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    題名: 長短客觀睡眠時數失眠患者之睡眠相關心理、生理特質，以及認知行為治療的療效比較
    Comparison of Sleep-Related Psychological and Physiological Features, and Treatment Efficacy of Cbt-I between Insomnia Patients with Short and Longer Objective Sleep Duration
    作者: 楊建銘;李信謙;林宜美
    貢獻者: 心理系
    關鍵詞: 失眠;短睡眠時數;心率變異;生理回饋;失眠認知行為治療;Beta波
    Insomnia;Short Sleep Duration;HRV;Biofeedback;CBT-I;Beta Wave
    日期: 2022-10
    上傳時間: 2025-05-13
    摘要: 失眠是最常見且影響廣泛的健康問題之一，近年來對於失眠的病理及治療上都有相當的進展，但部分的患者仍因病因的多元差異而不易受益。Vgontzas的研究團隊(2009; 2013)基於短客觀睡眠時數失眠者有較高比例的心血管及代謝疾病，提出兩種失眠的表現型：(1)短客觀睡眠時數 (<6hr) 的失眠--主要特徵為生理過度激發，導因於壓力相關的HPA 軸及交感神經系統過度活化；(2)正常客觀睡眠時數(≥6hr)的失眠--主要特徵為認知思緒的過度激發，並呈現睡眠錯誤知覺。後續研究更報告短客觀睡眠時數的患者對於失眠的認知行為治療(CBT-I)有顯著較差的反應。本計畫擬執行兩個研究進一步探討此分類的病理特性之差異，並設計與驗證不同的治療策略。研究一將針對長短客觀睡眠時數失眠者各40名，透過HRV及EEG頻譜分析分別測量自主及中樞神經系統的激發，並以問卷量測睡眠相關認知及行為因子，以了解兩類患者的生理及心理病理特徵；研究二則針對各40位兩類的失眠者，隨機分配各20人，分別接受兩種CBT-I外加的治療策略：(1) CBT-I加上HRV生理回饋--針對伴隨壓力生理激發的失眠所設計，以及(2) CBT-I加上引導式意象放鬆訓練--針對伴隨認知思考過度激發的失眠所設計。預期本研究將能提升對於失眠病理分類的瞭解，並發展對於不同病理更具效能的非藥物治療方式。
    Insomnia is one of the most common health related problems, which affects not only nocturnal sleep but also daytime functioning. There has been more understanding of the pathology of insomnia for the past decades. The treatment for insomnia has also been advaced. However, due to the heterogeneous and complex nature of the etiological factors, some patients still could not get the benefits from the new development. Based on the findings that insomnia patients with PSG-defined short total sleep time showed higher risk for cardiometabolic diseases, Vgontzas and colleagues (2013) in Penn State University proposed a model to categorize insomnia patients into two phenotypes based on objective sleep duration: short sleep durtion insomnia (<6hrs)--characterized by stress-related physical arousal, was proposed to be caused by hyperactivation of both HPA-axis and autonomic nervous system; normal sleep duration insomnia (?6hrs) -- characterized by cognitive hyperarousal and presented with sleep misperception. A more recent study further showed that insomnia patients with short actigraphy-defined sleep duration showed less improvement in responding to cognitive behavioral therapy for insomnia (CBT-I) withouth relaxation training. The current project proposed two study to further explore this issue. The first study will examine the physiological and psychological features of the two groups (40 subjects for each groups). Heart rate variabilty and EEG spectrum analysis will be conducted to measure the autonomic and cortical arousal. Self-rating scales will be used to measure sleep-related beliefs and behaviors. The second study will aim to develop different non-pharmacological treatments for the two types of insomnia. The first treatment will include CBT-I and HRV biofeedback, in order to conquer insomnia with high stress-related physiological arousal; the second treatemnt will contain CBT-I and guided imagery, designed to target insomnia with high cogntive arousal or rumination. Forty patient with each types of insomnia will be recruited and randomly assigned to the different treatments (with 20 subjects for each treatemnts). The study is expected to further clarify the underlying mechanism for the two types insomnia with different sleep duration and will develop more efficient treatemnt that target the underlying pathology of different types of patients.
    關聯: 科技部, MOST107-2410-H004-107-MY3, 107.08-110.07
    資料類型: report
    顯示於類別:[心理學系] 國科會研究計畫

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