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편도 및 아데노이드 비대증이 소아의 수면과 주의력 결핍 과잉행동 증상에 미치는 영향

Impact of Adenotonsillar Hypertrophy on Sleep and Attention Deficit-Hyperactivity Symptoms in Children

권영준|황보영|심세훈|정희연|안현웅|백병준|이치규
대한신경정신의학회 (Korean Neuropsychiatric Association)|2009.07|신경정신의학 (JOURNAL OF THE KOREAN NEUROPSYCHIATRIC ASSOCIATION)|제48권 제4호|pp. 262-270

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편도 아데노이드 비대증·수면호흡장애·ADHD ·K-SADS-PL·K-ARS·ADSAdenotonsillar hypertrophy·Sleep-disordered breathing·ADHD·K-ARS·ADS
주제분류정신과학

초록

본 연구에서 저자들은 구조화되어 다른 검사자들에게도 통 용될 수 있는 K-SADS-PL를 통해 편도 및 아데노이드 비 대증 환아들이 정상소아에 비해 주의력 결핍 과잉행동증상에 더 많이 이환된다는 것을 도출해 내는 도구로 사용했다는 것 에 의의를 찾을 수 있겠다. 또한 편도 및 아데노이드 비대증 을 가진 소아는 일반 인구에 비해 수면호흡장애와 주의력 결 핍 과잉행동증상을 보일 수 있음을 수면설문지 및 객관적으 로 정량화된 평가방법인 K-ARS, ADS를 통해 확인하였다. 따라서 이들에게는 수술적 치료를 포함한 집중적인 치료가 필요할 것으로 사료된다. 향후 본 연구와 유사한 연구를 통해 편도 및 아데노이드 비대증과 수면호흡장애, 주의력 결핍 과잉 행동장애와의 관계에 대해 더 잘 규명할 수 있기를 기대한다.

Abstract

Objectives Adenotonsillar hypertrophy is one of the principal causes associated with snoring, sleep apnea, and restless sleep. These sleep-disordered breathing (SDB) is associated with hyperactivity, rebellious behavior, aggressiveness, enuresis, inattention, social withdrawal, and learning difficulties. The purpose of this study was to assess the impact of adenotonsillar hypertrophy on attention deficit hyperactivity symptoms and sleep-related symptoms in children by standard tests. Methods Children aged 5 through 15 years old, a total of 65 who were scheduled for Tonsillectomy and Adenoidectomy, were studied. The control group consisted of 30 healthy children of the same age. In both groups, attention-deficit hyperactivity dis-order (ADHD) was evaluated by Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). The degree of inattention, hyperactivity and sleep-related symptoms was evaluated by Korean ADHD Rating Scales (K-ARS), ADHD diagnostic system (ADS) and pediatric sleep questionnaire. The K-ARS and sleep questionnaire were completed by the parents of the children. Results Acording to K-SADS-PL, 23 subjects out of 65 subjects in the patient group and 2 subjects out of 30 subjects in the control group were diagnosed with ADHD. According to sleep questionnaires, the patient group reported significantly more problems than the control group. The patients had significantly higher cumulative questionnaire scores than the control group. In linear regression analysis, the cumulative score of sleep questionnaire was associated with inattention subscale scores, hyperactivity/impulsivity subscale scores and the total score of K-ARS, and also with the response time and the standard deviation of response time of ADS. In relation to ADHD, the patient group had significantly higher ADHD scores in K-ARS inattention subscale and significantly slower response time in ADS compared to the control group. Comparing SDB children without ADHD and the control group without ADHD by excluding ADHD children in both groups, SDB children without ADHD did not show significantly higher scores in K-ARS but did show significantly slower ADS response time. Conclusion Children with adenotonsillar hypertrophy are associated with increased SDB and ADHD symptoms. Therefore they may need intensive treatment such as surgical intervention.

참고문헌 (47)

