수면다원검사를 통해 분석한 소아 뇌전증환자의 수면장애: 수면 및 발작과 관련된 영향인자
Polysomnographic Analysis of Sleep Problems in Children with Epilepsy: Influencing Factors in Sleep and Seizure Related Conditions
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목적: 수면증상을 호소하는 소아 뇌전증환자들에서 수면다원검사를 시행하여 수면질환의 분포를 조사하고 수면질환의 위험을 높이는요인을 확인하며 수면관련 인자가 발작의 조절 정도에 영향을 끼치는지분석하고자본연구를실시하였다 . 방법: 2001년 3월부터 2014년 12월까지 삼성서울병원 소아청소년과 및 신경과에 내원한 소아 뇌전증환자(평균 연령: 13.7±3.8세) 중 수면증상을 호소하여 수면다원검사를 시행한 94명의 의무기록과 수면다원검사 결과를 후향적으로 고찰하였다 . 수면질환 군과 수면질환이 없는 군의 임상 특성을 비교하였다 . 발작이 조절되는 군과 조절되지않는 군의 수면다원검사 결과를 비교하였다 . 결과: 환자들은 코골이,무호흡,구강호흡,주간졸림증,불면등다양한 수면증상을 호소하였다 . 총 94명 중 46명(48.9%)에서 수면질환이 진단되었다 . 폐쇄수면무호흡이 26명(27.7%)으로 가장 흔하였으며, 기면병 8명(8.5%), 주기성사지운동장애 8명(8.5%)이었다 . 발작이 조절되지 않는 군에서 3 -4단계 비렘수면이 유의하게 짧았다( P=0.010). 수면질환 군에서 발작이 조절되지 않는 환자의 비율이 더 높은 경향을 보였으나통계적인 유의성은 없었다( P=0.053). 결론: 소아 뇌전증환자들은 흔히 다양한 수면증상을 호소하며, 많은 환자는 다양한 정도의 수면질환을 가지고 있다 . 발작이 조절되지않는 환자들의 수면다원검사에서 서파수면의 감소 등 수면의 질의 저하가 확인되었다 . 따라서 소아 뇌전증환자에서 적극적인 병력 청취와 설문지 조사를 통하여 수면문제의 유무를 확인하는 것이 필요하며, 임상양상에 따라 수면다원검사를 이용하여 정확한 수면질환을 진단하는것이필요하다 .
Abstract
Purpose: The objectives of this study were to identify the characteristics of sleep disorders in children with epilepsy complaining of sleep problems, and to find out sleep-related factors that influence on the prognosis of epilepsy. Methods: We retrospectively reviewed medical records and polysomnographic data of 94 children (mean age 13.7±3.8 years), who visited our hospital for epilepsy between March 2001 and December 2014. The patients were evaluated with polysomnography and a questionnaire about sleepiness. We compared clinical characteristics between patients with and without sleep disorders. We analyzed the differences of sleep parameters between the prognostic groups of epilepsy. Results: The patients enrolled in this study complained of various sleep problems, such as snoring, apnea, mouth-breathing, excessive daytime sleepiness, and insomnia. Sleep disorders were diagnosed in 46 patients (48.9%). Obstructive sleep apnea was the most common sleep disorder (n=26), followed by narcolepsy (n=8) and periodic limb movement disorder (n=8). Patients with poor prognosis showed decrease of stage 3-4 sleep (P=0.010). There was no significant correlation between the presence of sleep disorders and seizure control (P=0.053). Conclusion: Various sleep complaints and sleep disorders are commonly found in children with epilepsy. Polysomnographic analysis of patients with uncontrolled seizure indicates a decline in sleep quality. Screening sleep problems and performing diagnostic test with polysomnography in patients with sleep problems is recommended in pediatric patients with epilepsy.
