Methylphenidate에 의해서 유발된 주의력결핍-과잉행동장애 환자의 수면장애에 대한 Mirtazapine의 치료효과 : 증례 및 고찰 = Mirtazapine Effect in Methylphenidate Associated Secondary Insomnia Patient with Attention Deficit Hyperactivity Disorder

국문 초록 (Abstract)

주의력결핍-과잉행동장애(Attention Deficit Hyperactivity Disorder)는 소아청소년시기에 5~10%의 유병율을 갖고 있는 매우 흔한 질환이다. 주의력결핍-과잉 행동장애에서 임상적으로 가장 많이 사용되고 있는 methylphenidate는 과잉행동 및 주의력 개선에 70~85% 정도의 높은 증상 개선율을 갖고 있지만 반면에 수면장애, 식욕부진, 두통 등의 부작용을 호소하는 아동으로 인하여 임상적으로 어려움을 겪기도 한다. 한편 mirtazapine은 노르아드레날린과 세로토닌의 신경전달을 함께 강화하는 새로운 항우울제이며, 또한 mirtazapine은 히스타민 수용체와 아드레날린성 및 콜린성 수용체를 길항함으로써 우울장애에 함께 수반된 수면장애에도 효과가 있었음을 보고하는 외국사례가 있었다. 본 저자는 주의력결핍-과잉행동장애로 진단받은 6세 아동에서 methylphenidate 투여를 시작한 이후 이차적으로 발생한 수면장애에 대해서 항우울제인 mirtazapine을 투여하여 수면다원 검사상 서파수면의 증가 및 REM수면의 감소 등 객관적인 수면장애 증상 개선을 보였기에 이를 보고하고 문헌을 함께 고찰하고자 한다.

다국어 초록 (Multilingual Abstract)

Objectives：This case presents a 6 year-old-boy diagnosed with ADHD. The patient was hospitalized under the chief complaint of hyperactivity behavior and distracted inattention. A secondary sleep disorder was found after 10㎎ qd of methylphenidate was started, administering mirtazapine revealed improvement of sleep disorder.
Case：On July 9 2005, the child was hit by a small vehicle on the road between his apartment and a shopping mall. After this accident a child was referred for treatment of hyperactivity and distractibility. After adding 10mg qd of methylphenidate IR, his PSQI global score was 9 and his ISI total score was 15 which are consistent with moderate stage of insomnia. Polysomnography was performed to detect the objective sleep disorder. As a result of the increase of REM sleep and the decrease of REM latent period further investigation was carried out. From the 16th day of hospitalization 15㎎ of mirtazapine was given hs for a week. Soon after starting mirtazapine the child fell a sleep without whining time and his shouting were much improved. On a 7th day of mirtazapine administration, PSQI global score of 2 and ISI total score of 3 was noted which represented a significant improvement. Polysomnography was reperformed on the 10th day as a result the delay of REM latent period and the decrease of REM sleep as a normal range, The normalization of REM sleep rhythm and the increase of slow wave were objectively improved.
Discussion：When methylphenidate is used in the treatment for ADHD, Clinical course shows a sleep disorder in 29~64% of ADHD subjects. mirtazapine(Remeron), the antidepressant, has an antagonistic effect for 5HT2a receptor and is recently used for its effect in the improvement of sleep disorder. The Author hereby report that mirtazapine objectively improves sleeping disorders which often results from giving methylphenidate in ADHD.

목차 (Table of Contents)

• 서론
• 증례
• 고찰
• 요약
• 참고문헌