ABSTRACT 抽象的

RESUMO 總結

INTRODUCTION 介紹

Sleep is a special physiological state that occurs cyclically in virtually all living things. Something very similar to sleep has been observed in a rudimentary rest and activity behavior (wake-sleep cycle) in animals as inferior on the zoological scale as insects ¹ . Defining sleep is not a simple task, since some sleep stages show electrophysiological patterns similar to wakefulness when breathing patterns, eye movements, electroencephalogram (EEG), and some body movements are observed, which are completely different from other sleep stages where stillness and slow waves are observed in the EEG.
睡眠是一種特殊的生理狀態，幾乎所有生物都會週期性地發生。在動物學上與昆蟲一樣低等的動物的基本休息和活動行為（覺醒-睡眠週期）中觀察到了與睡眠非常相似的東西¹ 。定義睡眠並不是一項簡單的任務，因為某些睡眠階段在觀察呼吸模式、眼球運動、腦電圖（EEG）和一些身體運動時表現出類似於清醒的電生理模式，這與其他睡眠階段的靜止和慢波完全不同在腦電圖中觀察到。

Although there have been an increasing number of studies on the subject recently, the probable role of sleep in our organic functioning has yet to be explored in order to clarify the impacts of this phenomenon on brain function. According to Eugene & Masiak, the neurobiological processes that occur during sleep are necessary for the maintenance of physical and cognitive health in - virtually - all species ² . Sleep, the value of which is ignored by most people, also plays a fundamental role in maintaining higher cognitive functions that is not yet understood by science despite recent advances. In everyday life, sleep affects mood, memory, attention, sensory perception, and reasoning, that is, most of the cognitive aspects that connect people to their environment ³ . Sleep disorders can lead to poor quality of performance and sometimes have serious health consequences.
儘管最近關於這個主題的研究越來越多，但睡眠在我們的有機功能中可能發揮的作用仍有待探索，以闡明這種現象對大腦功能的影響。根據尤金和馬西亞克的說法，睡眠期間發生的神經生物學過程對於維持幾乎所有物種的身體和認知健康都是必要的² 。睡眠的價值被大多數人忽視，但它在維持高階認知功能方面也發揮著重要作用，儘管最近取得了進展，但科學尚未了解這一點。在日常生活中，睡眠會影響情緒、記憶、注意力、感官知覺和推理，即將人們與環境連結的大部分認知面向³ 。睡眠障礙會導致表現品質不佳，有時會造成嚴重的健康後果。

During the sleep cycle, some stages are responsible for rejuvenating and restoring the health of the brain. Generally, sleep is interpreted as an unconscious state, but brain activity continues to operate in its phases, and in a normal/healthy person, sleep is divided into two main phases: phases with non-rapid eye movements and phases with rapid eye movements (represented by NREM and REM, respectively). Recent studies show that the glymphatic system functions like a garbage disposal during NREM sleep, meticulously removing the byproducts of cellular waste ⁴ .

Sleep deprivation affects all parts of the brain separately and independently, and its effects are recurrent issues in patients with sleeplessness or insomnia. For example, the temporal lobe is primarily responsible for speech processing, and patients with insomnia often report slurred speech due to the brain’s inability to process neuronal signals at their best. In NREM sleep, histamine neurotransmitters are also turned off, so that their receptors become sensitive again ² . Therefore, studies often find a correlation between anxiety and partial, or total, sleep deprivation.
睡眠剝奪分別獨立影響大腦的所有部分，其影響是失眠或失眠患者反覆出現的問題。例如，顳葉主要負責言語處理，失眠患者經常報告由於大腦無法以最佳狀態處理神經元訊號而導致言語不清。在 NREM 睡眠中，組織胺神經傳導物質也被關閉，因此它們的受體再次變得敏感² 。因此，研究經常發現焦慮與部分或全部睡眠剝奪之間存在相關性。

