한국 성인에서 렘수면의존폐쇄수면무호흡증 환자의임상양상

문혜진,임상훈,김도형,김동은,황상희,조용원 대한신경과학회 2016 대한신경과학회지 Vol.34 No.2

Background: Rapid-eye-movement-sleep-dependent obstructive sleep apnea (REM-OSA) is a sleep breathing abnormality in which apneas/hypopneas occur mainly during REM sleep periods. However, the clinical significance of REM-OSA compared to sleep-stage-non-dependent OSA (SND-OSA) has been controversial. This study evaluated differences in the clinical features, polysomnography (PSG) characteristics, and subjective symptoms between REM-OSA and SND-OSA. Methods: In total, 136 consecutive patients with mild-to-moderate OSA were enrolled. REM-OSA was defined as a rapid eye movement (REM):non-REM apnea-hypopnea index (AHI) ratio of >2 and a total duration of REM sleep exceeding 30 minutes. We compared the demographic, clinical, and PSG characteristics, and subject symptoms between REM-OSA and SND-OSA. Results: The REM-OSA group comprised 45 (33%) of the 136 subjects. The mean age and total AHI did not differ between the groups, but there was a significant female predominance (35.6% vs. 16.5%) in the REM-OSA group. In terms of PSG parameters, subjects with REM-OSA showed a lower percentage of light sleep and a lower AHI in a supine position despite spending more sleep time in that position. Subjective sleep complaints, depression, anxiety, and health-related quality of life did not differ between the two study groups. Conclusions: The female predominance and sleep architecture differed between REM-OSA and SND-OSA in this study. The AHI in subjects with SND-OSA was dependent on sleep position rather than sleep stage. Further study is needed to elucidate the pathomechanism and clinical significance of REM-OSA.

