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.

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.

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

목 적 : 본 연구는, 교대근무자에 있어 세 교대근무간의 수면양상과 자율신경계활동성을 비교함으로써, 근무자들은 어떤 근무시에 가장 적합하다고 느끼는지 그리고 교대근무자의 심리적, 신체적 문제점의 특성은 무엇인지를 알아보고자 하였다. 또한 본 연구는 근무자들이 교대근무에 좀 더 효과적으로 적응하는데 도움을 주고자 기획되었다. 방 법 : 3일 정도 연속적으로 한 교대근무를 한 후 1일 휴무, 그 다음에 다른 교대로 넘어가는 빠른 순환주기의 교대근무자 51명이 연구에 참여하였다. 각 대상은 수면일기를 작성하였으며 수면잠복기, 수면기간시간, 수면 중 깨어난 횟수를 세 교대근무간에 비교하였다. Epworth 졸음척도와 시각아날로그척도를 사용하여 졸음을 평가하였으며 기분상태는 기분상태척도로 평가하였다. 심박수변동성과, 스트레스 호르몬(아드레날린, 노르아드레날린) 및 그 대사산물을 측정하여 자율신경계 활동성을 살펴보았다. 심박수변동성에는 저주파영역의 스펙트럼 파워, 고주파영역의 스펙트럼 파워, 저주파영역의 파워와 고주파영역의 파워간의 비가 포함되었다. 결 과 : 수면기간시간은 오후근무시 가장 길었고 수면잠복기는 밤근무시 가장 짧았다. 깨어났을 때의 각성도는 오전근무시 가장 저하되었고 작업 중의 각성도는 밤근무 중 가장 떨어지는 것으로 나타났다. 밤근무시 근무자들은 신체적인 피곤감과 인지기능의 저하를 호소하였다. 심박수변동성의 비교를 통해 오후근무시 부교감신경계가 가장 활성화된다는 것을 알 수 있었으며 아드레날린 및 노르아드레날린 분비도 통계적인 의미는 없었지만 오후근무시 가장 감소하였다. 결 론 : 본 연구결과 오후근무가 교대근무자에게 가장 적합한 것으로 나타났다. 오전근무시에는 빛을 아침에 투여하고 밤근무시에는 근무 중에 빛을 투여하면 교대근무에의 적응이 촉진될 것으로 생각된다. 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.

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.

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

목 적: 하지불안증후군에서의 인지기능 저하는 흔히 동반되는 수면박탈, 불안, 우울 등에 의해 영향을 받는다. 본 연구의 목적은 투약 받지 않고 있는 한국 노인 인구에서 하지불안증후군과 인지기능 저하와의 관련성을 동반 증상의 영향을 배제하고 살펴보는 것이다. 방 법: 연구대상은 25명의 투약 받고 있지 않은 한국 노인 하지불안증후군 환자군과 나이, 성별, 교육연한에 따라 짝지은 50명의 대조군이다. 모든 연구대상에 대해 CERAD-K 신경심리평가, 중증인지감퇴평가 척도, 전두엽 기능 평가, 그리고 시계 그리기 검사(CLOX)를 포함한 광범위한 인지기능 평가를 시행하였다. 또한 수면의 질 평가를 위해 피츠버그 수면의 질 지수(Pittsburgh Sleep Quality Index, PSQI), 우울증의 평가를 위해 노인우울척도(Geriatric Depression Scale, GDS)를 사용하였다. 결 과: 환자군과 대조군 사이의 PSQI와 GDS 점수의 차이는 없었다. 구성 재인 검사에서 환자군이 대조군에 비해 더 낮은 점수를 보였으며(t=-2.384, p=0.02), 이를 제외한 모든 영역의 인지기능 평가에서 환자군과 대조군의 유의미한 차이는 관찰되지 않았다. 우울감이 있는 대상($GDS{\geq}10$)은 그렇지 않은 군에 비해 언어 유창성, 간이 정신상태 검사, 단어목록기억, 길 만들기 검사, 전두엽 기능 평가의 영역에서 유의한 인지기능 저하를 보였다. 수면의 질이 낮은 대상(PSQI>5)은 그렇지 않은 군에 비해 인지기능 평가의 전 영역에서 차이를 보이지 않았다. 결 론: 본 연구에서 하지불안증후군 환자군을 대조군과 비교한 결과 환자군은 불면과 우울의 영향을 배제하면 비교적 인지기능이 보존된 것으로 관찰되었다. 환자군에서 관찰되었던 시각 인지 영역의 저하는 하지불안증후군에서의 도파민 신경전달계의 장애와 연관하여 해석해 볼 수 있다. 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.

