렘수면행동장애의 진단

김지언 대한수면연구학회 2009 Journal of sleep medicine Vol.6 No.1

REM sleep behavior disorder (RBD) is characterized by abnormal behaviors emerging during REM sleep that cause injury or sleep disturbance. RBD is also associated with electromyographic abnormalities during REM sleep. The EMG demonstrates an excess of muscle tone or phasic EMG twitching activity during REM sleep. Sleep related injurious, potentially injurious, or disruptive behaviors by history and characteristic polysomnographic findings are essential for diagnosis of RBD. In this article, previous and current diagnostic criteria of RBD will be reviewed.

수면제한을 강화한 인지행동치료가 만성 불면증 환자의 수면에 미치는 효과: 예비연구

최수정,김금순 대한수면연구학회 2010 Journal of sleep medicine Vol.7 No.2

Objectives: Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the 1st choice of treat-ment for chronic insomnia patients. Among CBT-I program, sleep restriction (SR) has known as the most effective and relatively well-tolerated treatment tool, but in practice, it is not easy to apply to all insomnia patients due to a lack of properly trained therapist. This study is designed to investigate the clinical utility of SR-emphasized CBT-I (SRCBT-I) conducted by a trained nurse. Methods: Thirteen chronic insomniacs were enrolled for SRCBT-I (four biweekly-individual session) and eight (6 women; mean age 51.1 yr) of them completed the whole sessions. Control insomniacs (n=9; 7 women; age 56.8 yr) were treated with standard CBT-I. Eleven of them underwent night polysomnography before CBT-I. Main outcomes of treatment ev-aluation were sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST), time in bed, and sleep efficiency (SE), which were determined based on patients’ sleep diary before and after CBT-I. Results: All patients with standard or SRCBT-I reported the improvement in SOL (60.2 → 10.6 min), WASO (155.0 → 20.7 min), TST (242.2 → 32.6 min), SE (51.0 → 92.0%) and sleep medication (1.0 → 0.25 tablet). Compared to control insomniacs with standard CBT-I, patients with SRCBT-I showed a lesser WASO (Z=-2.792, p=0.005) and a higher SE (Z=-2.694, p=0.006) after CBT-I. Conclusions: Our preliminary study demonstrated that SRCBT-I is more effective than standard CBT-I especially for sleep maintenance in chronic insomnia patients.

과다수면증으로 오인된 양성수면인식장애

장철원,지기환 대한수면연구학회 2015 Journal of sleep medicine Vol.12 No.2

A condition of underestimation of sleep is classified as paradoxical insomnia or sleep state misperception. However, overestimation of sleep, so called positive sleep status misperception has not been clearly described. Here we report a middle-aged woman with positive sleep status misperception who presented excessive sleepiness mimicking hypersomnia.

수면다원검사 중 비디오 분석을 통한 렘수면행동장애를 가진 환자들의 꿈꾸면서 하는 행동들의 분석

박정준,김형지,조재욱,김지현 대한수면연구학회 2015 Journal of sleep medicine Vol.12 No.2

Objectives: The aim of this study is to analyze dream-enacting behaviors (DEB) using video REM sleep behavior disorder severity scale (RBDSS) during night polysomnography (PSG) and compare them between in patients with idiopathic RBD (iRBD) and patients with symptomatic RBD (sRBD). Methods: 21 consecutive patients with either iRBD or sRBD were recruited (15 female and 10 male, mean age 63.6±13.86 years). Video analysis of DEB in all the REM sleep during their night PSGs was retrospectively performed using RBDSS. According to the clinical history depicting behaviors were also categorized by RBDSS-C to compare with the video RBDSS. Comparison of difference of RBDSS in between patients with iRBD and in those with sRBD was done. The frequency of DEB during the night PSG was measured as RBD density. Results: iRBD patients had higher RBD density than sRBD despite the same disease duration. iRBD patients also tended to have higher RBDSS than sRBD, compatible with higher prevalence of injury history. Night-night variability was observed in the patients comparing RBDSS and RBDSS-C. Conclusions: RBDSS is an easy tool to analyze severity of DEB in patients with RBD. Analysis of clinical feature of DEB may give a clue to differentiation of RBD patients as well as the alarm for the treatment of RBD to prevent potential injury.

