폐쇄성 수면무호흡 증후군에서 앙와위 자세시간과 수면관련변인 간 상관관계 분석
Correlational Analysis of Supine Position Time and Sleep-related Variables in Obstructive Sleep Apnea Syndrome
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목 적：폐쇄성 수면무호흡 증후군(obstructive sleep apnea syndrome, OSAS)에서 앙와위는 비앙와위보다 수면무호흡을 증가시키는 것으로 알려져 있다. 앙와위 자세시간(supine position time, SPT)과 OSAS의 무호흡-저호흡 지수(apnea-hypopnea index, AHI)의 관련성에 대해서 많은연구가 있었으나, SPT가 OSAS에서 어떤 변수의 영향을 받는지는 알려져 있지 않다. OSAS에서 수면다원검사상 어떤변수가 SPT과 관련이 있는지를 평가하였다. 방 법：수면다원검사로 진단된 치료받지 않은 365 명의OSAS 남자 환자를 선정하였다. SPT(276.4 ± 92.3 분)가 인구 통계학적 데이터, 수면구조 관련변수, OSAS 관련변수및 심박변이도(Heart rate variability, HRV)와 상관관계가있는지 분석했다. SPT에 영향을 주는 요인을 알아보기 위해 SPT에 대해 다중회귀분석을 시행하였다. 결 과：전체 대상군의 상관분석에서 SPT는 총수면시간(total sleep time, TST) (r = 0.443, p ＜ 0.001)과 수면 효율(r = 0.300, p ＜ 0.001)과 가장 유의한 상관관계가 있었고, 코골이 시간(r = 0.238, p ＜ 0.001), 산소포화도 90 % 미만시간(r = 0.188, p ＜ 0.001), AHI (r = 0.180, p = 0.001), 산소탈포화지수(oxygen desaturation index, ODI), (r = 0.149, p = 0.004), NN50 count(r = 0.137, p = 0.036)와 SPT 간에 유의한 상관관계가 있었다. 다중회귀분석 결과 SPT에 유의한영향을 끼치는 요인으로 TST (t = 7.781, p ＜ 0.001), 코골이시간(t = 3.794, p ＜ 0.001), AHI (t = 3.768, p ＜ 0.001), NN50 count (t = 1.993, p = 0.047)가 있었다. 결 론：SPT는 OSAS 관련변수보다 수면구조 관련변수와 더 높은 상관관계를 보였다. 특히 SPT는 TST과 AHI 뿐만 아니라 NN50 count와도 밀접하게 관련되어 있었다. 이것은 SPT가 OSAS의 심각도뿐만 아니라 수면구조와 심박변이도에 의해서도 결정될 가능성이 있음을 시사한다.
Abstract
Objectives: A supine sleep position increases sleep apneas compared to non-supine positions in obstructive sleep apnea syndrome (OSAS). However, supine position time (SPT) is not highly associated with apnea-hypopnea index (AHI) in OSAS. We evaluated the correlation among sleep-related variables and SPT in OSAS. Methods: A total of 365 men with OSAS were enrolled in this study. We analyzed how SPT was correlated with demographic data, sleep structure-related variables, OSAS-related variables and heart rate variability (HRV). Multiple linear regression analysis was conducted to investigate the factors that affected SPT. Results: SPT had the most significant correlation with total sleep time (TST ; r = 0.443, p ＜ 0.001), followed by sleep efficiency (SE ; r = 0.300, p ＜ 0.001). Snoring time (r = 0.238, p ＜ 0.001), time at < 90% SpO2 (r = 0.188, p ＜ 0.001), apnea-hypopnea index (AHI ; r = 0.180, p = 0.001) and oxygen desaturation index (ODI ; r = 0.149, p = 0.004) were significantly correlated with SPT. Multiple regression analysis revealed that TST (t = 7.781, p ＜ 0.001), snoring time (t = 3.794, p < 0.001), AHI (t = 3.768, p ＜ 0.001) and NN50 count (t = 1.993, p = 0.047) were associated with SPT. Conclusion: SPT was more highly associated with sleep structure-related parameters than OSAS-related variables. SPT was correlated with TST, SE, AHI, snoring time and NN50 count. This suggests that SPT is likely to be determined by sleep structure, HRV and the severity of OSAS.
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