참고문헌 (30)
- Becker DA, "Sleep disturbance in children with epilepsy", Epilepsy Behav, 4, pp.651~658 (2003)
- Wirrell E, "Sleep disturbances in children with epilepsy compared with their nearest-aged siblings", Dev Med Child Neurol, 47, pp.754~759 (2005)
- Maganti R, "Excessive daytime sleepiness and sleep complaints among children with epilepsy", Epilepsy Behav, 8, pp.272~277 (2006)
- Foldvary-Schaefer N, "Sleep and epilepsy", Semin Neurol, 29, pp.419~428 (2009)
- Matos G, "The relationship between sleep and epilepsy: evidence from clinical trials and animal models", J Neurol Sci, 295, pp.1~7 (2010)
- Kothare SV, "The adverse effects of antiepileptic drugs in children", Expert Opin Drug Saf, 6, pp.251~265 (2007)
- van Golde EG, "Sleep disturbances in people with epilepsy; prevalence, impact and treatment", Sleep Med Rev, 15, pp.357~368 (2011)
- Malow BA, "Identification and treatment of obstructive sleep apnea in adults and children with epilepsy: a prospective pilot study", Sleep Med, 4, pp.509~515 (2003)
- Becker DA, "Daytime behavior and sleep disturbance in childhood epilepsy", Epilepsy Behav, 5, pp.708~715 (2004)
- Maganti R, "Sleep architecture in children with idiopathic generalized epilepsy", Epilepsia, 46, pp.104~109 (2005)
- Kaleyias J, "Spectrum of polysomnographic abnormalities in children with epilepsy", Pediatr Neurol, 39, pp.170~176 (2008)
- Shaheen HA, "Obstructive sleep apnea in epilepsy: a preliminary Egyptian study", Sleep Breath, 16, pp.765~771 (2012)
- Pereira AM, "The impact of epilepsy on sleep architecture during childhood", Epilepsia, 53, pp.1519~1525 (2012)
- Jain SV, "Obstructive sleep apnea and primary snoring in children with epilepsy", J Child Neurol, 28, pp.77~82 (2013)
- Rechtschaffen A, "A manual of standardized terminology, techniques and scoring system of sleep stages in human subjects", National Institutes Health, pp.1~12 (1968)
- Iber C, "The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications", pp.15~57 (2007), American Academy of Sleep Medicine
- Peter JH, "The international classification of sleep disorders: diagnostic and coding manual", pp.95~97 (2005), American Academy of Sleep Medicine
- Thigpen CH, "Unusual paranoid manifestations in a case of psychomotor epilepsy and narcolepsy", J Nerv Ment Dis, 122, pp.381~385 (1955)
- Lagrange AH, "Rasmussen’s syndrome and new-onset narcolepsy, cataplexy, and epilepsy in an adult", Epilepsy Behav, 4, pp.788~792 (2003)
- Yang Z, "Epilepsy and narcolepsycataplexy in a child", J Child Neurol, 27, pp.807~810 (2012)
- Joshi PA, "Juvenile myoclonic epilepsy and narcolepsy: a series of three cases", Epilepsy Behav, 51, pp.163~165 (2015)
- Challamel MJ, "Narcolepsy in children", Sleep, 17(8 Suppl), pp.1994~1917 (1994)
- Nunes ML, "Sleep and epilepsy in children: clinical aspects and polysomnography", Epilepsy Res, 89, pp.121~125 (2010)
- Cortesi F, "Sleep problems and daytime behavior in childhood idiopathic epilepsy", Epilepsia, 40, pp.1557~1565 (1999)
- Batista BH, "Evaluation of sleep habits in children with epilepsy", Epilepsy Behav, 11, pp.60~64 (2007)
- Minecan D, "Relationship of epileptic seizures to sleep stage and sleep depth", Sleep, 25, pp.899~904 (2002)
- Seda G, "Medication effects on sleep and breathing", Clin Chest Med, 35, pp.557~569 (2014)
- Malow BA, "Obstructive sleep apnea is common in medically refractory epilepsy patients", Neurology, 55, pp.1002~1007 (2000)
- Koh S, "Sleep apnea treatment improves seizure control in children with neurodevelopmental disorders", Pediatr Neurol, 22, pp.36~39 (2000)
- Segal E, "Effect of treatment of obstructive sleep apnea on seizure outcomes in children with epilepsy", Pediatr Neurol, 46, pp.359~362 (2012)