The International Classification of Sleep Disorders (ICSD, 3rd edition) lists seven majors categories, while the four major sleep complaints include excessive daytime sleepiness, insomnia, abnormal movements or behaviors during sleep, and inability to fall asleep at the desired time ⁵ . Since a healthy sleep cycle keeps the brain and body healthy, the right conclusion to draw is that sleep disorders can significantly disrupt basic brain functions.
國際睡眠障礙分類（ICSD，第 3 版）列出了七大類，而四大類睡眠疾病包括白天過度嗜睡、失眠、睡眠期間異常運動或行為以及無法在所需時間入睡⁵ 。由於健康的睡眠週期可以保持大腦和身體的健康，因此得出的正確結論是，睡眠障礙會嚴重破壞大腦的基本功能。

Attention is a topic that is widely discussed and studied in science and for which there are many conceptual definitions depending on the theoretical model, including psychology and neuroscience ⁶ .
注意力是科學界廣泛討論和研究的一個主題，根據理論模型，有許多概念定義，包括心理學和神經科學⁶ 。

In the present study, we start from the theoretical concept of neuropsychology that there are four types of ­attention: selective attention, sustained attention, divided attention, and alternate attention. In the context of sleep disorders, attention provides a comprehensive overview of its effects on cognition and the brain ⁷ .
在本研究中，我們從神經心理學的理論概念出發，認為注意力有四種：選擇性注意力、持續注意力、分心和交替注意力。在睡眠障礙的背景下，注意力可以全面概述其對認知和大腦的影響⁷ 。

Hennawy, who has discussed the influence of sleep disorders on Alzheimer’s disease (AD), develops a brief definition for the subtypes of attention used in this paper ⁷ . Selective attention is defined as the ability to focus on a single stimulus while blocking out all other distractions. Sustained attention, on the other hand, is defined as the ability to focus on a specific task for a long period of time. Divided attention is defined as the ability to attend to several tasks simultaneously. Finally, alternating attention or switching attention is the ability to effortlessly switch attention between tasks that require different cognitive demands.
Hennawy 討論了睡眠障礙對阿茲海默症 (AD) 的影響，並為本文中使用的注意力亞型製定了一個簡短的定義⁷ 。選擇性注意力被定義為專注於單一刺激，同時排除所有其他幹擾的能力。另一方面，持續注意力被定義為長時間專注於特定任務的能力。注意力分散被定義為同時處理多項任務的能力。最後，交替注意力或切換注意力是指在需要不同認知需求的任務之間毫不費力地切換注意力的能力。

The impact that sleep disorders may have on attention, particularly the specific types of attention that are most affected, and whether there is such a correlation is not well understood.

Considering the facts mentioned above, and taking into account the importance of studies investigating the association between sleep and attention for future public health research and the lack of studies summarizing the literature on this topic, the aim of this study was to conduct a systematic review that evaluates the relationship between sleep disorders and attentional performance.
考慮到上述事實，並考慮到調查睡眠與注意力之間關係的研究對於未來公共衛生研究的重要性以及缺乏總結該主題文獻的研究，本研究的目的是進行系統性回顧：評估睡眠障礙和注意力表現之間的關係。

METHODS 方法

The search was conducted between December 2020 and February 2021, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This systematic review was conducted in the SciELO, Medline/PubMed, and Cochrane databases within a 10-year period (2011-2020), using productions in both Portuguese and English. The following keywords were used in all databases: “attention and sleep” and “attentional performance and sleep”.
此檢索是在 2020 年 12 月至 2021 年 2 月期間進行的，遵循系統性回顧和薈萃分析首選報告項目 (PRISMA) 的指南。這項系統性回顧是在 10 年內（2011-2020 年）在 SciELO、Medline/PubMed 和 Cochrane 資料庫中進行的，使用葡萄牙語和英語兩種版本。所有資料庫中都使用了以下關鍵字：「注意力和睡眠」和「注意力表現和睡眠」。

