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題名 睡眠脆弱特質對認知激發狀態下的睡眠中訊息處理之影響
Effects of stress-related vulnerability to sleep disturbances on information processing during sleep作者 林晏瑄
Lin, Yen Hsuan貢獻者 楊建銘
Yang, Chien Min
林晏瑄
Lin, Yen Hsuan關鍵詞 睡眠脆弱性
激發狀態
事件相關電位
心跳變異率
主觀激發狀態
sleep-related vulnerability
arousal
event-related potential
heart rate variability
subjective arousal日期 2010 上傳時間 5-Oct-2011 14:39:18 (UTC+8) 摘要 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.參考文獻 中文部分：
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國立政治大學
心理學研究所
96752006
99資料來源 http://thesis.lib.nccu.edu.tw/record/#G0096752006 資料類型 thesis dc.contributor.advisor 楊建銘 zh_TW dc.contributor.advisor Yang, Chien Min en_US dc.contributor.author (Authors) 林晏瑄 zh_TW dc.contributor.author (Authors) Lin, Yen Hsuan en_US dc.creator (作者) 林晏瑄 zh_TW dc.creator (作者) Lin, Yen Hsuan en_US dc.date (日期) 2010 en_US dc.date.accessioned 5-Oct-2011 14:39:18 (UTC+8) - dc.date.available 5-Oct-2011 14:39:18 (UTC+8) - dc.date.issued (上傳時間) 5-Oct-2011 14:39:18 (UTC+8) - dc.identifier (Other Identifiers) G0096752006 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/51304 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學研究所 zh_TW dc.description (描述) 96752006 zh_TW dc.description (描述) 99 zh_TW dc.description.abstract (摘要) 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。 zh_TW dc.description.abstract (摘要) 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. en_US dc.description.tableofcontents 第一章 緒論 1第二章 文獻探討第一節 原發性失眠的定義及流行病學研究 4第二節 失眠的病程發展理論 5第三節 失眠的過度激發理論 7第四節 NREM睡眠中的ERPs 10第五節 壓力誘發之暫時性失眠 14第六節 研究問題與假設 16第三章 研究方法第一節 研究對象 19第二節 實驗設計與步驟 20第三節 研究工具 3.1 多頻道生理檢查（polysomnograph，PSG） 22 3.2 事件相關電位（event-related potentials, ERPs） 23 3.3 心跳變異率（heart rate variability，HRV） 24 3,4 壓力下失眠反應量表 25 3.5 MINI國際神經精神科晤談表台灣版 25 3.6 失眠嚴重度量表 26 3.7貝克憂鬱量表第二版中文版 26 3.8 貝克焦慮量表中文版 27 3.9 睡前激發程度量表 27 3.10 生活事件量表 28第四節 資料分析 29第四章 研究結果第一節 受試者人口統計學資料 31第二節 受試者控制及壓力操弄分析 31第三節 睡眠脆弱特質對於激發狀態下的睡眠之影響：ERPs結果 33 4.3.1 入睡後第一個睡眠階段二連續5分鐘的差異分析 33 4.3.2 前半夜睡眠階段二的ERPs差異分析 39 4.3.3 前半夜慢波睡眠的ERPs差異分析 45第四節 睡眠脆弱特質對於激發狀態下的自主神經系統之影響：心電圖結果 51第五節 睡眠脆弱特質對於激發狀態下的主觀感受影響 56第五章 討論第一節 睡眠中的訊息處理程度 62第二節 睡眠脆弱特質對壓力下的自主神經系統影響 66第三節 睡眠脆弱特質對於主觀激發程度之影響 67第四節 結論 67參考文獻 71 zh_TW dc.language.iso en_US - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0096752006 en_US dc.subject (關鍵詞) 睡眠脆弱性 zh_TW dc.subject (關鍵詞) 激發狀態 zh_TW dc.subject (關鍵詞) 事件相關電位 zh_TW dc.subject (關鍵詞) 心跳變異率 zh_TW dc.subject (關鍵詞) 主觀激發狀態 zh_TW dc.subject (關鍵詞) sleep-related vulnerability en_US dc.subject (關鍵詞) arousal en_US dc.subject (關鍵詞) event-related potential en_US dc.subject (關鍵詞) heart rate variability en_US dc.subject (關鍵詞) subjective arousal en_US dc.title (題名) 睡眠脆弱特質對認知激發狀態下的睡眠中訊息處理之影響 zh_TW dc.title (題名) Effects of stress-related vulnerability to sleep disturbances on information processing during sleep en_US dc.type (資料類型) thesis en dc.relation.reference (參考文獻) 中文部分： zh_TW dc.relation.reference (參考文獻) 孔繁鐘（1999）。DSM-VI精神疾病診斷與統計第四版。台北：合記圖書。 zh_TW dc.relation.reference (參考文獻) 行政院主計處（2005）。台灣地區社區發展趨勢調查統計結果。行政院。 zh_TW dc.relation.reference (參考文獻) 車先蕙、盧孟良、陳錫中、張尚文、李宇宙（2006）。中文版貝克焦慮量表之信效度。台灣醫學，10（4），447－454。 zh_TW dc.relation.reference (參考文獻) 林一真（2000）。貝克焦慮量表（BAI）中文版。台北：中國行為科學社。 zh_TW dc.relation.reference (參考文獻) 林詩淳（2008）。慢性失眠者與情境性失眠高危險族群之壓力因應與失眠的關係。 國立政治大學心理系碩士論文，未出版，台北。 zh_TW dc.relation.reference (參考文獻) 林詩淳、楊建銘、許世杰（2006）。失眠嚴重度量表、睡前激發程度量表及睡眠失功能信念及態度量表中譯版之信效度研究。台灣睡眠醫學會壁報論文發表，台灣睡眠醫學會第四屆研討會，台灣大學醫學院。 zh_TW dc.relation.reference (參考文獻) 陳心怡（2000）。貝克憂鬱量表第二版（BDI-II）中文版。台北：中國行為科學社。 zh_TW dc.relation.reference (參考文獻) 盧孟良、車先蕙、張尚文、沈武典（2002）。中文版貝克憂鬱量表第二版之信度和效度。台灣精神醫學，16（4），301－310。 zh_TW dc.relation.reference (參考文獻) zh_TW dc.relation.reference (參考文獻) 英文部分： zh_TW dc.relation.reference (參考文獻) AASM. 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