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수면장애에서 비침습적 뇌자극술의 치료 효과 고찰: 경두개자기자극술과 경두개직류전기자극술을 중심으로

A Review on Effects of Non-Invasive Brain Stimulation in the Treatment of Sleep Disorders

임수미|이수지|윤수정|김신혜
대한수면의학회 (Korean Academy of Sleep Medicine)|2021.12|수면정신생리 (Sleep Medicine and Psychophysiology)|제28권 제2호|pp. 53-96|DOI 10.14401/KASMED.2021.28.2.53

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키워드

수면장애Sleep disorders경두개자기자극술Transcranial magnetic stimulation경두개직류전기자극술비 침습적 뇌자극술신경 활성Transcranial direct current stimulationNeural activityNon-inva- sive brain stimulation
주제분류정신과학

초록

본 종설에서는 불면증, 과다수면증, 하지불안증후군, 폐 쇄수면무호흡에서 치료적 기법으로 TMS, tDCS를 적용한 연구들을 고찰하였다. 각 연구에서는 질환의 병리적 특성에 따른 대뇌피질 활성의 이상소견에 특화된 TMS와 tDCS 자 극 프로토콜이 적용되었고, 동일한 수면장애에서도 동반하 는 공존질환에 따라 뇌 내 자극의 위치와 자극강도가 다르 게 적용되었다.수면장애에 TMS 혹은 tDCS을 적용한 연구결과는, 비록 질환별로 수행된 연구의 수가 적고 연구별로 자극의 강도 및 주기가 상이한 프로토콜이 적용되었지만 대부분의 연구 에서특정뇌영역에대한TMS혹은tDCS자극이수면장애 개선 효과를 나타내는 것으로 보고하였다. 향후 수면장애 별 로 최적화된 프로토콜이 확립되고 그에 따른 연구결과가 축 적된다면 TMS와 tDCS의 수면장애 치료법으로서 역할을 기 대해볼수있을것이다.

Abstract

Sleep disorders, increasingly prevalent in the general population, induce impairment in daytime functioning and other clinical problems. As changes in cortical excitability have been reported as potential pathophysiological mechanisms underlying sleep disorders, multiple studies have explored clinical effects of modulating cortical excitability through non-invasive brain stimula- tion in treating sleep disorders. In this study, we critically reviewed clinical studies using non-invasive brain stimulation, partic- ularly transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), for treatment of sleep disor- ders. Previous studies have reported inconsistent therapeutic effects of TMS and tDCS for various kinds of sleep disorders. Specifically, low-frequency repetitive TMS (rTMS) and cathodal tDCS, both of which exert an inhibitory effect on cortical excit- ability, have shown inconsistent therapeutic effects for insomnia. On the other hand, high-frequency rTMS and anodal tDCS, both of which facilitate cortical excitability, have improved the symptoms of hypersomnia. In studies of restless legs syn- drome, high-frequency rTMS and anodal tDCS induced inconsistent therapeutic effects. Single TMS and rTMS have shown differential therapeutic effects for obstructive sleep apnea. These inconsistent findings indicate that the distinctive character- istics of each non-invasive brain stimulation method and specific pathophysiological mechanisms underlying particular sleep disorders should be considered in an integrated manner for treatment of various sleep disorders. Future studies are needed to provide optimized TMS and tDCS protocols for each sleep disorder, considering distinctive effects of non-invasive brain stimulation and pathophysiology of each sleep disorder.

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