臺灣博碩士論文加值系統

研究背景：流行病學的研究指出，現代社會由於光害以及夜間工作之職業型態導致代謝症候群之發生；而光害與夜間工作之職業型態均會導致晝夜節律異常。因此，探討晝夜節律週期在代謝性疾病之致病機轉所扮演的角色，已成為近年來醫學研究的熱門議題。
研究目的：（一）探討日韻律型態與罹患代謝症候群之相關性，（二）評估睡眠品質與罹患代謝症候群之相關性，（三）探討日韻律型態與睡眠品質對於罹患代謝症候群風險之合併作用。
研究方法：本研究採用病例對照研究設計。病例組為符合2007年國民健康署修訂的代謝症候群診斷標準病例，對照組為按照病例組年齡(±5歲)、性別配對的健檢民眾。研究個案是從彰化秀傳醫院及彰濱秀傳醫院收取。每位研究個案以中文版的匹茲堡睡眠品質指標量表(PSQI)和日韻律型態量表(MEQ)來收集睡眠狀態的資料。
研究結果：夜貓型罹患代謝症候群之危險性是中間型的1.31倍(95%信賴區間=0.56-3.08)；整體睡眠品質差罹患代謝症候群之危險性是睡眠品質佳的1.11倍(95%信賴區間=0.76-1.61)；而睡眠總時數小於6小時及超過9小時比睡7至8小時的人有較高的危險性罹患代謝症候群，分別為1.02倍(95%信賴區間=0.70-1.49)及2.22倍(95%信賴區間=0.79-6.21)。此外發現睡眠品質差的夜貓型有較高的危險性會罹患代謝症候群(OR=2.07, 95%信賴區間=0.75-5.70)。
結論：日韻律型態中為夜貓型、PSQI整體睡眠品質差的人以及睡眠總時數方面睡眠偏離7至8小時皆有較高危險性罹患代謝症候群。未來的研究應闡明日韻律型態與睡眠品質對於罹患代謝症候群風險影響的機制。

Background: Mounting evidence from epidemiological studies has led to the hypothesis that one of the major changes in the modern society that contributes to the pathogenesis of the metabolic syndrome (MetS) involves the introduction of artificial light and work into night time. Indeed, artificial light and work into night time will lead to circadian misalignment. Therefore, elucidation of the role of circadian rhythms in metabolic diseases has become critical in recent years.
Objectives: The study aims were to assess (i) the relationships between chronotype and the risk of MetS, (ii) to examine the association between sleep quality and the risk of MetS, (iii) to evaluate the combined effect of chronotype and sleep quality on the risk of MetS.
Methods: The study was a case-control study. Case and control subjects were recruited from the Show-Chwan Hospital in the Changhua area. Subjects fulfilled the diagnosis of MetS according to the Health Promotion Administration, Ministry of Health and Welfare guidelines were enrolled as the case group. Two control subjects matched to each case by age (±5 years), sex, and residential areas were selected from those attended the health examination center of the hospital. Global Sleep quality was measured using the validated Chinese version of the Pittsburgh Sleep Quality Index (PSQI) and chronotype was assessed by the Horne-Ostberg Morningness-Eveningness Questionnaire.
Result: The result showed that evening type had a 1.31-fold [95% Confidence interval (CI)= 0.56-3.08] odds ratio for MetS as compared with intermediate type. In addition, poor sleep quality had a 1.11-fold (95% CI=0.76-1.61) odds ratio for MetS as compared with better sleep quality. There were 1.02 (95% CI=0.70-1.49) and 2.22-fold (95% CI=0.79-6.21) odds ratios for MetS is associated with short and long sleep durations. Furthermore, poor sleep quality in conjunction with the evening type have a higher risk of MetS as compared with better sleep quality combined with intermediate type (OR=2.07, CI=0.75-5.70).
Conclude: The evening type and poor sleep quality increased the risk of MetS. Further studies are needed to elucidate the mechanisms of chronotype and sleep quality in the pathogenesis of MetS.

