한국 렘수면행동장애 환자의 렘수면무긴장소실의 정량적 분석:도수적 방법과 컴퓨터 지원 방법과의 비교

이지훈,신원철,정유진,차현극,최혜연 대한수면연구학회 2014 Journal of sleep medicine Vol.11 No.2

Objectives : The Polysomnographic(PSG) hallmark of REM sleep behavior disorder (RBD) is loss of muscle atonia during REM sleep; REM sleep without atonia (RSWA). However, the international classification of sleep disorders (ICSD) – 3 criteria did not suggest optimized diagnostic value of RSWA and how to score muscle activity during REM sleep. Many previous studies have been tried to figure out the objective quantitative cut- off values of RSWA. We investigated RSWA in Korean RBD patients compared with normal control, to figure out it’s cut-off value in diagnosis of RBD, using both manual and computer-assisted scoring methods (REM atonia index, RAI). Methods: We retrospectively analyzed PSG and clinical data of 40 patients, 10 age-matched controls by ICSD-3 criteria. The quantitative analysis of chin electromyography (EMG) density during REM sleep was done by both manual and computerized method. The RSWA and RAI were compared within two groups to figure out cut-off values for distinguishing two groups. Result: In computerized method, the mean RAI of RBD patient was 0.66 [±0.20, standard deviation (SD)], and 0.93 [±0.38, SD, p<0.001) in control group. Also, in manual method, RSWA were also significantly increased within RBD patient compared with normal controls. (tonic activity : 9.1±10.3 vs 0.1±0.2, phasic activity : 7.5±6.4 vs 1.6±1.2, p<0.002) Conclusion : We quantitatively figured out the characteristics of RSWA in Korean RBD patients and suggest that we may diagnose RBD who have RSWA more than 4.1% of total REM sleep duration and RAI lower than 0.84.

신경계 : 일반연재 ; 경동맥 초음파(Carotid duplex) 검사의 고찰

엄재광,노영경,신현직,노영구,차현극 대한임상병리사협회 2011 임상생리검사학회 발표자료집 Vol.2011 No.-

배경(Background) 현대인들은 불규칙적이고 서구화된 식습관, 운동부족, 스트레스 등으로 인해 고혈압, 당뇨, 고지혈증, 비만 등 성인병이 증가하고 있다. 또한 성인병 증가로 인한 뇌졸중(뇌경색)과 심근경색, 동맥경화증의 발병률이 증가하는 추세이다. 경동맥은 초음파를 이용하여 쉽게 영상을 얻을 수 있는 동맥으로써 경동맥의 동맥경화증 정도는 뇌졸중과 같은 뇌혈관 질환의 표식자일 뿐 아니라, 전신의 동맥경화증과 관련된 예측 인자로 잘 알려져 있다. 특히 경동맥의 내중막 두께(Carotid intima-media thickness, IMT)는 경동맥의 일반적인 동맥경화반의 존재가 없더라도 장기적인 뇌졸중 혹은 허혈성 심장질환의 발병을 예측할 수 있다. 방법(Methods) Duplex 초음파 검사는 B-mode 영상검사와 Doppler검사를 같이하는 검사로서 pulsed wave Doppler는 혈류학적 정보, 그리고 B-mode 영상은 해부학적 정보를 제공함으로써 Doppler sample volume을 혈관 내에서 원하는 곳에 위치시키기가 가능하며, 또한 angle of insonation의 교정을 가능하게 하여 준다. 이는 transcranial Doppler 검사의 한계를 극복할 수 있게 해주며, 혈관 촬영 없이 경동맥 초음파검사만으로 경동맥내막절제술을 가능하게 할 수 있다. 결과(Results) 경동맥 초음파 검사는 실제 혈관에 존재하는 동맥경화반을 찾을 수 있고 이를 이용해 쉽게 환자의 예후 및 치료 결과를 평가 할 수 있으며, 장기적인 뇌졸중 등의 뇌혈관 질환을 예측 할 수 있다. 또한 동맥경화반이 없는 경우에도 여러 곳 혹은 총경동맥의 원위부의 내중막 두께(Carotid intima-media thickness, IMT)를 측정함으로서 많은 혈관계 정보를 제공해 준다. 고찰(Discussion) 위와 같이 경동맥 초음파 검사를 통해 다양한 혈관계의 정보를 알 수 있으나 장비의 성능차이, 검사자의 숙련도 따라 검사 결과의 차이가 나타날 수 있고, 환자목둘레의 크기에 따라 여러가지 변수가 있을 수 있으므로 유의해야 한다.

