야뇨증의 병태생리: 뇌, 수면장애 그리고 정신적 효과
Pathogenesis of Enuresis: Brain, Sleep Dysfunction and Psychological Effects
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초록
야뇨증의 발생에 중요한 역할을 하는 수면장애는 주로 각성장애이며, 각성과 관련된 뇌간을 포함한 중추신경계의 기능이상이 야뇨증 환자에서 흔히 관찰된다. 야뇨증은 정신적인 문제와 밀접하게 연관되어 있으며 이에 대한 이해의 증가는 야뇨증의 적절한 치료를 위해 앞으로 더욱 중요해질 것으로 예상한다.
Abstract
The relationship between central nervous system (CNS) and enuresis has not been sufficiently elucidated despite the presence of several circumstantial evidences. Contrary to common belief, polysomnographic sleep analysis revealed that the disturbance of arousal rather than deep sleep was responsible for enuresis. Subsequent studies confirmed depressed sympathetic tone and retarded brainstem reflex indicating abnormal arousal threshold in enuretics. In accordance with the bladder-brain dialogue, chronic stimulation of bladder may modify the brainstem function elevating arousal threshold. Epidemiological studies have suggested the association between enuresis and various psychosomatic disorders like attention deficit hyperactivity disorder (ADHD), which has shown the abnormal brainstem reflex similar to enuresis. Taken together, CNS is assumed to play a crucial role in the pathogenesis of enuresis. Psychological assessment is vital to understand the psychodynamic effect of enuresis. Studies have shown that the prevalence of psychological problems was higher in enuretic children and externalization of the symptoms was usually found. Several explanations have been brought up regarding the development of enuresis and psychological problems. Enuresis may cause psychological problems and vice versa. Otherwise, both may be associated with other variables, such as socioeconomic status (SES).
참고문헌 (18)
- Wolfish NM, "Sleep", Arousal and enuresis subtypes, 2001, pp.166, 2444~2447
- Wolfish NM, "Elevated sleep arousal thresholds in enuretic boys: clinical implications", ActaPaediatr, 86, pp.381~384 (1997)
- Nevés T, "Sleep of children with enuresis: a polysomnographic study", Pediatrics, 103, pp.1193~1197 (1999)
- Hunsballe JM, "Increased delta component in computerized sleep electroencephalographic analysis suggests abnormally deep sleep in primary monosymptomatic nocturnal enuresis", Scand J Urol Nephrol, 34, pp.294~302 (2000)
- Gillin JC, "EEG sleep patterns in enuresis: a further analysis and comparison with normal controls", Biol Psychiatry, 17, pp.947~953 (1982)
- Yeung CK, "Cortical arousal in children with severe enuresis", N Engl J Med, 358, pp.2414~2415 (2008)
- Fujiwara J, "Evaluation of the autonomic nervous system function in children with primary monosymptomatic nocturnal enuresis--power spectrum analysis of heart rate variability using 24-hour Holter electrocardiograms", Scand J Urol Nephrol, 35, pp.350~356 (2001)
- Ornitz EM, "Prepulse inhibition of startle and the neurobiology of primary nocturnal enuresis", Biol Psychiatry, 45, pp.1455~1466 (1999)
- Baeyens D, "The impact of maturation of brainstem inhibition on enuresis: a startle eye blink modification study with 2-year followup", J Urol, 178, pp.2621~2625 (2007)
- Xiang B, "Functional brainstem changes in response to bladder function alteration elicited by surgical reduction in bladder capacity: a functional magnetic resonance imaging study", J Urol, 184, pp.2186~2191 (2010)
- Baeyens D, "The prevalence of ADHD in children with enuresis: comparison between a tertiary and non-tertiary care sample", Acta Paediatr, 95, pp.347~352 (2006)
- Baeyens D, "Attention-deficit", hyperactivity disorder (ADHD) as a risk factor for persistent nocturnal enuresis in children: a two-year follow-up study, 2005, pp.94, 1619~1625
- Baeyens D, "The prevalence of attention deficit-hyperactivity disorder in children with nonmonosymptomatic nocturnal enuresis: a 4-year followup study", J Urol, 178, pp.2616~2620 (2007)
- Durkin MS, "The effects of a natural disaster on child behavior: evidence for posttraumatic stress", Am J Public Health, 83, pp.1549~1553 (1993)
- Moffatt ME, "Nocturnal enuresis: psychologic implications of treatment and non treatment", J Pediatr, 114, pp.697~704 (1989)
- von Gontard A, "Psychological and psychiatric issues in urinary and fecal incontinence", J Urol, 185, pp.1432~1436 (2011)
- on Gontard A, "Comorbidity of functional urinary incontinence and encopresis: somatic and behavioral associations", J Urol, 171, pp.2644~2647 (2004)
- De Bruyne E, "Problem behavior, parental stress and enuresis", J Urol, 182, pp.2015~2020 (2009)