第五章、 討論
第七節、 結論 …
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此外,建議未來研究人員,在實驗結束後可與受試者進行訪談,確認其平常所慣 用的生氣表達方式與被歸類的類型是否相吻合;並可詢問其在實驗期間表達/壓 抑生氣情緒的程度為何,以此作為操弄檢核。
在誘發生氣情緒的實驗程序上,建議未來研究可在不違反道德倫理的前提之 下,去營造更逼真的人際衝突情境,並讓受試者使用語言等直接的方式表達生氣,
以求能更提升生態效度。
在研究對象方面,本研究係以年齡介於 20~35 歲、且無睡眠問題的健康成人 為研究對象;此可能是使本研究操弄無法在睡眠參數相關變項上產生顯著效果的 原因之一,亦即受到來自地板效應之限制。而樣本代表性的不足,也可能會使本 研究的推論受到限制;對此,建議未來可針對不同年齡與族群對象進行相關研究,
如此在臨床應用上應會更有助益。
第七節、結論
本研究結果顯示,在生氣情緒下,表達生氣是對於個體後續心血管反應之恢 復性較為有利的因應方式。然而,個人的敵意特質和慣用因應風格,不論是對於 在生氣當下所引發的生理激發程度、後續的生理恢復狀態,乃至於入睡歷程的腦 波活動,都有著一定程度的影響力,在此也再次凸顯了個人特質和個體差異在心 理生理激發中的重要角色。另外,雖然本研究部分支持了適配假說的觀點:若個 體實際採行的生氣表達方式與平日所慣用的方式一致,則較有利於之後的心血管 反應的恢復,然而在本研究中主要欲探討的幾個重要睡眠相關變項,例如主客觀 入睡耗時、睡眠效率、夜醒時間等睡眠參數,卻未能得到預期的研究結果,顯示 若欲以適配假說來預測後續較佳的主客觀睡眠品質,仍須後續更多的相關研究來 加以支持和驗證,且可能尚須納入其他重要變項加以探討,例如個人的認知風格、
內在情緒調節策略等。而除了前一小節所論述的本研究限制之外,建議未來可從 生理機制的角度出發,對於情緒、因應策略和睡眠之間的關係進行更深入的探討,
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例如更多元地結合其他的生理測量技術,如此應更能釐清生氣情緒和表達方式和 睡眠之間的關聯性。
本研究結果再度彰顯了睡前的生理激發和恢復狀態對於後續睡眠歷程的影 響力;而生理激發狀態在情緒、因應行為和睡眠間之關係所扮演的角色,也為急 性失眠的現象提供了一種可能的註解。除了生氣情緒之外,未來亦可針對其他負 向情緒(例如:難過、恐懼、焦慮等)進行相關研究,藉以釐清在急性失眠下的病 因機制,如此在未來的臨床應用上應會更具貢獻性。
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參考文獻
一、 中文部分:
林宜美(2009)。多向度敵意在冠狀動脈心臟病「心理生理反應模式」之驗證。
未出版博士論文,國立中正大學,嘉義市。
李瑞玲(1993)。以生物–心理–社會模式探討生氣歷程對血壓心理生理機制之影 響。未出版博士論文,國立台灣大學,臺北市。
黃春偉(2001)。生氣表達方式與心血管反應的關連性。未出版碩士論文,國立 中正大學,嘉義市。
翁嘉英、林宜美、呂碧鴻、陳秀蓉、吳英璋、鄭逸如(2008)。「短式華人敵意量 表」之發展與信效度考驗。測驗年刊,55(3),463-487。(TSSCI)
張嘉真、李美枝(2000)。親子間情感行為的溯源與文化塑形。中華心理衛生學 刊,13(2),1-35。
胡鈞凱(2004)。敵意特質與生氣表達方式對心血管自主神經反應的影響。未出 版碩士論文,國立中正大學,嘉義市。
二、英文部分:
Do not sleep with anger. (2008). Sleep and Health, 69. ISSN: 1547-1586.
al’Absi, M., Bongard, S., & Lovallo, W. R. (2000). Adrenocorticotropin responses to interpersonal stress: effects of overt anger expression style and defensiveness.
