• 수면정신생리
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• 제1권2호
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• pp.172-181
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• 1994

Obstructive sleep apnea syndrome(OSAS) is most frequently diagnosed in the sleep laboratories and its severity is objectively estimated. In terms of treatment, the most prevalent method is the continuous positive airway pressure(CPAP) application as of now. However, in Korea, CPAP is still not sufficiently known and it is attributable to the fact that sleep study facilities have not been popularized. In this article, the authors present their own experience with CPAP in nine subjects with OSAS. In this study, CPAP was found to decrease stage 1 sleep and to increase stage 2 sleep, with increasing mean oxygen saturation and decreasing lowest oxygen saturation during nocturnal sleep. Also, it tended to increase sleep continuity and generally to improve sleep architecture. Rebound slow wave and/or REM sleep stages during CPAP were also noted in 8 out of 9 cases. The authors suggest that CPAP should be considered as the primary mode of treatment for patients with obstructive sleep apnea syndrome and related educational programs for physicians should be developed and provided by sleep specialists.

• Annals of Clinical Neurophysiology
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• 제17권1호
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• pp.17-23
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• 2015

Background: Sleep-related disturbances and sleep disorders are common in Parkinson's disease (PD) and have a great impact on daily life of PD patients. This study was done to find the sleep characteristics and sleep disturbing factors in PD patients according to disease severity through clinical interview and polysomnographic (PSG) study. Methods: Fifty patients with PD (22 males, age $60.6{\pm}6.4$, Hoehn and Yahr (HY) stage $2.7{\pm}1.0$) were recruited and thoroughly interviewed about their sleep. PSG was performed on the patients taking routine antiparkinsonian medications. Patients were grouped into mild and moderate/severe group according to HY stage, and the results were compared between each group. Results: Ninety-four percent of total patients had one or more sleep-related disturbances based on the interview or PSG. On interview, the moderate/severe group complained more insomnia and REM sleep behavior disorder (RBD) than mild group. In PSG findings, the moderate/severe group showed lower sleep efficiency, longer sleep latency, REM sleep latency, waking time after sleep onset, and higher prevalence of RBD. Conclusions: In this study, most patients with PD had sleep disturbances. Clinical interview and PSG findings revealed deterioration of sleep quality along the disease severity. Our results suggest that sleep disturbances in PD patients are prevalent and warrant clinical attention, especially to the patients with advanced disease.

• 대한임상검사과학회지
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• 제43권4호
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• pp.188-193
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• 2011

Obstructive sleep apnea (OSA) is the most common type of sleep apnea and is caused by obstruction of the upper airway. Since it is closely related to sleep parameter and body indices, the study was focused on the relationship with them. The results of polysomnography (PSG) in obstructive sleep apnea was done at ENT department of Ewha women university Mokdong hospital from March to September 2010 with 52 subjects (male 35, female 17). The leads were placed to measure electroencephalogram (EEG), electrooculogram (EOG), mandibular and anterior tibialis electromyogram (EMG), airflow in nasal and oral cavity, chest and abdominal breathing pattern, snoring sound and arterial oxygen saturation ($SpO_2$) level. From sleep parameter and body indices of adult obstructive sleep apnea compared to normal adult revealed that age (p<0.01) and snoring sound (p<0.05) were increased, stage 1 sleep (p<0.01) was increased, the deeper stages (3&4) of sleep (p<0.05) were reduced. Respiratory disturbance index (RDI) (p<0.01), mean $SpO_2$ (p<0.05) and lowest $SpO_2$ (p<0.01) were also decreased. The correlation analysis from sleep parameter and body indices of OSA showed the positive correlation with age (r=0.463, p<0.001), snoring sound (r=0.278, p<0.05), stage 1 sleep (r=0.391, p<0.01) and RDI (r=0.409, p<0.01), but showed the negative correlation with the deeper stages (3&4) of sleep (r=-0.307, p<0.05), mean $SpO_2$=(r=-0.274, p<0.05) and lowest $SpO_2$ (r=-0.392, p<0.01). This study proves that obstructive sleep apnea and indices have closed related.

• 수면정신생리
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• 제12권1호
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• pp.68-71
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• 2005

