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1 종설접수번호 :09-029(2 차 -0710) 충남대학교의과대학충남대학교병원신경과 Sleep Disorders Associated With Movement Disorders and Dementia Daeyoung Kim, MD, Eungseok Oh, MD, Ae Young Lee, MD, PhD Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea Sleep disorders are common, occurring in both healthy elderly people and in association with neurodegenerative diseases, sometimes preceding other clinical manifestations of those diseases. The sleep disorders of neurodegenerative diseases include insomnia, hypersomnia, parasomnia, excessive nocturnal motor activity, circadian sleep-wake rhythm disturbances, and sleep breathing disorders. This review addresses the neuroanatomical basis of sleep, the associated regulatory mechanisms and neurotransmitters, and the relationship between cognitive function and sleep. Furthermore, the clinical features of sleep disorders in a wide variety of neurodegenerative diseases are reviewed, including movement disorders and dementia. J Korean Neurol Assoc 31(4): , 2013 Key Words: Sleep disorders, Neurodegenerative diseases, Dementia, Movement disorders 서 론 수면에대한과학적인이해가부족하던 19세기초에는뇌로유입되는정보가감소하여뇌가불활성또는수동상태가되는것이수면이라고생각하였다. 그러나수면중급속눈운동 (rapid eye movement, REM) 현상과꿈의연관성, 수면주기 (sleep cycle) 의발견은수면연구와이해에중요한전환점이되었다. 1-3 수면은 REM수면과 non-rem (NREM) 수면으로나누어지며 NREM수면은그깊이에따라 3단계로분류한다. 4 야간수면초반에는서파수면 (slow wave sleep, SWS) 에해당하는 N3 수면이주로나타나고후반에는 N2수면과 REM수면이주로나타난다 (Fig. 1). Received May 28, 2013 Revised August 13, 2013 Accepted August 13, 2013 *Ae Young Lee, MD, PhD Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon , Korea Tel: Fax: aelee@cnu.ac.kr *D. Kim and E. Oh contributed equally to this manuscript. 뇌의여러영역이수면과각성유지, REM수면과 NREM수면의전환에관여하며신경퇴행질환을비롯한다양한뇌질환에의해이런영역이손상된다. 따라서신경질환은각성중에나타나는증상이나징후뿐아니라수면중뇌기능에영향을주어다양한수면장애가생길수있다. 저자들은수면에관여하는뇌구조와기능을알아보고수면과이상운동질환, 인지장애또는치매와의연관성에대하여알아보고자한다. 본론 1. 수면에관여하는뇌구조 von Economo 5 는 20세기초에발생한기면뇌염 (encephalitis lethargica) 환자의사후연구를통해시상하부시각교차앞구역 (preoptic area, POA) 병변이심한불면증을초래하고시상하부뒤쪽병변에의해과다수면이발생하는것을규명하고이부위가각각수면과각성을조절하는부위로추정하였다. 지금도 POA는수면유도중추로, 시상하부뒤쪽은뇌줄기 (brainstem) 부터연결되는각성계의일부로알려져있다 (Fig. 2). J Korean Neurol Assoc Volume 31 No. 4,

2 Figure 1. Typical cyclic pattern of the human sleep. During the first half of the night, slow-wave sleep (N3) dominates, while REM sleep (R) prevails in the latter half of the night. (Illustrated by DK, based on data from Chungnam National University Hospital sleep laboratory) 1) 각성계 (arousal system) 교뇌 (pons) 상부와중뇌 (midbrain) 하부에서시작하여대뇌 (cerebrum) 로올라가는상향경로 (ascending pathway) 인망상활성계 (reticular activating system) 가각성유지에중요한역할을하는것으로생각하였다. 