노인에서의 수면 호흡 장애

신철,Shin, Chol 대한수면의학회 2001 수면·정신생리 Vol.8 No.1

In 2000, the number of people aged 65 and over increased to 3.37 million, accounting for 7.1% of the total population of South Korea. The elderly population will increase up to 19.3% in 2030. Sleep disordered breathing (SDB) seems to increase with age. More than 50-60% of old people complain of SDB-related signs and symptoms including awakening headache, excessive daytime sleepiness, fatigue, cognitive dysfunction, memory loss, personality changes, and depression. The influence of a mild degree of SDB upon the elderly is unclear, but moderate to severe SDB is well known to be associated with many diseases including hypertension, arrhythmia, myocardial infarction, stroke, dementia, and sudden death. Therefore, physicians should pay attention to elderly patients who complain of SDB related symptoms and signs that may not be normal signs of aging. Physicians need to become more sensitive to treat SDB in the elderly.

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.

다양한 상부전극에 따른 SBT 커패시터의 전기적 특성

曺春男(Choon-Nam Cho),吳容喆(Yong-Cheol Oh),金鎭士(Jin-Sa Kim),鄭一亨(Il-Hyung Jung),申喆基(Cheol-Gi Shin),崔雲植(Woon-Shik Chol),金忠爀(Chung-Hyeok Kim),李準雄(Joon-Ung Lee) 대한전기학회 2003 전기학회논문지C Vol.52 No.12

수면호흡장애의 유병률과 정의

신철 ( Chol Shin ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.1

수면호흡장애와 대사적 기능장애

주순재,신철,Joo, Soon-Jae,Shin, Chol 대한수면의학회 2005 수면·정신생리 Vol.12 No.1

Sleep-disordered breathing (SDB) is associated with increased cardiovascular and cerebrovascular morbidity. Epidemiological and clinic-based studies have shown that SDB is related to impaired glucose tolerance and increased insulin resistance, independent of obesity. Despite of a consistent association between SDB and impaired glucose-insulin metabolism, the mechanism underlying this relationship has not been fully elucidated. It is recognized that hypoxemia and hypercapnia that occur in SDB provoke sympathetic nervous activity and catecholamine, epinephrine and norepinephrine, and cortisol are released. Sympathetic hyperactivity and increased catecholamines can impair glucose homeostasis by increasing glycogenolysis and gluconeogenesis, which can result in increased circulating insulin levels and increased risk of insulin resistance. A prospective study is needed to investigate the causal relationship between SDB and impaired glucose-insulin metabolism in a healthy population without diabetes, hypertension and obesity as etiologic risk factors.

성인에서의 주간 수면과다증의 유병률 및 관련 요인

신경림(Shin, Kyungrim),이혜련(Yi, Hyeryeon),김진영(Kim, Jinyoung),신철(Shin Chol) 한국간호과학회 2006 Journal of Korean Academy of Nursing Vol.36 No.5

폐쇄성 수면 무호흡증의 병인 및 기전

최지호,이승훈,신철,Choi, Ji-Ho,Lee, Seung-Hoon,Shin, Chol 대한수면의학회 2005 수면·정신생리 Vol.12 No.2

The pathogenesis and mechanism of obstructive sleep apnea (OSA) has been under investigation for over 25 years, but its etiology and mechanism remains elusive. Skeletal (maxillary and/or mandibular hypoplasia or retrodisplacement, inferior displacement of hyoid) and soft tissue (increased volume of soft tissue, adenotonsillar hypertrophy, macroglossia, thickened lateral pharyngeal walls) factors, pharyngeal compliance (increased), pharyngeal muscle factors (impaired strength and endurance of pharyngeal dilators and fixators), sensory factors (impaired mechanoreceptor sensitivity, impaired pharyngeal dilator reflexes), respiratory control system factors (unstable respiratory control) and so on facilitate collapse upper airway. Therefore, OSA may be a heterogeneous disorder, rather than a single disease entity and various pathogenic factors contribute to the OSA varies person to person. As a result, patients may respond to different therapeutic approaches based on the predominant abnormality leading to the sleep-disordered breathing.

