憂慮、反芻、睡前認知激發與睡眠品質之關係——以客觀生理評估為例

The Relationship between Worry, Rumination, Pre-sleep Arousal, and Sleep Quality: Evidence from Objective Psychophysiological Assessment

研究目的：憂慮以及反芻性思考的相關研究已由憂鬱、焦慮等疾患拓展到睡眠品質相關領域，本研究以成年早期族群的受試者為研究對象，藉以探討反芻性思考、憂慮與睡眠品質的關聯，並且透過客觀生理睡眠評估檢驗反芻性思考、憂慮、睡前激發狀態與睡眠品質的關聯。研究方法：研究時間從2011年9月開始至2012年4月結束，分為兩階段。階段一為探討反芻性思考與憂慮的因素，受試者為193名大學生，包括男性68名，女性125名，平均年齡為20.78歲，受試者填答反芻性反應量表及賓州憂慮量表，並進行因素分析。階段二探討反芻性思考、憂慮與睡前激發狀態在主、客觀睡眠品質的關聯，階段二則從階段一的受試者中以貝克憂鬱量表及貝克焦慮量表排除中度及重度憂鬱或焦慮後，隨機選出30名受試者經過為期連續七天的活動腕錶（Actiwatch®）和睡眠日誌紀錄後，並進行一個晚上的多頻道睡眠紀錄。研究結果：階段一結果顯示憂慮與反芻量表可得到三個因素，包括負面主題性思考、擔憂性思考與主動的認知評估。階段二結果顯示擔憂性思考與客觀生理測量活動腕錶中的入睡時距有顯著相關，睡前認知激發與入睡時距有關，睡前生理激發越高，入睡時距越長且睡眠效率越差。研究結論：反芻性思考與憂慮這兩種清醒狀態下的認知特質，可能透過睡前激發程度的增加對睡眠品質造成影響。

Purpose: Research about repetitive thought and mental disorders has been extended form depressive and anxiety disorders to insomnia, and many studies have focused on the relationship between rumination, worry, and sleep quality. The purpose of this study is to investigate the relationships among rumination, worry, pre-sleep arousal, and sleep quality. We used subjective and objective measurements to examine the relationship between presleep arousal and both subjective and objective sleep quality. Methods: The Study began from September 2011 until April 2012 and there were two stages. Stage 1 included 193 participants (65 men and 125 women, mean age = 20.78). All participants completed the Ruminative response style questionnaire (RSQ) and the Penn state worry questionnaire (PSWQ). To rule out moderate to severe depression or anxiety, all participants completed the Beck depression inventory-second edition (BDI-II) and the Beck anxiety inventory (BAI). Stage 2 included 30 participants without depression or anxiety randomly selected form Stage 1. Participants completed 7 consecutive days of Actiwatch® records and we recorded one night of polysomnography data. Results: Factor analysis of Stage 1 data supported 3 factors: dwelling on the negative, worry engagement, and active cognitive appraisal. Stage 2 analysis showed that worry engagement significantly correlated with increased sleep latency as measured by Actiwatch®. Pre-sleep cognitive arousal correlated with increased sleep latency. Pre-sleep somatic arousal correlated with increased sleep latency and decreased sleep efficiency. Conclusions: We conclude that the psychophysiological effect of rumination and worry would entail increased pre-sleep arousal, which would impact sleep quality.