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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Sleep Medicine and Psychophysiology
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KOREAN ACADEMY OF SLEEP MEDICINE
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Volume & Issues
Volume 12, Issue 2 - Dec 2005
Volume 12, Issue 1 - Jun 2005
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Sleep and Memory
Cyn, Jae-Gong ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 5~10
Study in the field of sleep and memory has greatly expanded recently and the number of publications supporting the association between sleep and memory consolidation is rapidly growing. This study presents evidence related to sleep-dependent memory consolidation, ranging from behavioral task-performing studies to molecular studies, and several arguments against the association. Basic researches show that many genes are upwardly regulated during sleep and patterns of brain activation seen during daytime task training are repeated during subsequent REM sleep. Several electrophysiological studies demonstrate the correlation between spindle density increase following training and subsequent improvement in performing the training task. Overnight improvement or deterioration in task performance correlates with REM or SWS sleep. In the end, a lot of issues remain to be studied and discussed further in the future in spite of supporting evidence now available.
Insomnia in Medical Illnesses：The Secondary Insomnia
Lim, Se-Won ; Kim, Leen ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 11~16
Sleep can be easily disrupted by variety of conditions. Most of medical illnesses could be a primary condition causing secondary insomnia. The common underlying mechanism of secondary insomnia is presumed to be stress effects on sleep. The assessment and treatment of secondary insomnia are often complicated. Establishing an causal inference between primary condition and insomnia is the key to assessment. However, it can be difficult even for experienced clinicians due to diagnostic ambiguity of secondary insomnia. Therefore, through medical evaluation and integrative understanding of primary condition is essential to manage secondary insomnia properly. Although treatment have been usually focused on the primary medical illnesses per se, nonpharmacologic interventions, such as sleep hygiene, might be effective in many cases.
Sleep-Disordered Breathing and Metabolic Dysfunction
Joo, Soon-Jae ; Shin, Chol ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 17~22
Sleep-disordered breathing (SDB) is associated with increased cardiovascular and cerebrovascular morbidity. Epidemiological and clinic-based studies have shown that SDB is related to impaired glucose tolerance and increased insulin resistance, independent of obesity. Despite of a consistent association between SDB and impaired glucose-insulin metabolism, the mechanism underlying this relationship has not been fully elucidated. It is recognized that hypoxemia and hypercapnia that occur in SDB provoke sympathetic nervous activity and catecholamine, epinephrine and norepinephrine, and cortisol are released. Sympathetic hyperactivity and increased catecholamines can impair glucose homeostasis by increasing glycogenolysis and gluconeogenesis, which can result in increased circulating insulin levels and increased risk of insulin resistance. A prospective study is needed to investigate the causal relationship between SDB and impaired glucose-insulin metabolism in a healthy population without diabetes, hypertension and obesity as etiologic risk factors.
Diagnosis and Management of Bruxism
Kho, Hong-Seop ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 23~26
Bruxism is defined as 'diurnal or nocturnal parafunctional activity including clenching, bracing, gnashing, and grinding of the teeth'. Bruxism and clenching are two of the most common contributing factors in patients with temporomandibular disorders and craniofacial pain disorders. Even though many studies report the high prevalence of bruxism, its cause is still not clear. Occlusal interference has been regarded as a major etiologic factor. Nowadays, psychological stress and sleeping disorders are generally regarded as major possible etiologic factors. More than likely, the cause is multifactoral and overlapping, which makes it difficult for the practitioner to apply comprehensive and effective management strategies. Although dentists and psychologists generally believe that effective treatment is best achieved with a better understanding of the etiology of a given disorder, for now treatment for this type of disorder must proceed without a clear understanding of etiology. To overcome this obstacle, evidence-based comprehensive management protocols based on accumulated scientific findings should be provided. In this presentation, epidemiology, etiology, and the characteristics of bruxism are reviewed. Diagnostic procedures and management strategies focused on occlusal appliances and behavioral approaches are also discussed.