Amplatzer^® 혈관폐색장치를 이용한 거대 폐동정맥기형 색전술 1예

정기환,이승화,신철,김제형,Jung, Ki Hwan,Lee, Seung Hwa,Shin, Chol,Kim, Je Hyeong 대한결핵및호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.1

Pulmonary arteriovenous malformation (PAVM) is a rare pulmonary vascular anomaly due to an abnormal communication between the pulmonary artery and vein. The most common presenting symptom is a dyspnea on exertion related to this right-to-left shunt. If left untreated, PAVM has been known to result in serious complications. Incomplete pulmonary capillary network can be the cause of cerebral abscesses and other noninfectious neurological complications, such as stroke and transient ischemic attacks due to paradoxic embolism Transcatheter embolotherapy, using coils or balloons, has replaced surgical resection as the treatment of choice for PAVM. However, the risk of device embolization has limited the use of coil embolotherapy, while the size of PAVM is huge. Recently, Amplatzer$^{(R)}$ Vascular Plug has been proposed as an alternative endovascular occlusion device for arteriovenous malformation. We report a case of 81-year-old male patient with a giant PAVM, which was successfully treated by transcatheter embolotherapy using the Amplatzer$^{(R)}$ Vascular Plug. 폐동정맥기형은 드문 폐혈관 질환으로 출혈, 뇌농양, 기이 색전증(paradoxical embolism)에 의한 여러 신경학적 합병증의 발생 위험을 증가시켜 치료를 요한다. 과거에는 수술적으로 제거했으나, 최근에는 주로 코일 및 풍선 등의 다양한 색전물질을 이용한 경피적 색전술을 시행하여 치료하는 추세이다. 거대 폐동정맥기형의 경우에는 색전술 시행 과정에서 코일이 전신 순환으로 빠져 나가 장치 색전증 등의 합병증을 일으킬 위험이 높다. 저자들은 호흡곤란을 주소로 내원한 81세 남자 환자에게서, 지속되는 저산소혈증의 원인으로 거대 폐동정맥기형을 진단하고, Amplatzer$^{(R)}$ 혈관폐색장치를 이용한 경피적 색전술로 치료한 1예를 경험하였기에, 문헌 고찰과 함께 보고하는 바이다.

수면시간과 비만, 열량영양소 섭취비율 및 신체 활동량과의 관련성

백인경(In Kyung Baik),신철(Chol Shin) 대한지역사회영양학회 2011 대한지역사회영양학회지 Vol.16 No.3

There are a few studies that reported the association of sleep duration with calorie intake and energy expenditure. Using cross-sectional data from a population-based prospective study, we evaluated the association of sleep duration with indicators of obesity including body mass index and waist circumference, calorie intake and its proportion of macronutrients, and physical activity. The study subjects were 4,226 male and female adults, who were aged 40 to 69 years and were free of diagnosed cardiovascular disease, diabetes mellitus, and dyslipidemia at baseline. Robust regression analysis was used to analyze associations. The study found that sleep duration is inversely associated with waist circumference, calorie intake, and percent of calories from fat intake and is positively associated with percent of calories from carbohydrate intake and physical activity. The inverse association between sleep duration and waist circumference was stronger among men than among women. The inverse association between sleep duration and calorie intake was stronger among women than among men and such association was also stronger among obese persons than those with a normal body mass index. The positive association between sleep duration and physical activity was strongly demonstrated regardless of sex or obesity. Physical activity is positively associated with sleep duration independent of potential confounding factors including age, sex, income, occupation, marital status, education, smoking status, waist circumference, calorie and macronutrient intake, and alcohol intake. (Korean J Community Nutr 16(3) : 315~323, 2011)

폐쇄성 수면 무호홉증에서의 Homocysteine Level과 MTHFR 유전자 다형성

김진관 ( Jin Kwan Kim ),신철 ( Chol Shin ),이창규 ( Chang Kyu Lee ),이승관 ( Seung Gwan Lee ) 대한임상검사과학회 2002 대한임상검사과학회지(KJCLS) Vol.34 No.2