렘수면 의존성 수면무호흡증과 비렘수면 의존성 수면무호흡증의 특징

서민철,최재원,주은정,이규영,방수영,김의중 대한수면의학회 2017 수면·정신생리 Vol.24 No.2

목 적:폐쇄성 수면무호흡증(obstructive sleep apnea)은 수면 시 호흡을 하려고 하는 노력에도 불구하고 기도의 부분적/완전 폐색이 반복되는 수면 관련 호흡 질환이다. 일반적으로 렘수면에서 근긴장도의 저하가 나타나게 되므로 렘수면에서 수면무호흡증의 악화가 예상되지만 많은 경우에있어 비렘수면에서의 무호흡/저호흡 지수(apnea-hypopnea index, AHI)가 렘수면에서의 AHI보다 높은 경우가 관찰되었다. 그러나 그런 현상의 분명한 이유는 밝혀져 있지 않았기에 렘/비렘수면 의존성 수면무호흡증에 대한 특징을 종합적으로 알아보고자 하였다. 방 법:560명의 성인 수면무호흡증 환자를 대상으로 후향적 연구를 진행하였다. 모든 환자는 렘 수면시의 AHI (REMAHI), 비렘수면시의 AHI (NREM-AHI)의 비율에 따라 세군으로 분류하였다. 렘수면 의존성 수면무호흡증(REM sleep dependent OSA, REM-OSA)는 REM-AHI/NREMAHI > 2, 비렘수면 의존성 수면무호흡증(NREM sleep dependent OSA, NREM-OSA)는 NREM-AHI/REM-AHI > 2, 수면 단계 비의존성 수면무호흡증(Sleep stage independent OSA, IND-OSA)로 분류하였다. 수면다원검사 이외에도 주관적인 수면의 질, 낮시간 졸림, 정서와 연관된 설문지를 함께 시행하였다. 카이제곱 검정, 일원배치분산분석, 공분산분석을 시행하였다. 결 과:세 군 사이에서 연령의 차이는 보이지 않았다. REM-OSA는 대체로 경도의 수면무호흡증 환자가 많았고여성의 비율이 가장 높았다. 또한 주관적인 수면의 질이 가장 저하되어 있다고 느꼈으며 기분 상태 평가 척도인 KPOMS의점수는 가장 높았다. IND-OSA는 BMI, 목둘레(neck circumference, NC), 복부 둘레(abdominal circumfefence) 가 REM-OSA에 비해 높았고 주간 졸림의 호소는 세군 중 가장 컸고, 무호흡 관련 변인의 값이 가장 높아 중증도가 심한 군이었다. 공변량을 통제하고 시행한 공분산 분석의 결과에서 NREM-OSA는 앙와위에서의 AHI가 가장 높았고 수면 중 측와위의 비율이 가장 컸다. 또한 수면 효율이가장 떨어졌고 렘수면 잠복기가 가장 길었으며 입면 후 각성 시간의 비율이 가장 컸다. 결 론:REM-OSA는 여성이 많고 부정적인 정서를 가장많이 호소하는 군으로, 경도의 수면무호흡증을 가장 많이 포함하였고 IND-OSA는 중증의 수면무호흡증을 반영하였다. NREM-OSA는 자세 변화와 가장 밀접한 관련은 지니고 있었으며 수면 효율이 가장 떨어졌다. 세 군의 수면무호흡증이일련의 중중도 차이만이 아닌 또 다른 특성을 반영하는 것으로 보이고 이를 통해 폐쇄성 수면무호흡증의 이해를 넓힐수 있을 것이다. Objectives: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is characterized by repetitive collapse or partial collapse of the upper airway during sleep in spite of ongoing effort to breathe. It is believed that OSA is usually worsened in REM sleep, because muscle tone is suppressed during REM sleep. However, many cases showed a higher apnea-hypopnea index (AHI) during NREM sleep than during REM sleep. We aimed here to determine the characteristics of REM sleep-dependent OSA (REM-OSA) and NREM sleep-dependent OSA (NREM-OSA). Methods: Five hundred sixty polysomnographically confirmed adult OSA subjects were studied retrospectively. All patients were classified into 3 groups based on the ratio between REM-AHI and NREM-AHI. REM-OSA was defined as REM-AHI/NREM-AHI > 2, NREM-OSA as NREM-AHI/REM-AHI > 2, and the rest as sleep stage-independent OSA (IND-OSA). In addition to polysomnography, questionnaires related to subjective sleep quality, daytime sleepiness, and emotion were completed. Chi-square test, ANOVA, and ANCOVA were performed. Results: There was no age difference among subgroups. The REM-OSA group was comprised of large proportions of mild OSA and female OSA patients. These patients experienced poor sleep and more negative emotions than other two groups. The AHI and oxygen desaturation index (ODI) were lowest in REM-OSA. Sleep efficiency and N3 percentage of REM-OSA were higher than in NREM-OSA. The percentage of patients who slept in a supine position was higher in REM-OSA than other subgroups. IND-OSA showed higher BMI and larger neck circumference and abdominal circumference than REM-OSA. The patients with IND-OSA experienced more sleepiness than the other groups. AHI and ODI were highest in IND-OSA. NREM-OSA presented the shortest total sleep time and the lowest sleep efficiency. NREM-OSA showed shorter sleep latency and REM latency and higher percentage of N1 than those of REM-OSA and the highest proportion of those who slept in a lateral position than other subgroups. NREM-OSA revealed the highest composite score on the Horne and Östberg questionnaire. With increased AHI severity, the numbers of apnea and hypopnea events during REM sleep decreased, and the numbers of apnea and hypopnea events during NREM sleep increased. The results of ANCOVA after controlling age, sex, BMI, NC, AC, and AHI showed the lowest sleep efficiency, the highest AHI in the supine position, and the highest percentage of waking after sleep onset in NREM-OSA. Conclusion: REM-OSA was associated with the mild form of OSA, female sex, and negative emotions. IND-OSA was associated with the severe form of OSA. NREM-OSA was most closely related to position and showed the lowest sleep efficiency. Sleep stage-dependent characteristics could provide better understanding of OSA.

Treatment Outcomes of Mandibular Advancement Devices between Rapid-Eye-Movement (REM)-Related and Not-REM-Related OSA Patients

