• Journal of Dental Anesthesia and Pain Medicine
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• 제23권4호
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• pp.179-192
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• 2023

Obstructive sleep apnea (OSA) is a common sleep-breathing disorder associated with significant comorbidities and perioperative complications. This narrative review is aimed at comprehensively overviewing preoperative risk evaluation and perioperative management strategies for patients with OSA. OSA is characterized by recurrent episodes of upper airway obstruction during sleep leading to hypoxemia and arousal. Anatomical features, such as upper airway narrowing and obesity, contribute to the development of OSA. OSA can be diagnosed based on polysomnography findings, and positive airway pressure therapy is the mainstay of treatment. However, alternative therapies, such as oral appliances or upper airway surgery, can be considered for patients with intolerance. Patients with OSA face perioperative challenges due to difficult airway management, comorbidities, and effects of sedatives and analgesics. Anatomical changes, reduced upper airway muscle tone, and obesity increase the risks of airway obstruction, and difficulties in intubation and mask ventilation. OSA-related comorbidities, such as cardiovascular and respiratory disorders, further increase perioperative risks. Sedatives and opioids can exacerbate respiratory depression and compromise airway patency. Therefore, careful consideration of alternative pain management options is necessary. Although the association between OSA and postoperative mortality remains controversial, concerns exist regarding adverse outcomes in patients with OSA. Understanding the pathophysiology of OSA, implementing appropriate preoperative evaluations, and tailoring perioperative management strategies are vital to ensure patient safety and optimize surgical outcomes.

• 수면정신생리
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• 제20권1호
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• pp.5-9
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• 2013

One of hypothesis is that sleep loss related to a decrease in serotonergic activity plays a significant role in attempted suicide. A growing evidence suggests that central serotonergic activity plays a key role in the etiology of suicide. It has been reported that the cerebrospinal fluid (CSF) levels of 5-hydroxyindoleacetic acid (5-HIAA), the main metabolite of serotonin, were reduced in suicide attempters. In addition, there is evidence that tryptophan hydroxylase is associated with suicide. The association between sleep and suicide was also suggested by some researchers. Several recent studies have showed the association between sleep disturbance and suicide rates in patients with mental disorders and in a general population. In addition, it has been suggested that serotonin plays a role in maintaining arousal and regulating muscle tone and in regulating some of the phasic events of REM sleep. Especially, it is well-known that 5-HT2 receptors are related to slow wave sleep. In conclusion, it is clear that sleep, serotonin activity, and suicide are linked, although the direction of causation needs clarification. In future, large population-based cohort studies are needed to demonstrate the direction of causation in the relationships between sleep, serotonin activity, and suicide.

• Perspectives in Nursing Science
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• 제9권2호
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• pp.83-93
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• 2012

Purpose: The purpose of this study was to describe the post-traumatic stress experiences of firefighters and paramedics. Methods: The participants were 20 fire fighters and paramedics who belong to the Busan Fire Department. Data were collected through in-depth, unstructured audio-taped interviews by the investigator over a six-month period. The participants were asked to describe their post-traumatic stress. The data were analyzed according to Giorgi's method for phenomenological analysis. Results: The interview data were organized by theme into 7 categories that emerged from the analysis. Participants faced various post-traumatic stresses working as fire fighters or paramedics. The categories were suffering from disastrous situations, feeling of fear and helplessness in the face of death, re-experiencing vividly the past traumatic situation, avoiding painful reminders of the trauma, emotional numbing as time passes, suffering from emotional arousal and increased anxiety, and struggling to cope with the post-traumatic stress. Conclusion: This study provides a better understanding of post-traumatic stress experiences from fire fighters and paramedics and the knowledge gained from this study will help in developing appropriate post-traumatic stress management programs.

• 수면정신생리
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• 제8권1호
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• pp.5-10
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• 2001

The prevalence of insomnia and the degree of impairment due to insomnia is greater than in the of young. The cause for insomnia in the elderly are various factors among the elderly is known to be high including medical, psychiatric, drug issues, circadian rhythm changes, sleep disorders, and psychosocial. So the careful evaluation to find the cause of insomnia is needed for the eldery. Treatment options for insomnia include behavior modification and pharmacotherapy. Outcome data from previous studies indicate that behavioral approaches produce reliable and durable therapeutic benefits, as evidenced by improved sleep efficiency and continuity and enhanced satisfaction with sleep patterns. Treatment methods such as stimulus control and sleep restriction, which target maladaptive sleep habits, are especially beneficial for older insomniacs, whereas relaxation-based interventions aimed at decreasing arousal, produce more limited effects. Cognitive and educational interventions are instrumental in altering age-related dysfunctional beliefs and attitudes about sleep. The choice of hypnotics is based on matching the nature of the insomnia to the hypnotic agent. The ideal agent has rapid onset, duration of action that lasts through the night but no residual daytime effects, and no adverse effects. The key for the healthcare professional is finding the appropriate treatment or treatment combination, including behavioral modification and pharmacotherapy. When hypnotics are indicated, the most appropriate short-acting agent should be considered.