International Journal of Psychophysiology, 37, 257–265.
Awad, A. A., Ghobashy, M. A., Stout, R. G., Silverman, D. G., & Shelley, K. H.
(2001). How does the plethysmogram derived from the pulse oximeter relate to
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
62
arterial blood pressure in coronary artery bypass graft patients? Anesthesia &
Analgesia journal., 93, 1446-1471.
Adam, K., Tomeny, M., & Oswald, I. (1986). Physiological and psychological differences between good and poor sleepers. Journal of Psychiatric Research, 20 (4), 301–316.
Ax, A.F. (1953). The physiological differentiation between fear and anger in humans.
Psychosomatic Medicine 15, 433–442.
Baker, J., & Schaie, K. (1969). Effects of aggressing "alone" or "with another" on physiological and psychological arousal. Journal of Personality and Social Psychology, 12, 80-86.
Bastien, C. H., LeBlanc, M., Carrier, J., & Morin, C. M. (2003). Sleep EEG power spectra, insomnia, and chronic use of benzodiazepines. Sleep, 26 (3), 313-317.
Bardwell, W., & Berry, C. C. (1999). Ancoli-Israel. S., Dimsdale, J. E. Psychological correlates of sleep apnea. Journal of psychosomatic research, 47, 583-596.
Baglioni, C., Spiegelhalder, K., Lombardo, C., & Riemann, D. (2010). Sleep and emotions: a focus on insomnia. Sleep Medicine Reviews,14 (4), 227-238.
Biaggio, M. K., & Maiuro, R. D. (1985). Recent advances in anger assessment. In C.
D. Spielberger & J. N. Butcher (Eds.), Advances in personality assessment, 5, 71-111. Hillsdale, NJ: Erlbaum.
Bonnet, M. H., & Arand, D. L. (1992). Caffe use as a model of acute and chronic insomnia. Sleep, 15 (6), 526-536.
Bonnet, M. H., & Arand, D. L.(1997). Hyperarousal and insomnia. Sleep Medcine Reviews, 1 (2), 97-108.Borbely, A. A. (1982). A two process model of sleep
regulation. Human Neurobiology, 1, 195–204.
Breslau, N., Roth, T., & Burduvali, E. (2004). Sleep in lifetime posttraumatic stress disorder: a community-based polysomnographic study. Archives of General
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
63
Psychiatry, 61, 508–516
Brissette, I., & Cohen, S. (2002). The contribution of individual differences in hostility to the associations between daily interpersonal conflict, affect, and sleep. Personality and Social Psychology Bulletin, 28, 1265-1274.
Brosschot, J. F., & Thayer, J. F. (1998). Anger inhibition, cardiovascular recovery, and vagal function: a model of the link between hostility and cardiovascular disease.
Annals of Behavioral Medicine, 20 (4), 326-332.
Brosschot, J. F, Gerin, W., & Thayer, J. F. (2006). The perseverative cognition
hypothesis: a review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research, 60, 113–124.
Burns, J. W., Quartana, P. J., & Bruehl, S. (2007). Anger management style moderates effects of emotion suppression during initial stress on pain and cardiovascular responses during subsequent pain-induction. Annals of behavioral medicine: 34 (2), 154-165.
Cajochen, C., Brunner, D. P., Krauchi, K., Graw, P., & Wirz-Justice, A. (1995). Power density in theta/alpha frequencies of the waking EEG progressively increases during sustained wakefulness. Sleep, 18(10), 890-894.
Caska, C. M., Hendrickson, B. E., Wong, M. H., Ali, S., Neylan, T., & Whooley, M. A.
(2009). Anger expression and sleep quality in patients with coronary heart disease: findings from the Heart and Soul Study. Psychosomatic Medicine,71, 280-285.
