중년 남성에서 수면의 질과 주간 심박동변이 = The Relationship between Sleep Quality and Heart Rate Variability in Middle-Aged Men

국문 초록 (Abstract)

연구배경 : 본 연구에서는 Pittsburgh Sleep Quality Index (PSQI) 를 이용하여 평가한 수면의 질과 심장의 자율신경계 활성도와의 연관성을 알아보고자 하였다.
방 법 : 2007년 2월부터 4월까지 경기도 소재 대학부속병원 건강검진센터에 내원한 중년 남성 중 특이 병력이 없는 76명을 대상으로 하여 연령, 키, 체중, 혈압, 흡연력, 교육 정도, 운동력, 결혼 유무, 알코올 및 카페인 섭취량 조사와 함께 수면의 질과 심박동변이를 평가하였다. 수면의 질 측정을 위해 PSQI를 이용하였으며 6점 이상인 경우 불만족스러운 수면군으로 (N=32), 5점 이하인 군을 만족스러운 수면군 (N=44) 으로 분류하였다. 심박동변이의 평가는 안정 상태에서의 5분 동안 심전도 기록을 시간 범주와 주파수 분석으로 나누어 분석하였다.
결 과 : 수면의 질에 따라 분류한 두 군 간의 심박동변이 값의 차이를 분석한 결과, 시간 범주 분석 항목에서 RMSSD (Square root of the mean of the sum of the square of differences between adjacent NN intervals) 와 주파수 범주 분석 항목에서 HF (High Frequency)값이 불만족스러운 수면군에서 통계적으로 유의하게 감소하였다 (P=0.017, P=0.002). PSQI의 7가지 세부항목과 심박동변이의 지표들과의 연관성을 분석한 결과, 수면장애 (sleep disturbance) 가 심할수록 MHR (mean heart rate) 이 증가하였으며, SDNN,　RMSSD, HF 값이 통계적으로 유의하게 감소하였다. 습관적 수면 효율성 (habitual sleep efficiency) 이 좋지 않을수록 HF값이 유의하게 감소하였다.
결 론 : 중년 남성에서 수면의 질의 감소는 부교감신경의 활성도를 저하시키는 것을 알 수 있었으며, 이는 이들에게서 심혈관 질환의 위험이 증가할 수 있음을 의미한다. 수면의 질의 세부 항목 중 특히 수면장애 항목과 습관적 수면 효율성 항목이 부교감신경의 활성도 저하와 관련이 있다.

다국어 초록 (Multilingual Abstract)

Background : The aim of this study was to investigate the relationship between sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) and daytime autonomic nervous function reflected in heart rate variability.
Methods : Study subjects included those visiting a health promotion center at a medical college from February to April 2007. We assessed sleep quality (using the PSQI) and heat rate variability adjusting for age, weight, height, body mass index, alcohol and caffeine consumption, educational level, regularity of exercise, smoking history, and marital status. Healthy subjects, 76 in number, were divided into two groups- good sleepers (≤5, N=44) vs poor sleepers (≥6, N=32) by the PSQI global score. Five-minute electrocardiographic recordings were analyzed in terms of time and frequency domains.
Results : There were no significant differences in baseline characteristics between the two groups. In the spectral analysis of heart rate variability, the square root of the mean of the sum of the square of differences between adjacent NN intervals (RMSSD) and the natural logarithm high frequency (ln HF) were significantly lower in poor sleepers compared to good sleepers (P=0.017, P=0.002). The results of the stepwise multiple regression analysis assessing the relationship between the PSQI subscales and heart rate variability (HRV) parameters showed a significant increase in the mean heart rate (MHR) and a significant decrease in the standard deviation of normal to normal intervals (SDNN), RMSSD, and ln HF according to the "sleep disturbance" scores. in HF was significantly lower according to the "habitual sleep efficiency" scores.
Conclusions : We found a significant relationship between poor sleepers and reduced parasympathetic activity in daytime HRV in middle-aged men; and in particular, "sleep disturbance" and "habitual sleep efficiency" (subscales of the PSQI) were related to this reduction. Clinically, this reduced parasympathetic activity seen with poor quality sleep may explain the increased risk for cardiovascular disease.

