原發性失眠症患者的日間功能及自主神經活動

Daytime Functioning and Activity of the Autonomic Nervous System in Primary Insomnia

方素真(Su-Chen Fang)

指導教授 ： 蔡佩珊

臺北醫學大學/護理學院/護理學研究所/碩士(2006年)

摘要

本研究旨在比較原發性失眠患者與非失眠者日間功能及自主神經活動的差異。本研究共收集39位（原發性失眠組18位，非失眠者21位）年齡20－63歲之個案，其中原發性失眠組個案之診斷，乃依據美國精神醫學診斷統計手冊第四版（DSM-Ⅳ）之條件，並排除因精神疾患引起的失眠。 所有個案均參加一個安排於下午的日間功能及自主神經活動測試，測試內容包括1.認知執行功能（Wisconsin Card Sorting Test），2.日間嗜睡（中文版史丹福嗜睡及中文版愛渥斯嗜睡），3.注意力困難及疲倦，4.日間功能主觀評量（目前的清醒、活力及情緒狀態），5.焦慮狀態（情境─特質焦慮及貝氏焦慮）及6.心率變異性。研究結果顯示：1.兩組日間功能的認知執行功能、日間嗜睡、焦慮狀態、主觀清醒、活力及情緒狀態及每週因失眠引起注意力困難的天數無統計上的差異，而失眠者每週因失眠引起疲倦天數顯著高於非失眠者（p = .002）；2.兩組心率變異性無統計上的顯著差異。結論：本研究發現符合DSM-Ⅳ診斷條件之原發性失眠患者並沒有比睡眠狀況良好的人有較差的日間功能，此結果與研究假說吻合，而研究結果未能發現原發性失眠患者有異常的自主神經活動，可能與研究個案之失眠問題較輕微且非慢性失眠有關。

關鍵字

原發性失眠 ； 認知執行功能 ； 日間嗜睡 ； 心率變異性

並列摘要

This study examined the differences between good sleepers and primary insomniacs in daytime functioning and activity of the autonomic nervous system (ANS). A total of 39 individuals, aged 20-63, participated in this study. Among them, 18 were classified as primary insomniacs and 21 were good sleepers. The diagnosis of primary insomnia was made according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. All participants completed a test of executive cognitive functions (Wisconsin Card Sorting Test) and scales of daytime sleepiness (The Chinese version of the Stanford Sleepiness Scale; The Chinese version of the Epworth Sleepiness Scale) and anxiety (state-trait anxiety inventory). Participants were also asked to report the frequency (day/week) of fatigue and difficulty in concentration as a result of poor sleep during a typical week and their current states of alertness, vitality, and mood. Five-min recordings of HRV under resting conditions were obtained from all participants to assess the activity of the ANS. The results of this study indicate that cognitive executive functions, daytime sleepiness, frequency of concentration difficulty, subjective alertness, vitality and mood states were not significantly different between individuals with and without primary insomnia. The frequency of fatigue due to poor sleep was significantly higher in the primary insomnia group than that of the good sleepers (p = .002). Parameters of HRV were not significantly different between groups. Conclusion: Consistent with the proposed hypotheses, this study shows that DSM-Ⅳ primary insomniacs do not have excessive daytime dysfunction as compared with their counterparts. That this study did not find abnormalities of the ANS on the DSM-Ⅳ primary insomniacs may be because insomnia suffered by sample was not chronic and was in fact less severe than that of the clinical sample.

並列關鍵字

primary insomnia ； cognitive executive functions ； daytime sleepiness ； heart rate variability

參考文獻

蔡崇煌、陳宇嘉、王雪鳳、劉金明、吳萬慶、林高德(2000)?老人的睡眠障礙及其相關因子之探討-區域醫院之經驗?臺灣家庭醫學雜誌，10(3)，119-128。

楊建銘(2000)?失眠的行為及心理治療?臺灣醫學，4(6)，694-703。

頁)?台北市:國立台灣大學醫學院。 林信男(2000)?睡眠障礙症之藥物治療?臺灣醫學，4(6)，687-693。

李宇宙(2000)?身心疾病之睡眠障礙?臺灣醫學，4(6)，673-680。

蘇東平(2000)?睡眠障礙之診斷分類及臨床評估?臺灣醫學，4(6)，665-672。