微睡眠

微睡眠（英語：Microsleep）是指一小段維持幾秒到半分鐘不等的陷入睡眠或者睡意昏沉的時間，在此期間，人不對任何感官知覺有所反應而處於無意識狀態。^[1][2]微睡眠主要表現為在一小會兒失去意識後重新清醒，或者在清醒和昏睡的狀態之間快速切換。在行為學中，微睡眠的主要表徵為眼帘下垂、瞼閉遲緩、緩緩點頭。^[2]在電生理層面，微睡眠被定義為腦電圖代表着清醒狀態背景活動的8–13 Hz的α波（英語：alpha wave）活動為4–7 Hz的θ波（英語：theta wave）活動所取代。^[3]一些專家通過以上述的若干行為學指標來判斷微睡眠狀態，其餘多以腦電圖特徵為鑑定依據。^[4]

腦電圖α波示例

腦電圖θ波示例

儘管睡眠正常的人在重複單調工作時也可能會產生微睡眠，但微睡眠往往是睡眠不足的後果。^[5]微睡眠在例如開車、使用重型設備等需要高度警覺的環境下極其危險。人們經歷微睡眠時往往意識不到自己的微睡眠狀態，反倒以為自己一直專注工作或者只是覺得自己走了一會兒神。^[6]

與神經系統關聯

微睡眠時，大腦和睡意相關的區域活躍度增加，和醒意相關的區域活躍度下降。但因為存在單調的工作也可以導致微睡眠較為複雜的神經調節，且每個人的大腦結構有所差異，故客觀判斷與微睡眠相關的神經活動較為困難。因此建立對照用實驗組並進行對照檢驗極其重要。

一項對正常休息過的人同時透過眼視頻測試、行為反應測試、腦電圖、功能性核磁共振測試的實驗中^[2]，20名參與者需要看着操縱杆在屏幕上以上下左右四個方向移動長達50分鐘，動，過半數參與者在盯着操縱杆這一持續視覺運動任務時發生了腦電圖意義上的微睡眠，同時負責保持醒意的丘腦、中腦、後扣帶皮層活動減弱。^[2]

Chou (2011)的實驗檢測了五位受試者從微睡眠狀態被刺激甦醒時的神經激活模式^[5]，發現視覺區、額葉區、邊緣葉在收到直接刺激時的激活，以及前皮質、顳葉、主要運動皮質區、島葉在醒後的激活，由此得出「思考判斷能力滯後與甦醒後恢復，並有可能導致危險」的結論。

睡眠及睡意的產生由多種化學物質調節。多巴胺被認為促進了睡意，而腺苷被認為提升了醒意，共同參與微睡眠在內的睡眠調節。微睡眠狀態下，腦橋─膝狀核─枕葉波（英語：PGO waves）) 加強，抑制了基底核的視覺處理。視覺處理通路被抑制後，負責釋放多巴胺的上丘（英語：superior colliculus）細胞並不透過基底核的相同通路去抑制，導致了微睡眠發生和神經處理能力的下降。^[7]

生理學研究

微睡眠和許多疾病關聯。睡眠呼吸暫停是最為流行的與微睡眠相關疾病，影響了1,000到1,500萬人。^[8]其他關聯疾病包括發作性嗜睡病、嗜睡症、精神分裂症等造成白天過度嗜睡的疾病（英語：excessive daytime sleepiness）。微睡眠片刻往往被患者忽視，不常作為臨床診斷指標，多項睡眠測試常被用來偵測微睡眠。^[9]

由於反覆出現的微睡眠常常會影響正常的日常生活，多數臨床研究致力於利用藥物手段減少微睡眠在內的日間過剩的睡意。莫達非尼在此方面幾乎無副作用，故而在藥物選擇上十分流行；新藥研發中往往會有和莫達非尼及安慰劑的效果比較。莫達非尼也有用來治療或正被測試治療精神分裂症、發作性昏睡、猝倒症、睡眠呼吸暫停。在莫達非尼擴大治療對象和新藥與之比較療效的過程中，各類造成嗜睡疾病的藥物干預手段的研究正在完善。

