Sleep Medicine and Psychophysiology (수면정신생리)

KOREAN ACADEMY OF SLEEP MEDICINE (대한수면의학회)
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Change of Heart Rate Variability in Depressive Disorder after Physical or Psychological Stress

우울장애 환자에서 육체적 및 정신적 스트레스 시 심박변이도의 변화

  • Lee, Jong-Hwa (Department of Neuropsychiatry, Konkuk University Medical Center) ;
  • Yu, Jaehak (Department of Neuropsychiatry, Konkuk University Medical Center) ;
  • Ryu, Seung-Ho (Department of Neuropsychiatry, Konkuk University Medical Center) ;
  • Ha, Ji-Hyeon (Department of Neuropsychiatry, Konkuk University Medical Center) ;
  • Jeon, Hong-Jun (Department of Neuropsychiatry, Konkuk University Medical Center) ;
  • Park, Doo-Heum (Department of Neuropsychiatry, Konkuk University Medical Center)
  • 이종화 (건국대학교병원 정신건강의학과) ;
  • 유재학 (건국대학교병원 정신건강의학과) ;
  • 유승호 (건국대학교병원 정신건강의학과) ;
  • 하지현 (건국대학교병원 정신건강의학과) ;
  • 전홍준 (건국대학교병원 정신건강의학과) ;
  • 박두흠 (건국대학교병원 정신건강의학과)
  • Received : 2018.03.28
  • Accepted : 2018.05.16
  • Published : 2018.06.30
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Abstract

Objectives: This study was designed to assess the change of heart rate variability (HRV) at resting, upright, and psychological stress states in depressive disorder patients. Methods: HRV was measured at resting, upright, and psychological stress states in 62 depressive disorder patients. We used visual analogue scale (VAS) score to assess tension and stress severity. Beck depression inventory (BDI) and state trait anxiety inventories I and II (STAI-I and II) were used to assess depression and anxiety severity, respectively. Differences between HRV indices and VAS score were evaluated using paired t-tests. Gender difference analysis was conducted with ANCOVA. Results: SDNN (standard deviation of normal to normal intervals), LF/HF (low frequency/high frequency), and VLF (very low frequency) were significantly increased, while NN50 and pNN50 were significantly decreased in the upright position compared to resting state. SDNN, RMSSD (root mean square of the differences of successive normal to normal intervals), and VLF were significantly increased, while pNN50 was significantly decreased in the psychological stress state compared to resting state. SDNN, NN50, and pNN50 were significantly lower in an upright position compared to a state of psychological stress, and LF, HF, and LF/HF showed no significant differences Conclusion: The LF/HF ratio was significantly increased after physical stress in depressive disorder. However, the LF/HF ratio was not significantly increased after psychological stress, and the change in LF/HF ratio after physical stress and psychological stress did not significantly differ from each other. Significant increase in SDNN, NN50, and pNN50 in an upright posture compared to psychological stress suggests that depressive patients react more sensitively to physical stress than psychological stress.

목 적 : 본 연구는 우울장애 환자를 대상으로 안정 시와 기립 시기, 정신적 스트레스 시기에 심박변이도 지수(heart rate variability index, HRV index) 검사를 시행하여 자율신경계 불균형이 육체적 및 정신적 스트레스에서 어떻게 변화되는 지 알아보고자 하였다. 방 법 : 우울장애 환자 62명을 대상으로 연구를 수행하였다. 안정 시기, 기립 시기, 정신적 스트레스 자극을 준 시기동 안 각각 심박변이도 지수를 측정하였다. 긴장 정도와 스트레스 정도에 대해 visual analogue scale (VAS) score로 측정하였고, Beck depression inventory (BDI), state trait anxiety inventory-I, II (STAI-I, II)를 사용하여 불안증상과 우울증상 의 심각도를 평가하였다. 통계적 검증은 안정 시기와 기립 시기, 안정 시기와 정신적 스트레스 시기 간의 각각의 자율신경계 관련 지수 변화를 보기 위해 paired t-test로 분석하였고, 성별 차이를 보기 위해 ANCOVA로 비교 분석하였다. 결 과: 안정 시기와 비교하여 기립 시기에서 SDNN, LF/ HF의 유의한 증가(p < 0.01) 및 NN50(p < 0.05), pNN50(p < 0.01)의 유의한 감소를 보였다. 안정 시기와 비교하여 스트레스 시기에서 SDNN (p < 0.01), RMSSD (p < 0.05) 유의한 증가를 보였다. 기립 시기와 비교하여 스트레스 시기에 SDNN, NN50, pNN50 지수가 유의하게 높은 결과를 보였다. 결 론: 기립 시기만 안정 시기와 비교하여 자율신경계 불균형과 관련된 LF/HF ratio의 유의한 상승을 보였으나, 정신적 스트레스와 안정 시기, 두 스트레스 간 LF/HF ratio의 차이는 보이지 않았다. 정신적 스트레스에 비해서 기립시기에서 SDNN, NN50 및 pNN50의 유의 한 증가하였다는 것은 우울증 환자들이 정신적 스트레스에 비해 신체적 스트레스에 보다 좀 더 민감하게 반응하는 경향이 있다는 것을 제시할 수 있다.

Keywords

References

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