교대근무자에서 각 교대근무간의 수면양상 및 자율신경계 활성도 비교

윤인영,하미나,박정선,송병근,Yoon, In-Young,Ha, Mi-Na,Park, Jung-Sun,Song, Byoung-Gun 대한수면의학회 2000 수면·정신생리 Vol.7 No.2

Objectives: Through comparing sleep variables and autonomic activities among three shifts in shift workers, the authors intended to clarify which shift is most tolerable and to identify the characteristics of their psychological and physical problems. This study is also expected to help shift workers to adapt themselves to their work more effectively. Methods: Fifty one shift workers took part in this study. They were working in a rapidly rotating system in which they worked for 3 days in one shift with one day off between each shift. Based on a sleep diary, sleep latency (SL), sleep period time (SPT), and number of wake after sleep onset (NWASO) were estimated and compared among the three shifts. In assessing sleepiness, Epworth sleepiness scale (ESS) and visual analogue scale (VAS) were used. To evaluate mood states among the three shifts, profile of mood states (POMS) was administered. Heart rate variability (HRV), and the level of adrenaline and noradrenaline were measured to assess autonomic activities. HRV included low frequency power (LF), high frequency power (HF), and LF/HF. Results: SPT was significantly lengthened during the evening shift and SL was shortened during the night shift. The workers showed a drop in alertness at wake-up during morning shift and a drop in alertness at work during night shift. During night shift the subjects complained of physical fatigue and cognitive decline. Comparison of HRV showed that parasympathetic activity was most prominent during the evening shift. Secretion of adrenaline and noradrenaline decreased during the evening shift, though statistically not significant. Conclusion: We found that the evening shift was most tolerable among the three shifts. It is recommended that morning light exposure be done during the morning shift and nocturnal light exposure during the night shift.

렘수면행동장애와 악몽

윤인영,Yoon, In-Young 대한수면의학회 1995 수면·정신생리 Vol.2 No.1

In the International Classification of Sleep Disorders(ICSD), REM sleep behavior disorder(RBD) and nightmares are classified as 'parasomnias usually associated with REM sleep'. RBD can be defined as the intermittent absence of REM sleep EMG atonia and the appearance of the elaborate motor activity associated with dream mentation. Bilateral pontine tegmental lesions in cats induce RBD-like behavior, but in human cases, more than 60% are idiopathic. Polysomnograpy shows characteristic findings in REM sleep and treatment with clonazepam is highly effective. With nightmares as long, frightening dream decreasing with age, their persistence or apperance in adults is related with certain drugs, trauma, personality and psychotic episode. Psychotherapy, behavior techniques or medication is used for treatment, but all of nightmares do not require treatment.

주관적 각성정도, 기분, 수행능력의 일중변화

윤인영,Yoon, In-Young 대한수면의학회 1998 수면·정신생리 Vol.5 No.1

Circadian rhythms in subjective alertness, mood, and performance can be classified as psychological rhythm, compared with physiological rhythm such as body temperature and hormonal change. While in normal condition entrained by 24hr zeitgeber, subjective alertness would reach its maximum value around midday, subjective alertness would parallel body temperature rhythm with its peak at evening in non-entrained, free-running state. With desynchronization technique, subjective alertness rhythm is thought to be controlled by both temperature and sleep-wake rhythm oscillator. Circadian performance rhythms depend on the kind of task tested. It shows parallelism with body temperature rhythm when subjects are tested with simple, repetitive task. But when tested with tasks requiring complex verbal reasoning or immediate memory, subjects would perform them best at early morning, with performance decreasing as time of day advances. The desynchronization technique shows that circadian performance rhythm of simple, repetitive task is dependent on temperature oscillator but circadian performance rhythm of complex verbal reasoning is influenced by both temperature and sleep-wake rhythm oscillator or another independent oscillator. It would be worthwhile to compare psychological rhythm with hormonal change such as cortisol and melatonin. And more simple and time-saving method than desynchronization technique may facilitate the study of the mechanism underlying psychological rhythm.

불면증의 비약물학적 치료

윤인영,Yoon, In-Young 대한수면의학회 2000 수면·정신생리 Vol.7 No.1

Several nonpharmacological treatment methods of insomnia and their effects were reviewed. A long-term use of most hypnotics may produce tolerance, dependence, cognitive and psychomotor impairments at daytime, shallow sleep, and rebound insomnia on drug withdrawal. To reduce hypnotic abuse, nonpharmacological strategies have been developed to correct disordered behavioral and cognitive factors. These treatments aim at modifying maladaptive sleep habits, lowering physiological and cognitive arousal levels, and correcting dysfuctional beliefs and attitudes about sleep. These non-pharmacological or cognitive behavior treatments include stimulus control, sleep restriction, relaxation training, sleep hygiene education, cognitive therapy, and light therapy. Among them the stimulus control therapy has been demonstrated most effective as a single treatment or in combination with other treatments. Through nonpharmacological treatments, sleep latency was most significantly reduced and wake time after sleep onset was also reduced. About 50% of insomniacs reported clinical improvements in terms of nearly normalized sleep latency, awakening time, sleep efficiency, and reduction of hypnotic use. Compared to the hypnotic therapy, nonpharmacological treatments are more cost-effective and more readily accepted by patients, and their effects last longer.

