바이오피드백을 이용하여 측정한 불면증 환자의 정신생리적 특징
Psychophysiological Characteristics of Insomnia Patients Measured by Biofeedback System
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목 적：불면증은 여러 가지 신체질환, 정신질환에 공이환 된 경우가 많아 일차 진료에서 가장 흔한 문제 중 하나이다. 정신생리적 과각성이 병태생리에서 중요하다고 알려져 있다. 이 연구에서는 바이오피드백 기기를 이용한 스트레스 반응 검사로 일차성 불면증과 정상인 간에 생리신호 특성을 비교하였다. 방 법：일차성 불면증 환자 80명(남자 35, 여자 45명, 49.71 ± 12.91세)과 정상인 101명(남자 64, 여자 37명, 27.65 ± 2.77세)에게 바이오피드백 기기를 이용하여 스트레스 반응 검사를 하였다. 스트레스 반응 검사는 기저, 스트레스 1, 회복 1, 스트레스 2, 회복 2단계의 다섯 단계로 하였다. 각 단계에서 근전도(EMG), 심장박동수(heart rate), 피부전도(skin conductance), 피부체온(skin temperature), 그리고 호흡수(respiratory rate)를 각각 2분 동안 기록하여 평균값을 산출하였다. 측정값들의 양 군 사이 비교에는 독립 t-검정, 이전 단계와 비교한 측정값의 변화는 대응표본 t-검정으로 분석하였다(양측검정, p ＜ 0.05). 결 과：불면증 환자는 정상인에 비해 5단계 스트레스 반응 검사 모두에서 전두근이 더 긴장해 있었다(기저 : 7.72 ± 3.88 μV vs. 4.89 ± 1.73 μV, t = -6.06, p ＜ 0.001 ; 스트레스 1 : 10.29 ± 5.16 μV vs. 6.63 ± 2.48 μV, t = -5.84, p ＜ 0.001 ; 회복 1 : 7.87 ± 3.86 μV vs. 5.17 ± 2.17 μV, t = -5.61, p ＜ 0.001 ; 스트레스 2 : 10.22 ± 6.07 μV vs. 6.98 ± 2.98 μV, t = -4.37, p ＜ 0.001 ; 회복 2 : 7.88 ± 4.25 μV vs. 5.17 ± 1.99 μV, t = -5.27, p ＜ 0.001 ). 정상인은 불면증 환자와 비교하여 각 단계에 따른 심장박동수의 변화 정도가 더 컸다(스트레스 1-기저 : 6.48 ± 0.59 vs. 3.77 ± 0.59, t = 3.22, p = 0.002 ; 회복 1-스트레스 1 : -5.36 ± 0.0.59 vs. -3.16 ± 0.47, t = 2.91, p = 0.004 ; 스트레스 2-회복 1 : 8.45 ± 0.61 vs. 4.03 ± 0.47, t = 5.72, p ＜ 0.001 ; 회복 2-스트레스 2 : -8.56 ± 0.65 vs. -4.02 ± 0.51, t = -5.31, p ＜ 0.001). 결 론：일차성 불면증 환자는 정상인에 비해 전두근 근전도 측정값이 전반적으로 증가되었고, 심장박동수의 검사 단계별 변화 정도가 작았다. 이는 불면증 환자의 자율신경계가 정상인에 비해 과각성 상태에 있음을 시사한다.
Abstract
Background and Objectives: Insomnia is the most prevalent sleep disorder in the general population and is considered to be a disorder of hyperarousal. The aim of this study was to measure the psychophysiological responses in insomnia patients using a biofeedback system, and to compare them with results from normal healthy subjects. Materials and Methods: Eighty patients with primary insomnia (35 males and 45 females, average age 49.71 ± 12.91 years) and 101 normal healthy controls (64 males and 37 females, average age 27.65 ± 2.77) participated in this study. Electromyography (EMG), heart rate (HR), skin conductance (SC), skin temperature (ST), and respiratory rate (RR) were recorded using a biofeedback system during 5 phases (baseline, stress 1, recovery 1, stress 2, recovery 2) of a stress reactivity test, and average values were calculated. Difference in values between the two groups in each corresponding phase was analyzed with independent t-test, and change in values across phases of the stress reactivity test was analyzed with paired t-test (all two-tailed, p＜0.05). Results: Compared to normal controls, insomnia patients had higher EMG in all 5 phases (baseline : 7.72 ± 3.88 μV vs. 4.89 ± 1.73 μV, t = -6.06, p＜0.001 ; stress 1 : 10.29 ± 5.16 μV vs. 6.63 ± 2.48 μV, t = -5.84, p＜0.001 ; recovery 1 : 7.87 ± 3.86 μV vs. 5.17 ± 2.17 μV, t = -5.61, p＜0.001 ; stress 2 : 10.22 ± 6.07 μV vs. 6.98 ± 2.98 μV, t = -4.37, p＜0.001 ; recovery 2 : 7.88 ± 4.25 μV vs. 5.17 ± 1.99 μV, t = -5.27, p＜0.001). Change in heart rate across phases of the stress reactivity test were higher in normal controls than in insomnia patients (stress 1-baseline : 6.48 ± 0.59 vs. 3.77 ± 0.59, t = 3.22, p = 0.002 ; recovery 1- stress 1 : -5.36 ± 0.0.59 vs. -3.16 ± 0.47, t = 2.91, p = 0.004 ; stress 2-recovery 1 : 8.45 ± 0.61 vs. 4.03 ± 0.47, t = 5.72, p＜0.001 ; recovery 2-stress 2 : -8.56 ± 0.65 vs. 4.02 ± 0.51, t = -5.31, p＜0.001). Conclusion: Psychophysiological profiles of insomnia patients in a stress reactivity test were different from those of normal healthy controls. These results suggest that the sympathetic nervous system is more highly activated in insomnia patients.
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