The inclusion criteria for this review were: productions from the past 10 years with samples of people aged 18 years or older with sleep disorders, cross-sectional or longitudinal scientific studies that used attentional tests with psychometric evidence of validity and reliability, and productions in Portuguese and/or English. Case reports, literature reviews, and systematic reviews were excluded.
本篇回顧的納入標準是：過去10 年以18 歲或以上患有睡眠障礙的人為樣本的成果、使用注意力測驗以及有效性和可靠性心理測量證據的橫斷面或縱向科學研究，以及葡萄牙語的成果和/或英語。病例報告、文獻回顧和系統性回顧被排除在外。

A total of 1,682 references were found (1,327 in Cochrane, 321 in PubMED, and 34 in SciELO). Of these, 284 were duplicates and were therefore excluded. This left 1,398 references for abstract analysis. Sixty-one articles were selected and retrieved, and after reading the full-text, 15 were finally included (Table 1).
共找到 1,682 篇參考文獻（Cochrane 中 1,327 篇、PubMED 中 321 篇、SciELO 中 34 篇）。其中，284 個是重複的，因此被排除在外。這留下了 1,398 篇參考文獻供摘要分析。篩選檢索文章61篇，閱讀全文後最終納入15篇（表1 ）。

RESULTS

Among the 15 studies included in this review, it was found that the most common reasons for exclusion at this stage were studies of children and adolescents, mainly with Attention Deficit Hyperactivity Disorder (ADHD) (343 studies). These studies are not required to assess the cognitive part of attention because most of them have treated previously diagnosed ADHD. In this way, the disturbance found in attentional performance will influence sleep disorder, and not the other way around. Thus, there is a tendency to study the consequences of ADHD on healthy sleep, but not to do attentional testing. Another common reason for exclusion was pharmacological studies that investigated a specific drug, or the effect of a drug on patients with sleep disorders, but attention tests were not included (359 studies).

Studies selected from all databases for full-text review were subjected to duplication checking, which resulted in the exclusion of 284 studies. Subsequently, another 348 papers were excluded for not containing relevant data for the present study, such as, for example, inducing sleep deprivation in healthy patients. After the entire process of selecting and applying the eligibility criteria, 15 manuscripts were included in this systematic review. The whole process of selection and application of eligibility criteria is shown in the flowchart of the PRISMA Statement in Figure 1.

Open in a separate window

Figure 1. 圖 1.

Flowchart of the review process and study selection.
審查過程和研究選擇的流程圖。

Table 1 provides general information about the 15 studies included in this review, ordered by date of publication. The samples were from seven different nationalities: 4 Brazilian, 3 American, 3 Chinese, 1 Dutch, 1 Canadian, 1 Iranian, 1 Swedish, and 1 Italian. The studies were uniformly published between 2011 and 2020, and the 15 publications have a cross-sectional and/or longitudinal design.
表 1提供了本綜述中 15 項研究的一般信息，按發表日期排序。這些樣本來自七個不同的國籍：4 名巴西人、3 名美國人、3 名中國人、1 名荷蘭人、1 名加拿大人、1 名伊朗人、1 名瑞典人和 1 名義大利人。這些研究在 2011 年至 2020 年期間統一發表，這 15 篇出版物具有橫斷面和/或縱向設計。

The sleep disorders found were: insomnia (4), obstructive sleep apnea (OSA) (6), sleep deprivation (SP) (3), idiopathic REM sleep behavior disorder (iRBD) (1), and narcolepsy (1). Based on the samples, parameters such as the variety of sleep pathologies, the selection of tests for application, the duration of the intervention, and the sample size were analyzed.