  1. Marcus CL, "Sleep-disordered breathing in children", Am J Respir Crit Care Med, 164, pp.16~30 (2001)
  2. Hunt CE, "Neurocognitive outcomes in sleep-disordered breathing", J Pediatr, 145, pp.430~432 (2004)
  3. Ali NJ, "Snoring, sleep disturbance and behaviour in 4-5 year olds", Arch Dis Child, 68, pp.360~366 (1993)
  4. Rosen CL, "Obstructive sleep apnea syndrome (OSAS) in children: Diagnostic challenges", Sleep, 19(10), pp.S274~S277 (1996)
  5. Guilleminault C, "Dement WC. Sleep apnea in eight children", Pediatrics, 58, pp.23~30 (1976)
  6. Hyperactivity Disorder, "Attention-Deficit", pp.2001, Cho SC
  7. Jung EJ, "Executive Function Deficit of Children With Attention-Deficit", Hyperactivity Disorder, Ewha Women's University, 2003
  8. "National Institute of Mental Health"[URL]
  9. Hinshaw SP, "Academic underachievement, attention deficits, and aggression: comorbity and implications for intervention", J Consult Clin Psychol, 60, pp.893~903 (1992)
  10. De Serres LM, "Impact of adenotonsillectomy on quality of life in children with obstructive sleep disorders", Arch Otolaryngol Head Neck Surg, 128, pp.489~496 (2002)
  11. Chervin RD, "Inattention, hyperactivity, and symptoms of sleep-disordered breathing", Pediatrics, 109, pp.449~456 (2002)
  12. Brodsky L, "comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy", Int J Pediatr Otorhinolaryngol, 13, pp.149~156 (1987)
  13. Fujioka M, "Radiographic evaluation of adenoidal size in children: Adenoidal-nasopharyngeal ratio", AJR Am J Roent-genol, 133, pp.401~404 (1979)
  14. Kim JK, "Radiographic evaluation of adenoidal size in relatio to P.N.S X-ray & impedance audiometry in children with adenoid hypertrophy", Korean J Otolaryngol, 24, pp.177~186 (1981)
  15. Kaufman J, "Schedule for affective disorders and schizophrenia for school-age children-present and life time version(K-SADS-PL): Initial reliability and validity data", J Am Acad Child Adolesc Psychiatry, 36, pp.980~988 (1997)
  16. 김영신, "The Reliability and Validity of Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL-K)", Yonsei Medical Journal, 45(1), pp.81~89 (2004), 연세대학교의과대학
  17. Carroll JL, "Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children", Chest, 108, pp.610~618 (1995)
  18. Gozal D, "Sleep-disordered breathing and school performance in children", Pediatrics, 102(3), pp.616~620 (1998)
  19. DuPaul GJ, "Parent and teacher rating of ADHD symptoms: psychometric properties in a community-based sample", J Clin Child Psychol, 20, pp.245~253 (1981)
  20. 소유경, "한국어판 부모, 교사 ADHD 평가 척도의 신뢰도와 타당도 연구", 신경정신의학, 41(2) (2002), 대한신경정신의학회
  21. 김영신, "한국어판 부모 및 교사용 ADHD 평가 척도(K-ARS)의 규준연구", 신경정신의학, 42(3) (2003), 대한신경정신의학회
  22. Shin MS, "A study of the development and standardization of ADHD diagnostic system", J Kor Acad Child Adolesc Psychiatry, 11, pp.91~99 (2000)
  23. Lee JY, "Effects of intelligence ability on continuous performance test", J Kor Acad Child Adolesc Psychiatry, 17, pp.163~169 (2006)
  24. Li HY, "Impact of adenotonsillectomy on behavior in children with sleep-disordered breathing", Laryngoscope, 116, pp.1142~1147 (2006)
  25. Dillon JE, "DSM-IV diagnoses and obstructive sleep apnea in children before and 1 year after adenotonsillectomy", J Am Acad Child Adolesc Psychiatry, 46, pp.1425~1436 (2007)
  26. American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders, Text Revision. 4th ed" (2002), American Psychiatric Association
  27. Kim JY, "An Epidemiological study of attentiondeficit, hyperactivity disorder and learning disabilities in a rural area", J Korean Neuropsychiatr Assoc, 38, pp.784~793 (1999)
  28. 양 수 진, "주의력 결핍 과잉 행동 장애의 유병률과 관련 인자 : 서울시 학교 정신보건 사업", 신경정신의학, 45(1), pp.69~76 (2006), 대한신경정신의학회
  29. 구본조, "소아에서 편도 및 아데노이드 절제술이 주의력 결핍과과잉행동에 미치는 영향", 대한이비인후과학회지 두경부외과학, 49(2), pp.187~193 (2006), 대한이비인후과학회
  30. Ali NJ, "Sleep disordered breathings: effects of adenotonsillectomy on behaviour and psychological functioning", Eur J Pediatr, 155, pp.56~62 (1996)
  31. O'Brien LM, "Neurobehavioral implications of habitual snoring in children", Pediatrics, 114, pp.44~49 (2004)
  32. 박정준, "폐쇄성 수면무호흡증후군 소아에서 편도 및 아데노이드 절제술의 효과", 대한이비인후과학회지 두경부외과학, 50(8), pp.667~671 (2007), 대한이비인후과학회
  33. Goldstein NA, "Child Behavior and Quality of Life Before and After Tonsillectomy and Adenoidectomy", Arch Otolaryngol Head Neck Surg, 128, pp.770~775 (2002)
  34. 구수권, "편도 및 아데노이드 비대증이 소아의 인성과 행동에 미치는 영향", 대한이비인후과학회지 두경부외과학, 46(11), pp.959~964 (2003), 대한이비인후과학회
  35. Avior G, "The effect of tonsillectomy and adenoidectomy on inattention and impulsivity as measured by the Test of Variables of Attention (TOVA) in children with obstructive sleep apnea syndrome", Otolaryngol-Head Neck Surg, 131, pp.367~371 (2004)
  36. 이광호, "편도아데노이드절제술이 수면호흡장애 환아의 주의력결핍과과잉행동에 미치는 영향", 대한이비인후과학회지 두경부외과학, 50(7), pp.602~607 (2007), 대한이비인후과학회
  37. George CF, "Effect of nasal CPAP on simulated driving performance in patients with obstructive sleep apnoea", Thorax, 52, pp.648~653 (1997)
  38. Row BW, "Intermittent hypoxia is associated with oxidative stress and spatial learning deficits in the rat", Am J Respir Crit Care Med, 167, pp.1548~1553 (2003)
  39. Li RC, "Nitric oxide synthase and intermittent hypoxiainduced spatial learning deficits in the rat", Neurobiol Dis, 17, pp.44~53 (2004)
  40. Xu W, "Increased oxidative stress is associated with chronic intermittent hypoxia-mediated brain cortical neuronal cell apoptosis in a mouse model of sleep apnea", Neuroscience, 126, pp.313~323 (2004)
  41. Christou K, "Reactive oxygen metabolites (ROMs) as an index of oxidative stress in obstructive sleep apnea patients", Sleep Breath, 7, pp.105~110 (2003)
  42. Larkin EK, "Variation of C-reactive protein levels in adolescents: association with sleep-disordered breathing and sleep duration", Circulation, 111, pp.1978~1984 (2005)
  43. Beebe DW, "Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstructive to daytime cognitive and behavioral deficits", J Sleep Res, 11, pp.1~16 (2002)
  44. Bass JL, "The effect of chronic or intermittent hypoxia on cognition in childhood: a review of the evidence", Pediatrics, 114, pp.805~816 (2004)
  45. Huang YS, "Sleep disorders in Taiwanese children with attention deficit", hyperactivity disorder, 2004, pp.13, 269~277
  46. Golan N, "Sleep disorders and daytime sleepiness in children with attention-deficit", hyperactive disorder, 2004, pp.27, 261~266
  47. Sangal RB, "Patients with attention-deficit", hyperactivity disorder without observed apneic episodes in sleep or daytime sleepiness have normal sleep on polysomnography, 2005, pp.28, 1143~1148