• 감성과학
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• 제22권4호
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• pp.57-64
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• 2019

분노는 알코올 사용 장애자들이 재발하기 전에 가장 흔하게 경험하는 정서 중 하나이다. 본 연구는 알코올 사용장애자의 분노 경험에 따른 자율신경계 반응 특성을 규명하고자 하였다. 본 연구에는 알코올 사용 장애로 진단받고 치료 중인 남성 환자 12명과 이들과 연령 및 학력수준이 유사한 일반인 남성 14명이 참여하였다. 분노를 유발하기 위하여 시청각 동영상을 제시하고, 이때 나타난 심리 및 자율신경계 반응(피부전기 활동)을 측정하였다. 연구 결과, 참여자들이 경험한 정서의 강도에서는 알코올 집단과 일반인 집단에서 차이가 나타나지 않았다. 반면, 알코올 집단은 안정 상태에 비해 분노 상태에서 비중독자에 비해 피부전도 수준, 피부전도 반응 그리고 피부전도반응 수가 유의하게 낮았다. 이 결과는 알코올 중독자들이 분노를 처리하는 동안에 생리 반응에서 이상이 나타남을 시사하였다. 알코올 사용 장애자들의 분노 경험 동안에 나타난 생리 반응 이상을 완화할 수 있는 개입방법을 개발한다면 알코올 사용 장애자들의 정서 처리 문제를 해결할 수 있어 그들의 재발 방지에 도움을 줄 수 있을 것이다.

• 수면정신생리
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• 제4권2호
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• pp.191-200
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• 1997

Objectives : Periodic limb movements during sleep (PLMS) may cause arousals that may lead to non-restorative sleep. PLMS is characterized by long sleep latency, sleep fragmentation, frequent stage shifts, and rarity of stages 3/4 NREM sleep on polysomnography. However, controversies have existed and it still remains to be elaborated whether PLMS actually causes insomnia, since normal persons happen to have PLMS. Clinically, it would be crucial to know factors which might disturb sleep in PLMS. We became interested in Coleman's theory(1980) that invariant periodic movements disturb patients' sleep less. Though, Coleman's study seems to have been confounded by including PLMS patients with various co-morbid sleep disorders. Therefore, we attempted to study in patients only with PLMS the effects of movement patterns on sleep architecture. Methods : In 27 patients diagnosed as having PLMS only with clinical interview and nocturnal polysomnography, we studied the relationship between the movement patterns such as mean duration and variability of periodic limb movement's interval and the sleep architecture variables. Results : The shorter and the more regular the limb movement intervals were, the fewer arousals followed. The movement intervals of the older patients were shorter and more regular than the younger patients. The probability of the accompanying arousal with each limb movement increased as the duration and variance of the movement intervals increased. It decreased as the age and the frequency of limb movements increased. Among these factors the most significant one was the mean duration of the movement intervals. In other words, the shorter the movement intervals were, the less disturbed sleep was. Conclusion : PLMS frequency increases with aging but the probability of the accompanying arousal with each movement decreases with aging. Sleep-disturbing effects of PLMS depends more on the duration and variability of movement intervals than the PLMS frequency.

• Childhood Kidney Diseases
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• 제20권2호
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• pp.50-56
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• 2016

Purpose: Nocturnal enuresis (NE) is one of the most common problems in childhood. NE has a multifactorial etiology and is influenced by sleep and arousal mechanisms. The aim of the present study was to prospectively evaluate sleep problems and patterns in children with NE compared with normal healthy controls. Methods: Twenty-eight children with NE and 16 healthy controls were included in the study. To evaluate sleep habits and disturbances, parents and children filled out a questionnaire that included items about sleep patterns and sleep-related behaviors prior to treatment for NE. Demographic factors and other data were compared for the two groups based on the responses to the sleep questionnaire. Results: Night awakening, sleepwalking, and periodic limb movements were more prevalent in children with NE, but symptoms of sleep-disordered breathing were not increased in this group. There were statistically significant differences in periodic limb movements and daytime sleepiness between the two groups. Conclusion: Children with NE seemed to have more sleep problems such as night awakening, sleepwalking, and periodic limb movements. In addition, a higher level of daytime sleepiness and hyperactivity in patients with NE suggested a relationship between NE and sleep disorders.

