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양극성 장애에서의 수면장애: 일주기 리듬의 교란과 수면 무호흡증을 중심으로

Sleep Disorders in Bipolar Disorders: A Narrative Review on Circadian Rhythm Disturbances and Sleep Apnoea

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키워드

주제분류정신과학

초록

양극성 장애 환자는 임상 현장에서 수면과 관련된 문제를 호소하는 경우가 많으며, 특히 대부분의 환자는 수면-각성 주기와 관련된 어려움을 흔히 보인다. 이러한 일주기 리듬의 교란은 기분삽화의 발생 또는 재발을 유발하기도 한다. 양극성 장애와 관련된 일주기유형과 신경전달물질, 호르몬, 유전자, zeitgeber의 이상들이 최근 연구에서 광범위하게 보고되고 있으며, 일주기 리듬은 양극성장애의 치료에도 역할이 시사된다. 또한, 양극성 장애의 약물치료 중 부작용으로 체중 증가가 흔히 나타날 수 있는데, 그러한 환자에서 폐쇄성 수면 무호흡증의 발생 위험성이 높으므로 폐쇄성 수면 무호흡증에 대한 적극적 모니터링이 도움이 된다.

Abstract

Bipolar disorders are a group of mood disorders characterised by relapsing mood episodes throughout the course of illness. Patients with bipolar disorders commonly present with various sleep problems. Patients in a manic episode generally show decreased need of sleep and those in a depressed episode frequently complain about hypersomnia. Current literature even points to evidence that patients with bipolar disorder in euthymic state may still show signs of sleep disturbances when com¬pared to the general population. Clinicians may also note intricate interactions between changes of circadian rhythm and evolution of mood episodes in patients with bipolar disorder. Also, commonly prescribed medications which plays a crucial role in treatment of bipolar disorders including mood stabilisers and antipsychotic medications often cause significant weight gain over time. Being a risk factor of sleep apnoea, weight gain can predispose the patient to develop sleep apnoea. In this narrative review, we summarised current evidence and literature regarding characteristics of circadian rhythm and comorbid sleep apnoea in patients with bipolar disorder. We also present literature regarding implications of circadian disturbance and comorbid sleep apnoea in managing patients with bipolar disorder.

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