폐쇄수면무호흡과 뇌졸중; 폐쇄수면무호흡은 뇌졸중의 원인인가 결과인가?

김요식,박현영 대한수면연구학회 2008 Journal of sleep medicine Vol.5 No.1

Obstructive sleep apnea (OSA) is a common disorder which noted in 2-4% of general population. Patients considered it as a non-significant event and do not try to evaluate and treat it. The common manifestation of OSA is related to sleep fragmentation and is an excessive daytime sleepiness, decreased concentration, memory impairment and decreased job activity. Furthermore, OSA has negative effects on cardiovascular system. It increases prevalence and incidence of stroke and ischemic heart disease. OSA is associated with early neurological worsening and delay recovery from neurological deficit after stroke. OSA has negative effects on hypertension, platelet activation, fibrinogen, cardiac arrhythmia, endothelial function and IMT (intima-media thickness) in carotid artery. Treatment with continuous positive airway pressure (CPAP) has demonstrated reduction in risk factor abnormality and hope to decrease risk of cardiovascular events including stroke. However, OSA has not been considered as an independent risk factor for stroke, it needs conclusive evidence from well designed epidemiological studies.

폐쇄수면무호흡 환자에서 졸음운전 관련 교통사고 예방을 위한 제안

선우준상,조재욱,임수환,김대영,구대림,임희진,김혜윤,김경민,양광익,대한수면연구학회 대한수면연구학회 2021 Journal of sleep medicine Vol.18 No.3

Obstructive sleep apnea (OSA) is known to be associated with various health concerns, including sleepiness, fatigue, cognitive dysfunction, diminished quality of life, hypertension, cardiovascular diseases, and stroke. OSA-induced sleepiness at the wheel reduces vigilance and driving performance, which significantly increase the risk of motor vehicle accidents. Sleepiness-induced motor vehicle accidents are characterized by high morbidity and mortality. OSA is a well-established significant risk factor for drowsy driving-related motor vehicle accidents, which can be prevented through appropriate treatment. However, currently no clinical guidelines or regulations are available for evaluation or management of the risk of motor vehicle accidents in patients with OSA in Korea. In this review, we discuss the risk of motor vehicle accidents in patients with OSA, the effects of positive airway pressure therapy as a preventive measure to reduce this risk, and the published recommendations for OSA in other countries with regard to fitness to drive. We propose recommendations for screening, evaluation, and treatment of OSA with regard to the risk of motor vehicle accidents, which would serve as useful practical guidelines for sleep specialists in clinical practice. Further research is warranted to establish optimal strategies for effective improvements in OSA-related traffic safety.

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.

렘수면행동장애 유사 증상을 보인 폐쇄수면무호흡증후군 환자

오은혜,조재욱,김대진,김기태,김승주,노경하 대한수면연구학회 2014 Journal of sleep medicine Vol.11 No.2

REM sleep behavior disorder (RBD) is characterized by dream-enacting behaviors during REM sleep. However, many sleep disorders can produce RBD mimicking symptoms, also known as ‘pseudo-RBD’. We report a patient with severe OSA with ‘pseudo-RBD’ symptoms that were eliminated by continuous positive airway pressure (CPAP) treatment. Polysomnography is mandatory to establish the proper diagnosis of RBD.

수면관련섭식장애 1례

조재욱,정기영 대한수면연구학회 2008 Journal of sleep medicine Vol.5 No.2

Sleep-related eating disorders (SRED) comprise a spectrum of parasomnia and eating disorders, in which nocturnal arousals from sleep are followed by rapid and compulsory. Here we report a patient who showed unexpected and bizarre eating behavior with somnambulistic mental state during polysomnography.

서울시 중고등학교 학생들의 수면 양상과 수면에 대한 인식

김지현,이향운,문희수 대한수면연구학회 2014 Journal of sleep medicine Vol.11 No.1

Objectives:To investigate the sleep patterns of Korean adolescents and the subjective perception on their sleep pattern and daytime functioning related to sleep status.Subjects and methods:The questionnaire survey was done in 2007 for students in middle and high schools located in Mokdong region in Seoul.The questionnaire included sleep/wake schedules both on school days and weekends, various questions regarding sleepiness and other sleep complaints, and morningness-eveningness scale. Results:The third year of middle school, the first and second year of high school students were enrolled. A total of 1,252 students (boy: 65.3%) participated in the survey. The average bedtime was 12:46 AM, and 1:13 AM, respectively and the wake up time was 6:24 AM and 8:35 AM, respectively on school days and weekends. Total sleep time was 6.6 ±1.1, 5.89±1.1 and 5.65±0.9 hours on school days for students in the third year of middle school, the first year and the second year of high school, respectively. While 57% of students answered that they have sufficient sleep, only 36.7% of students reported they sleep sufficiently almost always. High school students reported shorter optimal sleep duration than middle school students. One third of students had a problem of daily or school life due to sleepiness. Conclusion: This study showed sleep deprivation on school days and compensating catch-up sleep on weekends in middle & high school students in Seoul.The perception of their sleep seems to be affected not only by current sleep status but also by the school year probably related to academic pressure.

기면병 환자의 졸음운전 관련 교통사고 예방을 위한 제안

조재욱,선우준상,임수환,김대영,구대림,임희진,김혜윤,김경민,양광익,대한수면연구학회 대한수면연구학회 2021 Journal of sleep medicine Vol.18 No.3

Narcolepsy is a chronic sleep disorder characterized by irresistible sleep attacks, hypersomnolence, cataplexy (sudden loss of muscle tone provoked by emotion), and sleep paralysis. Individuals with narcolepsy are at a high risk of experiencing sleepiness while driving leading to road traffic accidents. To prevent such accidents, some countries have regulations for commercial and noncommercial drivers with narcolepsy. Evaluating sleepiness is essential. Therefore, several subjective reports and objective tests were used to predict the possibility of car crashes or near-misses. Brain stimulants are effective in treating narcolepsy and can reduce daytime sleepiness in these patients. However, no guideline has been established for the driving safety of patients with narcolepsy in Korea. The Korean Sleep Research Society has prepared this proposal for preventing motor vehicle accidents caused by drowsy driving in patients with narcolepsy.

기면병의 야간수면 양상

이호원 대한수면연구학회 2008 Journal of sleep medicine Vol.5 No.1

The four classic symptoms of narcolepsy consist of excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic/ hypnopompic hallucinations. Tow of them is related directly to night sleep. And also a significant number of patients have trouble sleeping except sleep paralysis and hypnagogic/hypnopompic hallucinations at night. The aim of this review is to increase awareness on this issue, thereby enhancing the care of narcoleptic patients by more specific approaches to their disturbed night sleep.

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.