微睡眠有時是藥物治療的副作用，例如用於治療帕金森病的多巴胺刺激藥物，昏睡是普拉克索（英語：pramipexole）、羅匹尼羅等多巴胺抑制劑（英語：dopamine agonists）的負面作用之一。這些藥物可以在50%開車中的帕金森病人中導致突然起效的睡意。^[10]因此臨床研究也致力於減輕這種負面作用。

多數微睡眠在臨床上並不顯著。感到睏倦的人往往喜歡去使用一項無需處方的刺激劑，例如含咖啡中的咖啡因。高頻率的低劑量咖啡因的攝入在對延長清醒情況下保持注意力確實有效，因為咖啡因是腺苷的競爭性拮抗劑，實驗也從而證實腺苷在保持清醒中的作用。^[11]其它刺激劑還包括阿得拉爾、苯丙胺、可卡因和煙草等。^[12][13]

測試途徑

偵測微睡眠的方法有很多，惟尚無對最優偵測和分類微睡眠方案的定論。簡單的方式諸如心理測驗、語言測試、行為測試（如打哈欠測試和眼視頻測試）；複雜的也有如軟件輔助的腦電圖、核磁共振、眼電圖、多導睡眠圖。多項測試可能可以使得診斷更為準確。^[2]

方式	描述
多項生理睡眠檢查(PSG)	多項生理睡眠檢查，縮寫為PSG，檢查了睡眠期間的多項身體機能，包括了透過腦電圖檢測大腦活動、透過眼電圖檢測眼部活動以及對骨骼肌和心律的檢測。
腦電圖(EEG)	腦電圖，縮寫EEG，透過不同置於頭皮上的多電極記錄了大腦在20-40分鐘內的自發電活動[14]微睡眠期間，腦電圖中的α波（英語：alpha wave）活動為更低頻率的θ波（英語：theta wave）活動所取代。[15]
功能性磁共振成像(fMRI)	功能性核磁共振技術即用核磁共振技術掃描血液流動以檢測大腦有哪些活躍區域、何種活動情況。[16]
心理測試	包括心理測時法、Karolinska睡意量表[17]、維持清醒測試[18]、多重睡眠潛伏期測試（英語：Multiple Sleep Latency Test）等。[19]
眼電圖（英語：Electrooculogram）(EOG)	眼電圖測量視網膜的靜息電勢。[20]
眼視頻測試	透過觀察眨眼等眼部活動判斷微睡眠狀態。[21][22]
打哈欠測試	測量一段時間內打哈欠的次數。[23]
語言測試	觀測人說話時的表情和節律來判斷睡眠狀態。[17][24][25]

儘管有人試圖透過主要是腦電圖或者眼動測試來進行微睡眠總分類，現階段仍然存在不同條件下偵測到的不同種類的微睡眠。^[26]Karolinska睡意量表之類的主觀自述類型的心理測試儘管和腦電圖被認為有正關聯，但很難區別睡意的程度而存在局限性。^[27]未來的研究需要更加注重小而微的客觀現象，例如更短間隔內的腦電波細節等，來揭示電活動和行為活動的關係，以獲得更高的偵測準確率。^[28]如此，微睡眠可以自然而然地和不同的清醒狀態區別出來。^[29]

社會危害性

眼瞼下垂在眼視頻測試中代表微睡眠

微睡眠可能導致車禍

在美國，單單疲勞駕駛一項每年就造成1,550死40,000傷，使得睡眠不足成為重要的公共安全議題。^[30][31]微睡眠主要表現為在一小會兒失去意識後重新清醒，或者在清醒和昏睡的狀態之間快速切換。在行車途中，疲勞駕駛的司機會可能會經歷無知覺的幾秒鐘，這便是微睡眠的具體例子。司機很難發現自己失去了的幾秒鐘，但微睡眠期間的駕駛卻有極大造成交通事故的風險。^[32]

歷史上，不少交通事故在微睡眠期間發生。^[33]微睡眠狀態下的駕駛被指間接造成了2003年發生瀑布列車事故（英語：Waterfall train disaster）：火車司機心臟病發，而值班守衛卻被監察者指在微睡眠狀態，只是列車異常速度無法被正常響應。2009年的造成飛機墜毀大西洋的法國航空447號班機空難中，機長曾報告說：「我昨夜沒睡夠。只有一個小時，那不夠。」遂甩手給兩位副駕駛，後者未能在飛機遇到危險的時候合理處置，造成了事故。^[34][35]切爾諾貝爾核事故中，反應堆開始過熱的主要原因就是睡意昏沉的操作人員錯誤地關閉了製冷系統，最終導致了一系列事故發生。^[36]

