalties when classification error occurs. Furthermore, various background modeling techniques have been examined to address lighting changes at dawn in the bedroom for long-term monitoring. Validation experiments are carried out to compare the alertness level upon awakening with/without reported a lower level of sleepiness and higher level of vigorousness in comparison to the control group.

研究目的 失眠的過度激發假說是目前最廣為接受的失眠病因之一，失眠者通常可觀察到具有身心過度激發的狀態，其中認知神經過度激發假說更由中樞神經的角度探討失眠者的過度激發現象，且已有許多證據支持此觀點。然而過度激發因素在失眠病程上的影響仍不明確，不論在前置因子或是持續因子的層面，激發因素皆經常被提及與討論。本研究以未失眠但具有高睡眠脆弱特質之族群作為研究對象，企圖模擬失眠者在失眠初發之前的狀態，另加入睡前及早晨的自主神經系統與主觀激發狀態之測量，比較其與低睡眠脆弱特質組在有無壓力誘發狀態下，兩組的睡眠中訊息處理程度、睡前及早晨的自主神經系統激發程度與主觀激發狀態，藉以了解（1）壓力是否會引發個體進入較高的主、客觀激發狀態；(2)睡眠脆弱特質在不同的激發程度下，是否會對於個體的睡前、睡眠中及早晨的激發程度造成影響，以初步推論激發狀態因素在失眠病程中所扮演之角色。 方法 以壓力下失眠反應量表（Ford Insomnia Response to Stress Test, FIRST）區分出高睡眠脆弱特質組（HV）13位（6男、7女）、低睡眠脆弱特質組（LV）14位（6男、8女），年齡為19-32歲之健康成人。每位受試者均需在睡眠實驗室進行3個夜晚之夜間睡眠記錄，包含第一晚的PSG測量以排除個案有其他睡眠疾患，並讓受試者習慣實驗環境；第二晚及第三晚則交互平衡操弄基礎情境或壓力情境，在壓力情境下，受試者被告知將進行即席演講，需在睡前抽出演講題目，並於隔天早晨喚醒後10分鐘內發表一篇內容充實、呼應主題之演說，隨後測量心跳變異率（heart rate variability，HRV）、平均心跳間距（r-r interval，RRI）、主觀身心激發狀態（Pre sleep arousal scale，PSAS）等主客觀激發程度，入睡後進行整夜的ERP（事件相關電位[Event-related potential，ERP]）測量，誘發ERPs之實驗流程以oddball典範為主，並於早晨起床後再次進行HRV、RRI及PSAS之測量。 結果 以2（組別）x 2（情境）之混和設計二因子變異數分析比較各組在不同情境下的主客觀激發程度指標是否有所不同。結果顯示壓力確實能引發受試者進入較高的主客觀激發狀態，包含睡前及早晨有較快的平均心跳速率、較高的主觀身心激發程度，而在NREM睡眠中可發現HV在有壓力的情境下，對外界的訊息處理程度顯著較LV組增加，包含較快的N1與較慢的N350出現，但HV在壓力下亦有較快的P2與較強的P900，顯示對外界訊息的抑制功能上升，且隨著睡眠更深，進入慢波睡眠時，P2及P900亦顯著較LV強，表現出更多的抑制外界訊息能力。 結論 本研究探討睡眠脆弱特質在不同激發狀態下對於睡眠的影響，結果顯示壓力能引發個體較高的激發狀態，然而在未失眠族群中，高睡眠脆弱特質對於認知激發狀態下的睡眠中訊息處理程度雖有提高，但可發現高睡眠脆弱特質組亦有較高的抑制外界訊息能力，而不致於使得激發狀態過度影響其睡眠，此結果部分支持失眠的認知神經過度激發假說，過度激發因素可能在持續因子的部分影響性較大，造成個體產生對睡眠的抱怨。另一方面，本研究結果亦彰顯失眠的高危險群的及早介入預防之重要性。 / Introduction: Conditioned hyperarousal has been theorized to be a major etiological factor in chronic insomnia patients. It has been suggested that insomniacs showed more arousal than non-insomniacs in many psychological and physiological measures, including enhanced information processing during sleep as measured by NREM ERPs. However, the role of hyperarousal on the course of development of insomnia remained unclear, it has been considered as a predisposing trait and/or perpetuating factor in the cause of insomnia. The present study compared arousal levels around sleep onset, during sleep and in the morning between non-insomniac individuals with low and high vulnerability to stress-related sleep disturbance, as high vulnerable individuals were proposed to be predisposed to chronic insomnia. The objectives of the study are therefore to investigate: 1) the effect of an acute stressor on arousal level prior, after, and during sleep, and 2) the differences in stress reactivity between individual with high and low vulnerability to stress-related sleep disturbances. Method: Fourteen healthy individuals scoring low (LV) and thirteen healthy individuals scoring high (HV) on the Ford Insomnia Response to Stress Test (FIRST) were studied. All subjects had to sleep in the lab for three nights: a screening/ adaptation night, then a baseline