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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Sleep Medicine and Psychophysiology
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Journal DOI :
KOREAN ACADEMY OF SLEEP MEDICINE
Editor in Chief :
Volume & Issues
Volume 5, Issue 2 - Dec 1998
Volume 5, Issue 1 - Jun 1998
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Anatomy and Physiology in Human Circadian Rhythms
Sohn, Chang-Ho ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 1~11
Chronobiology is the area of medicine that is, how time-related event shape our daily biologic responses and apply to any aspect of medicine with regard to altering pathophysiology and treatment response. In mammals, there are several evidences that prove suprachiasmatic nuclei(SCN) is the major circadian pacemaker and the circadian rhythm influences so many biological aspects of an living organism such as rest-activity, thermoregulation, reproduction, and endocrine system. In case of human beings, there had been little information of circadian system. That may be due to the experimental, technical difficulties to study but also to the fact that human has the more complex environments that may alter the circadina rhythm like the artificial light, many socio-cultural aspects and so forth. However, several reports of these days indicate human's circadian system is composed of two or more circadian oscillators and SCN is the major circadian oscillator among them like the other mammals. Free-running circadinan period of mankind is about 24 hours rather than about 25 hours, and rest-activity rhythm is polymodal like other species. In addition to that, human may have capcities to change the circadian rhythm as the seasonal changes of daynight schedule. In this article, the author will summarize recent progress of anatomy and physiology of the circadian clock mechanism in humans.
Circadian rhythms in subjective activation, mood, and performance efficiency
Yoon, In-Young ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 12~17
Circadian rhythms in subjective alertness, mood, and performance can be classified as psychological rhythm, compared with physiological rhythm such as body temperature and hormonal change. While in normal condition entrained by 24hr zeitgeber, subjective alertness would reach its maximum value around midday, subjective alertness would parallel body temperature rhythm with its peak at evening in non-entrained, free-running state. With desynchronization technique, subjective alertness rhythm is thought to be controlled by both temperature and sleep-wake rhythm oscillator. Circadian performance rhythms depend on the kind of task tested. It shows parallelism with body temperature rhythm when subjects are tested with simple, repetitive task. But when tested with tasks requiring complex verbal reasoning or immediate memory, subjects would perform them best at early morning, with performance decreasing as time of day advances. The desynchronization technique shows that circadian performance rhythm of simple, repetitive task is dependent on temperature oscillator but circadian performance rhythm of complex verbal reasoning is influenced by both temperature and sleep-wake rhythm oscillator or another independent oscillator. It would be worthwhile to compare psychological rhythm with hormonal change such as cortisol and melatonin. And more simple and time-saving method than desynchronization technique may facilitate the study of the mechanism underlying psychological rhythm.
Sleep and Epilepsy in Clinical Practice "fears, rages, deliria, leaps out of bed and seizures during the night" - Hippocrates
Kim, Chang-Song ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 18~33
Sleep and Epilepsy either represent the opposite and independent spectrum of episodic manifestations from brain or closely interact with each other. Sleep or sleep deprivation may provoke epileptic seizures or activate epileptiform discharges in epilepsy patients whereas epilepsy may alter the sleep structure. Sleep stages are also known to influence pathophysiology of seizures in terms of ictogenesis. In this review, the impact of sleep on epilepsy as well as that of epilepsy on sleep are presented. Additionally the interaction between sleep and epilepsy will be discussed. This review will also comment on the differential diagnosis between nocturnal or sleep-related epilepsy and various sleep disorders. Finally, clinical application of the above perspectives of sleep and epilepsy will be suggested for the purpose of a better management of epilepsies.
Biological Rhythms and Food Intake
Lee, Young-Ho ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 34~44
Living organisms are influenced by many external rhythms and they have adapted their physiology to periodically changing conditions. These adaptive strategies are controlled by endogenous innate programs of behavior and physiology which are determined by external signals ("Zeitgeber"). There are many biological rhythms, each with its own characteristic functional adaptation. Among them, the presence of endogenous time control of feeding and drinking becomes obvious. There are increasing evidences that the control of food intake, food selection, and drinking are regulated by the endogenous rhythms including a circadian rhythm. However, there have been many restrictions in understanding the endogenous control of food intake itself and its mechanism. To broaden our know ledges of the endogenous time control of feeding and drinking, the author reviwed the characteristics of the endogenous timing for food intake, the influence of circadian pacemakers and food-entrainable oscillators, the interaction between the circadian control and the external and internal conditions in the control of food intake, the conseqences of feeding, the circadian control of food selection, and the biological cycles in energy balance.