6 그러나각성상태가시상하부를포함하여더광범위한영역에의해조절된다는것이알려지면서망상활성계개념이상향각성계 (ascending arousal system) 로대체되었다. 상향각성계는두가지경로로이루어진다. 7,8 첫번째경로는대뇌다리교뇌뒤판핵 (pedunculopontine tegmentum nucleus) 과외후방뒤판핵 (lateraodorsal tegmentum nuceli) 에서시작하는아세틸콜린신경세포로, 이는시상복측후방핵 (ventroposterior nuclei) 이나배내측핵 (dorsomedial nuclus) 같은중계신경세포 (relay neuron) 와망상핵 (reticular nucleus) 으로연결된다. 망상핵은주로감마아미노부티르산 (Gamma-aminobutyric acid, GABA) 신경세포로이루어져있으며시상을억제하는역할을한다. 아세틸콜린경로가이망상핵을억제하여시상을통한대뇌피질로감각자극입력을원활하게한다. 두번째경로에는모노아민신경세포에속하는청색반점 (locus ceruleus, 노르아드레날린 ), 배측과내측솔기핵 (dorsal and median raphe nuclei, 세로토닌 ), 팔곁핵 (parabrachian nucleus, 글루타민 ), 수도관주위회색질 (periaqueductal gray matter, 도파민 ), 결절유두핵 (tuberomammillary nucleus, 히스타민 ) 이포함된다. 여기서시작된축삭 (axon) 이외측시상하부를경유하여기저앞뇌 (basal forebrain) 와대뇌피질로연결된다. 외측시상하부에있는히포크레틴 (hypocretin) 신경세포와글루타민신경세포, 기저앞뇌의아세틸콜린과 GABA신경세포도상향각성계에영향을미친다. 이들은대뇌피질로축삭을뻗어대뇌피질을활성화하고감각입력처리를원활하게한다. Figure 2. Major neuroanatomical substrates of sleep and awaking. Structures involved in arousal system (blue) are cholinergic ascending pathways [pedunculopontine tegmentum nucleus (PPT) and laterodorsal tegmentum nucleus (LDT)], monoaminergic pathways [locus ceruleus (LC), dorsal raphe nucleus (DR), parabrachial nucleus (PB), periaqueductal gray matter (PAG), and tuberomammillary nucleus (TMN)], basal forebrain (BF), and hypocretin-containing neurons [lateral hypothalamic area (LHA) and posterior hypothalamus (PH)]. Sleep-promoting system (red) includes ventrolateral preoptic nucleus (VLPO) and median preoptic nucleus (MnPO). REM sleep (purple) is promoted by the REM generator subcoeruleus (SC). SC receives inhibitory inputs from ventrolateral periaqueductal gray matter (vlpag) and lateral pontine tegmentum (LPT). Pontine inhibitory area (PIA) exerts muscle atonia during REM sleep. Some of the most prominent structures of the circadian system (green) are suprachiasmatic nucleus (SCN), which serves as a circadian pacemaker, and pineal gland (PG) which secretes melatonin. Paraventricular zone (PVZ) is the primary area where SCN innervates. (Illustrated by DK, based on text.) 2) 수면유도계 (sleep-promoting system) 수면유도중추로알려진 POA는수면중 GABA신호를통해상향각성계신경세포를억제하며 POA 내신경세포는수면시활성화된다. 9 이중복외측시각교차앞핵 (ventrolateral preoptic nucleus, VLPO) 의신경세포는 GABA와갈라닌 (galanin) 이라는억제신경펩타이드 (inhibitory neuropeptide) 를함유하며수면시활성화되고손상되면수면량이줄어든다. 10,11 내측시각교차앞핵 (median preoptic nucleus, MnPN) 은 VLPO처럼수면중세포발화 (neuronal firing) 가증가하며 VLPO와유사한신경분포를보인다. 12,13 MnPN은수면요구가증가하면 VLPO를활성화시키므로수면에직접관여하는것으로추정한다. 12 3) REM 수면 REM수면은수면상태지만각성상태의여러특징을동반한 220 대한신경과학회지제 31 권제 4 호, 2013