Of the six studies that analyzed obstructive sleep apnea, only three performed polysomnographic testing, and, in addition, three others performed the Mini Mental State Examination (MMSE), a brief 30-item questionnaire used to screen for cognitive impairment. In three of these studies, Stroop Color Word Tests (SCWT) were also administered to assess selective attention, ability to maintain focus on an activity, and speed of information processing. Four articles used the Psychomotor Vigilance Test (PVT), a task that involves sustained attention and reaction time and measures the speed with which individuals respond to a visual stimulus. Five of the fifteen articles found used the Pittsburgh Sleep Quality Inventory (PSQI), which refers to sleep quality in the past month, and provides an index of severity and nature of disorder. Seven used the Epworth Sleepiness Scale (ESS), which is a more specific assessment of sleepiness, and ranges from 0 to 24, with excessive sleepiness characterized for scores above 10.
在分析阻塞性睡眠呼吸中止症的六項研究中，只有三項進行了多導睡眠圖測試，此外，另外三項進行了簡易精神狀態檢查（MMSE），這是一項包含30 項的簡短調查問卷，用於篩檢認知障礙。在其中三項研究中，也進行了斯特魯普色字測驗（SCWT）來評估選擇性注意力、保持專注於某項活動的能力以及資訊處理的速度。四篇文章使用了精神運動警覺性測驗（PVT），這項任務涉及持續的注意力和反應時間，並測量個體對視覺刺激的反應速度。發現的 15 篇文章中有 5 篇使用了匹茲堡睡眠品質量表 (PSQI)，該量表指的是過去一個月的睡眠質量，並提供了疾病嚴重程度和性質的指數。七人使用 Epworth 嗜睡量表 (ESS)，這是對嗜睡的更具體的評估，範圍從 0 到 24，得分超過 10 則表示過度嗜睡。

As can be seen from Table 1, the studies do not indicate a strong bias toward the use of any specific test of attention; they simply show that they test more sustained and selective attention. It was also not possible to determine a mean or mode of the attention test results, since it comes from different sleep disorders and this correlation would not be reliable or strong. However, it should be noted that 40% of the studies used the Pittsburgh scale to assess sleep quality, and of the six articles that used PSQI, five of them assessed sustained attention.
從表 1可以看出，這些研究並沒有顯示對使用任何特定的注意力測驗有強烈的偏見；它們只是表明他們測試的是更持久和有選擇性的注意力。也不可能確定注意力測試結果的平均值或模式，因為它來自不同的睡眠障礙，而這種相關性不可靠或不強。但值得注意的是，40%的研究使用匹茲堡量表來評估睡眠質量，而在使用PSQI的六篇文章中，其中五篇評估了持續注意力。

DISCUSSION 討論

Sleep disorders are highly heterogeneous in terms of their causative factors, clinical presentation, and morbidity, making knowledge of the neurological aspects of sleep and the most common sleep disorders essential for a better understanding of the phenomenon. The presence of a sleep disorder correlates with decreased alertness and difficulty in maintaining focus ⁸ .
睡眠障礙在病因、臨床表現和發病率方面具有高度異質性，因此了解睡眠的神經學方面和最常見的睡眠障礙對於更好地理解這種現象至關重要。睡眠障礙的存在與警覺性下降和難以保持注意力有關⁸ 。

This systematic review, therefore, sought to analyze the relationship between sleep disturbance and attentional performance and which type of attention is more impacted or not according to the results of this study. In its most general form, attention can be described as a general level of alertness or the ability to engage with the environment. Likewise, this study focused on the types of attention most commonly described in neuropsychology, namely selective attention, sustained attention, divided attention, and alternate attention. The selected articles sought to answer how sleep disorders such as insomnia, obstructive sleep apnea, narcolepsy, and others impact some of these types of attention.
因此，本系統綜述旨在分析睡眠障礙與注意力表現之間的關係，以及根據本研究的結果，哪種類型的注意力受到的影響更大。在最一般的形式中，注意力可以被描述為一般的警覺程度或與環境接觸的能力。同樣，這項研究重點關注神經心理學中最常見的注意力類型，即選擇性注意力、持續注意力、分散注意力和交替注意力。所選文章試圖回答失眠、阻塞性睡眠呼吸中止症、發作性睡病等睡眠障礙如何影響其中一些類型的注意力。