수면관련 호흡장애에서의 신경정신과적 증상

윤인영,Yoon, In-Young 대한수면의학회 1997 수면·정신생리 Vol.4 No.2

Sleep-related breathing disorders, especially sleep apnea syndrome are complicated by neuropsychiatric dysfunction such as excessive daytime sleepiness, cognitive dysfunction, and depression. As the determinants of daytime sleepiness, sleep fragmentation is more influential than nocturnal hypoxia. Daytime sleepiness can be improved by continuous positive airway pressure (CPAP) or surgery in up to 95% of the treated subjects. Both sleepiness and nocturnal hypoxia would cause cognitive dysfunction. While impairments in attention and verbal memory are more related with sleepiness and prominent in mild to moderate sleep apnea syndrome (SAS), impairments in general intellectual function and executive function are more related with nocturnal hypoxia and prominent in severe SAS. Several cognitive deficits related with nocturnal hypoxia may be irreversible despite CPAP or surgical treatments. So, early detection and early appropriate treatment of SAS would prevent sleepiness and cognitive deterioration.

치료(治療)에 반응(反應)한 특발성(特發性) 중추성(中樞性) 수면과다증(睡眠過多症) 5예(例) 분석(分析)

윤인영,정도언,Yoon, In-Young,Jeong, Do-Un 대한수면의학회 1997 수면·정신생리 Vol.4 No.1

The authors studied 5 cases of idiopathic CNS hypersomnia who visited Division of Sleep Studies, Seoul National University Hospital in 1995. Detailed medical history was taken and nocturnal polysomnography(NPSG), multiple sleep latency test(MSLT) and human leukocyte antigen(HLA) typing were performed. Neither cataplexy nor hypnagogic hallucination was reported in all cases and in NPSGs, there were tendencies of increased sleep period time and decreased slow wave sleep time. In MSLT, all the subjects showed average sleep latencies less than 8 minutes without sleep-onset rapid eye movement period(SOREMP). In HLA typing, some correlation between idiopathic CNS hypersomnia and HLA DR4 was observed. In contrast to previous reports, overall treatment response with methylphenidate was remarkable. Therefore, the authors suggest that patients suspected of idiopathic CNS hypersomnia be actively evaluated and treated with rather optimistic perspective.

수면과다증을 반복적으로 보이는 24세 여자환자

윤인영,정도언,Yoon, In-Young,Jeong, Do-Un 대한수면의학회 1995 수면·정신생리 Vol.2 No.1

A 24-year-old woman complained of recurrent episodes of hypersomnia lasting on the average about 15 days with mild mood alternation such as depression and irritability. During interepisode interval, she was free of any symptoms. Depending on the absence of excessive eating and hypersexuality, she was clinically diagnosed as recurrent monosymptomatic hypersomnia or the incomplete form of Kleine-Levin syndrome. When nocturnal polysomnography and multiple sleep latency test were performed 10 days after her recovery from a hypersomnic episode, reduced slow wave sleep % and pathologic daytime sleepiness were still noted. The authors suggest that the clinical recovery in recurrent monosymptomatic hypersomnia precede electrophysiological normalization by several days.

나이에 따른 수면무호흡증 임상적 특성의 변화

신윤경,윤인영,홍민철,윤영돈,Shin, Yoon-Kyung,Yoon, In-Young,Hong, Min-Chul,Yun, Yong-Don 대한수면의학회 2005 수면·정신생리 Vol.12 No.1