참고문헌 (Reference)

1 최희정, "성인에서 심박동수가 심혈관계 질환의 위험요인에 미치는 영향" 대한가정의학회 28 (28): 442-450, 2007

2 이용제, "대사증후군과 심박동수 변이와의 관계" 대한가정의학회 23 (23): 1432-1439, 2002

3 Mystakidou K, "The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients" 30 (30): 737-742, 2007

4 Daniel J, Buysse, "The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research" 28 : 193-213, 1998

5 Backhaus J, "Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia" 53 : 737-740, 2002

6 Pagani M, "Sympathetic overactivity in subjects complaining of unexplained fatigue" 87 (87): 655-661, 1994

7 Elsenbruch S, "Subjective and objective sleep quality in irritable bowel syndrome" 94 (94): 2447-2452, 1999

8 Knutson KL, "Stability of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Questionnaires over 1 year in early middle-aged adults: the CARDIA study" 29 (29): 1503-1506, 2006

9 Fiorentini A, "Sleep's quality disorders in patients with hypertension and type 2 diabetes mellitus" 114 (114): 50-52, 2007

10 Kageyama T, "Self-reported sleep quality, job stress and day time autonomic activities assessed in terms of short-term heart rate variability among male white-collar workers" 36 : 263-272, 1998

11 Tsuji H, "Reduced heart rate and mortality risk in an elderly cohort: The Framingham Heart Study" 90 : 878-883, 1994

12 Prieto-Rincon D, "Quality of sleep in hospitalized psychiatric patients" 47 (47): 5-16, 2006

13 Iliescu EA, "Quality of sleep and health-related quality of life in haemodialysis patients" 18 (18): 126-132, 2003

14 Kryger MH, "Principle and Practice of Sleep Medicine, 4th ed" Saunders 25-34, 2005

15 Ohayon MM, "Prevalence of insomnia and associated factors in South Korea" 53 : 593-600, 2002

16 Axelrod S, "Power spectrum analysis of heart rate flunctuation: a quantitative probe of beat to beat cardiovascular control" 213 : 220-222, 1981

17 Wolk R, "Obesity, sleep apnea, and hypertension" 42 (42): 1067-1074, 2003

18 Zhong X, "Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation" 98 (98): 2024-2032, 2005

19 Lavidor M, "How sleep is related to fatigue" 8 : 95-105, 2003

20 Inoue T, "High heart rate relates to clustering of cardiovascular risk factors in a screened cohort" 65 : 969-973, 2001

21 Axelrod S, "Hemodynalic regulation: Investigation by spectral analysis" 228 : 775-780, 1975

22 Task force of the European society of cardiology and the north American society of pacing and electrophysiology, "Heart rate variability-standard of measurement, physiological interpretation and clinical use" 17 : 354-381, 1996

23 Elsenbruch S, "Heart rate variability during waking and sleep in healthy males and females" 22 (22): 1067-1071, 1999

24 Bigger JT jr, "Frequency domain measures of heart period variability and mortality after myocardial infarction" 85 : 164-171, 1996

25 Tochikuho O, "Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder" 27 : 1318-1324, 1996

26 Tsuji H, "Determinants of heart rate variability" 28 : 1539-1546, 1996

27 Yeragani VK, "Depression and heart rate variabiltiy" 38 : 768-770, 1995

28 Wiklund U, "Autonomic cardiovascular regulation in patients with obstructive sleep apnoea: a study based on spectral analysis of heart rate variability" 20 (20): 234-241, 2000

29 Michel R, "Association between nocturnal vagal tone and sleep depth, sleep quality, and fatigue in alcohol dependence" 68 : 159-166, 2006

30 McCarty R, "Analysis of twenty-four hour heart rate variability in patients with panic disorder" 56 : 131-150, 2001