저자들은 렘수면에서만 주로 발생한 폐쇄성 수면무호흡증 1례를 경험하고 이를 보고하면서 그 의미를 고찰하고자 하였다. 증례는 55세 여자 환자였으며 수면클리닉에 와서 만성불면증을 호소하였다. 야간수면다원검사에서 호흡장애지수는 13.8, 혈중산소포화도가 90% 미만인 시간은 5.0%로 전반적으로는 경한 정도의 폐쇄성 수면무호흡증 소견을 보였다. 그러나 흥미롭게도 무호흡과 산소포화도저하가 주로 렘수면에서만 나타났고 렘수면단계에서만 산출한 호흡장애지수는 38.1, 그리고 혈중산소포화도의 저하소견도 더 심해져 90% 미만에 해당하는 시간의 비율이 13.9%로 중증의 수면무호흡증에 해당되었다. 이 증례에서 얻는 교훈은 다음과 같다. 첫째, 만성불면증의 일부에서는 폐쇄성 수면무호흡증을 앓고 있으며 야간수면 다원검사 없이는 단순한 불면증으로 오진할 가능성이 있다는 것이다. 둘째, 치료적 측면에서 렘수면 의존성인 폐쇄성수면무호흡증의 치료는 여러 수면단계에 걸쳐 나타나는 무호흡증의 치료와 달리 약물학적 치료, 특히 렘수면에 관여하는 약물을 이용한 치료법 개발의 좋은 모델이 될 가능성이 있다.

• 수면정신생리
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• 제3권1호
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• pp.47-55
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• 1996

Narcolepsy is characterized by sleep attack with excessive daytime sleepiness(EDS), cataplexy, sleep paralysis, and hypnagogic hallucination. Paradoxically, narcoleptics tend to complain of frequent arousals and shallow sleep during the night time despite their excessive sleepiness. However, nocturnal sleep fragmentation in narcoleptics is relatively ignored in treatment strategies, compared with sleep attack/EDS and cataplexy. In our paper, we attempted to investigate further on the poor nocturnal sleep in narcoleptics and to discuss possible treatment interventions. Out of consecutively seen patients at Seoul National University Sleep Disorders Clinic and Division of Sleep Studies, we recruited 57 patients, clinically assessed as having sleep attack and/or EDS. Nocturnal polysomnography and multiple sleep latency test(MSLT) were done in each of the subjects. We selected 19 subjects finally diagnosed as narcolepsy(mean age $26.0{\pm}18.3$ years, 16 men and 3 women) for this study, depending on the nocturnal polysomnographic and MSLT findings as well as clinical history and symptomatology. Any subject co-morbid with other hypersomnic sleep disorders such as sleep apnea or periodic limb movements during sleep was excluded. Sleep staging was done using Rechtschaffen and Kales criteria. Sleep parameters were calculated using PSDENT program(Stanford Sleep Clinic, version 1.2) and were compared with the age-matched normal values provided in the program. In narcoleptics, compared with the normal controls, total wake time was found to be significantly increased with significantly decreased sleep efficiency(p<.01, p<.05, respectively), despite no difference of sleep period time and total sleep time between the two groups. Stage 2 sleep%(p<.05), slow wave sleep%(p<.05), and REM sleep%(p<.01) were found to be significantly decreased in narcoleptics compared with normal controls, accompanied by the significant increase of stage 1 sleep%(p<.01). Age showed negative correlation with slow wave sleep%(p<.05). The findings in the present study indicate significant fragmentation of nocturnal sleep in narcoleptics. Reduction of REM sleep% and the total number of REM sleep periods suggests the disturbance of nocturnal REM sleep distribution in narcoleptics. No significant correlations between nocturnal polysomnographic and MSLT variables in narcoleptics suggest that nocturnal sleep disturbance in narcoleptics may be dealt with, in itself, in diagnosing and managing narcolepsy. With the objective demonstration of qualitative and quantitative characteristics of nocturnal and daytime sleep in narcoleptics, we suggest that more attention be paid to the nocturnal sleep fragmentation in narcoleptics and that appropriate treatment interventions such as active drug therapy and/or circadian rhythm-oriented sleep hygiene education be applied as needed.

• 수면정신생리
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• 제9권1호
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• pp.9-13
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• 2002

Alzheimer's disease (AD) is one of the most common and devastating dementing disorders of old age. Most AD patients showed significant alternation of sleep structure as well as cognitive deficit. Typical findings of sleep architecture in AD patients include lower sleep efficiency, higher stage 1 percentage, and greater frequency of arousals. The slowing of EEG activity is also noted. Abnormalities in REM sleep are of particular interest in AD because the cholinergic system is related to both REM sleep and AD. Several parameters representing REM sleep structure such as REM latency, the amount of REM sleep, and REM density are change in patients with AD. Especially, measurements of EEG slowing during tonic REM sleep can be used as an EEG marker for early detection of possible AD. In addition, a structural defect in the suprachiasmatic nucleus is suggested to cause various chronobiological alternations in AD. Most of alternations related to sleep make sleep disturbances common and disruptive symptoms of AD. In this article, the author reviewed the alternation of sleep structure and circadian rhythm in AD patients.

