多夢患者的夜間睡眠特徵與人格特質

Polysomnographic and Psychological Features of Patients with Epic Dreaming

研究目的：臨床上有一些患者抱怨頻繁作夢、整晚持續地作夢像沒有睡覺，並在醒後感到精疲力竭與疲倦，這種現象在過去的文獻中稱為epic dreaming，本研究中稱之為「多夢」。先前的研究發現這些患者中的21.4至25.0%有睡眠相關的呼吸疾病或週期性肢體抽動症（periodic limb movements disorder, PLMD），其餘的患者在多頻道睡眠記錄（polysomnography）上則未呈現顯著的異常。本研究進一步探討這些病患多夢的共同夜間睡眠生理以及心理特徵，並解釋多夢抱怨的可能成因。研究方法：本研究的受試者包含23個抱怨多夢的病患（8位男性，15位女性；平均年齡34歲），以及10個健康且正常睡眠的控制組受試者（3位男性，7位女性；平均年齡30歲）。所有受試者均接受睡眠病史的晤談與自填量表的評估（匹茲堡睡眠品質量表、華人健康量表與五因素人格量表），以及一晚的多頻道睡眠記錄儀檢查。研究結果：23位多夢病患中患有睡眠疾病的有7位、精神疾病的有6位、睡眠與精神疾病共病的有5位，其餘5位則單純僅有多夢的現象。多頻道睡眠記錄儀的結果顯示，多夢病患與控制組受試者有下列顯著或接近顯著的差異：（1）多夢病患組比起控制組有較高的睡眠潛伏期、階段一睡眠的比率與入睡後醒來時間的比率，以及較低的睡眠效率、階段三睡眠的比率、階段四睡眠的比率；（2）多夢病患組比起控制組在整晚睡眠有較高的總覺醒（arousal）、自發性覺醒、淺呼吸引起的覺醒與打鼾引起的覺醒次數；（3）多夢病患組比起控制組在階段一睡眠時的腦波（electroencephalogram）呈現較高的阿爾法波（α）與貝他波（β）相對能量、在慢波睡眠中則有較低的德爾他波（δ）相對能量的特徵。在人格特徵上，五因素人格量表顯示多夢病患組在神經質向度的得分顯著高於控制組，在開放性向度的得分雖與控制組沒有顯著差異，卻有較高的趨勢。研究結論：多夢病患的夜間睡眠生理活動與人格特質確實有某些共同的特徵。然而與這些睡眠生理以及心理特質相關的病因卻可能在個別患者有所不同，部分病患有睡眠疾病，部分病患有精神疾病，部分病患同時有睡眠與精神疾病，但仍有部分病患則沒有任何睡眠與精神方面的疾病。此結果反映多夢病患在多夢成因上的異質性與複雜性，本研究也提出一些有待進一步澄清的研究方向。

Purpose: Epic dreaming is defined as the recall of relentless, neutral-content dreaming throughout the night, with feelings of exhaustion upon awakening and fatigue during the day. Previous researchers who studied the polysomnographic (PSG) features of these patients found that 21.4 to 25.0% of them had sleep-related breathing disorders (SRBD) and/or periodic limb movement disorder (PLMD). However, the rest had unremarkable PSG findings. The present study further assessed the PSG, personality, and psychopathologic features of these patients in order to understand possible pathologies of this phenomenon. Methods: Twenty three patients (8 men, 15 women; mean age = 34 yrs) who complained of epic dreaming were recruited from a neurologic clinic to participate in the study along with 10 healthy control subjects (3 men, 7 women; mean age = 30 yrs). Clinical interviews concerning sleep and psychopathology were conducted and self-rating questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Chinese Health Questionnaire (CHQ-12), and the NEO five-factor inventory (NEO-FFI), were administered. One night of PSG recording was also conducted. Results: In terms of the sleep and mental diagnoses, 7 patients had specific sleep disorders, 6 patients had mental disorders, and 5 patients had both specific sleep disorders and mental disorders. The remaining 5 patients did not have any specific sleep or mental disorders. Several PSG sleep features differed between the patient and control groups. First of all, the patients with epic dreaming had longer sleep onset latency, a higher percentage of stage 1 sleep and waking during sleep, and lower sleep efficiency, and a lower percentage of stage 3 and 4 sleep than controls. Secondly, the patients with epic dreaming had more arousals including spontaneous and respiratory event-related arousal than controls. Thirdly, the patients with epic dreaming had lower electroencephalographic delta power in slow wave sleep and higher alpha and beta power in stage 1 sleep than controls. In terms of personality features, the result of the NEO-FFI showed that the patients with epic dreaming had higher trait scores in neuroticism and openness than controls. Conclusions: The results indicated that patients who complain of epic dreaming have some shared polysomnographic and personality features as a group. These sleep and psychological features may result from different pathologies in different patients. These findings indicate that the pathology of epic dreaming is heterogeneous and complicated. Some issues that require further research to clarify are discussed.