수면무호흡증 예측을 위한 선별검사 개발

이성훈,이희상,이정권,김경수,Lee, Sung-Hoon,Lee, Hee-Sang,Lee, Jeung-Gweon,Kim, Kyung-Soo 대한수면의학회 1995 수면·정신생리 Vol.2 No.1

연구목적 : 수면무호흡증 환자들은 수면다원검사를 통해 진단이 가능한데, 수면무호흡증이 의심되는 모든 환자를 검사의뢰하기에는 현실적으로 어려움이 많다. 따라서 저자들은 수면다원검사와 치료가 필요한 수면무호흡증 환자를 선별할 수 있는 간단한 검사 방법을 찾고자 본 연구를 시행하였다. 연구방법 : 코골기와 수면무호흡증으로 인해 수면 다원검사가 의뢰된 140명의 환자를 대상으로 하루 밤 동안 1회 수면다원검사를 실시하였다. 수면무호흡증의 증상은 18개의 문항으로 된 설문지로 평가하였고, 우울증은 Zung's 척도, 졸리움증은 Stanford Sleepiness Scale(SSS), 불면증은 이성훈 등(14)이 개발한 불면증척도 등을 이용하였다. 그외 혈압, 키, 체중, 목둘레 등을 측정하였고, 코골기의 가족력, 얼마나 오랫동안 코골기가 있었는지, 술, 담배를 어느 정도 하는지를 조사하였으며, digit symbol test, trail making B test 등의 인지기능검사를 시행하였다. 그리고 이 변수들과 호흡장애지수 간의 상관관계를 SPSS-PC 의 Pearson's correlation 으로 조사하였고, 통계적으로 유의하게 나온 변수들을 가지고 판별분석을 이용하여 호흡장애지수에 대한 이 변수들의 판별계 수를 구하고, 그것으로 판별식을 만들었다. 또한 판별분석상 호흡장애지수에 영향을 미치는 것으로 밝혀진 변수들에 대해 각각 기준점을 정하고, 호흡장애지수 20을 기준으로 하여 선별검사의 민감도를 조사하였다. 연구결과 : 판별분석결과 호흡장애지수에 영향을 미치는 것으로 나타난 6가지 변수 즉, 목둘레, 수면전 수축기혈압, 음주정도, 자다가 숨을 멈추는 정도, 잠잘 때 입안이 마르는 정도, 수면무호흡 설문지 점수를 가지고 판별식을 만들어 보았을 때, 호홉장애지수 20이상인 환자를 92.8%의 민감도로 찾아낼 수 있었다. 또한, 목둘레 40cm이상, 수축기 혈압 125mmHg 이상, 잦은 음주, 수면중 잦은 숨멈춤, 수면중 잦은 구갈증, 코골기 및 수면무호흡증 설문지 총점수 35점 이상 중 3개 이상 해당시 호홉장애지수 20이상인 환자를 87.6%의 민감도로 찾을 수 있었다. 그리고, 목둘레 40cm이상, 수축기 혈압 125mmHg이상, 잦은 음주, 체중 80kg이상 중 2가지 이상 해당 시 호흡장애지수 20 이상인 환자를 83.5%의 민감도로 찾을 수 있었다. 결론 : 외래에서 간단히 시행할 수 있는 설문지조사와 이학적검사를 이용한 위의 방법으로 호흡장애 지수 20이상인 환자를 높은 민감도로 구별해 낼 수 있었다. Objective : Patients with sleep apnea should be diagnosed with polysomnography(PSG). However, it is not easy to recommend PSG for all patients suspected with sleep apnea in practice. Therefore, we tried to develop the screening test for referral of PSG. Method : 140 patients with snoring and sleep apnea syndrome were studied by the PSG. Sleep apnea questionnaire. Zung's scale for depression. Stanford Sleepiness Scale(SSS), insomnia scale and neuropsychological test were administered. Also, blood pressure, height, weight and neck circumference were measured and some histories were taken. Correlations between respiratory disturbance index(RDI) and various parameters mentioned above and discriminant coefficients of the parameters to RDI were computed. And, we investigated sensitivities of screening tests for selection of the patients with RDI above 20. Results : Using six parameters(neck circumference, systolic blood pressure before sleep, degree of alcohol drinking, frequency of breath-holding during sleep, degree of dry mouth during sleep, sleep apnea score), the patients with RDI above 20 could be discriminated in 92.8% sensitivity. In case of more than two among six parameters(neck circumference of above 40cm, systolic blood pressure of above 125mmHg, frequent alcohol drinking, frequent breath-holding during sleep, frequent dry mouth during sleep, sleep apnea score of above 35), same patients could be discriminated in 87.6% sensitivity. And, in case of more than one among four parameters(neck circumference of above 40cm. systolic blood pressure of above 125mmHg, frequent alcohol drinking, body weight of above 80kg), discrimination sensitivity was 83.5%. Conclusions : Patients with RDI above 20 could be discriminated by above parameters with high sensitivity. Therefore, the screening test using above parameters can be applied in selection of the patients with sleep apnea for PSG in practice.