3 다. 뇌줄기와시상하부에는 REM수면동안활성화되는 REMon신경세포와활성도가낮은 REM-off신경세포가분포한다. 각성계중아세틸콜린, 도파민, 그리고글루타민신경세포는 REM-on신경세포며세로토닌, 노르아드레날린, 히스타민신경세포와히포크레틴 (hypocretin) 신경세포는 REM-off 신경세포다. REM수면과연관된신경세포중상부교뇌의청색반점바로아래있는 subcoeruleus가가장중요한 REM-on신경세포이자 REM생성원 (generator) 으로알려져있다. 14,15 Subcoeruleus 아래에 REM수면시무긴장 (atonia) 에중요한역할을하는교뇌억제구역 (pontine inhibitory area, PIA) 이있다. PIA에서내측연수 (medial medulla) 로연결되어운동신경세포를억제함으로써 REM수면시무긴장이나타나므로 subcoeruleus병변뿐아니라내측연수에서 PIA까지교뇌연수억제시스템 (pontomedullary inhibitory system) 경로가손상되면무긴장소실이유발될수있다. 16 Subcoeruleus로들어오는 GABA신경자극은복외측수도관주위회색질 (ventrolateral periaqueductal gray matter, vlpag) 과인접한외측교뇌뒤판 (lateral pontine tegmentum, LPT) 에서기인한다. 17 이들은 REM수면을억제하는역할을하며이부위를파괴하며 REM수면이증가한다. 18 요약하면 subcoeruleus에의해 REM수면이유지되며 subcoeruleus에서내측연수에이르는교뇌연수억제시스템에의해 REM수면중무긴장이유지된다. vlpag와 LPT는 subcoeruleus에의한 REM수면을억제하며이들과 subcoeruleus의상호작용에의하여 REM수면과 NREM수면의전환이이루어지는것으로추정한다. 4) 일주기계 (circadian system) 일주기계는 (1) 일주기조정자 (circadian pacemaker) 인시교차상핵 (suprachiasmatic nucleus, SCN), (2) 광자극입력경로, (3) 일주기조정자에의해조절되는리듬으로구성된다. 일주기리듬유지에가장중요한자극은빛이다. 광자극입력경로는광수용체인 melanopsin발현망막신경절세포가빛자극을감지하여 SCN으로전달되는것이다. SCN은생체시계로서수면각성일주기에대한신호를생성한다. 19 SCN은일차적으로시상하부의뇌실곁구역 (paraventricular zone, PVZ) 과연결되며 PVZ는다시 MnPN에직접연결되는동시에 VLPO를비롯한다른 POA의수면활성신경세포에도간접적으로연결되며이부위가손상되면일주기리듬이소실된다. 20,21 PVZ은또한척수중간외측세포기둥 (intermediolateral cell column) 의신경세포로연결되고다시상경추신경절 (superior cervical ganglion) 을통해송과체 (pineal gland) 의교감신경작용에영향을주어 SCN의멜라토닌 (melatonin) 분비를조절한다. 2. 수면관련이상운동질환 (sleep related movement disorders) 수면시작이나수면도중에나타나는이상운동질환은입면장애, 불면증 (insomnia) 그리고다음날주간과다졸림증 (excessive daytime sleepiness, EDS) 과피곤 (fatigue) 을유발하여수면의질을저하시킨다. 이런이상운동질환으로는하지불안증후군 (restless legs syndrome, RLS), 주기사지운동장애 (periodic limb movement disorder, PLMD), 수면관련하지경련 (sleep-related leg cramp), 수면이갈기 (sleep-related bruxism) 그리고수면관련율동이상운동질환 (sleep-related rhythmic movement disorder) 이있다. 22 1) 하지불안증후군 (restless legs syndrome, RLS) 다리에불편하고이상한감각이생겨서다리를움직이고싶은충동을느끼며움직이고나면이런감각이일시적으로호전된다. 도파민 (dopamine) 치료에반응이있거나수면장애를동반하는경우진단에도움이된다. 23 입면장애와수면중자주깨고다시잠들기힘든수면장애가나타나서수면의질이현저히떨어진다. Pearson 등 24 은 RLS 환자와수면이정상인사람의인지기능을비교한결과 RLS 환자의인지기능이뚜렷하게저하됨을보고하였다. 철결핍, 진행된신부전증, 말초신경병, 임신과동반된경우가많으며아직정확한병인은알려져있지않다 도파민또는도파민작용제 (dopamine agonist) 에효과가있고수면이나생활습관에대한행동치료를하면호전을기대할수있다. 28,29 2) 주기사지운동장애 (periodic limb movement disorder, PLMD) 수면중주기적으로다리를움직이는것이특징인수면장애이다. 수면장애는대부분불면증과주간과다졸림증으로나타나며이는 PLMD로인해자주깨는각성 (arousal) 때문이다. 30 전체인구의 3.9% 에서발생하며소아에서는흔하지않고나이가들수록증가한다. 31 개인에따라양상이다양하지만나이와증상의중증도와연관성은없다. 22 REM수면행동장애 (REM sleep behavior disorder, RBD) 환자에서 PLMD가동반되는경우가많으며 RBD 환자는 REM수면중에잘나타나며 RLS 환자는 NREM 수면중에 PLMD가잘동반된다. 32 도파민과클로나제팜이증상완화에도움이된다. J Korean Neurol Assoc Volume 31 No. 4,