오재택,장지희,정진우 대한안면통증∙구강내과학회 2016 Journal of Oral Medicine and Pain Vol.41 No.2

Purpose: Mandibular advancement devices (MAD) are used effectively and widely for the treatment of obstructive sleep apnea (OSA) and rapid-eye-movement (REM) dependency of the patients can affect the treatment outcome of OSA. The aim of this study was to compare treatment outcomes of MAD between REM-related and not-REM-related OSA patients. Methods: Fifty-six consecutive patients with OSA who received MAD therapy were evaluated using full night polysomnography before and after insertion of the MADs. The patients were divided into REM-related (REM apnea-hypopnea index [AHI] at least two times higher than their non-REM AHI) and not-REM-related (REM AHI less than two times higher than their nonREM AHI) OSA groups. Results: MAD is used for the treatment of OSA effectively. In respect of AHI, MAD therapy were effective both in REM-related OSA and not-REM-related OSA, but MAD therapy was more effective in not-REM-related OSA than REM-related OSA in overall sleep and non-REM sleep. SpO2 saturations were improved after MAD therapy, but were not different between two groups. Epworth sleepiness scale scores were not improved after MAD therapy. Percentage of REM sleep was increased after MAD therapy but was not different between two groups. Conclusions: MAD therapy was more effective in not-REM-related OSA than REM-related OSA and REM dependency can be a predictive factor of treatment outcome of oral appliance for OSA patients.

Treatment Outcomes of Mandibular Advancement Devices between Rapid-Eye-Movement (REM)-Related and Not-REM-Related OSA Patients

Oh, Jae-Tak,Jang, Ji-Hee,Chung, Jin-Woo Korean Academy of Orofacial Pain and Oral Medicine 2016 Journal of Oral Medicine and Pain Vol.41 No.2

Purpose: Mandibular advancement devices (MAD) are used effectively and widely for the treatment of obstructive sleep apnea (OSA) and rapid-eye-movement (REM) dependency of the patients can affect the treatment outcome of OSA. The aim of this study was to compare treatment outcomes of MAD between REM-related and not-REM-related OSA patients. Methods: Fifty-six consecutive patients with OSA who received MAD therapy were evaluated using full night polysomnography before and after insertion of the MADs. The patients were divided into REM-related (REM apnea-hypopnea index [AHI] at least two times higher than their non-REM AHI) and not-REM-related (REM AHI less than two times higher than their non-REM AHI) OSA groups. Results: MAD is used for the treatment of OSA effectively. In respect of AHI, MAD therapy were effective both in REM-related OSA and not-REM-related OSA, but MAD therapy was more effective in not-REM-related OSA than REM-related OSA in overall sleep and non-REM sleep. $SpO_2$ saturations were improved after MAD therapy, but were not different between two groups. Epworth sleepiness scale scores were not improved after MAD therapy. Percentage of REM sleep was increased after MAD therapy but was not different between two groups. Conclusions: MAD therapy was more effective in not-REM-related OSA than REM-related OSA and REM dependency can be a predictive factor of treatment outcome of oral appliance for OSA patients.