집중의 신경해부와 정신생리

이성훈,박윤조,Lee, Sung-Hoon,Park, Yun-Jo 대한수면의학회 1998 수면·정신생리 Vol.5 No.2

Attentional processes facilitate cognitive and behavioral performance in several ways. Attention serves to reduce the amount of information to receive. Attention enables humans to direct themselves to appropriate aspects of external environmental events and internal operations. Attention facilitates the selection of salient information and the allocation of cognitive processing appropriate to that information. Attention is not a unitary process that can be localized to a single neuroanatomical region. Before the cortical registration of sensory information, activation of important subcortical structures occurs, which is called as an orienting response. Once sensory information reaches the sensory cortex, a large number of perceptual processes occur, which provide various levels of perceptual resolution of the critical features of the stimuli. After this preattentional processing, information is integrated within higher cortical(heteromodal) systems in inferior parietal and temporal lobes. At this stage, the processing characteristics can be modified, and the biases of the system have a direct impact on attentional selection. Information flow has been traced through sensory analysis to a processing stage that enables the new information to be focused and modified in relation to preexisting biases. The limbic and paralimbic system play significant roles in modulating attentional response. It is labeled with affective salience and is integrated according to ongoing pressures from the motivational drive system of the hypothalamus. The salience of information greatly influences the allocation of attention. The frontal lobe operate response selection system with a reciprocal interaction with both the attention system of the parietal lobe and the limbic system. In this attentional process, the search with the spatial field is organized and a sequence of attentional responses is generated. Affective, motivational and appectitive impulses from limbic system and hypothalamus trigger response intention, preparation, planning, initiation and control of frontal lobe on this process. The reticular system, which produces ascending activation, catalyzes the overall system and increases attentional capacity. Also additional energetic pressures are created by the hypothalamus. As psychophysiological measurement, skin conductance, pupil diameter, muscle tension, heart rate, alpha wave of EEG can be used. Event related potentials also provide physiological evidence of attention during information process. NI component appears to be an electrophysiological index of selective attention. P3 response is developed during the attention related to stimulus discrimination, evaluation and response.

EP Augmenting / Reducing : Personality Correlates and Topographic Distribution

이성훈,Lee, Sung-Hoon,Haier, Richard J. KOREAN ACADEMY OF SLEEP MEDICINE 1995 수면·정신생리 Vol.2 No.2

증감뇌유발전위와 성격의 상호관계의 영상적 분포를 조사하기 위해 38명의 대학생에게 증감뇌유발전위를 검사하였다. 그리고 Zuckerman의 추구척도와 Eysenck 성격설문지로 그들의 성격을 조사하였다. 외향 및 내향성 척도와 증감뇌유발 전위 사이에 후 전두엽 부위에서는 유의한 정상관관계가 있었으나 우측 후반구에서는 유의한 부상관 관계를 보였다. 스릴과 모험추구 척도와는 우측 후 측두엽에서 유의한 부상관 관계를 보였다. 모든 검사자의 평균 증감뇌유발전위는 전두엽 부위에서는 증가 경사도를 보였으나 후반구 부위에서는 감소경사도를 보였다. Augmenting-reducing evoked potentials(AREP) were studied in 38 college students to explore the topographic distribution between AR slope and personality. The Zuckerman Seeking Scale(SSS) and Eysenck Personality Questionnaire(EPQ) assessed personality. There was a significant positive correlation between AR slope and Extraversion-Introversion(E) in the frontocentral area ; the right posterior area showed a significant negative correlation with E. The Thrill and Adventure Seeking(TAS) subscale showed a significant negative correlation with slope in the right posterior temporal area. The average slope map of all subjects revealed a distribution showing more augmenting in frontocentral areas and more reducing in posterior areas.