Sleep Patterns of Pregnant Women
Choi, Byeung-Sun ; Yoon, Jin-Sang ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 45~53
Objectives : The change of sleep patterns commonly occurs in association with the pregnancy. This study was to investigate sleep habits during the course of normal pregnancy. Methods : Sleep habits questionnaire was administered to healthy women in their first trimester(TR1) of pregnancy and then the same questionnaire was repeatedly administered during their second(TR2) and third(TR3) trimesters. The following aspects were assessed : patterns of night sleep, daytime status, sleep posture, reasons for sleep alteration, and the experience of any particular parasomnias, as well as sleep problem-related treatment or medication. Data analysis was based on 26 women who maintaind good health throughout their pregnancy and completed the questionnaire three times. Results : In comparisons between each trimester and non-pregnant state, total night sleep time, daytime tiredness, and sleepiness were significantly increased in all trimesters. Sleep latency was significantly decreased in TR1 and TR2, but not in TR3. In addition, refreshed feeling on waking the following day was significantly decreased and the number of awakenings during night sleep was significantly increased in TR3, but not in TR1 and TR2. In comparisons between trimesters, there was a significant increase in sleep latency, daytime sleepiness and the number of awakenings during night sleep and a significant decrease in refreshed feeling on waking the following day in TR3 compared to TR1 and TR2. Over the course of pregnancy, the rate of lateral position during sleep was gradually increased and all the pregnant women took the lateral sleeping posture in TR3. The major reasons for sleep pattern alteration were nausea, vomiting and heartburn in TR1, urinary frequency, fetal movement and ache in hips in TR2, and urinary frequency, fetal movement, cramp in legs and backache in TR3. Conclusion : These findings are expected to be useful for educating pregnant women about sleep hygiene. In future studies, the underlying factors and mechanisms regarding sleep patterns during pregnancy will need to be clarified.
Structural and Functional Changes of The Brain in The Patient with Schizophrenia, Paranoid type : Correlation among Brain MRI Findings, Neurocognitive Function and Psychiatric Symptoms
Kang, Cheol-Min ; Lee, Young-Ho ; Jung, Young-Jo ; Lee, Jung-Heum ; Kim, Su-Ji ; Park, Hyun-Jin ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 54~70
Objectives : The purpose of this study is to evaluate the role of structural and functional changes of the brain in the pathophysiology of schizophrenia. Methods : The authors measured the regions of interest on the magnetic resonance imaging of the brain in 20 patients with paranoid schizophrenia(15 men and 5 women) and 23 control subjects(15 men and 8 women). We also assessed the neurocognitive functions with the Wisconsin Card Sorting Test, the Benton Neuropsychological Assessment, and the Weschler IQ test-Korean version, soft neurologic signs, and psychiatric symptoms in the patient group. Results : In the patient group, all ventricles and basal ganglia including caudate nucleus and globus pallidus were significantly enlarged. Although there were no significant differences between the two groups in the values of right frontal lobe and left temporal lobe, there was a tendency of decrease in the values of right frontal lobe and left temporal lobe. There were significant positive correlations between the values of ventricles and the frequency of previous hospitalization. However, there were no significant correlations between other values of regions of interest and clinical data. The value of the right frontal lobe was significantly correlated with the score of soft neurologic signs, which is suggestive of the neurodevelopmental abnormalities. There were significant correlations between the value of frontal lobe and the scores of the various subscales of Benton Neuropsychiatric Inventory. In contrast, the value of left amygdala and putamen showed significant correlation with the score of verbal IQ on the Weschler IQ test. Structural changes of the temporal lobe areas were related with the positive and general symptom scores on PANSS, while those of the basal ganglia were related with the negative symptom scores. Conclusions : These results suggest that the structural changes of the brain in the patients with schizophrenia show the dual process, which is suggestive that the enlarged ventricle show the neurodegenerative process, while enlarged basal ganglia, and shrinked right frontal and left temporal lobe show the neurodevelopmental abnormalities. Among these changes, structural changes of the frontal lobe related with various neuropsychological deficits, while those of left temporal lobe related with language abnormality. Relative to the relation between structural changes and psychiatric symptoms, structural changes of the temporal lobe areas were related with the positive and general symptoms, while those of the basal ganglia were related with the negative symptoms.