4 3) 수면관련하지경련 (sleep-related leg cramp) 수면중주로장딴지 (calf) 나발에갑자기강한불수의적근수축이생기면서통증이유발되어수초에서수분동안지속된다. 이뇨제 (diuretics) 복용관련성을확인해야하며갑상선기능, 혈중요소질소 (blood urea nitrogen), 크레아티닌 (creatinine), 전해질 (electrolyte) 이상에대한혈액검사가필요하다. 22 모든연령에서생길수있으나고령에서더흔하며임신, 말초혈관질환, 관상동맥질환 (coronary artery disease) 과도연관되어있다. 33,34 걷거나해당근육을이완시키는마사지를하면호전되며퀴닌 (quinine) 유도체에효과가있다. 35 4) 수면이갈기 (sleep-related bruxism) 수면중이갈기는치아손상, 턱관절장애와두통을유발할수있다. 여성에서더흔하고 REM수면보다는 1단계수면 (light sleep stage) 에서잘나타난다. 36 환자나보호자가인지하지못하는경우가많으며최소한한쪽깨물근 (masseter muscle) 에근전도 (electromyography) 를하여근육활성을측정하며소리를녹음할수있는수면다원검사 (audio-video PSG) 를이용하면정확하게진단할수있다. 22 증상이심하면치아마모방지를위하여부드러운마우스가드 (mouth guard) 를사용할수있으나착용불편감때문에장기간사용은어려운경우가많다. 벤조디아제핀과근이완제그리고보툴리눔독소 (botulinum toxin) 가치료에도움이된다. 37 5) 수면관련율동이상운동질환 (sleep-related rhythmic movement disorder) 수면관련율동이상운동질환은유년기에많으며야간뇌전증 (nocturnal epilepsy) 과감별이필요하다. REM수면을포함한모든수면단계에서나타날수있으며 2단계수면에서가장흔하다. 38 몸이나머리를흔들거나구르는양상 (body rocking, body rolling, head banging, head rolling) 이가장흔하며이런행동을유년기운동발달과연관된생리현상으로생각하기도한다. 39 성인에서갑자기발생하는경우는흔하지않지만증상이있으면야간수면의질을떨어뜨리는요인이된다. 벤조디아제핀계약물에효과가있으며특히클로나제팜이좋은치료제로알려져있다. 40 6) REM 수면행동장애 (REM sleep behavior disorder, RBD) RBD는사건수면의한종류이며같이자는사람이입증하는경우가많다 세사이남자에서많으며수면중에비정상적으로소리를지르거나잠꼬대를하며주먹질을하고발로걷어차거나팔다리를휘두르는과격한움직임을보인다. 환자나같이자는사람이다치는것을막고불쾌한내용의수면을줄이는것이치료의목적이다. 41 동물실험이나사람을대상으로한연구를통해교뇌 연수구조 (pontomedullary structures) 가이런불수의운동을조절할것으로추정하며 REM수면과연관된신경세포가여기에속한다. 3. 수면과기억 (sleep and memory) 최근수면과연관된획기적인발견중한가지는수면이기억을향상시킨다는점이다. 42 삽화기억 (episodic memory) 과연관된학습 (learning) 시에나타나는해마 (hippocampus) 활성화는서파수면동안에도활성화되며서파수면동안해마가많이활성화될수록다음날기억재생력이우수하였으나 REM수면이나각성상태에서는기억향상이나타나지않았다. 43,44 서파수면동안삽화기억경화 (consolidation) 가일어나기억기능이향상되는것으로추정한다. 중년 (45-55세) 이되면서파수면감소에비례하여기억감퇴가나타나고서파수면이정상인사람은기억경화도상대적으로우수하므로기억경화감퇴는서파수면이감소하는중년기부터시작한다고할수있다. 45 서파수면감소에따른기억장애는노년기에서도나타나며노화에따른서파수면감소가직접기억경화를감소시키거나새로운기억을부호화하는해마에간접적으로영향을주어기억장애가나타나는것으로추정한다. 그러나일반적으로서파수면과인지기능의연관성은노화가진행할수록감소하는것으로알려져있으며젊은사람에서수면이인지기능을호전시키지만노인에서는상대적으로수면에의한영향력이적다. 46 실제로노인에서정상서파수면이뚜렷하게기억재생을향상시키지않았으며노인에서도수면에의한삽화기억경화가나타날수는있지만젊은사람처럼뚜렷한삽화기억향상을기대하기는어렵다. 47 잠자는동안삽화기억경화가일어나는기전을살펴보면서파수면동안해마에서새로부호화된정보가반복적으로활성화되며이를통해신피질 (neocortex) 에서시작된느린진동 (slow oscillation) 이활성화되고시상-피질회로의방추파활동 (spindle activity) 과해마재활성화가동시에일어난다. 각성상태에서는고농도의아세틸콜린과코티솔에의해해마에의한신피질활성화가억제되지만서파수면동안에는아세틸콜린과코티솔농도가낮아져탈억제상태가되어해마에서신피질로기억전이가활발해진다 (Fig. 3). 44 따라서서파수면동안해마기억이재활성화되고신피질로재배치되어신피질내기억관련연결망이견고해지는경화가일어나며기존기억과새로운기억사이의통합이이루어진다. 222 대한신경과학회지제 31 권제 4 호, 2013

Figure 3. Model of declarative memory consolidation during sleep. During slow-wave sleep (SWS), newly encoded information in the hippocampus is repeatedly reactivated.