Eyeblinks, EP Augmenting / Reducing and Personality

이성훈,Lee, Sung-Hoon,Haier, Richard J. KOREAN ACADEMY OF SLEEP MEDICINE 1994 수면·정신생리 Vol.1 No.2

목 적 : 눈깜작임은 뇌에서 감각을 조절하는 기능과 관계된 개인의 인지능력과 성격에 따라 달라질 수 있다. 저자들은 이러한 성격이 눈깜작임과 증감뇌유발전위 등과 상호 어떠한 연관이 있는지를 연구하려고 하였다. 방법 : 44 명의 정상 대학생에게 증감뇌유발전위, 눈깜작임과 Zuckerman 의 감각추구척도와 Eysenck 성격설문지 동을 조사하여 그 상호관계를 분석하였다. 결 과 : 증감뇌유발전위에서 빛의 강도가 증가할수록 눈깜작임이 증가하였다. 대부분의 성격척도에서 눈깜작임과 유의한 역상관관계를 보였으며 신경증척도만이 정상관관계를 보였다. 눈깜작임과 증감유발전위의 기울기와 가장 강한 정상관관계를 보인 뇌의 부위는 우측 후 측두엽이었다. 결 론 : 감각추구경향이 강할수록 눈을 적게 깜작이었다. 유발전위보다 눈깜작임이 성격과 더 높은 상관관계를 보여 눈깜작임이 더 일차적인 필터 역할을 한다고 생각된다. 그리고 우측 후 측두엽은 여러 뇌 부위 중 시각을 조절하는데 가장 중요한 역할을 하는 것으로 유추된다. Objectives: Eyeblinking varied depending on individual cognitive abilities or personality traits thought to related to brain mechanisms of sensory modulation. This study explored whether personality traits are related to the rate of eye blinks and how eyeblink and evoked potential augumenting-reducing(EPAR) interact Methods: Forty four students were studied with EPAR topography to explore how eyeblinks, personality and EPAR interact The Zuckerman Sensation Seeking Scale(SSS) and Eysenck Personality Questionnaire(EPQ) were used as personality measured by a stimulus response program during EP study. Results: Rate of blink increased as intensity of light increased. The General(GEN), Thrill and Adventure Seeking(TAS), Experience Seeking(ES) and Disinhibition(DS) subscales in SSS and Extraversion-Introversion(E) subscale in EPQ showed significant negative correlations with number of eyeblinks in the hightest intensity of light, whereas Neuroticism(N) subscales in EPQ showed a positive correlation. Correlation between number of eyeblinks with the brightest light and EPAR slope varied topographically. The strongest positive correlation was noted in right posterior temporal area. Conclusion: High sensation seekers blinked significantly fewer times than lower sensation seeker did. Higher personality correlations with eyeblink than with EP may imply that the eyeblink works as a primary filter since it is more directly related to central mechanisms of sensory modulation than EP. The right posterior temporal area may play an important role in modulation of visual stimuli.

망상의 신경심리학적 기전

이성훈,김동화,박윤조,박혜정,신윤식,Lee, Sung-Hoon,Kim, Dong-Wha,Park, Yun-Zo,Park, Hae-Jung,Shin, Yoon-Sik 대한수면의학회 2000 수면·정신생리 Vol.7 No.1