Comparison of Actigraphic Performance between
：Focused on Sleep Parameters Utilizing Nocturnal Polysomnography as the Standard
Shin, Hong-Beom ; Lee, Ju-Young ; Lee, Yu-Jin ; Kim, Kwang-Jin ; Lee, Eun-Young ; Han, Jong-Hee ; Im, Mee-Hyang ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 27~31
Objectives: We attempted to compare the performance of 2 commercially available actigraphies with focus on sleep parameters, using polysomnography as standard comparison tool. Methods: Fourteen normal volunteers (5 males and 9 females, mean age of
) participated in this study. All the participants went through one night of polysomnography, simultaneously wearing 2 different kinds of actigraphies on each wrist. Polysomnographic and actigraphic data were stored, downloaded, and processed according to standard protocols and then statistically compared. Results: Both
tended to overestimate the total sleep time, compared to the polysomnography.
tended to underestimate the sleep latency. The two actigraphs and the polysomnograph did not show significant difference of sleep efficiency, when compared with one another. In addition, all of the sleep parameters from the instruments showed linear correlations except in
sleep latency. The sleep parameters from the two actigraphs did not show much noteworthy difference, and linear relationships were found between the sleep parameters from the two actigraphs. There was no significant distinction in the results of the two different actigraphs. Conclusion: The results of two actigraphies can be used interchangeably since the sleep parameters of the two different actigraphies do not show significant differences statistically. Overall, it is not legitimate to use actigraphy as a substitute for polysomnography. However, since sleep parameters except sleep latency show linear correlations, actigraphy might possibly be used to follow up patients after polysomnography.
Supplemental Value of the Wrist-Worn Actigraphy in Diagnosing the Obstructive Sleep Apnea Syndrome
Im, Mee-Hyang ; Shin, Hong-Beom ; Lee, Yu-Jin ; Lee, Seung-Hi ; Won, Chang-Yeon ; Lee, Myung-Hee ; Lee, Soo-Young ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 32~38
Objectives: Obstructive sleep apnea syndrome (OSAS) has drawn increasing attention as medical community has become to be aware of its co-morbidities and complications, especially cardiovascular complications and excessive daytime sleepiness with accident proneness. As of now, polysomnography is the standard tool to diagnose sleep apnea and estimate the treatment validity. However, its being rather expensive and inconvenient, alternate diagnostic tools have been proposed including wrist actigraphy. So far, actigraphies have been adopted usefully to field-survey sleep apnea prevalence. In this study, we attempted in a sleep laboratory setting to assess the supplemental value of actigraphy in diagnosing OSAS. Methods: This study was done at the Division of Sleep Studies, the Seoul National University Hospital. Thirty-seven clinically suspected cases of OSAS underwent the one-night polysomnography, simultaneously wearing an actigraphy on non-dominant wrist. We analyzed the data of 27 polysomnographically-proven OSAS patients (male：female 20： 7；age
years old；age range 23 to 72 years) with no other sleep disorders. We calculated RDI (respiratory disturbance index) from the polysomnography data and FI (fragmentation index) from the actigraphy data. Pearson correlation was calculated in order to compare FI with RDI and to evaluate the supplemental diagnostic value of the actigraphy. Results: Mean total sleep time on polysomnography was
(range of 274.0 to 514.1 min). Mean RDI was
. Mean FI was
. RDI and FI showed significant correlation (r=0.55, p<0.01). Conclusions: Wrist actigraphy in OSAS patients generates a comparable outcome to polysomnography, in measuring the nocturnal sleep fragmentation. The actigraphy could be used supplementally in inpatients, outpatients, and field survey subjects, if polysomnography is unavailable or impossible. In follow-ups related with nasal CPAP (continuous positive airway pressure), upper airway surgery, and oral appliance in OSAS patients, the actigraphy might play a more dominant role in the future.