5 Figure 3. Model of declarative memory consolidation during sleep. During slow-wave sleep (SWS), newly encoded information in the hippocampus is repeatedly reactivated. The reactivation is driven by the excitation state of the slow oscillations originating in neocortical networks and synchronizes hippocampal reactivations with spindle activity in thalamocortical circuitry. The hippocampal input arriving in synchrony with spindle input at neocortical circuitry supports long-term plastic changes selectively at those synapses previously used for encoding, thereby building more persistent memories of the information in neocortical networks. (Adapted from reference 44) 서파수면과삽화기억의연관성과유사하게 REM수면과절차기억 (procedural memory) 의연관성을추정하고있으나아직관련연구결과가일치하지않으므로이에대한더많은연구가필요하다. 48,49 신경퇴행질환 (neurodegenerative diseases) 에서흔히나타나는수면장애 (sleep disorders) 로는불면증, 과다수면 (hypersomnia), 사건수면, 과도한야간운동활동 (excessive nocturnal motor activity), 일주기리듬수면장애 (circadian rhythm sleep disorders), 그리고수면호흡장애 (sleep-related breathing disorders) 가있다. 그중에서폐쇄수면무호흡 (obstructive sleep apnea, OSA) 은수면중반복적인상기도폐쇄때문에간헐적인저산소혈증 (hypoxemia) 과각성이나타나는것으로나이가들수록많아져노인의 25% 에서나타나며알츠하이머치매 (Alzheimer s dementia, AD) 에서는그빈도가 48% 로증가한다. 50 OSA가인지기능에작용하는기전은명확하지는않지만저산소혈증이나수면분절 (sleep fragmentation) 때문에집중력, 수행, 작업기억또는장기삽화기억을포함한다양한인지기능에장애가생기는것으로추정한다. OSA가치매환자의인지장애를악화시킬수있으며지속기도양압 (continuous positive airway pressure) 치료로인지기능이호전된다는보고도있다. 50 과다수면은뇌졸중뿐아니라인지장애발생위험성을 배정도증가시키며특히혈관치매 (vascular dementia) 위험성이 4배까지증가한다. 51 총수면시간 (total sleep time) 과치매발 생위험성의연관관계를알아본지역사회주민대상전향연구에의하면주 야간수면시간이정상인에비하여긴환자에서치매발생위험도가높아서 ( 상대위험도 =2.2) 과다수면이치매발생에부정적인영향을줌을시사하였다. 52 AD 환자의 33-55% 에서수면장애가나타나는데총수면시간과수면효율성 (sleep efficiency) 이감소하고서파수면이짧아지면서자주깨고낮잠을많이자고병이진행할수록 REM 수면은적어지고 REM수면잠복기는길어진다. 53,54 수면-각성리듬이깨지고수면분절과함께주간과다졸림증이생기면서일몰증후군 (sunset syndrome) 같은문제행동이증가하기도한다. AD 환자에서아세틸콜린경로와일주기조정자역할을하는 SCN이손상되어수면장애가나타나며 RLS가동반되어야간초조 (nocturnal agitation) 가생기기도한다. 55 AD 환자의수면장애와치매사이의인과관계에대한논란이많다. 최근사람과쥐에서수면-각성주기조절이뇌척수액의베타아밀로이드단백질 (Aβ protein) 양을조절하며수면을박탈한쥐의뇌에 Aβ 침착이증가하고멜라토닌이독성 Aβ에노출된신경세포보호작용이있어서멜라토닌분비장애가 AD 발병에관여한다는연구가있었다. 56 그러나다른신경퇴행질환에서처럼수면장애가질환의다른증상출현전에나타나는선행증상일가능성이있으므로인과관계규명을위한체계적인대규모연구가필요하다. RBD와파킨슨병 (Parkinson s disease, PD) 의연관성에관한연구로 Schenck 등 57 이 50세이상특발RBD 환자 29명을추적한결과 12.7년경과했을때 38% 에서 PD가발생하였다. 