목 적: 정신분열병이 뇌질환으로 인식되고 연구되면서 그 정신병리 역시 특정 뇌의 구조와 기능의 장애에 의해 발생될 것으로 기대되었다. 저자들은 그 대표적인 증상인 망상이 뇌의 어떤 구조와 기능의 장애와 관계되는 지를 알아보기 위해 기질적 뇌손상이 없는 정신과와 뇌손상 환자에서 신경심리 검사와 망상과의 관계성을 연구하였다. 방 법: 정신과 환자 69명, 뇌손상 환자 50명, 총119명의 환자에서 Halstead Reitan 신경심리 검사와 K-WAIS, 청각사건 관계전위 검사 및 MMPI를 시행하였다. MMPI 항목 중 망상과 관계되는 24개 항목에서 산출된 점수와 신경심리 검사와 N120과 P300의 전위와 잠복기와 어떤 상관 관계가 있는지를 통계적으로 알아보았다. 또 정신과 환자에서 망상 점수가 높은 고망상군 18명과 저망상군 21명을 t-test로 비교하였다. 결 과: 뇌손상 환자군에서 망상이 전두엽 기능을 보는 범주화 검사, 선로 잇기 AB 검사, 촉각 수행 검사, 숫자 상징 검사, 손끝 숫자 쓰기 검사와 전체적인 뇌손상 수준을 보는 IQ와 뇌손상 지수와 높은 유의한 상관 관계를 보였다. 또 좌측 측두 및 두정엽 기능을 보는 지식, 이해, 어휘, 공통성, 언어 발음 지각 검사, 높은 유의한 상관 관계를 보였고 피질하 기능을 보는 산수, 숫자 외우기, 집중력 점수, 숫자 상징 검사, 바꿔 쓰기, 선로 잇기 AB 검사와 유의한 상관 관계를 보였다. 또 우측 반구 기능을 보는 촉각 수행 검사의 위치, 빠진 곳 찾기, 동작 점수와 유의한 상관 관계를 보였다. 고망상군 정신과 환자군이 저망상군 정신과 환자에 비해 좌측 반구 기능을 보는 검사인 이해, 어휘, 언어성 점수에서 유의한 차이가 있었고, 피질하 기능을 보는 $N_1$의 전위, 산수와 숫자 상징에서 유의한 차이가 있었다. 결 론: 망상은 전두엽, 좌측 측두 및 두정엽, 피질하가 상호 중요한 역할을 하면서 발생되는 것으로 생각되며, 우측 반구도 부분적으로 관계 된 것으로 보인다. Objectives: The Psychopathology of schizophrenia was expected to be related with focal dysfunction of brain while schizophrenia is recognized and studied as the brain disease. Authors studied correlation between neuropsychological tests and delusion which is representative symptom of schizophrenia in patients with head trauma and psychiatric patients in order to explore the functional localization of brain in delusional symptom. Methods: Halstead Reitan Neuropsychological Test Battery and Korean Weschler Intelligent Scale and Minnesota Multiphasic Personality Inventory(MMPI) were administered to one hundred ninteen patients consisted of sixty nine psychiatric patients and fifty patients with brain damage. We tested correlation between results of neuropsychological tests and delusional scale made from twenty four items related with delusion in MMPI. T-test between eighteen higher delusion scorers and twenty one lower scorers was examed in psychiatric group. Results: In brain damage group, signigicant correlations were found in the tests related with function of frontal lobe such as category test, trail making AB test, tactual performance test, digit symbol test and fingertip number writing test, and significant correlations were also noted in the tests related with function of left temporal and parietal lobes such as information, comprehension, vocabulary, similarities and speech sound perception test. The tests related with the function of right hemisphere such as tactual performance test location, picture completion and performance, and the tests related with subcortical function such as arithmetic, digit span, attention, digit symbol test, digit symbol and trail making AB test were signigicantly corelated with delusional scale too. In psychiatric group there were significant difference of delusional score in the tests related with function of left hemisphere such as vocabulary, vocable IQ, comprehension and language, and in the tests related with subcortical function such as N 120 voltage, digit symbol and arithmetic. Conclusions: Delusion seems to be related with function of frontal lobe, left hemisphere and subcortex in both groups. Right hemisphere may be also partially related with delusion.

소아 수면 행태와 불면증

이성훈,Lee, Sung-Hoon 대한수면의학회 1996 수면·정신생리 Vol.3 No.2

The sleeplessness in childhood is quite different from that in adulthood in terms of causes, developmental process, and treatment. Sleep behavior in childhood is strongly influenced by parental personality and familial and cultural background. In understanding and management of sleeplessness of children, it is especially important to understand the separation anxiety and the ways of its management in bedtime because bedtime routine with children one of separation process from parents. Co-sleeping, parental intervention, transional object and bedtime routines can be appeared in order to reduce the anxiety from bedtime separation. Causes of sleeplessness in infant and toddler are bad sleep-onset association, nocturnal drinking, colic, and food allergy. In preschool and school aged children, limit-setting sleep problem and fears and nightmare can be causes of sleeplessness. When good sleep environment and habits are established sound sleep and more mature personality can be developed.