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편도아데노이드절제술이 수면호흡장애 환아의 주의력결핍과과잉행동에 미치는 영향김기식, 박가현, 박종옥, 이광호, 이종빈, 최진수대한이비인후과학회 · 대한이비인후과학회지 두경부외과학2007 · 제50권 제7호Effect of Adenotonsillectomy on Attention in Korean Children With Sleep-Disordered Breathing김동규, 김민재, 배성희, 이강현, 이성민대한이비인후과학회 · Clinical and Experimental Otorhinolaryngology2018 · 제11권 제3호Immediate and Sustained Improvement in Behavior and Life Quality by Adenotonsillectomy in Children With Sleep-Disordered Breathing공일규, 김재원, 박경훈, 송재진, 안재철, 원태빈, 전영진대한이비인후과학회 · Clinical and Experimental Otorhinolaryngology2016 · 제9권 제2호편도아데노이드 절제술이 수면호흡장애 소아의 증상과 성장에 미치는 영향：장기 추적관찰 결과강준명, 국진호, 김병국, 김수환, 김영하, 주영훈, 진선영대한이비인후과학회 · 대한이비인후과학회지 두경부외과학2009 · 제52권 제4호수면 장애 호흡 소아에서 편도 및 아데노이드 절제술 후 두부계측도 평가김성동, 박지환, 박혜진, 조규섭, 조영진대한이비인후과학회 부산,울산,경남 지부회 · 임상이비인후과2023 · 제34권 제4호Associations among High Risk for Sleep-disordered Breathing, Related Risk Factors, and Attention Deficit/Hyperactivity Symptoms in Elementary School Children김경민, Dohyun Kim, Eun Jung Kim, Hojang Kwon, Hyunjoo Joo, Jee Hyun Kim, Ki-Chung Paik, Mina Ha, Myung-Ho Lim, Seung Jin Yoo대한정신약물학회 · Clinical Psychopharmacology and Neuroscience2020 · 제18권 제4호

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