Among the fifteen studies found, there seems to be a trend toward tests related to sustained attention. Seven studies examined only sustained attention (46.6%), and two evaluated only selective attention (13.3%). Five papers evaluated both types of attention (33.3%), one of the manuscripts analyzed divided attention and selective attention (6.6%), and none of the papers evaluated alternating attention. A Brazilian study addressed executive functions and used the term ‘executive attention’ to refer to a mechanism of attention called Supervised Attentional System (SAS), which deals with inhibitory control of automatic responses as in the Norman and Shallice’s (1986) model ⁹ . In the present study, we did not consider this concept of attention because it is still discussed by most authors as an executive function skill rather than an attentional skill. It is important to mention that the study of Oliveira et al. (2013) used a type of attention test that can include divided attention, as it is described as “complex attention” or attention as an assessable unit (Table 2) ¹⁰ .
在發現的十五項研究中，似乎存在著與持續注意力相關的測試的趨勢。七項研究僅評估持續注意力（46.6%），兩項研究僅評估選擇性注意力（13.3%）。五篇論文評估了兩種類型的注意力（33.3%），其中一篇論文分析了分割注意力和選擇性注意力（6.6%），沒有一篇論文評估了交替注意力。巴西的一項研究涉及執行功能，並使用術語「執行注意力」來指稱一種稱為監督注意力系統（SAS）的注意力機制，該機制處理自動反應的抑制控制，如Norman 和Shallice（ 1986）的模型⁹所示。在本研究中，我們沒有考慮注意力這個概念，因為大多數作者仍然將其視為執行功能技能而不是注意力技能。值得一提的是，奧利維拉等人的研究。 (2013) 使用了一種可以包括分散注意力的注意力測試，因為它被描述為「複雜注意力」或作為可評估單位的注意力（表 2 ） ¹⁰ 。

Among the studies that addressed sleep disorders and tested sustained attention, there was no preference in the tests chosen for evaluation. Of the twelve studies, four used the Psychomotor Vigilance Test (PVT), three used the Mini Mental State Examination (MMSE), which is only a cognitive screening test, two used the Attention Network Test (ANT) and two used the D2 Attention Test. There was also a study by Li et al. (2016) ¹¹ that evaluated sustained attention using the Dot-Probe Test (DT) to assess the applicability of this test in an online context, which may be a trend for future studies as these tools are needed in times of social isolation and COVID-19.
在解決睡眠障礙並測試持續注意力的研究中，選擇用於評估的測試沒有偏好。在這12 項研究中，4 項使用了精神運動警覺測試(PVT)，3 項使用了簡易精神狀態檢查(MMSE)，這只是一種認知篩選測試，2 項使用了注意力網絡測試(ANT )，2 項使用了D2 注意力測試。 Li等人也進行了一項研究。 (2016) ¹¹使用點探針測試 (DT) 評估持續注意力，以評估該測試在線上環境中的適用性，這可能是未來研究的趨勢，因為在社會隔離和新冠疫情時期需要這些工具。 .

It is interesting to note that the impact of sleep disorders on sustained attention is notorious. In the study by Waggoner et al. ¹² , which observed changes in the nighttime habits of police officers, the PVT test demonstrated twice as many lapses of attention in sleep-deprived individuals compared to the control group. This study contrasts interestingly with two other studies in this review, by Niu and Oliveira, which evaluated the caregivers (in China and Brazil, respectively). The results of the sustained attention tests show an average deficit of 25% in the mean score of the Stroop Color Word Test (SCWT) and 14.8% in the Digit Symbol Substitution Test (DSST) ^{10 , 11 , 12 , 13} .
有趣的是，睡眠障礙對持續注意力的影響是眾所周知的。在瓦格納等人的研究中。 ¹²觀察了警察夜間習慣的變化，PVT 測試顯示，與對照組相比，睡眠不足的人注意力不集中的情況是對照組的兩倍。這項研究與本綜述中由 Niu 和 Oliveira 進行的另外兩項研究形成了有趣的對比，這兩項研究評估了護理人員（分別在中國和巴西）。持續注意力測驗的結果顯示，斯特魯普色詞測驗 (SCWT) 的平均分數平均落後 25%，數字符號替換測驗 (DSST) 的平均分數平均落後 14.8% ^{10 , 11 , 12 , 13} 。