신경계 : 일반연제 ; 경동맥 초음파(Carotid duplex) 검사의 원리이해

노영경,엄재광,신현직,차현극 대한임상병리사협회 2009 임상생리검사학회 발표자료집 Vol.2009 No.-

불면 증상으로 내원한 65세 이상 노인 환자들의 임상적 양상

이진산,신원철,유라영,성민지,남효정,권영남,조한아,차현극 대한수면연구학회 2013 Journal of sleep medicine Vol.10 No.1

Objective: Sleeping problems and disorders generally increase with aging, and these changes influence elderly functioning and well-being. We studied the clinical characteristics of the elderly patients with insomnia symptoms for the appropriate diagnosis in Korea. Methods: Patients with insomnia symptoms aged over 65 years were recruited from who visited the Sleep center of Kyung Hee University Hospital at Gangdong, from January 2010 to April 2013. General characteristics of sleep patterns, past medical history, previous medication related sleep, sleep diary, and the Minnesota Multiphasic Personality Inventory-2(MMPI-2) were analyzed to understand the sleep pattern and the clinical characteristics in the elderly patients with insomnia symptoms. Results: The study population included 143 patients(45 men, 98 female), and their mean age was 71.41± 5.32 years. These patients were classified according to the cause of insomnia symptoms, the primary cause was 39.1%(92.8% psychophysiological insomnia, 7.2% paradoxical insomnia), the secondary cause was 34.2%(depression, anxiety, associated medical illness, obstructive sleep apnea syndrome, restless legs syndrome), and circadian rhythm sleep disorder was 26.6%. The MMPI-2 profiles were not significant differences in the study population. Conclusion: The clinical characteristics in our study population were different in variable parameters from the general population. It is necessary to understand these differences in the elderly patients for approaching the appropriate diagnosis and medical care.

저용량과 고용량 현미쌀눈 유래 GABA가 수면시간과 질에 미치는 영향에 대한 무작위 이중 눈가림법 위약 처치시행 연구

신유용,변정익,정승은,성민지,조한아,차현극,신원철 대한수면연구학회 2016 Journal of sleep medicine Vol.13 No.2

Gamma-aminobutyric acid (GABA) has potential benefits in counteracting the sleep disruption and potential therapeutic effects on blood pressure, stress, cancer, and inflammatory diseases. Recently, High-dose GABA can be extracted from fermented rice germ using lactic acid bacteria. This study aimed to evaluate the effects of GABA natural extracts from fermented rice-germ on sleep latency, subjective sleep quality and insomnia symptoms. Methods: This was a prospective randomized double-blind placebo-controlled trial performed at Kyung-Hee University hospital at Gangdong from June 2013 to October 2013. Adult (age≥30) patients who was diagnosed of insomnia according to DSM-IV criteria was enrolled. They were randomized into three groups: high dose treatment group 300 mg; low-dose treatment group, 100 mg; and placebo group. Questionnaires including Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), WHO-5 Well-Being Index were performed, and 1-week actigraphy was recorded before and 1 week after the treatment. Results: Total of 114 patients were randomized into 3 groups: high-dose treatment (n=37), low-dose treatment (n=38), and placebo treatment group (n=39). At 1 week after the treatment, PSQI total score and C2 (sleep latency) score significantly decreased in low-dose and high-dose treatment group than the placebo groups [Repeated measures analysis of variance (ANOVA), p=0.017, 0.004 respectively]. ISI score also decreased in the two groups in dose-dependent manner (Repeated measures ANOVA, p=0.037). There were five (4.4%) patients who reported medication adverse events. Conclusions: This study suggests that treatment of low and high-dose GABA from unpolished rice-germ decreases sleep latency and improve insomnia severity without severe adverse events.

불면증상이 동반된 폐쇄성 수면 무호흡 환자의 정서적, 성격적 특성 : 미네소타 다면적 인성검사 분석

이지훈,신원철,나부석,이학영,최혜연,김상범,성민지,조한아,차현극 대한수면연구학회 2015 Journal of sleep medicine Vol.12 No.2

Objectives: Obstructive sleep apnea-hypopnea syndrome (OSAHS) and insomnia are two of the most common sleep disorders in the general population. Because OSAHS patients with insomnia may have difficulty in adapting to the sleep breathing medical equipment, it is necessary to pay special attention to the diagnosis and treatment of comorbid insomnia. This study is to investigate the emotion and personality in OSAHS patients with insomnia complaints by using Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Methods: We reviewed the results of the standardized questionnaires assessing sleep-related variables, MMPI, and polysomnographic findings of the patients diagnosed as OSAHS. Results: 145 subjects were 49.05±11.83 years of age. The mean Respiratory Disturbance Index was 33.57±19.91 and the mean score of Insomnia Severity Index (ISI) was 11.52±6.49. The mean scores of the Beck Depression Inventory (BDI) and MMPI-2 were within normal ranges. We divided the patients into two groups based on the scores of the ISI, OSAHS with insomnia (n=109) and OSAHS without insomnia (n=36). OSAHS patients with insomnia symptoms had significantly higher scores of hypochondriasis, hysteria, psychasthenia, schizophrenia, paranoia and psychopathic deviate scales and BDI than those without insomnia. Conclusions: Our results suggest that insomnia complaints are very common in OSAHS patients and the psychological problems are more frequently found in OSAHS patients with insomnia symptom than those without it. J Sleep Med 2015;12(2):59-63