原发性失眠注意偏爱行为的心理学机制研究

Insomnia, with high incidence, is serious damage to harm physical and mental health. Sleep-related attentional bias is defined as the tendency to selectively attend to sleep-related information in comparison to neutral information and has been suggested to represent an important factor for the inability to maintain sleep or fall asleep in patients with chronic insomnia. However, what drives the sleep-related attentional bias is still unclear. One one hand, patients with chronic insomnia strongly crave to get good sleep quality. On the other hand, they showed signs of threat and anxiety in response to sleep-related cues because of the long-term poor sleep quality. Therefore, we hypothesize that the sleep-related attentional bias is associated with the brain areas of both threat hypothesis and craving hypothesis. New memories are highly labile and vulnerable to modulation. Previous study have verified that the fear extinction may be selectively enhanced when re-exposure to the target cue in slow wave sleep. Thus, we utilized synchronous EEG-fMRI to dynamic monitoring electrical physiological and metabolic changes of the brain in response to sleep-related cue in patients with insomnia, by which, we help to find the target brain areas or network index to mirror the sleep-related attentional bias and explore its psychological mechanism. Furthermore, we want to develop a behavioral therapy to promote the fear extinction of sleep-related attentional bias by exposure to a target cue in slow wave sleep, which may be used to improve the sleep quality and thus for treatment for insomnia. It may have great social and economic effect. Meanwhile, we will evaluate the curative effect by exploring the influence from the behavioral therapy on the target brain areas or network index.

失眠发病率高，严重危害身体和心理健康。注意偏爱行为指失眠者过度担心或关注自己的睡眠问题，和其他中性信息相比，更倾向选择性地关注与睡眠相关信息，被认为是难以入睡或维持睡眠的重要原因，但目前机制不清。失眠者一方面渴望睡觉，另一方面对睡觉又非常恐惧。因此，我们假设：睡眠相关信息的注意偏爱行为可能与渴望及恐惧机制相关脑区均有关。新记忆在睡眠中高度不稳定，很容易被修改；既往研究证实睡眠中重新暴露与目标关联线索，可选择性标记恐惧记忆并将其清除。基于此，本项目利用同步EEG-fMRI技术动态监测失眠者在睡眠相关线索刺激时脑的电生理和代谢变化，以期挖掘能反映注意偏爱行为的目标脑区或网络指标，探讨其心理学机制；另外，拟开发一种在睡眠中暴露关联线索用于消除注意偏爱行为相关恐惧记忆的行为学疗法，用来改善睡眠，以期治疗失眠，有望带来一定的社会及经济效应，同时探讨该行为学疗法对目标脑区或网络指标的影响，评估其疗效。

失眠障碍在中国发生率高达38.2%，是心脏病、高血压和肥胖等疾病的风险因素。然而，失眠的神经网络机制并不清楚。我们发现慢性失眠可引起渴望系统、价值相关注意系统、默认网络、执行控制网络、凸显网络等多个功能脑网络的功能异常，这可能是导致失眠的重要原因。另外，失眠患者对睡眠相关线索的注意偏爱程度得分较正常睡眠被试更高。我们发现渴望系统相关网络、执行控制网络、凸显网络等参与失眠后负面情绪的调节，价值相关注意偏向系统相关脑网络参与睡眠调节，这可能是引起失眠的重要风险因素。目前，关于慢性失眠最广泛被接受的病理生理学模型是过度觉醒理论。该理论指出，启动和/或维持睡眠的困难是由于睡眠-觉醒周期中皮质和生理觉醒的全面增加引起的。我们利用静息态功能磁共振成像也证实了这个观点，慢性失眠可能与视觉通路系统相关脑区的过度觉醒有关。以上研究结果对我们阐述失眠发生的机制具有重要的参考价值。此外，我们开发了一个注意偏向系统，用于注意偏向系统的评估，并已申请2个软件著作权。

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