表目錄......III
附錄目錄....III
摘要........V
Abstract....VI
第一章、 緒論...............................................................1
第一節、 研究背景與重要性....................................................1
第二節、 研究動機...........................................................3
第三節、 研究目的...........................................................4
第二章、 文獻探討...........................................................5
第一節、 晝夜節律與日韻律型態................................................5
第二節、 睡眠品質...........................................................8
第三節、 代謝症候群流行病學特徵、現況與危險因子...............................10
第四節、 睡眠障礙對於代謝症候群的影響........................................12
第三章、 材料方法..........................................................16
第一節、 研究設計..........................................................16
第二節、 研究架構..........................................................17
第三節、 研究對象篩檢條件...................................................18
第四節、 評估工具..........................................................20
第五節、 統計分析..........................................................22
第四章、 研究結果..........................................................23
第一節、 研究對象基本特性、生活型態及睡眠品質分佈情形.........................23
第二節、 病例組及對照組其基本特性、生活型態與睡眠品質分佈情形..................28
第三節、 性別分層其基本特性、生活型態與睡眠品質分佈情形.......................35
第四節、 整體睡眠品質及日韻律型態對於代謝症候群之危險性分析...................44
第五節、 性別分層其睡眠品質及日韻律型態對於代謝症候群之危險性分析..............47
第六節、 睡眠品質及日韻律型態之合併作用對於代謝症候群之危險性分析..............52
第五章、 討論.............................................................54
第一節、 影響代謝症候群之危險因素...........................................54
第二節、 影響日韻律型態之因素...............................................56
第三節、 睡眠品質和日韻律型態與代謝症候群之相關性.............................58
第四節、 研究限制..........................................................61
第六章、 結論..............................................................62
參考文獻..................................................................63

1.Akerstedt, T., Kecklund, G., & Selen, J. (2010). Early morning work--prevalence and relation to sleep/wake problems: a national representative survey. Chronobiol Int, 27(5), 975-986. doi:10.3109/07420528.2010.489001
2.Ancoli-Israel, S. (2001). "Sleep is not tangible" or what the Hebrew tradition has to say about sleep. Psychosom Med, 63(5), 778-787.
3.Andersson, K., & Arner, P. (2001). Systemic nicotine stimulates human adipose tissue lipolysis through local cholinergic and catecholaminergic receptors. Int J Obes Relat Metab Disord, 25(8), 1225-1232. doi:10.1038/sj.ijo.0801654
4.Arora, T., Jiang, C. Q., Thomas, G. N., Lam, K. B., Zhang, W. S., Cheng, K. K., . . . Taheri, S. (2011). Self-reported long total sleep duration is associated with metabolic syndrome: the Guangzhou Biobank Cohort Study. Diabetes Care, 34(10), 2317-2319. doi:10.2337/dc11-0647
5.Barclay, N. L., Eley, T. C., Maughan, B., Rowe, R., & Gregory, A. M. (2011). Associations between diurnal preference, sleep quality and externalizing behaviours: a behavioural genetic analysis. Psychol Med, 41(5), 1029-1040. doi:10.1017/s0033291710001741
6.Bidulescu, A., Din-Dzietham, R., Coverson, D. L., Chen, Z., Meng, Y. X., Buxbaum, S. G., . . . Welch, V. L. (2010). Interaction of sleep quality and psychosocial stress on obesity in African Americans: the Cardiovascular Health Epidemiology Study (CHES). BMC Public Health, 10, 581. doi:10.1186/1471-2458-10-581
7.Borba, C. P., Fan, X., Copeland, P. M., Paiva, A., Freudenreich, O., & Henderson, D. C. (2011). Placebo-controlled pilot study of ramelteon for adiposity and lipids in patients with schizophrenia. J Clin Psychopharmacol, 31(5), 653-658. doi:10.1097/JCP.0b013e31822bb573
8.Brebbia, D. R., & Altshuler, K. Z. (1965). Oxygen consumption rate and electroencephalographic stage of sleep. Science, 150(3703), 1621-1623.
9.Broms, U., Kaprio, J., Hublin, C., Partinen, M., Madden, P. A., & Koskenvuo, M. (2011). Evening types are more often current smokers and nicotine-dependent-a study of Finnish adult twins. Addiction, 106(1), 170-177. doi:10.1111/j.1360-0443.2010.03112.x
10.Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res, 28(2), 193-213.
11.Cappuccio, F. P., Cooper, D., D'Elia, L., Strazzullo, P., & Miller, M. A. (2011). Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J, 32(12), 1484-1492. doi:10.1093/eurheartj/ehr007
12.Cappuccio, F. P., Taggart, F. M., Kandala, N. B., Currie, A., Peile, E., Stranges, S., & Miller, M. A. (2008). Meta-analysis of short sleep duration and obesity in children and adults. Sleep, 31(5), 619-626.
