다양한 수면장애의 주기성사지운동증의 임상적 의의
The Clinical Significance of Periodic Limb Movements During Sleep in Various Sleep Disorders
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다양한 수면 장애에서 PLMS는 흔히 발견된다. 나이가 듦 에 따라 PLMS가 증가하는 것을 도파민 기능의 저하에 따른 것이라고도 보는데, 이런 관점에서 도파민 관련 기전이 중요 한 역할을 하는 하지불안증후군이나 기면병, 렘수면 행동장 애에서 PLMS가 흔히 발견되는 것은 PLMS가 도파민 기능 저하를 반영한다는 시각을 뒷받침한다(Hornyak 등 2006). PLMS가 동반되는 수면장애마다 각 질환의 고유의 병인 기 전에 의해 PLMS 양상이 조금씩 다르게 나타나는 것으로 보 이나 아직 상세한 연구는 이뤄지지 않고 있고, PLMS가 각 성에 기여하는 기전에 대해서도 밝혀진 것이 거의 없다. 이 와 같이 각 수면 장애 내에서의 PLMS의 임상적 의의가 충 분히 밝혀지지 않은 현재 상황에서는 PLMS를 줄이는 것이 어떤 영향을 가져올 것인지 아직 분명치 않다. 추후 위에 언 급된 수면 장애에서 정교한 연구 설계를 기반으로 PLMS를 낮추는 시도를 하고 이것이 수면 구조 및 대뇌피질 각성, 자 율신경계 활성도, 주간 증상에 미치는 영향을 탐색하는 연 구를 시행할 필요가 있다. 이러한 연구들이 시행되고 그 결과가 쌓이기 전까지는 매 임상상황마다 PLMS가 증가된 환 자의 증례를 앞에 두고 병력과 증상, 수면다원검사 결과를 종합적으로 검토해서 PLMS에 대해 어떤 개입을 할 지 고 민을 하는 현재의 고단한 작업을 이어가야 할 것이다.
Abstract
Periodic limb movements during sleep (PLMS) are prevalent in various sleep disorders, such as restless legs syndrome (RLS), periodic limb movements disorder, obstructive sleep apnea (OSA), REM sleep behavior disorder (RBD), and narcolepsy. PLMS has been hypothesized to be related to the decline of dopaminergic transmission. In RLS, PLMS is suggested to be related to iron deficiency and symptom severity. PLMD is a rare sleep disorder, and the role of PLMS in PLMD has not been clearly investigated yet. PLMS in OSA, which remain after proper PAP therapy, may need further management. The clinical relevance of PLMS in RBD and narcolepsy have not been investigated thoroughly and need further studies. Whether PLMS are to be considered as a mere symptom of individual sleep disorders or not can be elucidated through studies investigating the efficacy of therapeutic approaches to reduce PLMS in various sleep disorders.
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