배경 : 폐쇄성 수면 무호흡은 독립적으로 고혈압, 심혈관 질환, 치매의 위험요인으로 알려져 있다. 이러한 연관성에 대한 정확한 기전은 아직 밝혀져 있지 않지만, 야간의 hypoxicsπess로 인한 혈관손상이 이러한 질병을 유발하는 것으로 최근 보고되고 있다. 이에 본 연자는 폐쇄성 수면 무호흡 환자에서 심혈관계 질환의 위험요인으로 알려진 homocystein 농도와의 연관성에 대하여 알아보고자 본 연구를 시행하였다. 방법 Community-based ansan study 가운데, 야간의 portable 수면검사를 실시한 총81명의 중년남성을 대상으로 시행하였으며, 이 가운데 RDI ≥ 20 (moderate to severe OSA, group A),5 RDI<20 (mild OSA, group B), RDI<5 (control, group C)로 정의하였다. 연구에 포함된 대상군은 설문지를 이용하여 과거력 및 수면 위생에 대하여 조사하였고, 혈중 homocysteine,vitamin B12, folic acid 농도를 측정하였으며, DNA 추출 후 MTHFR 의 유전자 다형성에 대하여 조사하였다. 결 과 : 세 군간의 biochemical data 및 homocysteine 의 평 균비 교에 있어서 , biochechemicaldata는 유의한 차이가 없었지만, homocysteine 농도는 세 군간에 유의한 차이가 있었다. (Gr. A:14.72.7 Gr. B : 9.74.4 Gr.C : 7.73.7, p<0.001). 그러나 수면 무호흡군에 있어서 MTHFR 유전자 다형성 (C677T)의 유의한 차이를 보이지 않았다. (p<0.175). 또한 homocysteine 농도에 대한multiple regression analysis 분석 결과, RDI, MTHFR 유전자의 동형 접합성 유전자 변이(T677T)가 유의한 연관성이 있는 것으로 분석되었다. 결론 : 야간의 심한 수면 무호흡은 독립적으로 homocysteine 농도에 영향을 줄수 있으며, 이러한 결과는 수면 무호흡과 섬혈관계 질환의 연관성에 대한 부분적인 근거를 마련할수 있을 것으로 생각되며, 원인에 대한 추가적인 연구가 필요할 것으로 사료된다. Obstructive sleep apnea (OSA) is characterized by repetitive obstruction of upper airway, leading to repeated arterial oxygen desaturation. The prevalence of cardiovascular disease, including arterial hypertension, myocardial infarction, atherosclerosis and stroke is increased among patients with OSA. Although exact mechanism for this reason is not understood, it is postulated that hypoxic stress induced by OSA may be involved in the etiology of cardiovascular disorder. Homocysteine (Hey), which has been reported as independent risk factors for vascular disease in many studies, is a sulfur-containing amino acid formed during the metabolism of methionine. Therefore, we hypothesized that OSA induced hypoxic stress might be correlated with oxidative stress, we investigated association between homocysteine and MTHFR gene mutation in OSA patients. Levels of homocysteine, cholesterol, low-density lipoprotein, high-density lipoprotein, try glycerides, creatinine, vitamin B 12 and folic acid were determined in 82 participants after overnight fasting. All subjects underwent computerized portable polysomnogram (PSG) in the home. Among these study participants, inclusion criteria were Apnea Hypopnea Index (AHI)>20 for moderate to severe OSA (Group A), 5 ~AHI ~20 for mild OSA subjects (Group B) and AHI<5 for control subjects (Group C) matched by age. Moderate to severe OSA patients has significantly higher homocysteine levels (14.72.7 umolfL, P<0.001) than other groups. MTHFR (C677T) gene polymorphism did not differ between patients and control. Homocysteine level showed positive correlation with square root transformed AHI (r=0.663, P<0.001). Also, AHI and MTHFR gene mutation (T677T) have an independent effect on homocysteine levels in multiple regression models. Severe OSA is an independent effect on elevated homocysteine levels. We hypothesize that these results may be explained by endothelial dysfunction combined with excess free-radical formation in OSA patients. Further study will be warranted to elucidate the relationship between hypoxic stress and homocysteine levels in OSA patients.