| 摘要: | 引言: 印尼十五歲及以上人口中罹患憂鬱症的年發病率持續上升，凸顯了解決這個問題的迫切性。睡眠品質、睡眠時數和睡眠時型等睡眠相關變量，與憂鬱症的發展有關，這強調了瞭解這些變量之間的關聯性對社區內有效預防策略的重要性。然而，在印尼很少有研究將睡眠品質(同時考慮睡眠時數)與憂鬱症風險進行比較。此外，心率變異性(Heart Rate Variability, HRV) 已被視為壓力和睡眠指標。考慮到音樂療法在促進HRV和提高睡眠品質方面的潛力，值得注意的是，印尼的傳統甘美朗音樂，具有作為治療工具的潛力。儘管如此，目前尚未有研究評估甘美朗音樂對心率變異性和睡眠品質的影響。
目的: 本研究目的為探討與憂鬱症相關的因素，並考慮所有年齡組別的睡眠品質與睡眠時數的關係，此外，本研究試圖使用統合分析方法(meta-analysis approach)探討青少年睡眠時數、睡眠時型和憂鬱症之間的關聯。同時，本研究目的亦包括評估甘美朗音樂介入對年輕人心率變異性和睡眠質量的影響。
方法: 本研究分兩個階段。第一階段包含兩個步驟，第一步驟為橫斷面研究分析 “印度尼西亞家庭生活調查(Indonesian Family Life Survey, IFLS) 次級資料庫，使用多變量邏輯回歸分析憂鬱症的風險，並使用多項式邏輯回歸分析與睡眠時數有關的較差睡眠品質的風險。
第二步驟使用縱貫性的統合分析方法，探討睡眠時數、睡眠時型和憂鬱症之間的關聯。 於於2022年5月，對Ebsco、Embase、Medline、PubMed、PsycInfo、Scopus電子資料庫進行電子檢索，並對相關文章進行人工篩選。統計結果以運用隨機效應模型計算的勝算比(OR)和 95%信賴區間 (95%CI)呈現。第二階段採用隨機對照試驗於探討甘美朗音樂介入對心率變異性和睡眠品質的影響。結果指標在基線(T0)、第一天(T1)、第二天(T2)、第三天(T3)、第四天(T4)和介入結束的隔一天(T5)進行測量。使用廣義估計方程 (GEE) 比較不同組別的心率變異性結果，並使用共變異數分析(ANCOVA)評估睡眠品質。
結果: 第一階段研究發現，睡眠品質差(OR = 4.2; 95%CI: 3.7, 4.6)比長睡眠時數(OR = 1.4; 95%CI: 1.2, 1.6)有更高的憂鬱風險。性別、年齡、婚姻狀況、教育水平、財務指數、活動水平、慢性病、季節以及城市地區等變項與印尼人口中較差睡眠品質的風險顯著相關(p < 0.05)。此外，與憂鬱症相關的變量為晚睡眠時型(OR=1.24; 95%CI: 1.08-1.42)和短睡眠時數(OR= 1.14; 95%CI: 1.03-1.26)，但與長睡眠時數無關(OR= 0.98; 95%CI: 0.84-1.13)。平日的短睡眠時數(OR= 1.18; 95%CI: 1.07, 1.3)和周末的短睡眠時數(OR= 1.3; 95%CI: 1.18, 1.47),，以及周末的長睡眠時數(OR= 1.15; 95%CI: 1.06, 1.25)與憂鬱症狀顯著相關。然而，每週平均短睡眠時數(OR= 1.09; 95%CI: 0.9, 1.3)和平日的長睡眠時數(OR= 0.95; 95%CI: 0.81, 1.12)與憂鬱症狀無顯著相關。
第二階段研究發現，與對照組和基線測量相比，甘美朗音樂介入對心率變異性的各項生理指標產生影響，該介入在以下指標具有顯著影響效果： SDNN在T4(B=8.85; 95%CI: 1.58, 16.12)和T5(B= 11.81; 95%CI: 3.71, 19.91)； HR在T3(B= -5.43; 95%CI: -8.48, -2.39)、T4(B=-4.81; 95%CI: -8.79, -0.83)和T5 (B=-5.65; 95%CI: -10.31, -1)； LF在T4(B=-0.78; 95%CI: -1.18, -0.38)、T5 (B=-0.51; 95%CI: -0.92, -0.08)； LF%在T4 (B= -0.26; 95%CI: -.0.45, -0.07)、T5 (B=-0.30; 95%CI: -0.50, -0.09); HF在T4 (B=-0.49, 95%CI: -0.89, -0.08)、T5 (B=-0.63; 95%CI: -1.02, -0.24)； 以及LF/HF在T5 (B= -0.58; 95% CI -1.06, -0.09)。此外，甘美朗音樂介入對主觀睡眠品質、睡眠時數、日間功能障礙分數和PSQI總分有顯著影響(p<0.05)。
結論：睡眠品質和睡眠時數與憂鬱症相關。憂鬱症亦與晚睡和短睡眠時數有顯著相關，但與長睡眠時數則無關。此外，平日的短睡眠時數和周末的短睡眠時數，以及周末的長睡眠時數與憂鬱症狀顯著相關。然而，每週平均短睡眠時數和平日的長睡眠時數則與憂鬱症狀無相關。相較於甘美朗音樂(中音調、複雜節奏、長發聲、大音量、弱音色、快節奏)，甘美朗音樂(低音調、中節奏、短發聲、中音量、中音色、中節奏)可有效改善心率變異性相關指標，包括在第四次測量(T4)時改善SDNN、HR、LF、LF%和HF，以及第五次測量(T5)時改善的LF/HF和睡眠品質。
Introduction: The annual incidence of depression among Indonesians aged fifteen and above is steadily rising, highlighting the urgency to address this pressing issue. Sleep variables, such as sleep quality, duration, and chronotype, have been implicated in the development of depression, emphasizing the importance of understanding their interconnectedness for effective prevention strategies within the community. However, few studies compared sleep quality while considering sleep duration to the risk of depression in Indonesia. Furthermore, Heart Rate Variability (HRV), has been observed as a stress and sleep indicator on numerous occasions. Recognizing the potential of music therapy to promote HRV and enhance sleep quality, it is worth noting that Indonesia's Gamelan music tradition, which holds promise as a therapeutic tool. Despite this, no previous study has assessed Gamelan music’s effect on HRV and sleep quality. Objectives: The purpose of the study was to explore the factors that related to depression, and examine the factors associated with sleep quality while considering sleep duration across all age groups. The study also tried to investigate the association between sleep duration, chronotype, and depression in adolescents with meta-analysis approach. Furthermore, the purpose was to examine the effect of Gamelan music intervention on HRV and sleep quality in young adult. Methods: To attain the objectives, the study conducted in 2 phases. The first phase had 2 steps, the first step was conducted with cross-sectional approach from secondary dataset “Indonesian