因此，微睡眠常常在用來檢測司機的睡意（英語：driver drowsiness detection）以及預防工傷和公共安全事故。相關數據如下：

• 44%深夜開車的司機會陷入危機行車安全的睡意中。^[37]
• 極度勞累的工作流程會提升至多35%的事故發生率。^[38]
• 長期微睡眠增加工人傷亡概率及缺勤率，降低工人生產效率。^[39]
• 美國疾病控制與預防中心研究指出，來自12州的74,571的成年受訪者中，僅35.3%稱自己24小時能有7小時睡眠，48.0%稱自己打鼾，37.9%稱自己近前一月至少一次無意識陷入睡眠，4.7%稱自己前一月至少一次在開車時陷入睡意。^[30]
• 美國國家公路交通安全管理局估計疲勞駕駛發生於2.5%致命道路交通事故及2%的致傷事故中。^[40]
• 1993年到2009年的16年間，疲勞駕駛造成的空難造成了250人死亡。^[41]

例如無聊的課程等單調事務也會導致微睡眠狀態的發生，這時微睡眠也叫白日類催眠狀態（英語：daytime parahypnagogia）。^[42]

參見

• 睡債（英語：Sleep debt）
• 失眠症
• 昏睡
• 入睡抽動

附錄：藥理文獻摘選

文獻標題	藥物干涉方式	研究疾病
Effects of BF2.649 in the Treatment of Excessive Daytime Sleepiness in Narcolepsy.[43]	藥物：BF2.649[註 1]、藥物：莫達非尼、藥物：安慰劑	發作性睡病
Efficacy and Safety Study of BF2.649 in the Treatment of Excessive Daytime Sleepiness in Narcolepsy[44]	藥物：BF2.649、莫達非尼、安慰劑	發作性睡病、過度日間睡意、猝倒症（英語：Cataplexy）等睡眠障礙
Dose Range Finding Study of BF2.649 Versus Placebo to Treat Excessive Daytime Sleepiness in Parkinson's Disease Patients[45]	藥物：安慰劑、藥物：BF 2.649 5 mg、藥物：BF 2.649 10 mg、藥物：BF 2.649 20 mg、藥物：BF2.649 40 mg	過度日間睡意、帕金森氏症
A Study Of A Novel Compound For Excessive Daytime Sleepiness Associated With Narcolepsy[46]	藥物：安慰劑、藥物：PF-03654746	過度日間睡意、發作性睡病
Treatment of Refractory Excessive Daytime Sleepiness in Patients With Obstructive Sleep Apnea/Hypopnea Syndrome (OSA/HS) Using Nasal Continuous Positive Airway Pressure (nCPAP) Therapy (0249-015)[47]	比較藥劑：MK0249, 藥物：比較藥劑：安慰劑, 藥物：比較藥劑：莫達非尼	阻塞性睡眠呼吸暫停、淺呼吸綜合症、過度日間睡意
Pitolisant to Assess Weekly Frequency of Cataplexy Attacks and EDS in Narcoleptic Patients (HARMONY CTP)[48]	藥物：BF2.649, 藥物：安慰劑	伴猝倒症及過度日間睡意的發作性睡病
Comparison of Modafinil and Methylphenidate in Treatment of Excessive Daytime Sleepiness in Patients With Parkinson's Disease[49]	藥物：莫達非尼、藥物：哌甲酯	帕金森病
Modafinil Augmentation Therapy for Excessive Daytime Sleepiness and Negative Symptoms in Patients With Schizophrenia[50]	藥物：莫達非尼、藥物：安慰劑	精神分裂症
Efficacy and Safety of BF2.649 in Excessive Daytime Sleepiness (EDS) in Parkinson's Disease[51]	藥物：BF2.649	帕金森病
Trial of Xyrem for Excessive Daytime Sleepiness and Sleep Disturbance in Parkinson's Disease (PD)[52]	藥物：Γ-羥基丁酸鈉	帕金森病

參考資料

文內註記

1. 也稱Pitolisant。

文內腳註

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