night and a stress night. The sequences of the later two nights were counterbalanced across subjects. During the stress night, subjects were informed that they would be required to give a speech immediately after waking up. Heart rate variability (HRV), r-r interval (RRI) of EKG and subjective arousal level (Pre sleep arousal scale, [PSAS]) was accessed before lights off and in the morning. Then sleep ERP was recorded during the night. An odd-ball paradigm was conducted to evoke ERPs throughout the night. Result: Mixed two-way ANOVAs were used to compare the differences between vulnerabilities and conditions. Both HV ans LV showed higher subjective arousal level and smaller RRI under the stress condition than the baseline condition. During NREM sleep, HV showed increased information processing under stress condition than LV as shown by faster N1, slower N350. Also, HV showed increased inhibition under stress condition than LV, with faster P2 and higher P900. Stronger P2 and P900 were also observed in HV when reached slow-wave sleep stage, comparing to LV. Conclusion: Both groups showed more arousal under stress condition than baseline condition, indicating an acute stress can lead to a higher arousal level. Moreover, high vulnerable individuals showed increased information processing during NREM sleep than low vulnerable individuals, but also showed more inhibition to prevent sleep from being disturbed by external stimulus. The results suggest that increased information processing in reacting to stress may be a predisposing trait for sleep disturbances. However, sleep may be protected by a compensatory inhibitory process in those who have not developed a long-term insomnia.

研究目的：失眠已是臨床上常見的健康抱怨之一，而近年來在探討原發性失眠的病因理論上，又以失眠患者的過度激發（hyperarousal）有較多的實徵研究支持。主要的理論之一為Perlis等人提出的「失眠神經認知模式」，該模式認為失眠患者的睡眠問題乃肇因於其在睡眠時內在的認知運作仍處於過度活躍狀態。後續相關研究透過腦波頻譜分析發現，原發性失眠患者不論在靠近入睡開始或NREM睡眠，都較一般正常睡眠者有增加的高頻腦波活動與減少的低頻腦波活動，顯示失眠患者確實有較高的生理激發狀態與較低的睡眠恆定趨力。而臨床上，失眠患者最常見的主觀抱怨為入睡困難，故本研究希望透過原發性失眠患者在睡眠中的腦波頻譜分析，以探討失眠患者在入睡歷程的生理激發狀態與睡眠恆定趨力的變化，並進一步探討失眠患者睡前主觀激發狀態感受與客觀生理激發測量之相關性。 研究方法：本研究的原發性失眠組共30人（男10人，女20人，平均年齡為36.7歲），正常睡眠者（控制組）共25人（男8人，女17人，平均年齡為34.8歲）。參與者需至睡眠實驗室進行一晚的多頻道睡眠檢查（PSG），以作為睡眠相關呼吸疾患與睡眠相關運動疾患之篩檢，並以入睡前5分鐘至入睡後15分鐘（共20分鐘）所記錄之腦電波（EEG）作為後續腦波頻譜分析之用。另外，參與者須在睡前填寫睡前激發量表（PSAS），以評估參與者在睡前的主觀激發狀態感受。 研究結果：在睡前主觀激發狀態評估中，原發性失眠患者不論在生理激發或認知激發主觀感受上，皆顯著高於一般正常睡眠者(F = 23.950，p < .001；F = 64.235，p < .001)。在PSG記錄的睡眠相關參數上，則顯示失眠患者有較多的入睡後醒來總時數(F = 5.510，p = .023)、較少的階段二睡眠時間與比例(F = 7.088，p = .010；F = 32.616，p < .001)、較少的REM睡眠比例(F = 4.810，p = .033)，以及較差的睡眠效率(F = 8.685，p = .005)。在入睡歷程的腦波頻譜分析上，結果顯示失眠患者在睡醒的過渡期有較高的Alpha波功率，在進到睡眠後則有較低的Delta波功率，並且在整個入睡歷程中則是有較高的Theta波功率與Beta波功率。進一步比較兩組在入睡歷程腦波頻譜波段的上升與下降速度，結果顯示失眠患者在入睡歷程中，不論是睡眠恆定趨力上升的速度或生理激發下降的速度，皆顯著較一般正常睡眠者慢。另外，主觀認知激發狀態感受與入睡後的Delta波呈現顯著正相關；而與Theta波的相關上，則主要在入睡過渡階段有顯著正相關；Alpha波則僅與入睡歷程最後階段有顯著負相關；在與Beta波相關上，則從入睡過渡階段到入睡後皆有顯著負相關。主觀生理激發狀態感受則僅有與入睡過渡階段的Theta波有顯著正相關。 結論：本研究發現原發性失眠患者在入睡歷程中，不論在睡眠恆定趨力的上升速度或生理激發的下降速度上，皆明顯較正常睡眠者慢，雖生理激發狀態仍會隨著時間而有所降低，但卻仍維持較一般正常睡眠者高；睡眠趨力雖亦會有所增加，卻較一般正常睡眠者難以發揮較佳的作用，而可能造成失眠患者在入睡歷程中需花費更長的時間才能入睡，且進入睡眠後，仍維持較高的生理激發狀態與睡眠趨力發揮較差，進而可能導致失眠患者較淺眠或難以維持睡眠等問題。 / Introduction：Insomnia is a common healthy complain. The neurocognitive perspective of hyperarousal model of insomnia, as proposed by Perlis(1997), hypothesized that the sleep difficulties in insomniacs may result from enhanced information processing around sleep onset and during sleep. Supporting evidences were primarily from the findings that insomnia patients have increased high frequency EEG activity and decreased low frequency EEG activity during sleep, indicating insomniacs in general have higher physical arousal and lower sleep homeostasis. This study further aims to explore arousal level and sleep homeostasis during the period of sleep onset by comparing the level and change of EEG spectrum in primary insomnia patients and normal control subjects during the process of sleep onset. Methods：30 patients with primary insomnia (10 men, 20women, mean age of 36.7years) and 25 normal sleepers (8 men, 17women, mean age of 34.8years) underwent one night of PSG recording in a sleep laboratory to screening sleep-related breathing disorders and sleep-related movement disorders. They also completed the Pre-sleep Arousal Scale (PSAS) before bedtime. EEG spectrum analyses were conducted for the EEG data collected during the 5 minutes prior to sleep onset and the 15 minutes after. Results：Subjective ratings of both pre-sleep cognitive and somatic arousal were significantly higher in insomnia group (F = 23.950, p < .001; F = 64.235, p < .001) than control group. More WASO (F = 5.510, p = .023), less time and percentage of stage 2 sleep (F = 7.088, p = .010; F = 32.616, p < .001), less percentage of REM sleep (F = 4.810, p = .033), and poor sleep efficiency (F = 8.685, p = .005) were showed in PSG. The EEG spectrum during sleep-onset period showed that insomniacs had higher alpha power in the sleep-wake transition, lower delta power after falling asleep, and higher theta and beta power during sleep-onset period. In terms of the slope of EEG specrtrum change during the period of sleep onset, insomniacs had slower change than normal sleepers in increasing of sleep homeostasis and decreasing of physical arousal. In addition, the correlations between PSAS score and EEG power, cognitive arousal and delta power after falling asleep and theta power in sleep-onset process showed significant positive correlation. Alpha power in the later part of sleep-onset period and beta power around sleep-wake trainsition, on the other hand, showed negative correlations with cognitive arousal. Physcial arousal only showed positive correlation to theta power in sleep-wake trainsition. Conclusions：Patients with primary insomnia showed significantly less and slower increase in sleep homeostatic drive as well as less and slower decrease in EEG arousal during sleep-onset period. Although EEG arousal did showed gradually decreased by time, it still maintianed higher than normal sleepers. Sleep homeostasis did also increase, but may be interfered by the hyperarousal. This may explain the complaints in insomnia patients of difficulty falling asleep, difficulty maintaining sleep, and light sleep.

