研究背景
當女性邁入老年前，會先經歷一段多面向及多變化的中年階段。並且，中年期是老年階段的重要準備期，若能提前識別出健康變化的跡象，將能有效延伸初級預防的範圍。晝夜節律調控著人體各機能運作，維持晝夜節律的規律性對健康甚為重要，本研究以客觀數據探討中年女性在更年期及不同心理、信念與行為的交織影響下，其晝夜節律之面貌，試圖找尋女性在不同更年期階段之個體差異間，不同的心理行為健康促進建議。

研究目的
探討在不同更年期階段的45至60歲女性的心理行為因子及晝夜節律的分布狀況為何，以及驗證心理行為因子如何影響及調節不同更年期階段女性的晝夜節律。

研究方法
本研究為橫斷面的探索性研究，資料收集方式採用調查研究法。以方便取樣及滾雪球方式在社區及婦科診所招募 45 至 60 歲女性。利用結構式問卷收集更年期階段、六類心理行為 (包含：孤獨感、憂鬱、藥物信念、主觀年齡、運動頻率、社會參與)、社會人口學、健康狀況及更年期相關變項，並連續配戴七日的腕戴式體動記錄儀收集休息–活動數據，呈現晝夜節律與睡眠樣貌，數值包含測量活動量的MESOR、夜間活動量、日間活動量、相對振幅；測量24小時晝夜節律規則與片斷化程度的每日穩定度、每日變異度；測量睡眠狀況的睡眠延遲時間、入睡後清醒時間、總清醒時間、總睡眠時間、睡眠效能。受試者依照自評月經週期狀態被分類為為四組更年期階段：週期規則、週期不規則、停經三年內、停經超過三年以進行資料分析。分析方法採用巢狀模型多元線性迴歸與獨立樣本二因子變異數分析。

研究結果
本研究已有完成問卷及配戴五日 (7200分鐘) 為有效樣本，共87位 (81.3%)。其中，週期規則組28位 (32.2%)；週期不規則組14位 (16.1%)；停經三年內組14位 (16.1%)；停經超過三年組31位 (35.6%)。結果顯示：
(1) 相對於女性尚在經期規則的階段，在進入更年期後，相對振幅及每日穩定度會顯著提升。
(2) 更年期症狀愈嚴重，將使得睡眠效能降低、睡眠延遲時間與總清醒時間延長。
(3) 憂鬱程度愈高者，有較低的睡眠效能 (p= .015)，以及睡眠延遲時間 (p= .034) 與總清醒時間 (p= .010) 增加的現象；孤獨感程度較高，有較穩定的晝夜節律趨勢 (p= .062)。
(4) 較低的運動頻率與較低的每日穩定度顯著相關 (p= .046)； 無固定社會參與者則發現每日穩定度較高 (p= .039)。
(5) 整體而言，感到自身心境年齡愈衰老者，有相對振幅愈低 (p= .075)；睡眠效能愈低 (p= .085)；睡眠延遲時間愈長 (p= .065) 的趨勢。區分停經前後則可發現，心境年齡較年輕者，在停經前有較高的每日穩定度 (M= 0.58 vs 0.49, p= .042)；在停經後則有較短的睡眠延遲時間 (M= 17.50 vs 34.72分鐘, p= .024)。
(6) 在停經前的更年期階段與心理行為因子的交互作用中，社會參與為停經前女性的睡眠效能有效的調節因子：週期規則的女性無論社會參與與否，睡眠效能相似 (M= 85.05 vs 85.27%, p= .919)，而週期不規則的女性，有社會參與者的睡眠效能顯著減少 (M= 76.64 vs 85.50%, p= .006)。
(7) 在停經後的更年期階段與心理行為因子的交互作用中，孤獨感及憂鬱程度為停經後女性每日穩定度的調節因子：比起較不孤獨或憂鬱的女性，較高孤獨感或憂鬱的女性，在停經三年內有較高的每日穩定度，但此差距在停經超過三年後縮小。另外，憂鬱程度亦為停經階段與女性睡眠延遲時間相關的調節因子，高憂鬱者在停經超過三年，其睡眠延遲時間較停經三年內者增加 (M= 48.90 vs 8.00分鐘, p= .014)；但低憂鬱者其睡眠延遲狀況則隨更年期時間拉長，睡眠延遲時間有減少的趨勢 (M= 16.55 vs 23.96分鐘, p= .241)。

結論
本研究支持中年女性的睡眠品質並不完全根據更年期的來臨而有負面影響，了解其更年期的症狀嚴重度及憂鬱狀況才是改善睡眠品質的關鍵。此外，此階段若保有年輕的心（即自評心境較年輕）對晝夜節律與睡眠品質皆有幫助，運動習慣也有助於增進晝夜節律的穩定。社會參與對更年期過渡階段的女性不見得為保護因子；對停經後女性而言，改善孤獨感及憂鬱情況，有助於提升較好的晝夜節律及睡眠品質。顯示在不同更年期階段的女性保健上，我們應多加聯結心理行為因子的影響，給予更個人化的衛教與建議。

Middle age is a significant turning point in life. Yet, at the same time, it is also the preparatory stage of entering old age and a crucial period of healthy aging. However, studies investigating the relationship between psychobehavioral factors and circadian rhythm are scarce. This study aims to examine how psychobehavioral correlates moderate women’s circadian rhythm at different menopausal stages. This is exploratory cross-sectional research. Women at age 45-60 were recruited from community and a gynecology clinic. We used wearable actigraphy recorders to measure circadian rhythm and sleep parameters; questionnaires to assess sociodemographic characteristics, health status, menopausal factors, and six psychobehavioral variables. The findings showed that: Women with severer depressive symptoms had significantly lower levels of sleep efficiency, longer sleep latency, and longer total wake time. Women with frequent exercise or without social participation had higher levels of interdaily stability. There was an interaction between menopausal stages and loneliness on interdaily stability, also between menopausal stages and depressive symptoms on interdaily stability and sleep latency among postmenopausal women. Furthermore, there was an interaction between menopausal stages and social participation on sleep efficiency among women before menopause. In conclusion, findings from this study provided insight that psychobehavioral factors might be a moderator between menopausal stages and circadian rhythm. We suggested that the influence of psychobehavioral factors should be linked to give more personal health education to women at different menopausal stages.

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