Sleep Medicine and Psychophysiology (수면정신생리)

KOREAN ACADEMY OF SLEEP MEDICINE (대한수면의학회)
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Association of Sleep Perception With Objective and Subjective Sleep Variables in Insomnia Patients

불면증 환자의 수면인식과 객관적, 주관적 수면변수의 연관성에 대한 연구

  • Yoon, Gahui (Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital) ;
  • Oh, Seong Min (Topclass Psychiatric Clinic) ;
  • Seo, Min Cheol (Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital) ;
  • Lee, Mi Hyun (KoSleep Clinic) ;
  • Yoon, So Young (Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital) ;
  • Lee, Yu Jin (Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital)
  • 윤가희 (서울대학교병원 정신건강의학과 수면의학센터) ;
  • 오성민 (서울탑클래스정신건강의학과) ;
  • 서민철 (서울대학교병원 정신건강의학과 수면의학센터) ;
  • 이미현 (코슬립수면의원) ;
  • 윤소영 (서울대학교병원 정신건강의학과 수면의학센터) ;
  • 이유진 (서울대학교병원 정신건강의학과 수면의학센터)
  • Received : 2021.10.18
  • Accepted : 2021.11.13
  • Published : 2021.12.31
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Abstract

Objectives: Our study aims to investigate the clinical and polysomnographic variables associated with subjective sleep perception. Methods: Among the patients who underwent nocturnal polysomnography (PSG) at the Center for Sleep and Chronobiology of Seoul National University Hospital from May 2018 to July 2019, 109 diagnosed with insomnia disorder based on DSM-5 were recruited for the study, and their medical records were retrospectively analyzed. Self-report questionnaires about clinical characteristics including Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI), and Epworth sleepiness scale (ESS) were completed. Subjective sleep quality was measured using variables of subjective total sleep time (subjective TST), subjective sleep onset latency (subjective SOL), subjective number of awakenings, morning feeling after awakening, and sleep discrepancy (subjective TST-objective TST) the morning after PSG. Pearson and Spearman correlation analyses were used to determine the factors associated with subjective sleep perception. Results: In patients with insomnia, subjective TST was negatively correlated with Wake After Sleep Onset (WASO) (p = 0.001) and N1 sleep (p = 0.039) parameters on polysomnography. Also, it was negatively correlated with PSQI (p < 0.001) and BDI (p = 0.014) scores. Sleep discrepancy was negatively correlated with PSQI score (p = 0.018). Morning feeling was negatively correlated with PSQI (p = 0.019) and BDI (p < 0.001) scores. Conclusion: Our results demonstrated that subjective sleep perception is associated with PSG variables (WASO and N1 sleep) and with PSQI and BDI scores. In clinical practice, it is helpful to assess and manage insomnia patients in consideration of objective sleep variables, subjective sleep quality, and depressed mood, which can influence subjective sleep perception.

목 적 : 본 연구의 목적은 불면증 환자의 주관적 수면인식과 관련 있는 임상적, 객관적 요인들을 알아보고 임상에서 불면증 환자의 이해와 평가 및 치료에 도움을 주기 위함이다. 방 법 : 109명의 불면증 환자들을 대상으로, 수면다원검사 결과와 자가보고 설문지를 후향적으로 분석하였다. 주관적 수면인식은 아침자가보고 설문지의 주관적 총 수면시간(subjective total sleep time, subjective TST), 입면 잠복시간(subjective sleep onset time; subjective SOL), 각성횟수, 아침 개운함 정도로 측정하였으며, 주관적-객관적 수면차이를 계산하였다. 임상적 특징은 Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), Epworth Sleepiness Scale (ESS)를 측정하였다. 변수들 사이의 관련성을 알아보기 위하여 상관분석을 시행하였다. 결 과 : 109명의 불면증 대상자(남성 = 72명, 나이 43.49 ± 15.32세)를 분석한 결과, 주관적 총 수면시간(subjective TST)은 수면다원검사에서의 입면 후 각성시간(wake after sleep onset, WASO) (p < 0.001), N1 수면(p = 0.039), PSQI (p < 0.001), BDI (p = 0.014)와 유의한 음의 상관관계를 보였다. 수면차이는 PSQI (p = 0.018)와 유의한 음의 상관관계가 있었다. 아침 개운함 정도는 PSQI (p = 0.019), BDI (p < 0.001)와 유의한 음의 상관관계가 있었다. 결 론 : 불면증 환자에서 주관적 수면인식은 수면다원검사의 입면 후 각성시간(WASO), N1 수면과 관련성이 있었으며, 우울감과 평소 수면의 질과 관련성이 있었다. 불면증 환자에서 다양한 객관적 수면변수, 평소 수면의 질 및 우울감이 주관적 수면인식에 영향을 미치므로, 이를 고려하여 환자를 평가 및 치료해야 하겠다.

Keywords

Acknowledgement

본 논문은 한국산업기술진흥원 산업혁신기반구축사업(과제번호: P0014279)의 지원으로 수행되었음.

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