특발RBD 환자 50명중에서후각이상을보이는경우가 63-97% 였고이중 5명이 PD 진단을받았으며도파민운반체영상 (dopamine transporter image) 으로재확인하였다. 58 이는시누클레인병 (α-synucleinopathy) 진행에따라후각망울 (olfactory bulb) 을침범하는 1단계에서후각이상이발생하고연수를침범하는 2단계에서 RBD가생기며 3단계에서흑질 (substantia nigra) 을침범하여 PD의운동증상을보이는병리경과와일치하므로 PD나레비소체치매 (lewy body dementia) 에서 RBD와후각이상을질환의생물표지자 (biomarker) 로간주하기도한다. 59 진행핵상마비 (progressive supranuclear palsy, PSP) 는타우병 (tauopathy) 중에서수면장애가나타나는대표적인질환으로대부분의환자가수면시작과수면유지장애를호소한다. 실제로 PSP에서뇌줄기 (brainstem) 손상이더심하고수면중움직이기어렵거나야간배뇨, 우울증때문에 AD보다수면장애가더흔하다. 60 J Korean Neurol Assoc Volume 31 No. 4,

6 결 론 수면은일생의 1/3 정도를차지하므로매우긴시간이다. 복잡한뇌구조물이연결된신경회로망과신경전달물질이수면에관여하며신경회로망의손상이나신경전달물질이상에의해과도한졸음이나피로가생기기도하고신경퇴행질환에의하여영구적인수면장애와인지기능장애가유발되기도한다. 수면장애, 운동질환그리고치매에대해대규모, 장기추적연구가없고부검을통한병리연구의뒷받침이부족하기때문에수면과운동질환그리고치매를포함한인지장애에대한체계적인장기연구를통해인과관계규명이필요하다. 또한수면장애가인지장애나신경퇴행질환에미치는영향을알아보고적절한수면장애치료를통하여신경퇴행질환의발생또는진행을억제할수있는치료법의개발을기대할수있을것이다. REFERENCES 1. Aserinsky E, Kleitman N. Regularly occurring periods of eye motility, and concomitant phenomena, during sleep. Science 1953;118: Aserinsky E, Kleitman N. Two types of ocular motility occurring in sleep. J Appl Physiol 1955;8: Dement W, Kleitman N. Cyclic variations in EEG during sleep and their relation to eye movements, body motility, and dreaming. Electroencephalogr Clin Neurophysiol 1957;9: Iber C, Sleep AA. The AASM manual for the scoring of sleep and associated events : rules, terminology, and technical specifications. American Academy of Sleep Medicine, von Economo C. Sleep as a problem of localization. J Nerv Ment Dis 1930;71: Moruzzi G. 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<The natural sleep cycle of a healthy adult: Life Enhancement Magazine September 1999> (2) 수면단계에 영향을 주는 요소 (1) 연령 수면단계 분포에 영향을 주는 가장 중요한 요소는 연령이다. 신생아

<The natural sleep cycle of a healthy adult: Life Enhancement Magazine September 1999> (2) 수면단계에 영향을 주는 요소 (1) 연령 수면단계 분포에 영향을 주는 가장 중요한 요소는 연령이다. 신생아 수면장애(1) 주경미 데일리팜 부사장 약학정보원 학술자문위원 개요 사람은 일생의 약 1/3을 잠을 자며 보낸다. 충분한 잠은 지친 뇌와 신체를 회복시켜 기억력, 학습 능력, 감정 조절, 성장 발달, 면역력, 심혈관계 기능, 성기능 등을 건강하게 한다. 산업의 발전으로 24시간 사회 가 되면서 활동시간과 수면을 취하는 시간의 변화로 뇌 속 생체시계가 교란되고