Objectives: Much attention has been paid to sleep apnea syndrome (SAS) in the elderly because of its high prevalence. It is expected that SAS in the elderly has both similarities and differences compared to SAS in the young or middle-aged populations. The aim of this study was to elucidate the characteristics and consequences of SAS in the elderly. Methods: In this study we included 210 young or middle-aged adults between 23 and 59 years (20 women and 190 men) and 65 older adults between 60 and 83 years of age (16 women and 49 men). Respiratory disturbance indices (RDIs) of the study subjects were more than 5 in an overnight polysomnography. They completed the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Informations about body mass index (BMI), neck, waist, and hip measurements, and blood pressure were obtained. Results: No difference was observed between older adults with SAS (older SAS) and adults aged under 60 with SAS (SAS aged under 60) in RDI, apnea index, % time of oxygen saturation less than 90%, and PSQI. Obstructive apnea index and oxygen desaturation index (ODI) were lower in older SAS. Compared to SAS aged under 60, lowest oxygen saturation and central apnea index were higher in older SAS, but they were statistically not significant. BMI and neck circumference were significantly lower in older SAS compared to SAS aged under 60. Diastolic blood pressure was lower in older SAS compared to SAS aged under 60 with no difference in systolic blood pressure. Older SAS showed lower scores in ESS than SAS aged under 60. Significant correlation was observed between RDI and BMI in SAS aged under 60, but not in the case of older SAS. The relationships between RDI and neck circumference, systolic and diastolic pressure, and ESS were similar. Conclusions: The elderly with SAS were not over-weight and there was no relationship between body weight and the severity of SAS. Also, the behavioral and cardiovascular effects of SAS were not marked in the elderly, which might be partly explained by decreased ODI and relatively higher lowest oxygen saturation in older SAS. The normal aging process, aside from increased body weight, might contribute to the development of SAS in the elderly with modest complications.

노인 하지불안증후군에서의 인지기능 저하

김은수,윤인영,권국주,박혜연,이정석,한은경,김기웅,Kim, Eun Soo,Yoon, In-Young,Kweon, Kukju,Park, Hye Youn,Lee, Chung Suk,Han, Eun Kyoung,Kim, Ki Woong 대한수면의학회 2013 수면·정신생리 Vol.20 No.1

Objectives: Cognitive impairment in restless legs syndrome (RLS) patients can be affected by sleep deprivation, anxiety and depression, which are common in RLS. The objective of this study is to investigate relationship between cognitive impairment and RLS in the non-medicated Korean elderly with controlling for psychiatric conditions. Method: The study sample for this study comprised 25 non-medicated Korean elderly RLS patients and 50 age-, sex-, and education- matched controls. All subjects were evaluated with comprehensive cognitive function assessment tools- including the Korean version of Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K), severe cognitive impairment rating scale (SCIRS), frontal assessment battery (FAB), and clock drawing test (CLOX). Sleep quality and depression were also assessed with Pittsburgh sleep quality index (PSQI) and geriatric depression scale (GDS). Results: PSQI and GDS score showed no difference between RLS and control group. There was no significant difference between two groups in nearly all the cognitive function except in constructional recognition test, in which subjects with RLS showed lower performance than control group (t=-2.384, p=0.02). Subjects with depression ($GDS{\geq}10$) showed significant cognitive impairment compared to control in verbal fluency, Korean version of Mini Mental Status Examination in the CERAD-K (MMSE-KC), word list memory, trail making test, and frontal assessment battery (FAB). In contrast, no difference was observed between subjects who have low sleep quality (PSQI>5) and control group. Conclusions: At the exclusion of the impact of insomnia and depression, cognitive function was found to be relatively preserved in RLS patients compared to control. Impairment of visual recognition in RLS patients can be explained in terms of dopaminergic dysfunction in RLS.

정신건강의학과 개방병동 입원 환자의 진단군별 약물 처방 경향 변화 : 경기도 소재 일 대학병원에서의 11년 비교 연구

변선정,김의태,유희정,하태현,윤인영,김기웅,Byun, Seonjeong,Kim, Euitae,Yoo, Hee Jeong,Ha, Tae Hyon,Yoon, In-Young,Kim, Ki Woong 대한생물정신의학회 2015 생물정신의학 Vol.22 No.4

Objectives This study investigated the patterns of psychotropic medications prescribed to patients admitted to an open psychiatric ward. Methods We reviewed 4282 medical records of patients who were discharged from an open psychiatric ward from May 2003 through April 2014. Data were collected on each patient's age, sex, length of hospital stay, number of past admissions, discharge diagnosis, and kinds and dosages of psychotropic medications at discharge. Results Among the 1384 male and 2898 female patients, 3.56 psychotropic medications were prescribed on average, with the number increasing across years, from 3.30 in 2003-2008 to 3.76 in 2009-2014. Prescription rates of antipsychotics, anxiolytics, and hypnotics significantly increased in patients with depressive disorders, bipolar disorders, anxiety disorders, delirium, dementia, and amnestic and other cognitive disorders. Only lithium prescription rates decreased significantly. Prescriptions for two or more anxiolytics and antipsychotics increased during the survey years, while antidepressant polypharmacy rates decreased. Conclusions Recently, there has been a significant increase in the number of psychotropic medications prescribed, including antipsychotics, anxiolytics, and hypnotics. Caution should be exercised when prescribing medications to avoid cost increases and the risk of side effects, with uncertain gains in the quality of care.