Chang, F. C., & Opp, M. R. (2001). Corticotropin-releasing hormone (CRH) as a regulator of waking. Neuroscience and Biobehavioral Reviews, 25, 445–453.
Chen, W., Kobayashi, T., Ichikawa, S., & Takeuchi, Y. (2000). Continuous estimation of systolic blood pressure using the pulse arrival time and intermittent
calibration. Medical & Biological Engineering & Computing, 38, 569-574.
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
64
Chida Y., & Hamer, M. (2008). Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: A quantitative review of 30 years of investigations. Psychological Bulletin, 134, 829-884.
Ciesla, J. A., & Roberts, J. E. (2007). Rumination, negative cognition, and their interactive effects on depressed mood: Two laboratory studies. Emotion, 7, 555-565.
Davidson, L. M., Fleming, R., & Baum, A. (1987). Chronic stress, catecholamines, and sleep disturbance at Three Mile Island. Journal of Human Stress, 13, 75-83.
Dijk, D. J, & Beersma, D. G. (1989). Effects of SWS deprivation on subsequent EEG power density and spontaneous sleep duration. Electroencephalography and Clinical Neurophysiology, 72, 312–320.
Dorr, N., Brosschot, J. F., Sollers, J. J., & Thayer, J. F. (2007). Damned if you do, damned if you don’t: the differential effect of expression and inhibition of anger on
cardiovascular recovery in black and white males. International Journal of Psychophysiology, 66, 125–134.
Engebretson, T. O., Matthews, K. A., & Scheier, M. F. (1989). Relations between anger expression and cardiovascular reactivity: Reconciling inconsistent findings through a matching hypothesis. Journal of Personality and Social Psychology, 57, 513-521.
Ehlers, C. L., Reed, T. K., & Henriksen, S. J. (1986). Effects of corticotropin-releasing factor and growth hormone-releasing factor on sleep and activity in rats.
Neuroendocrinology, 42, 467–474.
Espie, C. A. (2002). Insomnia:conceptual issues in the development, persistence,and treatment of sleep disorder in adult. Annual Review of Psychology, 53, 215-243.
Freedman, R. R., & Sattler, H. L. (1982). Physiological and psychological factors in sleeponset insomnia. Journal of Abnormal Psychology, 91, 380–389.
Freedman, R. R. (1986). EEG power spectra in sleep-onset insomnia.
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
65
Electroencephalography and Clinical Neurophysiology, 63, 408–413.
Funkenstein, D. H., King, S. H., & Drolette, M. (1954). The direction of anger during a laboratory stress-inducing situation. Psychosomatic Medicine, 16, 404–413.
Gambaro, S., & Rabin, A. (1969). Diastolic blood pressure responses following direct and displaced aggression after anger arousal in high- and low-guilt subjects.
Journal of Personality and Social Psychology ,12, 87-94.
Gerin, W., Davidson, K. W., Christenfeld, N. J., Goyal, T., & Schwartz, J. E. (2006).
The role of angry rumination and distraction in blood pressure recovery from emotional arousal. Psychosomatic Medicine, 68, 64–72.
Geddes, L. A., Voelz, M. H., Babbs, C. F., Bourland, J. D., & Tacker, W. A. (1981).
Pulse transit times as an indicator of arterial blood pressure, Psychophysiology, 20, 71-74.
Geddes, L. A., Voelz, M. H., James, S., & Reiner, D. (1981). Pulse arrival time as a method of obtaining systolic and diastolic blood pressure indirectly. Medical &
Biological Engineering & Computing, 19, 671-672.
Glynn, L. M., Christenfeld, N., & Gerin, W. (2002). The role of rumination in recovery from reactivity: cardiovascular consequences of emotional states.
Psychosomatic Medicine, 64, 714–726.
Grano, N., Vahtera, J., Virtanen, M., Keltikangas-Ja rvinen, L., & Kivimaki, M.
(2008). Association of hostility with sleep duration and sleep disturbances in an employee population. International Journal of Behavioral Medicine,15, 73–80.
Harburg, E., Erfurt, J. C., Chape, C., Hauenstein, L. S., Schull, W. J., & Schork, M. A.
