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불면증 환자의 수면인식과 객관적, 주관적 수면변수의 연관성에 대한 연구

Association of Sleep Perception With Objective and Subjective Sleep Variables in Insomnia Patients

윤소영|이유진|이미현|서민철|오성민|윤가희
대한수면의학회 (Korean Academy of Sleep Medicine)|2021.12|수면정신생리 (Sleep Medicine and Psychophysiology)|제28권 제2호|pp. 70-77|DOI 10.14401/KASMED.2021.28.2.70

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불면증수면다원검사Polysomnography수면인식수면차이Insomnia disorderSleep discrepancySleep perception
주제분류정신과학

초록

목 적:본 연구의 목적은 불면증 환자의 주관적 수면인식 과 관련 있는 임상적, 객관적 요인들을 알아보고 임상에서 불 면증 환자의 이해와 평가 및 치료에 도움을 주기 위함이다. 방 법:109명의 불면증 환자들을 대상으로, 수면다원검 사 결과와 자가보고 설문지를 후향적으로 분석하였다. 주관 적 수면인식은 아침자가보고 설문지의 주관적 총 수면시간 (subjective total sleep time, subjective TST), 입면 잠복시간 (subjective sleep onset time; subjective SOL), 각성횟수, 아 침 개운함 정도로 측정하였으며, 주관적-객관적 수면차이를 계산하였다. 임상적 특징은 Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), Epworth Sleep- iness Scale (ESS)를 측정하였다. 변수들 사이의 관련성을 알아보기 위하여 상관분석을 시행하였다. 결 과:109명의불면증대상자(남성=72명,나이43.49± 15.32세)를 분석한 결과, 주관적 총 수면시간(subjective TST) 은 수면다원검사에서의 입면 후 각성시간(wake after sleep onset, WASO) (p < 0.001), N1 수면(p = 0.039) , PSQI (p < 0.001), BDI (p = 0.014)와 유의한 음의 상관관계를 보였다. 수 면차이는 PSQI (p = 0.018)와 유의한 음의 상관관계가 있었 다. 아침 개운함 정도는 PSQI (p = 0.019), BDI (p < 0.001)와 유의한 음의 상관관계가 있었다. 결 론:불면증 환자에서 주관적 수면인식은 수면다원검 사의 입면 후 각성시간(WASO), N1 수면과 관련성이 있었 으며, 우울감과 평소 수면의 질과 관련성이 있었다. 불면증 환자에서다양한객관적수면변수,평소수면의질및우울 감이 주관적 수면인식에 영향을 미치므로, 이를 고려하여 환자를 평가 및 치료해야 하겠다.

Abstract

Objectives: Our study aims to investigate the clinical and polysomnographic variables associated with subjective sleep percep- tion. Methods: Among the patients who underwent nocturnal polysomnography (PSG) at the Center for Sleep and Chronobiology of Seoul National University Hospital from May 2018 to July 2019, 109 diagnosed with insomnia disorder based on DSM-5 were recruited for the study, and their medical records were retrospectively analyzed. Self-report questionnaires about clinical characteristics including Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI), and Epworth sleepiness scale (ESS) were completed. Subjective sleep quality was measured using variables of subjective total sleep time (subjective TST), subjective sleep onset latency (subjective SOL), subjective number of awakenings, morning feeling after awakening, and sleep discrepancy (subjective TST–objective TST) the morning after PSG. Pearson and Spearman correlation analyses were used to determine the factors associated with subjective sleep perception. Results: In patients with insomnia, subjective TST was negatively correlated with Wake After Sleep Onset (WASO) (p = 0.001) and N1 sleep (p = 0.039) parameters on polysomnography. Also, it was negatively correlated with PSQI (p < 0.001) and BDI (p = 0.014) scores. Sleep discrepancy was negatively correlated with PSQI score (p = 0.018). Morning feeling was negatively correlated with PSQI (p = 0.019) and BDI (p < 0.001) scores. Conclusion: Our results demonstrated that subjective sleep perception is associated with PSG variables (WASO and N1 sleep) and with PSQI and BDI scores. In clinical practice, it is helpful to assess and manage insomnia patients in consideration of objective sleep variables, subjective sleep quality, and depressed mood, which can influence subjective sleep perception.

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