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.

렘수면 행동 장애와 퇴행성 신경계 질환

천상명 대한수면연구학회 2009 Journal of sleep medicine Vol.6 No.1

REM sleep behavior disorder (RBD) is characterized by dream-enacting violent behavior during REM sleep, which usually start at the age of older than 50. Patients with idiopathic RBD (IRBD) show various features similar to parkinsonian disorders and many of patients are known to be developing symptoms of neurodegenerative disorders in the course of disease. These close associations suggest that clinicians need to know the potential risk of developing parkinsonism and pay more attention to various features beyond sleep complaint when they manage the IRBD patient.

렘수면행동장애 진단을 위한 렘수면무긴장소실의 정량적 분석: 후향적 환자-대조군 연구

김지영,이가현,성상민,김태웅,정대수 대한수면연구학회 2020 Journal of sleep medicine Vol.17 No.1

Objectives: Rapid eye movement (REM) sleep without atonia (RSWA) fulfils one of the criteria for diagnosing REM sleep behavior disorder (RBD) according to the International Classification of Sleep Disorders, Third Edition. However, RSWA quantification is an unresolved issue, which is associated with the future direction of revising the diagnostic criteria. The purpose of this study was to evaluate the quantification of RSWA in patients with RBD and identify an optimal cut-off value of quantitative RSWA for RBD diagnosis. Methods: Medical records and polysomnographic results were analyzed retrospectively to diagnose sleep disorders from June 2017 to May 2018 at Pusan National University Hospital. Nineteen subjects with idiopathic RBD were included in the present study. Propensity score matching was used to control age, gender, and anti-depressant factors, which influenced RSWA. RSWA was scored according to the American Academy of Sleep Medicine scoring manual. Cohen’s kappa coefficient was measured to test inter-rater reliability between two polysomnography raters. Results: Cohen’s kappa coefficients were 0.755 (p<0.001) and 0.689 (p<0.001) for tonic and phasic activities, respectively. RSWA was significantly increased in subjects with RBD compared with controls [median and interquartile range: 16.5 (8.8–24.6) vs. 6.3 (4.1–7.2) p=0.001]. The optimal cut-off value was 8.0% for the proportion of RSWA (sensitivity 78.5%, specificity 85.7%, area under the receiver-operating characteristic curve 0.837). Conclusions: Subjects with RBD had significantly increased RSWA compared to controls. The proportion of RSWA during REM sleep can be applied to discriminate subjects with RBD from controls.