(1973). Socioecological stressor areas and black-white blood pressure. Journal of Clinical Endocrinology and Metabolism, 86 (9), 595–611.
Harburg, E., Gleiberman, L., Russell, M., & Cooper, M. L. (1991). Anger-coping styles and blood pressure in black and white males. Psychosomatic Medicine, 53,
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
66
153–164.
Haynes, S. N., Follingstad, D. R., & McGowen, W. T. (1974). Insomnia: sleep patterns and anxiety level. Journal of Psychosomatic Research, 18, 69–74.
Haynes, S. N., Adams, A., & Franzen, M. (1981). The effects of presleep stress on sleep-onset insomnia. Journal of Abnormal Psychology, 90 (6), 601–606.
Hokanson, J., & Shelter, S. (1961). The effects of overt aggression on physiological arousal level. Journal of Abnormal and Social Psychology, 63, 446-448.
Hokanson, J., & Burgess, M. (1962). The effects of three types of aggression on vascular processes. Journal of Abnormal and Social Psychology, 64, 446-449.
Hokanson, J., & Burgess, M. (1962). The effect of status, type of frustration, and aggression on vascular processes. Journal of Abnormal and Social Psychology, 65, 232-237.
Hokanson, J., Burgess, M., & Cohen M. (1963). The effects of displaced aggression of systolic blood pressure. Journal of Abnormal and Social Psychology, 67, 214-218.
Hokanson, J. E., & Edelman, R. (1966). Effects of three social responses on vascular processes. Journal of Personality and Social Psychology, 3, 442– 447.
Hokanson, J. E., Willers, K. R., & Koropsak, E. (1968). The modification of
autonomic responses during aggressive interchange. Journal of Personality, 36, 386–404.
Huber, H. P., Hauke, D., & Gramer, M. (1988). Frustrationsbedingter blutdruckanstieg und dessen abbau durch aggressive reaktionen. Zeitschrift für experimentelle und angewandte Psychologie, 35, 427-440
Ireland, J. L., & Culpin, V. (2006). The relationship between sleeping problems and aggression, anger, and impulsivity in a population of juvenile and young offenders. Journal of Adolescent Health, 38, 649–655.
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
67
Johns, M. W., Gay, T. J. A., Masterton, J. P., & Bruce, D. W. (1971). Relationship between sleep habits, adrenocortical activity and personality. Psychosomatic Medicine, 33, 499–508.
Kaiser, J., Hertrich, I., Ackermann, H., Mathiak, K., & Lutzenberger, W. (2005).
Hearing lips: gamma-band activity during audiovisual speech perception. Cereb Cortex, 15, 646-653.
Koh, K. B., Cho, S. Y., Kim, J. W., Rho, K. S., Lee, S. H., & Park, I. H. (2004). The relationship of anger expression and alexithymia with coronary artery stenosis in patients with coronary artery diseases. Yonsei Medical Journal, 45, 181–186.
Krantz, D. S., Olson, M. B., Francis J. L., Phankao C., Bairey Merz C. N., et al.
(2006). Anger, hostility, and cardiac symptoms in women with suspected coronary artery disease: the Women's Ischemia Syndrome Evaluation (WISE) Study. Journal of Women's Health, 15 (10), 1214-1223.
Khalfa, S., Isabelle, P., Jean-Pierre, B., & Manon, R. (2002). Event-related skin conductance responses to musical emotions in humans. Neuroscience Letters, 328 (2), 145-149.
Lane, J. D., Greenstadt, L., & Shapiro, D. (1983). Pulse transit time and blood pressure – an intensive analysis. Psychophysiology, 20, 45-49.
Lai, J. Y., & Linden, W. (1992). Gender, anger expression style, and opportunity for anger release determine cardiovascular reaction to and recovery from anger provocation. Psychosomatic Medicine, 54, 297-310.