Six of the fifteen studies selected in this review addressed OSA and all evaluated sustained attention, providing categorical results. Four of these studies performed some type of intervention, such as double-blind placebo-controlled trials and controlled clinical trials. An interesting contrast is provided by two studies, both conducted in the United States by Djonlagic and Richards, who evaluated the Continuous Positive Airway Pressure (CPAP) treatment, one immediately after the first night of intervention and the second study with follow-ups of 6 months and 1 year after CPAP intervention ^{14 , 15} . Both studies provided robust results on cognitive assessment after the use of CPAP. Djonlagic’s study concluded that OSA patients treated with CPAP on the first night showed immediate improvement in attentional and vigilance performance the next morning based on PVT results, and OSA patients using CPAP in a long-term treatment showed improvement in sleep quality ¹⁴ .
本次綜述中選擇的 15 項研究中有 6 項涉及 OSA，所有研究都評估了持續注意力，並提供了分類結果。其中四項研究進行了某種類型的干預，例如雙盲安慰劑對照試驗和對照臨床試驗。兩項研究提供了一個有趣的對比，這兩項研究均由Djonlagic 和Richards 在美國進行，他們評估了持續性正壓呼吸器(CPAP) 治療，其中一項研究是在第一個晚上進行幹預後立即進行的，第二項研究則^對6 名^患者進行了追蹤。這兩項研究都提供了使用 CPAP 後認知評估的可靠結果。 Djonlagic 的研究得出結論，根據PVT 結果，第一晚接受CPAP 治療的OSA 患者在第二天早上的注意力和警覺性表現立即得到改善，而在長期治療中使用CPAP 的OSA 患者則顯示出睡眠品質的改善¹⁴ 。

A study by Swedish researchers investigated the prevalence of sleep disorders in Public Transport Operators (PTOs) and evaluated the effects of interventions on hypersomnolence and neurocognitive function in individuals diagnosed with OSA ¹⁶ . This study had a satisfactory sample size, performed several examinations (polysomnography, electrocardiography, ANT, CTT, sleep scales, among others), and produced very promising and complete results. Patients diagnosed with an occupational injury during the OSA intervention (59%) were more likely to have an occupational injury than patients without OSA (37%, p<0.08). This study was also based on an intervention for recent diagnoses and demonstrated significant improvements in neurocognitive measures of attention assessed with the Compensatory Tracking Task (CTT) ¹⁷ .
瑞典研究人員進行的一項研究調查了公共交通運輸業者 (PTO) 中睡眠障礙的盛行率，並評估了乾預措施對診斷患有 OSA ¹⁶的個體的嗜睡和神經認知功能的影響。這項研究的樣本量令人滿意，進行了多項檢查（多導睡眠圖、心電圖、ANT、CTT、睡眠量表等），並產生了非常有希望和完整的結果。在 OSA 介入期間診斷為職業傷害的患者 (59%) 比沒有 OSA 的患者 (37%, p<0 id=149> 17 )更有可能發生職業傷害。

It is also noteworthy that four Brazilian studies are included in this review. Two of these studies worked with OSA, one with narcolepsy, and one with sleep deprivation ^{10 , 18 , 19 , 20} . Interestingly, none of the Brazilian studies had an intervention, and with the exception of Oliveira’s study (n=102), the samples were relatively small (average=40). The study by Moraes was the only one that addressed narcolepsy and assessed attention tests ²⁰ . It is important to mention that this study dealt with executive functions, and the test chosen to assess “executive attention” was the Victoria Stroop Test (VST), which may be a way to assess this Executive Function (EF) ²⁰ . However, the study found that the narcolepsy patients performed significantly slower on the tests than the control group and took up to twice as long to perform the VST and TMT-B.
另外值得注意的是，本次綜述中納入了四項巴西研究。其中兩項研究針對 OSA，一項針對發作性睡病，另一項針對睡眠剝奪^{10 , 18 , 19 , 20} 。有趣的是，巴西的研究都沒有乾預，而且除了奧利維拉的研究（n=102）之外，樣本相對較小（平均=40）。 Moraes 的研究是唯一一項針對發作性睡病並評估注意力測試的研究²⁰ 。值得一提的是，這項研究涉及執行功能，而選擇評估「執行注意力」的測試是維多利亞斯特魯普測試（VST），這可能是評估執行功能（EF）的一種方法²⁰ 。然而，研究發現，發作性睡病患者在測試中的表現明顯慢於對照組，執行 VST 和 TMT-B 的時間是對照組的兩倍。