• 생물정신의학
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• 제5권2호
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• pp.278-282
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• 1998

Various neurotransmitters have been proposed as possible mediators of penile erection. Especially, norepinephrine and serotonin might have a important role in sexual arousal and penile erection. And it could be hypothesized that the psychogenic impotence is associated with the depletion or imbalance of norepinephrine and serotonin from evidences, such as the symptomatic manifestation of depression and the antidepressantinduced sexual dysfunction. The authors investigates the association of norepienphrine and serotonin with psychogenic impotence. The psychogenic impotent group(PIG) consisted of twenty-three patients with psychogenic impotence and the controlled group(CG) consisted of twenty-seven patients without psychogenic impotence. PIG had no organic cause accounting for their erectile dysfunction. The Beck Depression Inventory(BDI) and the State-Trait Anxiety Inventory(STAI) were applied to each subject to assess mood, state anxiety(SA) and trait anxiety(TA). Plasma norepinephrine level from systemic blood and 5-hydroxyindoleacetic acid(HIAA) levels from 24-hours urine were measured in each subject. The mean score of BDI of PIG was significantly higher than that of CG(p=0.015). PIG had a tendency of higher TA compared with CG(p=0.054). And also SA was higher in PIG, but did not show significant difference(p=0.193). The level of norepinephrine was significantly lower in patient with psychogenic impotence(p=0.000). And the level of 24-hours urine 5-HIAA was lower in PIG but did not show significant difference(p=0.494). Although the authors did not exclude depressive disorders in PIG, the present findings suggest that psychogenic impotence might have higher depressive mood and trait anxiety, and be associated with the depletion of norepinephrine in systemic blood.

• 한국콘텐츠학회논문지
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• 제14권9호
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• pp.247-254
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• 2014

최근 발생하고 있는 범죄는 심각하고 흉포화 되었다. 이러한 특성은 그 범죄를 수사하는 경찰에게도 심각한 영향을 미치고 있다. 이러한 범죄를 접하는 경찰관도 인간이기 때문에 심리적인 미칠 수 있다. 실제로 많은 수사관련 경찰관이 큰 사건을 겪은 이후 수사 부서를 떠나거나, 경찰직을 그만두고 있다. 이러한 문제에 대하여 본 연구에서는 외상 후 스트레스 장애(Post Traumatic Stress Disorder; PTSD)가 실제 경찰관에게 미치는 영향을 살펴보고 이러한 영향이 조직몰입에 미치는 영향을 살펴보고자 하였다. 연구의 목적을 달성하기 위하여 본 연구에서는 과각성, 회피, 침습, 수면장애를 외상 후 스트레스 장애의 하위영역으로 설정하고, 조직몰입을 정서적 몰입, 지속적 몰입, 규범적 몰입으로 하위영역으로 나누었다. 측정을 위하여 만들어진 설문지는 대구지방경찰청 소속 경찰관 중 수사경과를 가지고 있는 형사부서 경찰관을 대상으로 설문을 실시하여 미치는 영향을 살펴보았다. 그 결과, 외상 후 스트레스 장애의 하위요인 중 침습이 정서적 몰입에 유의미한 영향을 미치는 것으로 나타났으며, 회피는 지속적 몰입에 유의미한 영향을 미친다고 나타났고, 침습과 회피는 규범적 몰입에 유의미한 영향을 미치는 것으로 나타났다.

• 수면정신생리
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• 제26권1호
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• pp.44-48
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• 2019

목 적 : 불면증은 대표적인 수면 질환이다. 최근 연구에 의하면 인지적 신체적 각성이 불면증을 야기하는 주요 역할을 한다. 아울러 대뇌 피질의 과각성으로 인한 정보처리과정 장애가 정상적인 입면과 수면의 연속성을 방해한다는 연구 결과도 있다. 뉴로피드백은 행동치료의 한 방식으로 피검자의 뇌파에 영향을 미쳐서 대뇌 과각성을 감소 시킬 수 있다. 이에 본 연구에서는 불면증 환자에서 뉴로피드백 치료가 뇌파 특성에 미치는 영향을 분석하고자 한다. 방 법 : 본 연구는 불면증 진단기준을 만족하는 피검자 13명과 성별 및 연령이 매칭된 대조군 14명을 대상으로 진행하였다. 뉴로피드백 치료와 Sham 치료를 무작위로 각각 30분씩 시행하였다. 각각의 치료 세션 중 뇌파를 측정하고 스펙트럼 분석을 시행하여, 뉴로피드백 치료가 뇌파 스펙트럼에 미치는 영향을 비교 분석하였다. 결 과 : 불면증 환자에서 치료적인 1회기 뉴로피드백을 한 경우, Sham 치료를 한 경우에 비해서 세타 및 시그마 파워($13.9{\pm}2.6$ vs. $12.2{\pm}3.8$ and $3.6{\pm}0.9$ vs. $3.2{\pm}1.0$ in %, respectively ; p < 0.05)가 통계적으로 유의한 수준으로 증가하였다. 그 외 뇌파상으로 통계적으로 유의미한 변화는 없었다. 결 론 : 본 연구는 국내 최초로 불면증 환자에서 1회기 뇌파 뉴로피드백을 통해 입면에 도움이 되는 세타파의 비율이 증가하는 것을 확인하였으며, 이는 입면주기를 앞당길 수 있는 새로운 방법에 대한 제안을 줄 수 있다. 불면증 자체의 치료 반응을 평가하지 못한 제한점은 있으며, 향후 불면증상의 변화까지 평가할 수 있는 후속 연구가 이어져야 한다.