Lamarche, C. H., & Ogilvie, R. D. (1997). Electrophysiological changes during the sleep onset period of psychophysiological insomniacs, psychiatric insomniacs, and normal sleepers. Sleep, 20, 724-733.
Lin, T. K., Weng, C. Y., Chen, C. C., Lin, I. M., & Lin, C. L. (2008). Hostility trait and vascular dilatory functions in healthy Taiwanese. Journal of Behavior
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
68
Medicine, 31 (6), 517-524.
Lyubomirsky, S., Caldwell, N. D., & Nolen-Hoeksema, S. (1998). Effects of ruminative and distracting responses to depressed mood on retrieval of
autobiographical memories. Journal of Personality and Social Psychology, 75, 166-177.
Marie, G. V., Lo, C. R., Van Jones, J., & Johnston, D. W. (1984). The relationship between arterial blood pressure and pulse transit time during dynamic and static exercise. Psychophysiology, 21, 512-527.
Matthews, K. A., Owens, J. F., Kuller, L. H., Sutton-Tyrrell, K., & Jansen- McWilliams, L. (1998). Are hostility and anxiety associated with carotid
atherosclerosis in healthy postmenopausal women? Psychosomatic Medicine, 60, 633–638.
Madigan, M. F., Jr, Dale, J. A., & Cross, J. D. (1997). No respite during sleep:
heart-rate hyperreactivity to rapid eye movement sleep in angry men classified as type A. Perceptual and Motor Skills, 85, 1451–1454.
Mendelson, W. B., Garnett, D., Gillin, C. G., & Weingartner, H. (1984). The experience of insomnia and daytime and nighttime functioning. Journal of Psychiatric Research, 12, 235–250.
Merica, H., Blois, R., & Gaillard, J. M. (1998). Spectral characteristics of sleep EEG in chronic insomnia. European Journal of Neuroscience, 10, 1826–1834.
Michael, H. B., & Donna, L. A. (2010). Hyperarousal and insomnia: State of the science. Sleep Medicine Reviews, 14, 9-15.
Monroe, L. J. (1967). Psychological and physiological differences between good and poor sleepers. Journal of abnormal psychology, 72, 255–264.
Neylan, T. C., Lenoci, M. A., Maglione, M. L., Rosenlicht, N. Z., & Metzler, T. J.
(2003). Delta Sleep Response to Metyrapone in Posttraumatic Stress Disorder,
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
69
Neuropsychopharmacology, 28, 1666-1676.
Neylan, T. C., Otte, C., Yehuda, R., & Marmar, C. R. (2006): Neuroendocrine regulation of sleep disturbances in PTSD. Annals of the New York Academy of Sciences, 1071, 203-215.
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569–582.
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504–511.
Norlander, T., Johansson, Å ., & Bood, S. Å . (2005). The affective personality: its relation to quality of sleep, well-being and stress. Social Behavior and Personality, 33, 709–722.
Ochiai, R., Takeda, J., Hosaka, H., Sugo, Y., Tanaka, R., & Soma, T. (1999). The relationship between modified pulse wave transit time and cardiovascular changes in isoflurane anesthetized dogs. Journal of Clinical Monitoring and Computing, 14, 493-501.
Parry Fung, G., Dumont, C., Ries, C., & Mott, M. Ansermino. (2004). “Continuous noninvasive blood pressure measurement by pulse transit time”. IEEE
Engineering in Medicine and Biology Society,1, 738-741.
Perlis, M. L., Giles, D. E., Mendelson, W. B., Bootzin, R. R., & Wyatt, J. K. (1997).
Psychophysiological insomnia: the behavioural model and a neurocognitive perspective. Journal of Sleep Research, 6 (3), 179-188.
Perlis, M. L., Merica, H., Smith, M. T., & Giles, D. E. (2001) Beta EEG Activity and Insomnia. Sleep Medicine Reviews, 5, 365-376.
Pilcher, J. J., Ginter, D. R., & Sadowsky, B. (1997). Sleep quality versus sleep quantity: relationships between sleep and measures of health, well-being and
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
70
sleepiness in college students. Journal of Psychosomatic Research, 42, 583–
596.