13.Carnethon, M. R., Loria, C. M., Hill, J. O., Sidney, S., Savage, P. J., & Liu, K. (2004). Risk factors for the metabolic syndrome: the Coronary Artery Risk Development in Young Adults (CARDIA) study, 1985-2001. Diabetes Care, 27(11), 2707-2715.
14.Choi, K. M., Lee, J. S., Park, H. S., Baik, S. H., Choi, D. S., & Kim, S. M. (2008). Relationship between sleep duration and the metabolic syndrome: Korean National Health and Nutrition Survey 2001. Int J Obes (Lond), 32(7), 1091-1097. doi:10.1038/ijo.2008.62
15.Cizza, G., Skarulis, M., & Mignot, E. (2005). A link between short sleep and obesity: building the evidence for causation. Sleep, 28(10), 1217-1220.
16.De Silva, D. A., Woon, F. P., Xie, X. Y., Li Hsian Chen, C., Chang, H. M., & Wong, M. C. (2007). Metabolic syndrome among ethnic South Asian patients with ischemic stroke and comparison with ethnic Chinese patients: the Singapore General Hospital experience. J Stroke Cerebrovasc Dis, 16(3), 119-121. doi:10.1016/j.jstrokecerebrovasdis.2007.01.001
17.Despres, J. P., & Lemieux, I. (2006). Abdominal obesity and metabolic syndrome. Nature, 444(7121), 881-887. doi:10.1038/nature05488
18.Duffy, J. F., Rimmer, D. W., & Czeisler, C. A. (2001). Association of intrinsic circadian period with morningness-eveningness, usual wake time, and circadian phase. Behav Neurosci, 115(4), 895-899.
19.Durmer, J. S., & Dinges, D. F. (2005). Neurocognitive consequences of sleep deprivation. Semin Neurol, 25(1), 117-129. doi:10.1055/s-2005-867080
20.Elliot, D. L., Goldberg, L., Kuehl, K. S., Moe, E. L., Breger, R. K., & Pickering, M. A. (2007). The PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) firefighter study: outcomes of two models of behavior change. J Occup Environ Med, 49(2), 204-213. doi:10.1097/JOM.0b013e3180329a8d
21.Esposito, K., Chiodini, P., Colao, A., Lenzi, A., & Giugliano, D. (2012). Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. Diabetes Care, 35(11), 2402-2411. doi:10.2337/dc12-0336
22.Ford, E. S. (2005). Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care, 28(7), 1769-1778.
23.Goldberg, G. R., Prentice, A. M., Davies, H. L., & Murgatroyd, P. R. (1988). Overnight and basal metabolic rates in men and women. Eur J Clin Nutr, 42(2), 137-144.
24.Gramaglia, E., Ramella Gigliardi, V., Olivetti, I., Tomelini, M., Belcastro, S., Calvi, E., . . . Broglio, F. (2014). Impact of short-term treatment with benzodiazepines and imidazopyridines on glucose metabolism in healthy subjects. J Endocrinol Invest, 37(2), 203-206. doi:10.1007/s40618-013-0016-y
25.Grundy, S. M. (2008). Metabolic syndrome pandemic. Arteriosclerosis, thrombosis, and vascular biology, 28(4), 629-636.
26.Hall, M. H., Muldoon, M. F., Jennings, J. R., Buysse, D. J., Flory, J. D., & Manuck, S. B. (2008). Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep, 31(5), 635-643.
27.Hampton, S. M., Morgan, L. M., Lawrence, N., Anastasiadou, T., Norris, F., Deacon, S., . . . Arendt, J. (1996). Postprandial hormone and metabolic responses in simulated shift work. J Endocrinol, 151(2), 259-267.
28.Hansen, J. (2001). Increased breast cancer risk among women who work predominantly at night. Epidemiology, 12(1), 74-77.
29.Haseli-Mashhadi, N., Dadd, T., Pan, A., Yu, Z., Lin, X., & Franco, O. H. (2009). Sleep quality in middle-aged and elderly Chinese: distribution, associated factors and associations with cardio-metabolic risk factors. BMC Public Health, 9, 130. doi:10.1186/1471-2458-9-130
30.Horne, J. A., & Ostberg, O. (1976). A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol, 4(2), 97-110.