A Dutch study also stands out because its intervention was very different from other studies ²¹ . Interestingly, this study evaluated insomnia from a therapeutic perspective, using a randomized, double-blind, placebo-controlled trial design to examine the efficacy of attentional bias modification (ABM) training in treating insomnia as an alternative to Cognitive Behavioral Therapy for Insomnia (CBT-I), which is widely used to treat this sleep disorder.
荷蘭的一項研究之所以引人注目，也因為它的干預措施與其他研究非常不同²¹ 。有趣的是，這項研究從治療角度評估了失眠，使用隨機、雙盲、安慰劑對照試驗設計來檢驗注意力偏差修正（ABM）訓練作為失眠認知行為療法（CBT）的替代療法治療失眠的功效。

The Dot-Probe paradigm is a computer-based fast reaction time task in which two clues appear simultaneously in different locations on a computer screen to assess selective attention. The study showed that the ABM approach was not appropriate for treating patients with insomnia and that there were insufficient differences between the ABM-treated patients and the control group, even on tests of selective attention. Studies such as these were rare in this systematic review, once the inclusion criteria were attention tests and randomized trials, and the results showed that there were few such productions.
點探針範例是一種基於電腦的快速反應時間任務，其中兩個線索同時出現在電腦螢幕上的不同位置以評估選擇性注意力。研究表明，ABM 方法不適合治療失眠患者，即使在選擇性注意力測試中，ABM 治療的患者與對照組之間也沒有足夠的差異。此類研究在本次系統性回顧中很少見，納入標準是注意力測試和隨機試驗，結果顯示此類研究很少。

It is also interesting to mention that all the studies found in this review show impaired attention in sleep disorders, leading to negative effects on daily life and work. In this study, it was not possible to properly identify which type of sleep disorder has a greater impact on selective and sustained attention because of the few number of studies.
值得一提的是，本次綜述中發現的所有研究都表明，睡眠障礙導致注意力受損，進而對日常生活和工作產生負面影響。在這項研究中，由於研究數量較少，無法正確確定哪種類型的睡眠障礙對選擇性和持續注意力的影響更大。

However, recent studies have shown that total sleep deprivation for only 24 hours already potentially decreases selective and sustained attention, components of attention, as well as cognitive inhibition, a component of executive functions ²² . Experiments by Norton (1970) with a group of college students indicated that selective attention was the most impacted in sleep-deprived individuals ²³ .
然而，最近的研究表明，僅 24 小時的完全睡眠剝奪就可能會降低選擇性和持續注意力（注意力的組成部分）以及認知抑制（執行功能的組成部分²² ）。 Norton（1970）對一群大學生進行的實驗表明，選擇性注意力對睡眠不足的人影響最大²³ 。

In this review, some authors concluded that attention and episodic memory were the most affected aspects. Thus, changes in a more basic physiological phenomenon such as attention were considered additional factors in the global decline in cognitive performance ¹⁸ . In turn, Karimi’s study showed that OSA treatment improved drivers’ ability to maintain alertness and performance in standardized situations involving monotonous tasks, as well as their selective attention and episodic memory.
在這篇綜述中，一些作者得出結論，注意力和情景記憶是受影響最大的面向。因此，注意力等更基本的生理現象的變化被認為是認知能力整體下降的額外因素¹⁸ 。反過來，卡里米的研究表明，OSA 治療提高了駕駛員在涉及單調任務的標準化情況下保持警覺性和表現的能力，以及他們的選擇性注意力和情景記憶。