원가구조와 실제영업활동을 통한 이익조정 -과잉생산을 통한 실제이익조정을 중심으로-

이세용,노밝은 한국세무학회 2012 세무와 회계저널 Vol.13 No.1

This study investigated how firm characteristics can differentiate possibilities of implementing the real activity earnings management(REM) using actual business activities. Among the various REM methods, the REM through overproduction(OPREM) that adjusts profit report by increasing a production level more than it is needed in normal is of particular interest;the research questions are if a larger OPREM is observed from the firms with the cost structure characterized by high fixed expenses and if OPREM have a substitute relationship with the REM through sales manipulation (AbCFO) and the REM through discretionary expenditure manipulation(AbDISE). The analysis results are as follows. First, the relationship between fixed asset ratio(FAR) and fixed asset to long-term capital ratio(FALCR) with OPREM has been investigated to verify if a larger OPREM is observed from the firms having the cost structure with high fixed expenses. As a result, the higher the rates of fixed expenses are, the more actively the firms tend to implement OPREM. Second, a portfolio analysis that controlled overall REM levels has been conducted to see if the firms with high fixed expenses show relatively smaller profit adjustment levels when the AbCFO or the AbDISE is used. The result showed the firms high rate of fixed expenses tend to have the larger OPREM and the smaller AbCFO or AbDISE when the overall REM levels are controlled. The results means that even among the firms that have the similar levels of REM in overall, firms with high fixed expenses rate implement the OPREM more actively due to the cost structure and the other REM such as AbCFO and AbDISE are relatively less used. In conclusion, the current study result implies that the previous research might have reported a biased result unless firm characteristics are properly considered. Therefore, basic firm characteristics that can influence the implementation and effects of REM should be incorporated to analyze the REM effects with more accuracy. 본 연구는 기업특성에 따라 실제 영업활동을 이용한 이익조정(Real activity earnings management,이하 REM)의 실행가능성이 달라지는지를 검증하고자 하였다. 구체적으로 REM의 여러 방법 중에서 정상적인 매출에 필요한 수준 이상으로 생산량을 과도하게 증가시켜 보고이익을 조정하는 과잉생산 REM에 초점을 두고, 고정비 비중이 큰 원가구조를 갖는 기업에서 과잉생산 REM이 크게 나타나는지, 이러한 과잉생산 REM이 매출액 조정 REM과 재량적 지출액 조정 REM과 대체관계를갖는지를 분석하였다. 분석 결과는 다음과 같다. 첫째, 고정비 비중이 큰 원가구조를 갖는 기업에서 과잉생산 REM이크게 나타나는지를 검증하기 위하여 원가구조의 대용치인 고정비율(FAR)과 고정장기적합률(FALCR)의 크기에 따라 과잉생산을 통한 REM이 달라지는지를 분석하였다. 그 결과, 고정비의 비중이 높은원가구조를 갖는 기업일수록, 과잉생산을 통한 REM을 더욱 적극적으로 수행하고 있음을 발견하였다. 둘째, 고정비 비중이 큰 원가구조를 갖는 기업의 경우, 이들 기업의 매출액 조정 REM과 재량적지출액 조정 REM은 과잉생산 REM에 비하여 그 이익조정의 수준이 상대적으로 작게 나타나는지를 기업의 전체적인 REM 수준을 통제하는 포트폴리오를 구성하여 검증하였다. 분석결과, 기업의전체적인 REM의 크기를 통제한 상태에서 고정비의 비중이 큰 원가구조를 가지는 기업일수록 과잉생산 REM은 증가하는 추이로 나타나는 반면, 다른 REM의 수단인 매출액 조정 REM은 과잉생산 REM과는 반대로 감소하는 추이가 나타나고 있었다. 이러한 결과는 기업의 전체적인 REM의수준이 유사한 경우에도 고정비의 비중이 높은 기업은 그 원가구조의 특성 때문에 과잉생산 REM 을 보다 적극적으로 수행하고 있으며, 그에 따라 다른 REM의 수단인 매출액 조정 REM은 상대적으로 적게 사용한다는 것을 의미한다. 종합적으로 보아 본 연구의 결과는 기업특성을 고려하지 않을 경우, REM에 대한 선행연구들의결과에 편의가 존재할 가능성이 있음을 암시하는 것으로 REM의 효과를 보다 정확하게 분석하기위해서는 REM의 실행가능성과 그 경제적 효과에 영향을 미칠 수 있는 기본적인 기업 특성을 고려해야 할 필요가 있음을 시사하는 것이다.