폐쇄성 수면 무호흡증에서 활동기록기의 주기성 사지운동 진단에 관한 타당도 검증

윤영훈,이민환,김천식,정유삼,김우성,김민주,이상암 대한수면연구학회 2010 Journal of sleep medicine Vol.7 No.2

Objectives: Several validation studies of actigraphy for periodic limb movements (PLMs) detection reported a high sensitivity and specificity in restless leg syndrome and periodic limb movement disorder. But PLMs also arise in association with a variety of other sleep disorders such as the sleep apnea syndrome. We compared PLM counts obtained with polysomnography (PSG) to those obtained from actigraphy with PAM-RL and assess the validity in patients with obstructive sleep apnea. Methods: Sixty patients with obstructive sleep apnea underwent actigraphy from both legs and simultaneous PSG during awakeness and sleep. Each of left and right PLM indices by unilateral actigraphy were calculated automatically and compared to PLM index by PSG of ipsilateral leg. Additionally, a comparison among the severity of apnea-hypopnea index (AHI) in obstructive sleep disorder was performed. Results: PLM index obtained with actigraphy were not different from PLM index by PSG [7.93(±11.65)/h vs. 6.50(±12.45)/h; p=0.257]. The sensitivity and specificity of actigraphy identifying patients with PLM index ≥15/h against respective PLM index determined by PSG were calculated (sensitivity/specificity: 0.53/0.88). The actigraphy didn’t overestimate PLM in overall OSA, but overestimate only in severe OSA. Conclusions: This discrepancy between PSG and actigraphy in patient with OSA may be due to overestimate of actigraphy in severe OSA and to underestimate of PLM as PLM index increases. Actigraphy can’t replace PSG in the diagnostic assessment of PLM using cut-off values in patients with obstructive sleep apnea on account of this problem 울산대학Objectives: Several validation studies of actigraphy for periodic limb movements (PLMs) detection reported a high sensitivity and specificity in restless leg syndrome and periodic limb movement disorder. But PLMs also arise in association with a variety of other sleep disorders such as the sleep apnea syndrome. We compared PLM counts obtained with polysomnography (PSG) to those obtained from actigraphy with PAM-RL and assess the validity in patients with obstructive sleep apnea. Methods: Sixty patients with obstructive sleep apnea underwent actigraphy from both legs and simultaneous PSG during awakeness and sleep. Each of left and right PLM indices by unilateral actigraphy were calculated automatically and compared to PLM index by PSG of ipsilateral leg. Additionally, a comparison among the severity of apnea-hypopnea index (AHI) in obstructive sleep disorder was performed. Results: PLM index obtained with actigraphy were not different from PLM index by PSG [7.93(±11.65)/h vs. 6.50(±12.45)/h; p=0.257]. The sensitivity and specificity of actigraphy identifying patients with PLM index ≥15/h against respective PLM index determined by PSG were calculated (sensitivity/specificity: 0.53/0.88). The actigraphy didn’t overestimate PLM in overall OSA, but overestimate only in severe OSA. Conclusions: This discrepancy between PSG and actigraphy in patient with OSA may be due to overestimate of actigraphy in severe OSA and to underestimate of PLM as PLM index increases. Actigraphy can’t replace PSG in the diagnostic assessment of PLM using cut-off values in patients with obstructive sleep apnea on account of this problem교 의과대학, 서울아산병원 신경과학교실

Deep Learning Based Symbol Detection in Engineering Drawings

Joon-Young Kim(김준영),Taekyong Lee(이태경) 대한기계학회 2020 대한기계학회 춘추학술대회 Vol.2020 No.12

렘수면행동장애 환자의 수면다원검사에 대한 정량적 분석을 통한 진단적 접근

박석경,신동진,박현미,이영배,신동훈,박기형 대한수면연구학회 2012 Journal of sleep medicine Vol.9 No.2

Rapid eye movement sleep behavior disorder (RBD) is characterized by the intermittent absence of electromyogram (EMG) atonia during rapid eye movement (REM) sleep and the increase of motor activity associated with dream mentation. However, ICSD-2 criteria did not suggest validated diagnostic criteria and previous studies had no consistency with value ranged 10-20% of REM sleep without atonia (RSWA) in polysomnography (PSG). We investigated standard value about RSWA of Korean RBD patients. Methods: Thirty one patients diagnosed with RBD and 31 normal age- and sex-matched controls were selected. All RBD patients and normal controls were studied using PSG from 2007 to 2012. ICSD-2 criteria was used to select RBD patients and RSWA. We defined RSWA as increasing amplitude by 4 times that of baseline EMG and occupying at least 50% of each epoch or five 3 second mini-epochs. Results: PSG findings showed increased N1 sleep, periodic leg movement index and decreased N2 sleep in RBD patients compared to normal controls. Mean RSWA was 19.21% [±9.93, standard deviation (SD)], with a range of 5.21-38.22% in RBD patients, whereas the mean RSWA in normal control was 0.43% (±0.74, SD) with a range of 0-2.3%. Conclusions: We quantitatively figured out the characteristics of PSG and RSWA in Korean RBD patients. The outcome shows definite differences between RBD patients and normal controls. This study suggest that we may diagnose RBD who have RSWA over 5% of the REM sleep periods.