전두측두치매 ... 과도한 수면(기면증)에 대한 탐구

[문형철]

2년동안 와상으로 누워있던 전두측두치매 환자 치료중

한달만에 기억이나 인지는 조금 좋아지는 과정

하지만 Excessive daytime sleep 과도한 낮 수면으로 다음단계(치매 2단계) 치료과정으로 넘어가지 못하고 있음.

이 과도한 낮 수면문제를 어떻게 해결해야 하는가? 탐구중!!

Sleep Disturbances in Patients with Frontotemporal Dementia 

Nathan Walker, Bradley Vaughn

Sleep, Volume 44, Issue Supplement_2, May 2021, Pages A312–A314, https://doi.org/10.1093/sleep/zsab072.800

Published:

03 May 2021

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Abstract

Introduction

Frontotemporal dementia (FTD) is a degenerative process and,as the name implies, involves the frontal and temporal lobes of the brain. Patients with FTD make up 10–15% of all cases of dementia and 20% diagnosed before age 65, however not much is reported about sleep disturbances in these patients. Given the area of neuronal loss one would expect that sleep may be influenced early and by issues in arousal mechanisms and in breathing pattern. This study examined the polysomnography (PSG) reports of patients with a diagnosis FTD.

전두측두엽 치매(FTD)는 퇴행성 질환으로, 이름에서 알 수 있듯이 뇌의 전두엽과 측두엽이 손상되는 질환입니다. 전두측두엽 치매 환자는 전체 치매 환자의 10~15%, 65세 이전에 진단된 환자는 20%를 차지하지만, 이러한 환자의 수면 장애에 대한 보고는 많지 않습니다. 신경세포 손실 영역을 고려할 때 수면은 각성 메커니즘과 호흡 패턴의 문제로 인해 조기에 영향을 받을 수 있을 것으로 예상할 수 있습니다. 이 연구에서는 FTD 진단을 받은 환자의 수면다원검사(PSG) 보고서를 조사했습니다.

Methods

A retrospective chart review was performed to identify patients with both a diagnosis of FTD and having undergone a PSG. 23 patients were identified as fulfilling both requirements. Data recorded included, diagnosis, age at time of PSG, Epworth sleepiness scale (ESS), total sleep time (TST), wake after sleep onset (WASO), sleep latency (SL), REM sleep latency, sleep efficiency (SE), percentage of stage N1, N2, N3, and REM sleep, apnea-hypopnea index (AHI), presence of Cheyne-Stoke breathing, periodic limb movement index, and presence of REM without atonia.

Results

Patient age ranged from 57–85 years. Average ESS was 8.8 with only 5 patients reported excessive daytime sleepiness(as assessed by ESS). The average TST was 290 minutes, average SL was 37.9 minutes, average WASO was 147.5 minutes, and average sleep efficiency was 60.3%. Patients spent the majority of time in N2 sleep with an average of 68.3% of the time spent in N2. The average time spent in N3 was 9.6% of sleep. 8.9% of sleep was spent in REM. 83% of patients were diagnosed with sleep apnea (as defined by an AHI > 5), with an average AHI of 20.2 events/hour. Cheyne-Stokes breathing was only noted in 4 of the 23 patients, or 17%. Periodic limb movements of sleep were noted in 48% of the patients (n=11). REM without atonia or RBD was not noted for any patients.

환자 연령은 57-85세였습니다. 평균 ESS는 8.8이었으며 과도한 주간 졸음을 보고한 환자는 5명에 불과했습니다(ESS로 평가한 기준). 평균 TST는 290분, 평균 SL은 37.9분, 평균 WASO는 147.5분, 평균 수면 효율은 60.3%였습니다. 환자들은 전체 수면 시간 중 평균 68.3%를 2단계 수면에서 보냈으며, 대부분의 시간을 2단계 수면에서 보냈습니다. N3 수면에서 보낸 시간은 평균 9.6%였습니다. 수면의 8.9%는 렘수면에서 보냈습니다. 환자의 83%가 수면 무호흡증(AHI 5 이상)으로 진단받았으며, 평균 AHI는 시간당 20.2 회였습니다. 체인-스톡스 호흡은 23명의 환자 중 4명(17%)에게서만 관찰되었습니다. 환자의 48%(n=11)에서 주기적인 수면 중 사지 움직임이 관찰되었습니다. 운동실조증이나 RBD가 없는 렘수면은 어떤 환자에서도 관찰되지 않았습니다.

Conclusion

This study shows that patients with FTD suffer from typical sleep disturbances, however there is a high preval‎ence of sleep apnea as well as PLMS. In addition, patients with FTD have decreased sleep efficiency with increased WASO.

결론
이 연구에 따르면 FTD 환자는 전형적인 수면 장애를 겪지만 수면 무호흡증과 PLMS의 유병률도 높습니다. 또한, FTD 환자는 수면 효율이 감소하고 WASO가 증가했습니다.