在全球化價值鏈垂直分工的趨勢下，台灣企業大多扮演的是代工角色，但在低價競爭的模式下，代工產業必須考慮下一階段轉型策略思考，而品牌經營的轉型是目前許多代工廠商期待的策略方向。本研究以居家照護醫療器材領導廠商的立場，由品牌推廣的角度思考以策略聯盟合作進入新市場/新產品，並針對以下問題進行研究： 　1.　在自有品牌經營型態的架構下，進入市場的策略計畫為何？ 　2.　為達到策略計畫的目標，如何選擇當地的合作對象與合作模式？ 　3.　如何評估合作模式之成效？ 　　首先藉由外部產業分析、內部資源能力評估，確認這個新市場是否能夠符合企業成長的需求，規劃新產品進入新市場的產品定位及行銷策略。再以SWOT分析進行整合，找出環境之主要威脅且企業資源不足之處，以策略聯盟合作方式予以彌補。針對合作對象的選擇，主要考量本身對於夥伴的條件需求、對方與本身合作的動機、與此策略聯盟合作是否能夠符合雙方需求而定。並擬定策略聯盟合作的目標，以雙贏的4P行銷策略，相互提供知識基礎的資源，作為主要合作模式。最後以量化指標檢視是否達成原訂目標。 　　本研究藉由理論於實務上的應用，希望能發揮具策略性思考的價值，並且提出一具體可行的合作模式，協助廠商進入新市場並推廣與建立品牌。

博士(スポーツ健康科学) / Doctor of Philosophy in Health and Sports Science / 同志社大学 / Doshisha University

研究背景:成人午睡對於認知與情緒影響的正面效益，已獲得許多研究證實，不過兒童夜間各睡眠期所占比例與成人不同，而且至今少有兒童午睡效益的研究，因此，本研究旨在探討短暫午睡對於國小學童認知功能、學習表現與情緒狀態的影響。 實驗設計與方法:以研究一實驗室情境，配合研究二教室現場實地研究兩種方式進行探討。研究一採組內設計，以30名國小五年級學童，在睡眠實驗室分別接受單日20分鐘的午睡與清醒的實驗，並以五種神經心理測驗，進行前測與後測，並以相依樣本t考驗進行比較兩種實驗情境在五種神經心理測驗表現的差異，並以性別×情境×時間三因子變異數分析，比較睏睡度與情緒的分數差異，並以皮爾森積差相關統計分析午睡睡眠參數資料與神經心理測驗分數的相關性。研究二採組內設計，以67名五年級學童，在兩週分別接受三日教室現場的午睡以及三日清醒情境的安排，並實施國語、數學、社會教學，作為午睡效益的評量依據，並以重複樣本t考驗比較兩種實驗情境國語科、數學科、社會科學習成效測驗分數是否有所差異，另以午睡習慣×實驗情境×時間三因子變異數分析，比較睏睡度與情緒量表分數的差異性。 研究結果:研究一發現受試者經歷20分鐘的午睡後，在專心度表現顯著比清醒好，不過午睡後的抑制刺激干擾的錯誤率卻顯著比清醒時高；至於在工作記憶、敘述性記憶、程序性動作記憶的表現，兩種情境則無顯著差異。另外，發現午睡後13:10的主觀睏睡度明顯比清醒時要低，在其他情緒狀態上則無顯著差異。而且發現睡眠第一期時間與抑制刺激干擾能力表現達顯著負相關；睡眠第二期時間與敘述性記憶表現成正相關:睡眠第三期時間則與敘述性記憶表現成負相關;:研究二則發現午睡後學生睏睡度顯著比沒午睡時要低，而且三日內15:30的睏睡度皆比剛睡醒13:10時要低，且第三日15:30睏睡度有顯著降低，但其他情緒則無顯著影響。另外，國語、數學、社會三科的學習成效，在兩種實驗情境皆無顯著差異。 結論:兒童午睡過程睡眠期與成人不太相同，且從兒童夜間睡眠與認知相關研究，也可以發現兒童似乎能夠補償短暫午睡缺乏，造成對認知功能損害或情緒的負面影響，因此，短暫午睡似乎對於兒童的正面顯著效益，並不如成人ㄧ般，不過，本研究實驗室或教室研究情境，皆ㄧ致發現兒童午睡仍能減少受試者主觀睏睡度，而且也發現隨著午睡日數增加所帶來的正面效益。未來，進行實地研究可以更嚴謹的睡眠偵測及判讀工具，來確認受試者午睡情況，減少主觀判斷與檢核所產生的誤差。 / Background: It has been confirmed by many researches that taking the afternoon nap has positive effects on adult cognition and emotion. However, the proportion of children’s sleep stages at night is quite different from that of adults. Since there are few studies on the effects of children’s afternoon nap, this paper aims to discuss the effects of short nap on cognitive ability, academic performance and emotional state of elementary school pupils. Experimental Design and Methods: The study mainly adopted two methods--------- laboratory situation and field study in the classroom. The first method was conducted among 30 fifth-grade pupils from the elementary school, with each one dealing with 20-minute long nap and sober status respectively in a day. Besides, five neuropsychological tests were carried out to pre-test and post-test their performance with the paired sample t-test to compare their difference. Based on the variance analysis of gender, situation as well as time factors, sleepiness degree and