Family Life Survey”, the risk of depression was examined using multivariate logistic regression, and the risk of poor sleep quality with regard to sleep duration was examined using multinomial logistic regression. A meta-analysis of longitudinal studies was used in the second step to investigate an association among sleep duration, chronotype, and depression. In May 2022, electronic searches of the Ebsco, Embase, Medline, PubMed, PsycInfo, and Scopus electronic databases were conducted, and relevant articles were manually screened. The statistical results are presented in the form of odds ratios (OR) with 95% confidence intervals (95%CI) calculated using a random-effects model. The second phase, randomized controlled trial was used to examine the effect of Gamelan music intervention on HRV and sleep quality. Outcome were measured at the baseline (T0), first day (T1), second day (T2), third day (T3), fourth day (T4), and one day after the last intervention (T5). The outcomes of HRV were compared between groups by using generalized estimating equations (GEE), and ANCOVA for the sleep quality. Results: The first phase of the study found that poor sleep quality associated with a higher risk of depression (OR = 4.2; 95%CI: 3.7, 4.6) than long sleep duration (OR = 1.4; 95%CI: 1.2, 1.6). Gender, age, marital status, level of education, financial index, activity level, chronic medical condition, season, and as well as urban area were found to be variables which substantially raised the risk of poor sleep quality in Indonesian population (p < 0.05). Furthermore, the variables that had correlation to depression were eveningness (OR=1.24; 95%CI: 1.08-1.42), and short sleep duration (OR= 1.14; 95%CI: 1.03-1.26), but not for the long sleep duration (OR= 0.98; 95%CI: 0.84-1.13). Short sleep durations on weekday (OR= 1.18; 95%CI: 1.07, 1.3) and weekend (OR= 1.3; 95%CI: 1.18, 1.47), moreover long sleep duration on weekend (OR= 1.15; 95%CI: 1.06, 1.25) were significantly correlated with depressive symptoms, whereas short weekly average (OR= 1.09; 95%CI: 0.9, 1.3) and long weekday (OR= 0.95; 95%CI: 0.81, 1.12) sleep durations were not. The second phase of the study found that, compared to control group and baseline measurement, Gamelan music intervention had an effect in the group and time for SDNN at time 4 (B=8.85; 95%CI: 1.58, 16.12) and 5 (B= 11.81; 95%CI: 3.71, 19.91); HR at time 3 (B= -5.43; 95%CI: -8.48, -2.39), 4 (B=-4.81; 95%CI: -8.79, -0.83), and 5 (B=-5.65; 95%CI: -10.31, -1); LF at time 4 (B=-0.78; 95%CI: -1.18, -0.38) and 5 (B=-0.51; 95%CI: -0.92, -0.08); LF% at time 4 (B= -0.26; 95%CI: -.0.45, -0.07) and 5 (B=-0.30; 95%CI: -0.50, -0.09); HF at time 4 (B=-0.49, 95%CI: -0.89, -0.08) and 5 (B=-0.63; 95%CI: -1.02, -0.24); and LF/HF at time 5 (B= -0.58; 95% CI -1.06, -0.09). Moreover, Gamelan music intervention had a significant effect to the subjective sleep quality, sleep duration, daytime disfunction score, and total PSQI global score (p<0.05).
Conclusion: Sleep quality and duration were found to be related to depression. Depression also found significantly correlated with eveningness and short sleep durations, but not with long sleep durations, moreover short weekday and weekday sleep duration, and long sleep duration on weekend were significantly correlated with depressive symptoms, whereas short weekly average and long weekday sleep durations were not. Compared with Gamelan music (middle pitch, complicated rhythm, long articulation, loud volume, weak timbre, and fast tempo), Gamelan music intervention (low pitch, mid rhythm, short articulation, mid volume, mid timbre, and mid-tempo) was effective in improving the HRV parameters such as SDNN, HR, LF, LF%, and HF at minimum time 4, and LF/HF at time 5 and sleep quality. |