31.Howerton, T. C., O'Connor, M. F., & Collins, A. C. (1983). Lipid solubility is correlated with hypnotic and hypothermic responses of long-sleep (LS) and short-sleep (SS) mice to various depressant drugs. J Pharmacol Exp Ther, 227(2), 389-393.
32.Hwang, L. C., Bai, C. H., Chen, C. J., & Chien, K. L. (2007). Gender difference on the development of metabolic syndrome: a population-based study in Taiwan. Eur J Epidemiol, 22(12), 899-906. doi:10.1007/s10654-007-9183-5
33.Jennings, J. R., Muldoon, M. F., Hall, M., Buysse, D. J., & Manuck, S. B. (2007). Self-reported sleep quality is associated with the metabolic syndrome. Sleep, 30(2), 219-223.
34.Ju, S. Y., & Choi, W. S. (2013). Sleep duration and metabolic syndrome in adult populations: a meta-analysis of observational studies. Nutr Diabetes, 3, e65. doi:10.1038/nutd.2013.8
35.Kanerva, N., Kronholm, E., Partonen, T., Ovaskainen, M. L., Kaartinen, N. E., Konttinen, H., . . . Mannisto, S. (2012). Tendency toward eveningness is associated with unhealthy dietary habits. Chronobiol Int, 29(7), 920-927. doi:10.3109/07420528.2012.699128
36.Karatsoreos, I. N., Bhagat, S., Bloss, E. B., Morrison, J. H., & McEwen, B. S. (2011). Disruption of circadian clocks has ramifications for metabolism, brain, and behavior. Proc Natl Acad Sci U S A, 108(4), 1657-1662. doi:10.1073/pnas.1018375108
37.Katano, S., Nakamura, Y., Nakamura, A., Murakami, Y., Tanaka, T., Takebayashi, T., . . . Ueshima, H. (2011). Relationship between sleep duration and clustering of metabolic syndrome diagnostic components. Diabetes Metab Syndr Obes, 4, 119-125. doi:10.2147/dmso.s16147
38.Kita, T., Yoshioka, E., Satoh, H., Saijo, Y., Kawaharada, M., Okada, E., & Kishi, R. (2012). Short sleep duration and poor sleep quality increase the risk of diabetes in Japanese workers with no family history of diabetes. Diabetes Care, 35(2), 313-318. doi:10.2337/dc11-1455
39.Knutson, K. L. (2010). Sleep duration and cardiometabolic risk: a review of the epidemiologic evidence. Best Pract Res Clin Endocrinol Metab, 24(5), 731-743. doi:10.1016/j.beem.2010.07.001
40.Knutson, K. L., Spiegel, K., Penev, P., & Van Cauter, E. (2007). The metabolic consequences of sleep deprivation. Sleep Med Rev, 11(3), 163-178. doi:10.1016/j.smrv.2007.01.002
41.Knutson, K. L., & Van Cauter, E. (2008). Associations between sleep loss and increased risk of obesity and diabetes. Ann N Y Acad Sci, 1129, 287-304. doi:10.1196/annals.1417.033
42.Kobayashi, D., Takahashi, O., Deshpande, G. A., Shimbo, T., & Fukui, T. (2011). Relation between metabolic syndrome and sleep duration in Japan: a large scale cross-sectional study. Intern Med, 50(2), 103-107.
43.Krishnan, V., & Collop, N. A. (2006). Gender differences in sleep disorders. Curr Opin Pulm Med, 12(6), 383-389. doi:10.1097/01.mcp.0000245705.69440.6a
44.Kudielka, B. M., Federenko, I. S., Hellhammer, D. H., & Wust, S. (2006). Morningness and eveningness: the free cortisol rise after awakening in "early birds" and "night owls". Biol Psychol, 72(2), 141-146. doi:10.1016/j.biopsycho.2005.08.003
45.Lack, L., Bailey, M., Lovato, N., & Wright, H. (2009). Chronotype differences in circadian rhythms of temperature, melatonin, and sleepiness as measured in a modified constant routine protocol. Nat Sci Sleep, 1, 1-8.
46.Lakka, H. M., Laaksonen, D. E., Lakka, T. A., Niskanen, L. K., Kumpusalo, E., Tuomilehto, J., & Salonen, J. T. (2002). The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. Jama, 288(21), 2709-2716.