Kleine-Levin Syndrome의 수면 다원 검사 소견

이성훈,Lee, Sung-Hoon 대한수면의학회 1996 수면·정신생리 Vol.3 No.1

Kleine-Levin syndrome is a disorder characterized by recurrent episodes of hypersomnia, hyperphagia and hypersexuality that typically occur weeks or months apart. A 17-years-old male showed these episodes and took nocturnal polysomnography(NPSG) and multiple sleep latency test(MSLT). As results of NPSG, sleep latency was 82.5min, sleep efficiency was 82.5min, sleep efficiency was 82.5%, latency and percentage of REM sleep were 106.5min and 14.6% and percentage of slow wave sleep was 12.7%. In 4 times MLST, average of sleep latency and REM latency were 8min 7sec and 5min 20sec with 3 times sleep onset REM period(SOREMP). These findings are consistent with these of Keine-Levin syndrome. And the possible causes and classification of this syndrome were discussed.

다공성 실리콘을 이용한 LED의 발광 특성에 관한 연구

이성훈,이치우,Lee Sung-Hoon,Lee Chi-Woo 한국전기화학회 2000 한국전기화학회지 Vol.3 No.1

n형 실리콘으로 제조한 다공성 실리콘을 이용하여 Light-emitting diode(LED)를 제작하고, LED를 구성하는데 있어서 전극 물질들을 변화시켰을 때 나타나는 LED의 전류 대 전압의 특성과 공급되어지는 전류의 세기에 따른 전계 발광 (Electroluminescence: EL) 세기의 변화를 관찰하고, 일정 전위에 대한 EL 세기의 시간 의존도를 여러 전위에 대해서 알아보았다. 또한 전극 물질과 다공성 실리콘층(Porous Silicon Layer: PSL)의 접촉 면적을 넓혀주기 위해서 In을 PSL 위에 전기 화학적으로 전착시켰을 때 나타나는 LED의 전기적 특성과 EL의 특성에 대해 알아보았다. The light emitting diode (LED) was fabricated from n-type porous silicon. We investigated both the current-voltage characteristics of the LED with various electrode materials and changes of electroluminescence with applied current density. Also we probed changes in electroluminescence as a function of operation time at a given current. In order to Improve the contact area between the electrode material and porous silicon layer, we deposited indium on porous silicon layer by electroplating and investigated the electric characteristics of the LED and changes of electroluminescence.

고연색 LED용 적색 Sr₂Si₅N₈:Eu²⁺ 형광체의 합성 및 발광특성 연구

이성훈,김종수,강태욱,류종호,이상남,Lee, Sung Hoon,Kim, Jong Su,Kang, Tae Wook,Ryu, Jong Ho,Lee, Sang Nam 한국반도체디스플레이기술학회 2017 반도체디스플레이기술학회지 Vol.16 No.4

Red phosphors, $Sr_2Si_5N_8:Eu^{2+}$, were synthesized as a single-phase crystal structure by optimizing carbon and $Eu^{2+}$ contents in a carbothermal reduction nitridation method. With increasing $Eu^{2+}$ contents, the photoluminescence spectra were red-shifted from 600 nm peak for 1 mol% for to 700 nm for 7 mol%. It was suggested that this red shift is attributed to the energy transfer from one low-energy sited $Eu^{2+}$ (1) to other high-energy sited $Eu^{2+}$ (2). Finally, the best red sample (620 nm emission peak and 80 nm half width for 3 mole% of $Eu^{2+}$) was packaged on a Blue LED together with two additional green and yellow phosphors, the fabricated White LED showed a high color-rendering index of 90 and white color coordinates of x= 0.321 and y = 0.305.

수면 설문지를 통한 수면장애의 진단

이성훈,Lee, Sung-Hoon 대한수면의학회 1995 수면·정신생리 Vol.2 No.1

It is very difficult to evaluate sleep disorders by simple history taking, because which covers very comprehensive areas such as psychobiosocial fields. Although polysomnography is used for the method of final diagnosis, systemic history taking and sleep question-aires are still critically important especially in evaluation of insomnia. Proper informations through sleep questionnaires can provide very precise data for effective treatment as well as exact diagnosis. Sleep questionnaires consist of largely four kinds of questionnaires, which are screening questionnaire of sleep disorders, sleep diary and questionnaire of sleep hygine, diagnostic questionnaire for specific sleep disorder and questionnaire of special symptoms of sleep disorders including insomnia, daytime sleepiness, cognitive function, mental symptom and personality, parasomnia, physical illness and sexual function. However, for more conclusive diagnosis especially in excessive daytime sleepiness nocturnal polysomnography and multiple sleep latency test should be performed.