노년기 우울증 환자의 수면의 질 저하가 삶의 질에 미치는 영향
Poor Sleep Quality and Its Effect on Quality of Life in the Elderly with Late Life Depression
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우울증은 정신과 질환 중에서 가장 흔한 질환중의 하나지만, 인간의 삶에 미치는 영향은 매우 심각하다. 우울증은 인류에게 가장 큰 부담(burden of disease)을 초래하는 10대 질환 중 4위이고, 2020년에는 2위, 2030년에는 1위가 될 것으로 예측된다.1)2) 특히 노년기 우울증은 우리나라를 비롯하여 노년층 인구가 급증하고 있는 아시아 국가에서 심각한 공중 보건상의 문제로 대두되고 있다. 노인우울증에서 수면장애의 비율은 매우 높아서 약 2/3 이상에서 수면장애를 동반하고 있고,3) 수면장애 자체도 인지기능과 정동상태에 부정적인 영향을 주고 전반적인 삶의 질을 떨어뜨린다.4)5)연령이 증가함에 따라 수면은 점점 단편화되며, 야간 각성 및 주간 수면의 양상을 보이게 된다.6) 나이의 증가는 수면 장애를 예측하는 가장 중요한 예측 인자로 알려져 있고, 노인환자의 50% 습관적인 수면 문제를 지니고 있다.7)8) 불면증도연령이 증가함에 따라 유병률이 증가하는 것으로 알려져 있으며, 이에 따른 수면제의 사용도 연령에 따라 증가하는 것으로알려져 있다. 이러한 수면 장애는 주요우울장애, 면역 기능의감소, 심혈관계 질환의 증가와 관련된다. 연구마다 불면증의 유병률은 차이가 나는데 이는 불면증의정의와 조사 방법의 차이에 기인한다. 국내의 연구에 의하면65세 이상 노인의 대략 22%에서 57.7%의 노인에서 불면증이있는 것으로 보고되고 있다.9)10)우리나라 노인의 주요우울장애 유병률은 다른 아시아권 국가들이나 서구의 2~4%보다 대체적으로 높아서 5.4%였고,11)한국판 단축형 노인우울척도(Short form of Korean versionof the Geriatric Depression Scale)12) 점수를 이용해 그 점수가 8점 이상이 우울증으로 정의할 때 유병률은 27.7%로 다른아시아권 국가들이나 서구에 비해서 높았다.13)수면장애와 우울장애의 관계는 양방향적이다.14) 즉 만성 불면증은 우울증 발병의 위험요인으로 작용할 뿐만 아니라,15)16)불면증의 우울장애의 잔존증상으로 남아 있을 경우 향후 우울증의 재발의 위험을 높인다.17) 또한 불면증은 우울장애의주요한 증상 중의 하나로 주요우울장애의 70% 이상에서 동반하게 된다.3)이전의 연구들의 초점은 주로 불면증과 우울장애의 연관관계나,14) 각 질환들이 삶에 질에 미치는 영향이 독립적으로연구되었다.18)19) 현재 노년기 우울증에 동반된 수면장애에 대한 연구는 부족한 실정이다. 본 연구는 노년기 우울장애군 환자를 대상으로 수면질 저하군과 수면질 양호군의 임상적 특징을 비교하고 또한 노년기 우울장애에서 수면의 질 저하가 삶의질에 저하에 미치는 영향을 조사하고자 한다.
Abstract
Objectives : More than half of the elders suffer from chronic sleep disturbances. Moreover, sleep disturbances are more prevalent in patients with depressive disorder than in community dwelling elderly. In this study, we aim to estimate the risk factors of poor sleep quality and its effect on quality of life in patients with late life depression. Methods : This study included 159 depressive patients aged 65 years or older who completed Pittsburgh Sleep Quality Index (PSQI). A global PSQI score of 5 or greater indicates a poor sleeper. Structural diagnostic interviews were performed using the Korean version of Mini International Neuropsychiatric Interview (MINI). Depression was evaluated by the Korean form of Geriatric Depression Scale (KGDS). Global cognition was assessed by Mini-Mental State Examination in the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease assessment packet. Quality of life was evaluated by the Korean version of Short-Form 36-Item Health Survey (SF-36). Results : The frequencies of poor sleepers were 90.5% in major depressive disorder, 71.8% in minor depressive disorder, 47.1% in subsyndromal depressive disorder, and 73.0% in all types of depressive disorders. Multivariate logistic regression analysis indicated that female [odds ratio (OR) = 2.83, 95% confidence interval (CI) = 1.20–6.67] and higher KGDS score (OR = 1.13, 95% CI = 1.05–1.21) were risk factors of poor sleep quality in patients with late life depression. In the analysis of ANCOVA adjusted for age, gender, education and KGDS score, the mean scores of vitality mental health and mental component summary of SF-36 were lower in poor sleepers than in good sleepers. Conclusions : Poor sleepers among patients with late life depression are very common and are associated with female and higher KGDS scores. Poor sleep quality causes a significant negative effect on mental health quality. So researchers and clinicians should be more vigilant in the evaluation and treatment of sleep disturbances in patients with late life depression.
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