Sleep Patterns, Daytime Sleepiness and Personality Factors in Rotating Shiftworkers
Kim, Hyun ; Kim, Leen ; Suh, Kwang-Yoon ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 71~79
Objectives : This study was to evaluate sleep patterns and daytime sleepiness resulting from rotating shiftwork. The authors, also, tried to find out the relationship between the severity of daytime sleepiness and personality factors. Methods : The subjects consisted of 41 female rotating shiftwork nurses and the control group consisted of 39 female day timeworkers. All of them completed the Sleep questionnaire of Korea University Sleep Disorder Clinic, the Epworth Sleepiness Scale(ESS), the 16 Personality Factors(16PF), the Beck Depression Inventory(BDI) and the State Trait Anxiety Inventory(STAI). Multiple regression analysis of 16PF of the rotating shiftwork nurses was done to find out possible predictors of the severity of daytime sleepiness. Results : The mean duration of deprived sleep due to rotating shiftwork was
. The frequency of sleep difficulty(
, p < 0.05), time needed to fall asleep(
, p < 0.05), sleep duration when having some difficulties in sleep (
., p < 0.001), recent changes in energy(
, p < 0.05), worrying about sleep(
, p < 0.05), and taking naps(
, p < 0.05) showed significant differences between rotating shiftworkers and normal controls. The ESS socre of shiftworkers (
) was greater than that of normal controls (
)(p < 0.01). Personality factors such as C factor(
), I factor(
) and G factor(
) were related with the severity of the daytime sleepiness(p < 0.001). Conclusions : The rotating shiftwork nurses had more difficulties in sleep such as having difficulties in falling asleep and in maintaining sleep, and showed lowered energy, decreased senses of well-being and so on. The rotating shiftwork nurses experienced more severe daytime sleepiness than controls did. Personality factors, such as C factor, I factor, and G factor of 16PF were suggested to be useful for predicting the severity of daytime sleepiness resulting from rotating shiftwork.
Relationship among Anger Expression Mode, Depression, and Blood Pressure in Korean Male Military Draftees Subjected to the Examining Procedure
Park, Dong-Kyoon ; Youn, Tak ; Shin, Min-Sup ; Lee, Sang-Sun ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 80~87
Objectives : The purpose of this study was to investigate the relationship among anger expression mode, depression, and blood pressure. Method : Eight hundred sixty-eight male military draftees were asked during the examination procedure to answer Spielberger's Anger Expression Inventory, MMPI Repression Scale, and Beck Depression Inventory(BDI). Blood pressures, weight, and height were also measured. Results : 1) No significant difference was found in the anger-in and anger-out subscales of Spielberger Anger Expression Inventory, MMPI Repression Scale, and BDI between the hypertensives and the normotensives. 2) No significant difference of blood pressure was found between the groups determined by upper and lower 25% of each of the above scales and inventory. 3) The interaction effect of anger-in and anger-out on depression was found to be significant. Conclusion : These findings suggest that there is no relationship among anger-in, anger-out, depression, and blood pressure in young male military draftees. Interestingly, ambivalence of anger expression, i.e. the interaction of anger-in and anger-out, was found to be an important factor related to depression.
Obstructive Sleep Apnea Symptoms Prevalence and Sleep Apnea-Associated Factors in Korean Adult Population: A Cross-sectional Survey of Three Rural Communities
Sohn, Chang-Ho ; Jeong, Do-Un ; Sung, Joo-Hon ; Chang, Song-Hun ; Lee, Kun-Sei ; Lee, Won-Jin ; Shin, Hai-Rim ; Lee, Bu-Ok ; Cho, Soo-Hun ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 88~102
Objectives : We attempted to study obstructive sleep apnea symptoms prevalence and sleep apnea-associated factors in Korean rural adult population. Methods : In 1,441 adult subjects of three rural communities selected by cluster sampling, we administered an epidemiologic survey using questionnaire methods from July 14, 1996 to July 28, 1996. Results : 1) In 14.1% of the subjects, snoring was reported to occur almost daily and 2.9% of the subjects reported sleep apnea symptoms occurring almost daily. 2) Snoring and sleep apnea symptoms were found more frequently in males or in mid-aged group(45 - 64 years old) than in females or in younger- and older-aged groups, respectively. Compared with the subjects who have no snoring, the subjects who have snoring or sleep apnea symptoms had greater body mass index(BMI), waist-hip ratio, hemoglobin level, RBC count, and higher diastolic blood pressure. 3) Cigarette smoking and alcohol drinking more than once a week were significantly associated with suffering from sleep apnea symptoms. 4) In multiple logistic regression analysis, being male, mid-aged, and greater BMI were independently associated with the presence of snoring and sleep apnea symptoms. Conclusion : We conclude that, in the Korean rural adult population, males or mid-aged group suffers more from snoring and sleep apnea symptoms than females or younger- and older-aged groups. In addition, being male, mid-aged, and greater BMI were significantly associated independently with the presence of snoring and sleep apnea symptoms.