• 종양간호연구
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• 제12권4호
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• pp.339-346
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• 2012

Purpose: The purpose of this study was conducted to identify the impact of Symptom Severity and Symptom Interference on Sleep Disturbance among cancer patients. Methods: This study was conducted from October 8th to October 25th, 2012. One hundred eight cancer patients were recruited from S city in Korea. The instruments used in this study were the Symptom Severity, Symptom Interference and the Sleep Disturbance scales for patients with cancer. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and multiple regression with the SPSS/WIN 20.0 program. Results: The Sleep Disturbance for cancer patients showed a significant relationship with Symptom Interference and cancer stage. The significant factors influencing Sleep Disturbance were Symptom Severity and Symptom Interference. They explained 40.5% of the variance in stage IV. Conclusion: Patients with cancer experienced Symptom Severity and Symptom Interference which led to a negative effect on Sleep Disturbance. The results suggest that intervention programs to reduce Symptom Severity, Symptom Interference could improve Sleep Disturbance for cancer patients.

• 전기전자학회논문지
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• 제23권4호
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• pp.1273-1279
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• 2019

수면 질환에 사용되는 수면다원검사는 그 비용 및 시간적 제약으로 새로운 대안을 찾을 필요가 절실하다. 최근 웨어러블 헬스기기가 대중화 되면서 기존의 액티그래피를 이용한 수면분석을 대신하려는 다양한 연구가 되고 있으나 이들 기기의 데이터 및 알고리즘은 접근성 및 성능에 있어 매우 제한적인 상황이다 본 논문에서는 자체 제작된 가속도계 센서모듈을 이용한 수면 중 움직임 정보를 이용하여 AASM표준 방식 기준으로 분류된 수면 단계를 예측하고, 센서의 움직임 정보와 뇌파의 δ파와 θ파의 파워스펙트럼 비교를 통해 수면의 주기를 추정할 수 있는 방법을 제시했다. 31명의 공개된 PSG 분석결과를 이용한 수면 단계 예측 결과 85.26%의 정확도를 보였다. 움직임 신호의 특성과 δ파와 θ파의 파워 변화를 비교한 결과 REM수면과 NREM수면의 반복 주기를 제시한 알고리즘으로 찾을 수 있는 가능성이 있음을 보였다.

• Clinical and Experimental Pediatrics
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• 제50권8호
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• pp.711-717
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• 2007

Sleep is a vital, highly organized process regulated by complex systems of neuronal networks and neurotransmitters. Normal sleep comprises non-rapid eye movement (NREM) and REM periods that alternate through the night. Sleep usually begins in NREM and progresses through deeper NREM stages (2, 3, and 4 stages), but newborns enter REM sleep (active sleep) first before NREM (quiet sleep). A period of NREM and REM sleep cycle is approximately 90 minutes, but newborn have a shorter sleep cycle (50 minutes). As children mature, sleep changes as an adult pattern: shorter sleep duration, longer sleep cycles and less daytime sleep. REM sleep is approximately 50% of total sleep in newborn and dramatically decreases over the first 2 years into adulthood (20% to 25%). An initial predominant of slow wave sleep (stage 3 and 4) that peaks in early childhood, drops off abruptly after adolescence by 40% from preteen years, and then declines over the life span. The hypothalamus is recognized as a key area of brain involved in regulation of sleep and wakefulness. The basic function of sleep largely remains elusive, but it is clear that sleep plays an important role in the regulation of CNS and body physiologic processes. Understanding of the architecture of sleep and basic mechanisms that regulate sleep and wake cycle are essential to evaluate normal or abnormal development of sleep pattern changes with age. Reduction or disruption of sleep can have a significant impact on daytime functioning and development, including learning, growth, behavior, and emotional regulation.

• 수면정신생리
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• 제11권1호
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• pp.10-16
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• 2004

Sleep is associated with definite changes in respiratory function in normal human beings. During sleep, there is loss of voluntary control of breathing and a decrease in the usual ventilatory response to both low oxygen and high carbon dioxide levels. Especially, rapid eye movement (REM) sleep is a distinct neurophysiological state associated with significant changes in breathing pattern and ventilatory control as compared with both wakefulness and non-rapid eye movement (NREM) sleep. REM sleep is characterized by erratic, shallow breathing with irregularities both in amplitude and frequency owing to marked reduction in intercostal and upper airway muscle activity. These blunted ventilatory responses during sleep are clinically important. They permit marked hypoxemia that occurs during REM sleep in patients with lung or chest wall disease. In addition, sleep-disordered breathing (SDB) is more frequent and longer and hypoventilation is more pronounced during REM sleep. Although apneic episodes are most frequent and severe during REM sleep, most adults spend less than 20 to 25% of total sleep time in REM sleep. It is, therefore, possible for patients to have frequent apneas and hypopneas during REM sleep and still have a normal apnea-hypopnea index if the event-rich REM periods are diluted by event-poor periods of NREM sleep. In this review, we address respiratory physiology according to sleep stage, and the clinical implications of SDB and hypoventilation aggravated during REM sleep.