자사주 취득 및 처분기업의 이익조정

기현희,김민철 한국회계정책학회 2012 회계와 정책연구 Vol.17 No.3

This study examines earnings management of SR (stock repurchase) and SD (stock disposition) announcement firms. The sample of this study consists of 186 SR and 153 SD firms listed in the Korean Stock Exchanges from 2002 to 2008. And manager’s earnings management was measured by DA (discretionary accruals) and REM (real earnings manipulation). This study tests four hypotheses:Hypothesis 1, 2 are that SR firms will try to downward adjustment in DA and REM, and the more SRA (stock repurchase amount) has, the lower earnings management has in year t-1 (before the announcement of repurchase) and year t(announcement year). Hypothesis 3, 4 are that SD (stock disposition) firms will try to upward adjustment in DA and REM, and the more SDA (stock repurchase amount) has, the higher earnings management has in year t-1 and year t. The results of this empirical study are as follows. First, SR and SRA have negative sign in year t only on DA and REM. This implies that SR firms utilize downward earnings adjustment with both DA and REM to buy stock repurchase with low price in year t. Second, SD and SDA were not statistically significant in both year t-1 and year t on DA and REM. This implies that SD firms dont’t have earnings management to stock disposition with high price. 본 연구는 자기주식의 취득과 처분을 공시한 2002년부터 2008년까지 거래소의 비금융업을 대상으로 자기주식을 취득하거나 처분할 경우 유리한 가격으로 거래하고자 보고이익을 조정하는지와 취득 또는 처분금액의 크기가 이익조정에 영향을 미치는지를 알아보고자 하였다. 이익조정은 발생액조정(DA)과 실제이익조정(REM)으로 구분하여 DA의 측정모형으로는 수정존스 모형을, REM의 측정모형으로는 Roychowdhury(2006)가 도출한 방법을 사용하였으며 연구결과는 다음과 같다. 첫째, 자기주식취득공시 1년 전(t-1기)에서는 SR(취득)의 경우 REM과 DA모두에서 음(-)의 계수이나 유의하지 않았으며, 공시당해연도(t기)의 경우는 SR이 음(-)의 값으로 1%에서, DA의 경우에도 음(-)으로 10%에서 유의하였다. 이는 자기주식취득기업의 경우 REM과 DA를 낮게 함으로써 보고이익을 하향조정하고 있음을 의미한다. SRA(취득금액)의 경우에도 t-1기에는 REM, DA 모두에서 유의하지 않으며 t기에 REM과 DA에 대해서 SR이 모두 음(-)의 값으로 5%에서 유의하게 나와 자기주식의 취득금액이 클수록 REM과 DA를 하향조정하고 있음이 나타났다. 둘째, SD(자기주식처분), SDA(처분금액)의 경우는 REM과 DA에 대해 공시직전연도와 공시당해연도 모두에서 유의하지 않았다. 즉 자기주식의 처분을 공시한 기업들은 처분공시직전연도와 처분공시당해연도에 처분가치를 높이기 위해 이익조정을 하고 있지는 않는 것으로 나타났다.

REM 수면 관련 수면호흡장애

신철,이현주,Shin, Chol,Lee, Hyun-Joo 대한수면의학회 2004 수면·정신생리 Vol.11 No.1

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.

감사품질차이가 실제 활동을 통한 이익조정에 미치는 영향에 관한 연구

조현연,김도원 한국회계정보학회 2010 재무와회계정보저널 Vol.10 No.4

This paper investigates whether levels of real earnings management(REM) vary with audit quality. To test the hypothesis I collect samples consisting of 4,172 firm-years in Korea from 2001 to 2008. I use big4 auditor(BIG4) and auditor industry specialty(ISP) as two proxies for audit quality and estimate the levels of real earnings management based on the model formulated in studies of Roychowdhury(2006) and Kim et al.(2008). In the result, firms audited by auditor in big size and with industry specialty tend to not only show smaller magnitude of overall real earnings management but also play an important role in reducing levels of abnormal operating cash flows, abnormal discretionary expense, and abnormal production cost, which are three individual proxies for real earnings management. In addition to the result using data in annual report, I find that, although the relation between audit quality and real earnings management is weaker in semi-annual data as compared with that from annual data, the result remains the same, and thus auditor of higher quality also reduces real earnings management appearing in semi-annual report. These results have consistency with those of prior literature that audit quality inhibits managers from using their discretion and I conclude that auditor plays a certain role in monitoring managements' manipulation of their earnings by means of real earnings management. My study is distinguished from prior literature which has focused mainly on existence of real earnings management, in terms of paying attention to audit quality and its influence. Moreover the fact that my paper investigates empirically a relation between audit quality and real earnings management rather than accrual based earnings management is the other contribution to research considering audit quality and earnings management. 본 연구는 발생액을 통한 이익조정(AEM)외에 실제 활동을 통한 이익조정(REM)이 감사품질에 따라 그 수준이 다르게 나타나는 지를 검증하는 것을 목적으로 하여 연구를 수행하였다. 다수의 선행연구에서 나타난 바와 같이 감사품질이 높을수록 경영자의 재량권이 제한되어 발생액을 통한 이익조정(AEM)이 억제되고 있다면, 경영자의 재량권을 행사할 수 있는 또 다른 유형인 실제 활동을 통한 이익조정(REM)의 경우에도 제약을 받을 것으로 판단된다. 이를 검증하기 위하여 본 연구에서는 2001년부터 2008년까지의 표본기간동안 총 4,172개의 표본을 대상으로 실증분석을 수행하였다. 감사품질의 대용 치로는 선행연구들에서 사용하고 있는 감사인 규모(Big4)와 산업전문성을 사용하였으며, REM은 대표적인 국내연구인 김지홍 등(2008)과 Roychowdhury(2006)의 추정모형을 이용하여 측정하였다. 분석결과, 감사인의 규모가 크거나(Big4) 산업전문감사인에게 감사를 받는 피감사기업의 경우 그렇지 않은 기업에 비하여 전체 REM수준은 전반적으로 억제되고 있는 것으로 나타났으며, REM의 개별 측정치인 비정상영업현금흐름과 비정상재량지출액, 그리고 비정상생산원가를 통한 이익조정에서도 감사품질이 높을수록 각각의 이익조정의 수준은 제약을 받는 것으로 나타났다. 이러한 결과는 감사품질이 높을수록 경영자의 재량권이 제한된다는 선행연구의 결과와 일관성을 가지는 것으로, 감사품질이 높은 감사인의 경우 REM에서도 감사인이 이를 인지하고 모니터링 하는 역할을 수행하고 있음을 시사한다. 본 연구는 현재까지 진행되어 온 REM의 존재 여부만을 탐지하는 연구에서 나아가 감사품질을 고려하였다는 데에서 선행연구와 차별성을 가진다. 또한 감사품질과 기업의 이익조정에 대한 연구에서 AEM의 측면 이외에 REM의 측면에서 감사품질과의 관련성을 실증하였다는 점에서 선행연구에 추가적인 공헌점이 있다.