Characteristics of Sleep Apnea Syndrome in the Elderly in a Clinical Setting
Shin, Yoon-Kyung ; Yoon, In-Young ; Hong, Min-Chul ; Yun, Yong-Don ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 39~44
Objectives: Much attention has been paid to sleep apnea syndrome (SAS) in the elderly because of its high prevalence. It is expected that SAS in the elderly has both similarities and differences compared to SAS in the young or middle-aged populations. The aim of this study was to elucidate the characteristics and consequences of SAS in the elderly. Methods: In this study we included 210 young or middle-aged adults between 23 and 59 years (20 women and 190 men) and 65 older adults between 60 and 83 years of age (16 women and 49 men). Respiratory disturbance indices (RDIs) of the study subjects were more than 5 in an overnight polysomnography. They completed the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Informations about body mass index (BMI), neck, waist, and hip measurements, and blood pressure were obtained. Results: No difference was observed between older adults with SAS (older SAS) and adults aged under 60 with SAS (SAS aged under 60) in RDI, apnea index, % time of oxygen saturation less than 90%, and PSQI. Obstructive apnea index and oxygen desaturation index (ODI) were lower in older SAS. Compared to SAS aged under 60, lowest oxygen saturation and central apnea index were higher in older SAS, but they were statistically not significant. BMI and neck circumference were significantly lower in older SAS compared to SAS aged under 60. Diastolic blood pressure was lower in older SAS compared to SAS aged under 60 with no difference in systolic blood pressure. Older SAS showed lower scores in ESS than SAS aged under 60. Significant correlation was observed between RDI and BMI in SAS aged under 60, but not in the case of older SAS. The relationships between RDI and neck circumference, systolic and diastolic pressure, and ESS were similar. Conclusions: The elderly with SAS were not over-weight and there was no relationship between body weight and the severity of SAS. Also, the behavioral and cardiovascular effects of SAS were not marked in the elderly, which might be partly explained by decreased ODI and relatively higher lowest oxygen saturation in older SAS. The normal aging process, aside from increased body weight, might contribute to the development of SAS in the elderly with modest complications.
The Temperament and Character Pattern of Korean Narcolepsy Patients
Choi, Jong-Bae ; Lee, Yu-Jin ; Kim, Seog-Ju ; Lyoo, In-Kyoon ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 45~49
Objectives: To compare the biogenetic temperament and character patterns of subjects with narcolepsy and those of healthy control subjects. Methods: Twenty-two subjects with narcolepsy, diagnosed with the International Classification of Sleep Disorder (ICSD) criteria, and 22 healthy control subjects were recruited. The Korean version of the Temperament and Character Inventory was administered to all subjects. Results: Compared to healthy control subjects, subjects with narcolepsy showed significantly higher Novelty-Seeking (ANCOVA, F=5.42, p=0.025), lower Persistence (F=8.41, p=0.006) and lower Self-Directedness scores (F=4.70, p=0.036). Conclusion: Narcoleptic patients have a distinct pattern of biogenetic temperament and character. Our findings suggest that narcoleptic patients are exploratory in response to novelty but give up easily. In addition, our findings show that narcoleptic patients consider themselves ineffective, purposeless, and fragile.
Clinical Characteristics and Heart Rate Variability in Patients with Comorbid Panic Disorder and Major Depressive Disorder
Choi, Young-Hee ; Kim, Won ; Kim, Min-Sook ; Yoon, Hye-Young ; Choi, Seung-Mi ; Woo, Jong-Min ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 50~57
Objectives: This study was designed to evaluate the differences in clinical characteristics and severity of symptoms between panic patients with and without comorbid major depressive disorder, and to ascertain the differences in the function of the autonomic nerve system measured by heart rate variability (HRV). Methods: The subjects were 60 patients who have panic disorder without major depressive disorder and 19 patients who met DSMIV criteria for both panic disorder and major depressive disorder. First, they drew up symptom checklists and self-rating scales, and were measured by Anxiety Disorder Inventory Schedule-Panic Attack & Agoraphobia (ADIS-P&A), Clinical Global Impression (CGI), Hamilton Rating Scale for Depression (HAM-D), Panic Disorder Severity Scale (PDSS) and Heart Rate Variability (HRV). For statistical analysis, we performed t-test to compare the scores of self reported scales and clinician’s rating scales in panic patients with comorbid major depressive disorder and those without major depressive disorder. ANCOVA was used to compare the variables of HRV, considering age as a covariate. Results: The subjective severities of depression and anxiety that comorbid patients complained of were higher than those of patients with only panic disorder. Futhermore, comorbid patients were more sensitive to anxiety and physical sensations, and they tend to be more negative in their thinking. The scores of clinician-rating scales such as CGI and PDSS were also higher in the comorbid patients. However, there were no significant differences in HRV variables between both groups, despite a tendency to low heart rate variability in the comorbid group. Conclusion: This study suggests that patients with panic disorder and comorbid major depressive disorder tend to complain of more symptoms and to be more sensitive to various symptoms than those with panic disorder without comorbid depression. However, in this study comorbid major depressive disorder did not have a significant impact on the HRV variables of patients with panic disorder.