emotional difference were compared and the relationship between nap parameters and neuropsychological test scores was analyzed with Pearson's correlation analysis method. The second method was conducted among 67 fifth-grade pupils from the elementary school, dealing with afternoon nap and sober situation respectively for three days in two weeks. Besides, Chinese, Mathematics and Sociology were taught as the basis to assess the effects of afternoon nap with the paired samples t-test. Based on the variance analysis of nap habits, environmental situation and time factors, sleepy degree and emotional difference were compared. Research Result: The first study showed that concentration degree of pupils after 20-minute afternoon nap was much higher than that before sleeping, so was the error rate to inhibit stimulation’s interference. As for the performance in working, declarative and procedural motor memory, there was no significant difference. In addition, we found that the subject sleepiness degree after 13:10 was lower than that when awake and there was no significant difference in other emotional states. The duration of stageⅠwas significantly negative-related to the performance to inhibit stimulation’s interference, and the duration of stageⅡwas positive-related to declarative memory performance; while the duration of stageⅢwas negative-related to declarative memory performance. The second study showed that subjective sleepiness degree of pupils after afternoon nap was much lower than that before nappinging, so was the sleepiness degree of 15:30 much lower than that of 13:10 in three days. In particular, the sleepiness degree of 15:30 in the third day decreased significantly, while other emotional states were not affected greatly. What’s more, there was no significance between these two experimental situations on study effects of Chinese, Mathematics and Sociology Conclusion: Children have a different afternoon nap course from adults. Related researches on children’s night sleep and cognition show that children seem to be able to .compensate for the lack of a short nap, resulting in cognitive impairment or emotional impact of negative.Therefore, the positive benefit of short nap of children is not as significant as that of adults. However, both laboratory and classroom situation showed that children’s afternoon nap could still reduce the subjective sleepiness. As the napping days increased, the positive effect was much more evident. In the near future, more rigorous sleep state detection and scoring tools for field study can be used to identify the nap situation and to reduce subjective misunderstanding and detection errors.