Radio environment maps: The survey of construction methods

( Marko Pesko ),( Tomaz Javornik ),( Andrej Kosir ),( Mitja Stular ),( Mihael Mohorcic ) 한국인터넷정보학회 2014 KSII Transactions on Internet and Information Syst Vol.8 No.11

Radio environment maps (REMs) and geolocation database represent an important source of information for the operation of cognitive radio networks, replacing or complementing spectrum sensing information. This paper provides a survey of methods for constructing the radio frequency layer of radio environment map (RF-REM) using distributed measurements of the signal levels at a given frequency in space and time. The signal level measurements can be obtained from fixed or mobile devices capable of sensing radio environment and sending this information to the REM. The signal measurements are complemented with information already stored in different REM content layers. The combined information is applied for estimation of the RF-REM layer. The RF-REM construction methods are compared, and their advantages and disadvantages with respect to the spatial distribution of signal measurements and computational complexity is given. This survey also indicates possible directions of further research in indirect RF-REM construction methods. It emphasizes that accurate RF-REM construction methods should in the best case support operation with random and clustered signal measurements, their operation should not be affected by measurements outliers, and it must estimate signal levels comparably on all RF-REM locations with moderate computational effort.

이익조정과 시장반응 효율성 검증

이진수 한국자료분석학회 2011 Journal of the Korean Data Analysis Society Vol.13 No.5

본 연구는 발생액을 통한 이익조정(AEM)과 실제영업활동을 통한 이익조정(REM)이 미래 경영성과에 미치는 영향을 살펴보며 시장 참여자들이 이러한 영향을 효율적으로 주가에 반영하는지 Mishkin’s test(1983)를 통하여 조사한다. 분석결과, 첫째, 발생액이익조정(AEM)과 실물이익조정(REM) 모두 미래 경영성과에 음(-)의 영향을 미치는 것으로 나타났다. 이는 회계처리선택에 의한 발생액이익조정과 실질 경영의사결정과 현금흐름의 변동을 수반하는 실물이익조정 모두 기업가치에 부정적임을 의미한다. 둘째, 시장 참여자들은 발생액이익조정(AEM)과 실물이익조정(REM)의 함축적 의미에 대해 평가오류를 범하는 것으로 나타났다. 이는 발생액이익조정과 실물이익조정의 주식가격에 미치는 영향을 시장참여자들은 효율적으로 포착하지 못한다는 것을 의미한다. This paper studies the effect of accrual based earnings management (AEM) and real earnings management (REM) on the future firm performance. Also, this paper analyses how the market participants respond to the above effect of AEM and REM. Using the 2001 through 2009 data, the results of empirical analysis are as follows. First, we find that both AEM and REM have negative effect on the future performance. Second, the market participants overestimate the importance of AEM and REM for the future firm performance. This evidence means that the market participants do not fully price the effect of AEM and REM on the future firm performance. This paper adds a kind of contribution to the prior research. Unlike prior research, this paper exams the differential prediction ability of AEM and REM for future earning. Also, it investigates the market efficiency on the effect of AEM and REM on the future firm performance.