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수면 중 주기성 사지운동의 원인 및 병태생리

The Etiology and Pathophysiology of Periodic Limb Movements During Sleep

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키워드

주제분류정신과학

초록

PLMS는 수면다원검사에서 흔히 발견되는 소견으로 여 러 수면 장애 뿐 아니라 각종 신체 질환과 동반되며 사망률 증가와 관련되기도 한다(Choi 등 2017). 때문에 PLMS의 원인을 탐색하고자 하는 연구가 꾸준히 이루어졌고 최근 수면 의학의 발전과 함께 원인과 기전에 대한 이해의 폭이 넓어 졌다. PLMS의 형태는 실제로는 전형적이지 않고 그 주기와 LM의 시간에 따른 분포 등은 다양하게 나타날 수 있다. 따 라서 PLMS의 판독 기준에 해당하는 움직임 내에도 실제로 는 원인이 다른 움직임이 존재할 가능성이 있다. 이에 대해 PLMS의 표현형을 보다 분명하게 구분하고자 시도해 왔고, 진정한 PLMS는 10-90초의 주기성과 수면의 전반부에 두드 러지고 시간이 지남에 따라 감소하는 형태를 보였다.

Abstract

Periodic limb movement during sleep (PLMS) is repetitive and stereotyped limb movements that occur during sleep. Though this phenomenon, commonly observed in polysomnography, has significant associations with various sleep and physical disorders, its etiology has not been clearly identified. In fact, PLMS, which is not entirely stereotyped, might include similar movements ac¬tually caused by different mechanisms. According to attempts to classify the phenotypes of PLMS, genuine PLMS is character¬ized by a periodicity of 10-90 seconds, predominantly appearing in the first half of sleep, and gradually decreasing over time. The MEIS1 and BTBD9 genes are associated with iron and dopamine metabolism, and these genetic variants are associated with an increase of PLMS. Brain iron deficiency could be the reason of dopamine and glutamate dysfunctions. Pre-synaptic hy¬perdopaminergic state leads to down-regulation of post-synaptic dopamine 2 receptor, which result in a nocturnal dopaminergic deficit. It could induce spinal hyperactivity via the A11 dopamine-inhibitory spinal descending pathway. Due to a hyperactivity of spinal cord, the central pattern generators in the spinal cord might be activated, possibly forming synchronous patterns of PLMS. The periodicity of PLMS could be regulated by the cyclic alternating pattern, one of the microstructures of sleep, which means the modulation of cortical-subcortical regions. To date, definitive research on the etiology and pathophysiology of PLMS is lack¬ing. Future research will require a precise definition of PLMS, use of parameters with less inter-night variability with analyzing the microstructure of sleep.

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