47.Laposky, A. D., Bass, J., Kohsaka, A., & Turek, F. W. (2008). Sleep and circadian rhythms: key components in the regulation of energy metabolism. FEBS Lett, 582(1), 142-151. doi:10.1016/j.febslet.2007.06.079
48.Lee, J., Choi, Y. S., Jeong, Y. J., Lee, J., Kim, J. H., Kim, S. H., . . . Jeon, T. H. (2013). Poor-quality sleep is associated with metabolic syndrome in Korean adults. Tohoku J Exp Med, 231(4), 281-291.
49.Liu CS, H. Y., Liao PT, Lin CC, Li TC, Yeh CC. (2012). The risk factors of metabolic syndrome. . Journal of Chang Gung Institute of Technology, 16, 1-14.
50.Lucassen, E. A., Zhao, X., Rother, K. I., Mattingly, M. S., Courville, A. B., de Jonge, L., . . . Cizza, G. (2013). Evening chronotype is associated with changes in eating behavior, more sleep apnea, and increased stress hormones in short sleeping obese individuals. PLoS One, 8(3), e56519. doi:10.1371/journal.pone.0056519
51.Masulli, M., & Vaccaro, O. (2006). Association between cigarette smoking and metabolic syndrome. Diabetes Care, 29(2), 482; author reply 482-483.
52.McBurnett, K., Lahey, B. B., Rathouz, P. J., & Loeber, R. (2000). Low salivary cortisol and persistent aggression in boys referred for disruptive behavior. Arch Gen Psychiatry, 57(1), 38-43.
53.Meijer, A. M., Habekothe, H. T., & Van Den Wittenboer, G. L. (2000). Time in bed, quality of sleep and school functioning of children. J Sleep Res, 9(2), 145-153.
54.Merikanto, I., Kronholm, E., Peltonen, M., Laatikainen, T., Lahti, T., & Partonen, T. (2012). Relation of chronotype to sleep complaints in the general Finnish population. Chronobiol Int, 29(3), 311-317. doi:10.3109/07420528.2012.655870
55.Merikanto, I., Lahti, T., Puolijoki, H., Vanhala, M., Peltonen, M., Laatikainen, T., . . . Partonen, T. (2013). Associations of chronotype and sleep with cardiovascular diseases and type 2 diabetes. Chronobiol Int, 30(4), 470-477. doi:10.3109/07420528.2012.741171
56.Mottillo, S., Filion, K. B., Genest, J., Joseph, L., Pilote, L., Poirier, P., . . . Eisenberg, M. J. (2010). The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. Journal of the American College of Cardiology, 56(14), 1113-1132.
57.Natale, V., Ballardini, D., Schumann, R., Mencarelli, C., & Magelli, V. (2008). Morningness–eveningness preference and eating disorders. Personality and Individual Differences, 45(6), 549-553.
58.Nguyen, J., & Wright, K. P., Jr. (2010). Influence of weeks of circadian misalignment on leptin levels. Nat Sci Sleep, 2, 9-18.
59.Okubo, N., Matsuzaka, M., Takahashi, I., Sawada, K., Sato, S., Akimoto, N., . . . Nakaji, S. (2014). Relationship between self-reported sleep quality and metabolic syndrome in general population. BMC Public Health, 14, 562. doi:10.1186/1471-2458-14-562
60.Pabst, S. R., Negriff, S., Dorn, L. D., Susman, E. J., & Huang, B. (2009). Depression and anxiety in adolescent females: the impact of sleep preference and body mass index. J Adolesc Health, 44(6), 554-560. doi:10.1016/j.jadohealth.2008.11.012
61.Pajer, K., Gardner, W., Rubin, R. T., Perel, J., & Neal, S. (2001). Decreased cortisol levels in adolescent girls with conduct disorder. Arch Gen Psychiatry, 58(3), 297-302.
62.Park, Y. W., Zhu, S., Palaniappan, L., Heshka, S., Carnethon, M. R., & Heymsfield, S. B. (2003). The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med, 163(4), 427-436.