Nasal Continuous Airway Pressure Titration Unmasks Periodic Limb Movements in Obstructive Sleep Apnea Syndrome
Park, Doo-Heum ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 103~110
Objectives : High co-morbidity of periodic limb movements during sleep(PLMS) and obstructive sleep apnea syndrome(OSAS) is well known and their incidences tend to increase in the elderly. Previous studies have inconsistently rep0l1ed increase or no change of periodic limb movement index(PLMI) by nasal continuous positive airway pressure(CPAP) in OSAS without analyzing possible variables affecting PLMI. We attempted to examine PLMI change evoked during CPAP titration and also factors affecting it in OSAS. Methods : Twenty-nine OSAS patients(M:F=26:3, mean age:
) without other sleep disorders except for PLMS were selected, based on the nocturnal (baseline) polysomnograhy. Another night of noctumal polysomnography was performed for CPAP pressure titration. We compared between those two nights PLMI, mean and lowest
, and sleep variables. We also calculated PLMI differences between baseline and CPAP nights, named as delta PLMI (value of CPAP night PLMI minus value of baseline night PLMI). Correlations were calculated between delta PLMI and factors such as age, body mass index, applied CPAP pressure, baseline night values of respiratory disturbance index, mean and lowest
, and sleep parameter differences between baseline and CPAP nights. Results : Decrease of RDI(p<.01) and increase in mean and lowest
(p<.05, p<.01) were observed during CPAP night. No sleep parameters showed significant change except for the decrease of total stage 1 sleep%(p<.01) during CPAP night. Ten out of 29 patients showed PLMI increase, while the other 19 patients showed either no change(n=14) or even PLMI decrease(n=5) during CPAP night. The 10 patients showing PLMI increase during CPAP night showed a significant positive correlation between delta PLMI and baseline night RDI(p<.05), which meant that PLMI increase was found to be more prominent in higher RDI patients than in lower RDI ones. There were no significant correlations between delta PLMI and other factors in the other 19 patients. Conclusions : We suggest that during the baseline night PLMS would have been underscored and/or masked due to the overlapping of PLMS and apneas/hypopneas or the arousals induced by apneas/hypopneas. Despite its still unknown mechanism, the CPAP application may unmask PLMS and increase PLMI in a subgroup of OSAS patients. It needs to be evaluated further whether the chronic CPAP use sustains the above finding.
Investigation of 'First-Night Effect' in Normal Young Adult Male Subjects on Polysomnography
Kim, Eui-Joong ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 5, issue 1, 1998, Pages 111~117
Objectives : 'First-night effect' has been a well-known concept since 1960's. It is important because it is one of the major factors to be considered in assessing the reliability of polysomnographic data. However, 'reverse first-night effect' has also been described, resulting in the inconsistency of conceptualization. We attempted to investigate on the first-night effect in adults by having each of them take two nights of polysomnography in a controlled environment. Young healthy adult volunteers were chosen as subjects in order to rule out age- or health-related confounders. Methods : Polysomnography was performed on eight male medical students (mean
) for two nights with Grass model 78 polysomnograph. We scored manually under the standard protocol each epoch of the sleep records. Sleep variables were obtained and compared between the two nights. Results : Sleep period time(SPT) and total sleep time(TST) of the third fraction of night were significantly longer on the first night than on the second night (p<0.05). However, other sleep variables such as percentage of each sleep stage, sleep latency, REM sleep latency, number of waking, and sleep efficiency were not different between the two nights. Conclusion : We could not confirm the existence of first-night effect in this study. In healthy young male adults, it may not happen at all or may happen to a very negligible degree. Young healthy adults may have more adaptability to a new sleep environment. Also, the provision of a reasonably comfortable sleep environment could have helped them with abolition of first-night effect.