The study by Niu and colleagues showed significant results in groups of nurses who performed tests of attention, indicating that among the types of attention examined in this study, selective attention was the most impaired, severely affecting professional practice and prompting organizations to pay more attention to quality sleep education in this work setting ¹³ . Although this study does not discuss why sleep affects this type of attention, the results indicate that the loss of precision in tasks involving complex visual information may result from a decrease in sensitivity or a change in bias response.
Niu及其同事的研究在進行注意力測試的護理人員群體中顯示出顯著的結果，表明在本研究檢查的注意力類型中，選擇性注意力受損最嚴重，嚴重影響了專業實踐，並促使組織更重視工作環境中的優質睡眠教育¹³ ．儘管這項研究沒有討論為什麼睡眠會影響這種類型的注意力，但結果表明，涉及複雜視覺訊息的任務中精確度的喪失可能是由於敏感性降低或偏差反應的變化造成的。

Confirming the relationship between the impact of sleep disorders on attention, Zhao argues that insomnia triggers a variety of negative emotions, including anxious somatic arousal, rumination, and worry. These negative emotions, in turn, in addition to insomnia itself, may directly lead to a crucial decline in attentional control. Negative emotions was not discussed in the other included manuscripts, which encourages future studies to investigate the correlation between attentional control and emotional comorbidities resulting from sleep disorders ^{24 , 25 , 26} .
趙證實了睡眠障礙對注意力影響之間的關係，他認為失眠會引發各種負面情緒，包括焦慮的身體喚醒、沉思和擔憂。這些負面情緒，除了失眠本身之外，還可能直接導致注意力控制能力的嚴重下降。其他納入的手稿中沒有討論負面情緒，這鼓勵未來的研究調查注意力控制與睡眠障礙引起的情緒合併症之間的相關性^{24 , 25 , 26} 。

Also in Zhao’s study, it was discussed that a potential mechanism for the impairment of executive attentional control often observed in patients with insomnia could be insufficient slow-wave sleep (SWS) during nighttime sleep. From the perspective of neurological functioning, a study published in Nature in 2017 ²⁷ assessing individuals by examining EEG and local field potentials (LFPs) showed that sleep deprivation alters the functioning of neurons that generate slow and theta waves during wakefulness. Thus, attention and memory lapses are observed during the performance of activities.

In the full reading of the manuscripts, the degree of cognitive impairment (mild, moderate, or severe) was not discussed. What is known is that sleep disorders affect cognition, but vary widely in terms of the cognitive aspect, the disturbance, and the severity of the impact.

Of the seven nationalities examined in the studies, the Brazilian results corroborate the findings of foreign studies, that is, there is a strong correlation between attentional variations and sleep disorders.

However, it is necessary to conduct further studies with specific samples to better inform future research, considering the uniqueness of each type of sleep disorder.

Analysis of the articles selected for this systematic review revealed that there is a significant relationship between sleep and attention performance. In general, the sleep disorders evaluated in this study are related to greater impacts on sustained attention than the other types of attention, but selective attention is also severely compromised.

Despite the strong influence of poor quality of sleep and its impact on attention, the number of studies on sleep and its correlation with attentional performance is small. Nationally, few studies correlated these two topics and undertook interventions to measure their outcomes. Furthermore, most of these the studies are of small sample sizes, making generalizations to the entire population difficult.

Considering that sleep can affect behavior, emotions, and physical and cognitive development, as well as attention levels and other cognitive aspects, it is worth noting that poor sleep habits that may have started in childhood and adolescence can accompany the person in adulthood and lead to sleep deprivation, resulting in more complex problems. These diseases can occur at all stages of development, so further research on the relationship between sleep and attention is needed for scientific progress.

References