63.Rajaratnam, S. M., & Arendt, J. (2001). Health in a 24-h society. Lancet, 358(9286), 999-1005. doi:10.1016/s0140-6736(01)06108-6
64.Regitz-Zagrosek, V., Lehmkuhl, E., & Weickert, M. O. (2006). Gender differences in the metabolic syndrome and their role for cardiovascular disease. Clin Res Cardiol, 95(3), 136-147. doi:10.1007/s00392-006-0351-5
65.Reutrakul, S., Hood, M. M., Crowley, S. J., Morgan, M. K., Teodori, M., Knutson, K. L., & Van Cauter, E. (2013). Chronotype is independently associated with glycemic control in type 2 diabetes. Diabetes Care, 36(9), 2523-2529. doi:10.2337/dc12-2697
66.Roehrs, T., & Roth, T. (2008). Caffeine: sleep and daytime sleepiness. Sleep Med Rev, 12(2), 153-162. doi:10.1016/j.smrv.2007.07.004
67.Roenneberg, T., Kuehnle, T., Juda, M., Kantermann, T., Allebrandt, K., Gordijn, M., & Merrow, M. (2007). Epidemiology of the human circadian clock. Sleep Med Rev, 11(6), 429-438. doi:10.1016/j.smrv.2007.07.005
68.Roeser, K., Obergfell, F., Meule, A., Vogele, C., Schlarb, A. A., & Kubler, A. (2012). Of larks and hearts--morningness/eveningness, heart rate variability and cardiovascular stress response at different times of day. Physiol Behav, 106(2), 151-157. doi:10.1016/j.physbeh.2012.01.023
69.Sabanayagam, C., Zhang, R., & Shankar, A. (2012). Markers of Sleep-Disordered Breathing and Metabolic Syndrome in a Multiethnic Sample of US Adults: Results from the National Health and Nutrition Examination Survey 2005-2008. Cardiol Res Pract, 2012, 630802. doi:10.1155/2012/630802
70.Saleh, D. K., Nouhi, S., Zandi, H., Lankarani, M. M., Assari, S., & Pishgou, B. (2008). The quality of sleep in coronary artery disease patients with and without anxiety and depressive symptoms. Indian Heart J, 60(4), 309-312.
71.Santos, A. C., Ebrahim, S., & Barros, H. (2007). Alcohol intake, smoking, sleeping hours, physical activity and the metabolic syndrome. Prev Med, 44(4), 328-334. doi:10.1016/j.ypmed.2006.11.016
72.Sato-Mito, N., Shibata, S., Sasaki, S., & Sato, K. (2011). Dietary intake is associated with human chronotype as assessed by both morningness-eveningness score and preferred midpoint of sleep in young Japanese women. Int J Food Sci Nutr, 62(5), 525-532. doi:10.3109/09637486.2011.560563
73.Scheer, F. A., Hilton, M. F., Mantzoros, C. S., & Shea, S. A. (2009). Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci U S A, 106(11), 4453-4458. doi:10.1073/pnas.0808180106
74.Schlesselman, J. J. (1982). Case-control studies: design, conduct, analysis: Oxford University Press.
75.Schubert, E., & Randler, C. (2008). Association between chronotype and the constructs of the Three-Factor-Eating-Questionnaire. Appetite, 51(3), 501-505. doi:10.1016/j.appet.2008.03.018
76.Shanmugam, V., Wafi, A., Al-Taweel, N., & Büsselberg, D. (2013). Disruption of circadian rhythm increases the risk of cancer, metabolic syndrome and cardiovascular disease. Journal of Local and Global Health Science(2013), 3.
77.Sharma, S., & Kavuru, M. (2010). Sleep and metabolism: an overview. Int J Endocrinol, 2010. doi:10.1155/2010/270832
78.Siegel, J. M. (2003). Why we sleep. Sci Am, 289(5), 92-97.
79.Sigurdson, K., & Ayas, N. T. (2007). The public health and safety consequences of sleep disorders. Can J Physiol Pharmacol, 85(1), 179-183. doi:10.1139/y06-095
80.Spiegel, K., Knutson, K., Leproult, R., Tasali, E., & Van Cauter, E. (2005). Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol (1985), 99(5), 2008-2019. doi:10.1152/japplphysiol.00660.2005
81.Spiegel, K., Leproult, R., & Van Cauter, E. (1999). Impact of sleep debt on metabolic and endocrine function. Lancet, 354(9188), 1435-1439. doi:10.1016/s0140-6736(99)01376-8
82.Spiegel, K., Tasali, E., Penev, P., & Van Cauter, E. (2004). Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med, 141(11), 846-850.