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

목 적:본 연구에서는 노인 수면 무호흡증과 성인 수면 무호흡증에서의 특성들을 비교하고, 이미 알려진 성인 수면무호흡증에서의 위험인자들과 노인 수면무호흡증에서의 호흡장애지수 사이의 상관관계를 살펴 노인 수면무호흡증의 특징을 조사하고자 하였다. 방 법:호흡장애지수가 5 이상이면서 연령이 20세 이상인 275명의 수면 무호흡증 환자들을 대상으로 하였고, 연구 대상에게 간단한 신체검사, Pittsburgh 수면질척도, Epworth 졸림증 척도 등을 포함한 설문지 평가, 수면다원검사를 시행 하였다. 60세 미만의 성인 수면무호흡증 집단과 60세 이상의 노인 수면무호흡증 집단 간에 자료들이 비교, 분석 되었다. 결 과:노인과 성인 수면무호흡증에서 호흡장애지수, 무호흡지수, 90% 미만 산소포화도 기간의 백분율, Pittsburgh 수면질척도 등은 두 집단 간에 차이가 없었다. 노인 수면무호흡증은 성인 수면무호흡증에 비해 폐쇄성 무호흡지수와 산소포화도저하지수가 낮았다. 또한 통계적 유의성은 없으나, 최저 산소포화도와 중추성 무호흡지수가 높았다. 노인 수면무호흡증에서 체질량지수와 목둘레가 성인 수면무호흡증에 비해 작았다. 확장기 혈압도 노인에서 성인 수면무호흡증에 비해 낮았으나, 수축기 혈압은 두 집단 간에 차이가 없었다. 노인 수면무호흡증에서 성인에 비해 Epworth 졸림증 척도 점수가 낮았다. 성인 수면무호흡증에서는 호흡장애지수와 체질량지수 사이에 유의한 상관관계가 있었으나, 노인 수면무호흡증에서는 두 변수 사이에 상관관계가 관찰되지 않았다. 이와 유사한 결과가 호흡장애지수와 목둘레, 수축기 혈압, 그리고 확장기 혈압 사이에서도 나타났다. 결 론:노인 수면무호흡증 집단은 비만하지 않았고, 노인에서의 수면무호흡증의 심각도는 체중과 관련이 없었다. 또한, 노인에서는 수면무호흡증이 행동과 심혈관계에 미치는 영향이 현저하지 않았는데, 이는 노인 수면무호흡증에서 성인에 비해 산소포화도저하지수가 낮고, 최저 산소포화도가 상대적으로 높은 것에 의해 일부 설명되어질 수 있을 것이다. 체중 증가보다는 정상 노화과정이 합병증이 적은 노인 수면무호흡증 발생에 좀 더 기여하는 것으로 생각된다. 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.

열차행선안내게시시스템 개선방안 연구

윤인영(Yoon In-Young),여용주(Yeo Yong-Joo),김광휘(Kim Kwang-Hwi),김호창(Kim Ho-Chang) 한국철도학회 2007 한국철도학회 학술발표대회논문집 Vol.- No.-

Urban railway system that leads the urban public transportation enables the passengers to use the subway system safely and conveniently by indicating the destination of, status of approach of and other information on train through Train Destination Equipment(TDE), which is one of the important passenger services. The existing system is composed of Host Station Equipment(HSE) and operator panel that receives necessary input on train information from Total Traffic Control System(TTC), Local Station Equipment(LSE) that controls Train Destination Indicator(TDI) installed at each station, and Train Destination Indicator that ultimately displays train information to the passengers using the train system. This study aims to realize stabilized and reliable announcement system for destination of train by considering processing procedure and method of expression of inputted information of the existing system of notification of announcement of destination of train that can be applied in the RFID, which is the base technology of USN for which service expansion is easy, and to realize system that considers interface with USN and expandability with other facilities in the future.