Pollak, M. H., & Obrist, P. A. (1983). Aortic-radial pulse transit time and ECG Q-wave to radial pulse wave interval as indices of beat-by-beat blood pressure change. Psychophysiology, 20, 21-28.
Ritsner, M., Maayan, R., Gibel, A., Strous, R. D., Modai, I., & Weizman, A. (2004).
Elevation of the cortisol/dehydroepiandrosterone ratio in schizophrenia patients.
European Neuropsychopharmacology, 14 (4), 267-273.
Schachter, J . (1957). Pain, fear, and anger in hypertensives and normotensives: A psychophysiological study. Psychosomatic Medicine, 19, 17-29.
Schmidt, R. E., Gay, P., & Van der Linden, M. (2008). Facets of impulsivity are differentially linked to insomnia: Evidence from an exploratory study.
Behavioral Sleep Medicine, 6, 178–192.
Scott, B. A., & Timothy, A. J. (2006). Insomnia, Emotions, and Job Satisfaction: A Multilevel Study. Journal of Management, 32 (5), 622-645.
Smith, T. W., & Gallo, L. C. (1999). Hostility and cardiovascular reactivity during marital interaction. Psychosomatic Medicine, 61, 436–445.
Spielberger, C. D., Johnson, E. H., Russell, S. F., Crane, R. J., Jacobs, G. A., &
Worden, T. I. (1985). The experience and expression of anger: Construction and validation of an anger expression scale. In M. A. Chesney & R. H. Rosenman (Eds.), Anger and hostility in cardiovascular and behavioral disorders. New York: Hemisphere/McGraw-Hill.
Staner L., Cornette F., Mauriced., Viardot G., Le Bon O., Haba J., Staner C., Luthringer R., Muzet A., & Macher J.P. (2003). Sleep microstructure around sleep onset differentiates major depressive insomnia from primary insomnia.
Journal of Sleep Research, 12, 319-330.
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
71
Steptoe, A., Cropley, M., Griffith, J., & Kirschbaum, C. (2000). Job strain and anger expression predict early morning elevations in salivary cortisol. Psychosomatic Medicine, 62, 286–292.
Vgontzas, A. N., Bixler, E. O., Lin, H. M., Prolo, P., Mastorakos, G.,& Vela-Bueno, A.
(2001). Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: Clinical implications. Journal of Clinical Endocrinology and Metabolism, 86, 3787–3794.
Vincent, N., Cox, B., & Clara I. (2009). Are Personality dimensions associated with sleep length in a large nationally representative sample? Comprehensive Psychiatry, 50, 158–163.
Weng, C. Y., Lin, T. K., Shen, S. C., & Lin C. L. (submitted). The effects of hostility manifestation traits and anger-coping behaviors on the endothelial function.
Psychosomatic Medicine.
Williams, J. E., Nieto, F. J., Sanford, C. P., Couper, D. J., & Tyroler, H. A. (2002). The association between trait anger and incident stroke risk: the atherosclerosis risk in communities (ARIC) study. Stroke, 33, 13–19.
‧
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
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【基本資料】
(1) 姓名:_______________
(2) 系級:_______________
(3) 性別:□ 男 □ 女
(4) 年齡:_______________歲 (出生日期:_____年_____月_____日) (5) 家族病史:□ 無
□ 心臟疾病 □中風 □高血壓 □高血脂症 □ 其他心血管疾病___________
(6) 您是否罹患以下疾病:
□ 心臟/心血管疾病 □ 中風 □ 高血壓 □ 高血脂症
□ 神經系統疾病 □ 呼吸系統疾病 □ 精神疾患 □ 頭痛
□ 睡眠障礙 (失眠、嗜睡/猝睡、夢遊)
□ 睡眠相關疾患 (睡眠呼吸中止症、不寧腿症候群、週期性肢體抽動症)
□ 肌肉骨骼疾病 □ 其他:__________________
□ 肌肉骨骼疾病 □ 其他:__________________