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수면무호흡증과 수면변수가 인지기능에 미치는 영향과 우울증의 매개효과

The Effects of Sleep Apnea and Variables on Cognitive Function and the Mediating Effect of Depression

송옥선|은헌정|김병조|김형욱|김태형|최말례|박경원
대한수면의학회 (Korean Academy of Sleep Medicine)|2017.12|수면정신생리 (Sleep Medicine and Psychophysiology)|제24권 제2호|pp. 86-96|DOI https://doi.org/10.14401/KASMED.2017.24.2.86

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수면무호흡증·수면변인·인지기능·수면다원검사·우울증.Cognitive function·Depression·Polysomnography·Sleep apnea·Sleep variables
주제분류정신과학

초록

목 적：본 연구는 폐쇄성 수면무호흡증 환자에서 수면무호흡지수, 수면관련척도, 기분관련척도, 그리고 인지기능간의 연관성을 보고자 하였다. 방 법：폐쇄성 수면무호흡증후군을 보이는 105명의 환자를 선정하였다. 수면무호흡지수로 RDI, AHI가 사용되었고, 수면관련척도로는 PSG에서 측정되는 TST, Duration N1, Duration N2, Duration N3, Duration R, Arousal Index, PLM Index, Snoring Index, Mean SpO2, Minimum SpO2 와 설문지로 측정되는 PSQI, ESS, SIS (snoring index by scale)를 사용하였으며 기분관련척도로는 BDI, 인지기능관련 척도로는 Moca-K, MMSE-K, CDR을 사용하였다. 이를 이용하여 수면무호흡증 환자에서 수면무호흡지수, 수면및 기분관련척도와 인지기능간의 상관관계를 분석하였으며수면무호흡증 환자에서 보이는 인지기능장애의 기전을 밝히고자 우울증의 매개효과를 분석하였다. 결 과：Duration N1가 증가할수록 그리고 TST가 감소할수록 MOCA-K에 부적 인과관계를 나타내었다(p ＜ 0.01). BDI와 Supine RDI가 증가할수록 MOCA-K에 부적인과관계를 보였다(p ＜ 0.01). PSQI가 증가할수록(p ＜ 0.001) 그리고 MMSE-K가 감소할수록(p ＜ 0.01) 또한 SIS가 증가할수록(p ＜ 0.01) BDI에 정적 인과관계를 보였다. 폐쇄성수면무호흡증 환자에서 나이가 MOCA-K에 미치는 영향에BDI가 부분 매개하는 것으로 확인되었다. 결 론：수면무호흡증 환자에서 Duration N1, TST, BDI, Supine RDI가 인지기능과 연관성이 있었으며, 특히 BDI로측정되는 우울증상이 수면무호흡증 환자의 인지기능저하에 부분적으로 매개 하였다.

Abstract

Objectives: This study aimed to analyze causality among sleep apnea, depression and cognitive function in patients with obstructive sleep apnea. Methods: We reviewed the medical records of 105 patients with sleep apnea and snoring who underwent overnight polysomnography (PSG). We analyzed various biological data, sleep variables (sleep duration and percentage) and respiratory variables [arousal index (AI), periodic leg movement index (PLM index), snoring Index (SI), mean SpO2, minimum SpO2, apnea-hypopnea index (AHI), and respiratory disturbance index (RDI)]. We also analyzed various data by sleep, cognition, and mood related scales: Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), snoring index by scale (SIS), Montreal Cognitive Assessment-Korean (Moca-K), Mini-mental State Examination-Korean (MMSE-K), clinical dementia rating (CDR), and Beck Depression Inventory (BDI). We analyzed causation among sleep, and respiratory, mood, and cognition related scales in obstructive sleep apnea patients. We analyzed the mediating effects of depression on sleep apnea patient cognition. Results: As Duration N1 increased and Total sleep time (TST) decreased, MOCA-K showed negative causality (p ＜ 0.01). As BDI and supine RDI increased, causality was negatively related to MOCA-K (p ＜ 0.01). As PSQI (p ＜ 0.001) and SIS (p ＜ 0.01) increased and as MMSE-K (p ＜ 0.01) decreased, causality was positively related to BDI. BDI was found to mediate the effect of age on MOCA-K in patients with obstructive sleep apnea. Conclusion: Duration N1, total sleep time, BDI, and supine RDI were associated with cognitive function in obstructive sleep apnea patients. Depression measured by BDI partially mediated cognitive decline in obstructive sleep apnea patients.

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