2015-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/657889摘要：失眠是常見而且影響甚廣的精神健康議題。失眠症與精神疾患關係緊密而且可能互為因果。原發性失眠症患者的預後不同，僅有部分的原發性失眠症會演進為共病精神疾患之失眠症，因此原發性失眠症族群的病因可能存在有相當之異質性。然而，現有睡眠疾患的分類系統並沒有針對原發性失眠症進行有效的分群。因此，我們需要多面向、整合性的評估方式進一步對原發性失眠症進行分群。本研究旨在以表現型（臨床症狀、精神病理、治療反應）、內在表現型（心臟自律神經功能、睡眠神經生理）與基因型（夜間靜默基因 KCNK與 KCMAL1之多態性）等面向之整合性指標進行原發性失眠症之分群研究。本計畫預計於兩年期間，納入 128名未經治療之原發性失眠症患者，除了傳統紙筆測量之外，亦使用生態即時評估法前瞻性地紀錄失眠相關之症狀與治療反應。以潛在類別分析針對表現型變項進行實徵性分群後，進一步比較跨分群之內在表現型與基因型差異。本研究預期可以全盤了解原發性失眠症日夜不同面向症狀之關連性與不同分群之特性差異。日後也可以依此進行追蹤研究，檢視不同分群失眠症患者出現共病精神疾患風險與病程之差異。<br> Abstract: Insomnia is a prevalent issue which impairs multiple health domains. Insomnia disorder and mental disorders are closely related and of bi-directionality relationship. The prognosis of patients with primary insomnia differs. Because only a portion of patients with primary insomnia develop subsequent mental disorders, the nature and etiology of primary insomnia should be heterogeneous. However, as for subtyping primary insomnia, current diagnostic system does not provide effective classification rationale. A multi-dimensional, integrative approach is necessary for subgrouping primary insomnia. The present study aims to subgroup primary insomnia with indicators related to phenotype (e.g. symptoms, psychopathology and treatment response), endophenotype (e.g. cardiac autonomic control, sleep neurophysiology) and genotype (the polymorphism of nightly silencing genes KCNK and KCMAL1). A total of 128 subjects with untreated primary insomnia is expected to be recruited during 2-year period. In addition to traditional paper-and -pencil questionnaires, a prospective strategy of data collection, i.e. ecological momentary assessment, will be utilized to sample information with regard to insomnia phenotype. Latent class analysis will be used to empirically subgroup patients with primary insomnia. Further cross-group comparisons will be conducted with respect to endophenotype and genotype. The present study expects to explore the relationship among various dimension of nighttime and daytime symptoms and to disentangle the differences among patients with primary insomnia. In the future, the present study could also provide an established cohort for follow-up studies. In these longitudinal studies, we will have chances to examine the risk factors and features of clinical courses associated with subsequent incident mental disorders.