83.Staels, B. (2006). When the Clock stops ticking, metabolic syndrome explodes. Nat Med, 12(1), 54-55; discussion 55. doi:10.1038/nm0106-54
84.Su, T. P., Huang, S. R., & Chou, P. (2004). Prevalence and risk factors of insomnia in community-dwelling Chinese elderly: a Taiwanese urban area survey. Aust N Z J Psychiatry, 38(9), 706-713. doi:10.1080/j.1440-1614.2004.01444.x
85.Sun, K., Ren, M., Liu, D., Wang, C., Yang, C., & Yan, L. (2014). Alcohol consumption and risk of metabolic syndrome: a meta-analysis of prospective studies. Clin Nutr, 33(4), 596-602. doi:10.1016/j.clnu.2013.10.003
86.Takahashi, J. S., Hong, H. K., Ko, C. H., & McDearmon, E. L. (2008). The genetics of mammalian circadian order and disorder: implications for physiology and disease. Nat Rev Genet, 9(10), 764-775. doi:10.1038/nrg2430
87.Taub, J. M., & Berger, R. J. (1973). Performance and mood following variations in the length and timing of sleep. Psychophysiology, 10(6), 559-570.
88.Tsai, P. S., Wang, S. Y., Wang, M. Y., Su, C. T., Yang, T. T., Huang, C. J., & Fang, S. C. (2005). Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res, 14(8), 1943-1952. doi:10.1007/s11136-005-4346-x
89.Van Cauter, E., Polonsky, K. S., & Scheen, A. J. (1997). Roles of circadian rhythmicity and sleep in human glucose regulation. Endocr Rev, 18(5), 716-738. doi:10.1210/edrv.18.5.0317
90.Vink, J. M., Groot, A. S., Kerkhof, G. A., & Boomsma, D. I. (2001). Genetic analysis of morningness and eveningness. Chronobiol Int, 18(5), 809-822.
91.Wittmann, M., Dinich, J., Merrow, M., & Roenneberg, T. (2006). Social jetlag: misalignment of biological and social time. Chronobiol Int, 23(1-2), 497-509. doi:10.1080/07420520500545979
92.Wu, M. C., Yang, Y. C., Wu, J. S., Wang, R. H., Lu, F. H., & Chang, C. J. (2012). Short sleep duration associated with a higher prevalence of metabolic syndrome in an apparently healthy population. Prev Med, 55(4), 305-309. doi:10.1016/j.ypmed.2012.07.013
93.Yen, A. M., Chiu, Y. H., Chen, L. S., Wu, H. M., Huang, C. C., Boucher, B. J., & Chen, T. H. (2006). A population-based study of the association between betel-quid chewing and the metabolic syndrome in men. Am J Clin Nutr, 83(5), 1153-1160.
94.Yu, J. H., Yun, C. H., Ahn, J. H., Suh, S., Cho, H. J., Lee, S. K., . . . Kim, N. H. (2015). Evening chronotype is associated with metabolic disorders and body composition in middle-aged adults. J Clin Endocrinol Metab, 100(4), 1494-1502. doi:10.1210/jc.2014-3754
95.Zimmet, P., Magliano, D., Matsuzawa, Y., Alberti, G., & Shaw, J. (2005). The metabolic syndrome: a global public health problem and a new definition. Journal of atherosclerosis and thrombosis, 12(6), 295-300.
96.行政院主計處. (2005). 台灣地區社會發展趨勢調查報告. Retrieved from https://www.dgbas.gov.tw/lp.asp?CtNode=4793&CtUnit=1308&BaseDSD=7&mp=1
97.周舒翎. (2008). 高中生睡眠型態與學業表現的關係. 國立政治大學心理學研究所碩士論文.
98.黃鈺理. (2009). 高職生及其相關因子. 國立陽明大學 臨床社區暨研究所.
99.衛生福利部國民健康署. (2007). 代謝症候群之判定標準(2007台灣). Retrieved from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=639&pid=1219
100.衛生福利部國民健康署. (2012). 2007年台灣地區高血壓、高血糖、高血脂之追蹤調查研究報告. Retrieved from http://www.hpa.gov.tw/File/Attach/1243/File_1005.pdf
101.衛生福利部統計處. (2015). 103年度全民健康保險醫療統計年報. Retrieved from http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=312&fod_list_no=5692