Journal of Korean Neuropsychiatric Association (신경정신의학)

Korean Neuropsychiatric Association (대한신경정신의학회)
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Sleep of PTSD

외상후 스트레스 장애의 수면

Lim, Se-won;Kim, Leen
임세원;김린

  • Published : 2005.03.30
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Abstract

Sleep disturbance is a very common complaint among patients with posttraumatic stress disorder (PTSD). Recent studies suggest that sleep disturbances such as nightmare and insomnia are important in predicting later development of PTSD as well as diagnosing PTSD. Despite of its clinical significance and importance, consistent characterization of the neurophysiology underlying sleep symptoms in PTSD has been elusive. However, hyperarousal by increased noradrenergic activity in symphathetic nervous system and/or dysregulation and fragmentation of REM sleep seem to have a significant role in mediating sleep disturbances of this disorder. In this article, the authors reviewed various literatures on sleep of PTSD and emphasized the importance of evaluating sleep disturbances in PTSD.

PTSD환자에서 수면장애는 매우 흔하며 불면과 악몽이 대표적인 증상이다. 수면장애는 PTSD의 진단에 있어서도 중요하지만, 외상의 경험후 초기에 수면장애가 발생하는 경우 향후 PTSD발병의 예측인자가 된다는 최근의 연구보고들은 외상을경험한 환자에서 수면장애의 존재여부를 확인하는 것의 임상적 중요성을 새삼 일깨워 주는 것이다. PTSD에서 수면증상의 임상적 중요성과 심각성에 비해 현재까지의 수면다원검사를 비롯한 다양한 측면의 연구결과들은 PTSD환자의 수면특성에 대해 아직 일관성 있는 결론에 이르지는 못하고 있는 상태이다. PTSD에서 수면장애가 발생하는 기전을 신경내분비학적 혹은 정신생리학적관점에서 단일하게 설명하기는 어려우며 여러 가지 기전이 복합적으로 관여된 것으로 여겨진다. 그러나 현재까지의 연구결과를 종합해 보면, 교감신경계에서 노르에피네프린 활성증가와 그에 관련된 생리적 과각성 및 렘수면의 분절화등 렘수면조절의 이상이 PTSD에서 수면장애의 병태생리와 관련성이 큰것으로 여겨지고 있다. 향후 좀더 많은 연구가 PTSD에서의 수면장애에 대해 진행되어져야 하겠으며 임상의는 PTSD의 평가와 치료에 있어 수면장애의 중요성을 항상 염두에 두어야 하겠다.

Keywords

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