Comparison of Clinical Characteristics and Polysomnographic Findings between REM Sleep Behavior Disorder with and without Associated Central Nervous System Disorders
Lee, Yu-Jin ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 58~63
Objectives: REM sleep behavior disorder (RBD), characterized by excessive motor activity during REM sleep, is associated with loss of muscle atonia. In recent years, it has been reported that RBD has high co-morbidity with CNS disorders (especially, Parkinson's disease, dementia, multiple system atrophy, etc.). We aimed to assess differences in clinical and polysomnographic findings among RBD patients, depending on the presence or absence of central nervous system (CNS) disorders. Methods: The medical records and polysomnographic data of 81 patients who had been diagnosed as having RBD were reviewed. The patients were classified into two groups: associated RBD (aRBD, i.e., with a clinical history and/or brain MRI evidence of CNS disorder) and idiopathic RBD (iRBD, i.e., without a clinical history and/or brain MRI evidence of CNS disorder) groups. Twenty-one patients (25.9%) belonged to the aRBD group and 60 patients (74.1%) belonged to the iRBD group. The clinical characteristics and polysomnographic findings of the two groups were compared. Results: Periodic limb movement disorder (PLMD), i.e., PLMI (periodic limb movement index)>5, was observed more frequently in the aRBD group than in the iRBD group (p<0.001, Fisher's exact test). Also, obstructive sleep apnea syndrome (OSAS), i.e., RDI (respiratory disturbance index)>5, was found more frequently in the aRBD group (p=0.0042, Fisher's exact test). The percentages for slow wave sleep and sleep efficiency were significantly lower in the aRBD group than in the iRBD group. Conclusion: We found that 1 out of 4 RBD patients had associated CNS disorders, warranting more careful neurological evaluation and follow-up in this category of RBD. In this category of RBD patients, we also found more frequent PLMD and OSAS. These patients were also found to have lower slow wave sleep and sleep efficiency. In summary, RBD patients with associated CNS disorders suffer from more disturbed sleep than those without them.
One Case of Nasal Surgery in Obstructive Sleep Apnea Syndrome
Choi, Ji-Ho ; Lee, Heung-Man ; Kwon, Soon-Young ; Lee, Sang-Hag ; Shin, Chol ; Lee, Seung-Hoon ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 64~67
Obstructive sleep apnea syndrome(OSAS) is a common disease in the field of otorhinolaryngology and is characterized by repeated upper airway occlusions occurring during sleep. OSAS can occur due to various etiologies of the nasal, oral, pharyngeal and laryngeal airway in adults. Nasal obstruction can be caused by septal deviation, nasal polyps, concha bullosa, choanal atresia, neoplasms, foreign body, postoperative/post-traumatic synechiae, various rhinitis and so on. There are various kinds of surgical treatment of OSAS including nasal surgery, LAUP, UPPP, surgery of tongue base, tracheostomy and so on, but the effect of nasal surgery on snoring and OSAS is controversial. The authors report the case of a patient who had experienced nasal obstruction, moderate snoring and OSAS and who improved after septoplasty and turbinoplasty.
A Case of REM-Dependent Obstructive Sleep Apnea Syndrome
Lee, Ju-Young ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 68~71
We report a case of obstructive sleep apnea syndrome, which occurred primarily during the REM sleep stage. A 55-year-old female patient who complained of chronic insomnia on the initial visit turned out to have obstructive sleep apnea syndrome of a mild degree (respiratory disturbance index (RDI) of 13.8/hour, %time spent below 90% of SaO2=5.0%) on nocturnal polysomnography. Interestingly, apnea episodes and desaturations mainly occurred during REM sleep stage. And RDI and destaturations during REM sleep stage were found to be severe enough to classify as a severe degree of obstructive sleep apnea syndrome. These findings suggest that severe obstructive sleep apnea syndrome might be masked under the symptom of chronic insomnia and that apneas can be predominantly localized within REM sleep epochs. In terms of treatment, "REM sleep-dependent" apneas may call for different methods of treatment, especially REM sleep-specific pharmacological intervention.
꿈의 연수 - UCSD 연수를 다녀와서
Kim, Ui-Jung ;
Sleep Medicine and Psychophysiology, volume 12, issue 1, 2005, Pages 72~73