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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 6, Issue 2 - Dec 1999
Volume 6, Issue 1 - Jun 1999
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Drug Treatment of Insomnia : Sedative-Hypnotics
Park, Doo-Heum ;
Sleep Medicine and Psychophysiology, volume 6, issue 1, 1999, Pages 5~18
A growing number of people are concerned about their sleep. There are many people with chronic sleep disorders. Sedativehypnotics including benzodiazepine and non-benzodiazepine have been widely used in chronic insomniacs. It is widely accepted that current hypnotics are efficient in alleviating subjective symptoms of insomnia. Non-benzodiazepine hypnotics include zolpidem, zopiclone, and melatonin. These novel non-benzodiazepine hypnotics that have efficacy comparable to benzodiazepines were developed with more understanding of benzodiazepine receptor pharmacology. Their unique pharmacologic profiles may offer few significant advantages in terms of adverse effects of benzodiazepines. However, most of hypnotics including non-benzodiazepine have some of dependence, tolerance, impaired daytime function and rebound insomnia. Currently, it is accepted that combination therapy with pharmacologic and behavioral intervention is the most effective for chronic insomniacs.
Control of Ventilation during Sleep
Kim, Woo-Sung ;
Sleep Medicine and Psychophysiology, volume 6, issue 1, 1999, Pages 19~25
Sleep alters both breathing pattern and the ventilatory responses to external stimuli. These changes during sleep permit the development or aggravation of sleep-related hypoxemia in patients with respiratory disease and contribute to the pathogenesis of apneas in patients with the sleep apnea syndrome. Fundamental effects of sleep on the ventilatory control system are 1) removal of wakefulness input to the upper airway leading to the increase in upper airway resistance, 2) loss of wakefulness drive to the respiratory pump, 3) compromise of protective respiratory reflexes, and 4) additional sleep-induced compromise of ventilatory control initiated by reduced functional residual capacity on supine position assumed in sleep, decreased
production during sleep, and increased cerebral blood flow in especially rapid eye movement(REM) sleep. These effects resulted in periodic breathing during unsteady non-rapid eye movement(NREM) sleep even in normal subjects, regular but low ventilation during steady NREM sleep, and irregular breathing during REM sleep. Sleep-induced breathing instabilities are divided due primarily to transient increase in upper airway resistance and those that involve overshoots and undershoots in neural feedback mechanisms regulating the timing and/or amplitude of respiratory output. Following ventilatory overshoots, breathing stability will be maintained if excitatory short-term potentiation is the prevailing influence. On the other hand, apnea and hypopnea will occur if inhibitory mechanisms dominate following the ventilatory overshoot. These inhibitory mechanisms include 1) hypocapnia, 2) inhibitory effect from lung stretch, 3) baroreceptor stimulation, 4) upper airway mechanoreceptor reflexes, 5) central depression by hypoxia, and 6) central system inertia. While the respiratory control system functions well during wakefulness, the control of breathing is commonly disrupted during sleep. These changes in respiratory control resulting in breathing instability during sleep are related with the pathophysiologic mechanisms of obstructive and/or central apnea, and have the therapeutic implications for nocturnal hypoventilation in patients with chronic obstructive pulmonary disease or alveolar hypoventilation syndrome.
Neuropsychology of Attention
Kim, Chang-Yoon ; Kim, Seong-Yoon ;
Sleep Medicine and Psychophysiology, volume 6, issue 1, 1999, Pages 26~31
"Attention" is not defined sufficiently. This term incorporates several dimensions or complex information processes such as alertness, spatial distribution, focused attention, sustained attention, divided attention and supervisory attentional control. In practice, however, various aspects of attention cannot be assessed separately with a single test. Moreover, a particular test is never assessing attention only, because the several intervening variables may influence the attentional component. Therefore, one can only assess a certain aspect of human behavior with special interest for its attentional component. This paper attempted to clarify various concepts of attention, reviewed signal detection theories with receiver operating characteristic(ROC) curves, and listed practical methods for assessment of attention.
Prevalence of DSM-III-R Axis II Personality Disorders in College Women with Bulimia Nervosa
Lyoo, In-Kyoon ; Lee, Joo-Nam ; Cho, Maeng-Je ; Cho, Doo-Young ; Rhi, Bou-Yong ;
Sleep Medicine and Psychophysiology, volume 6, issue 1, 1999, Pages 32~37
Objectives: To evaluate the prevalence of the DSM-III-R personality disorders in Korean college women with bulimia nervosa. Methods: Sixty-two subjects with bulimia nervosa, as identified by the Structured Clinical Interview for DSM-III-R, were compared to the age- and gender-matched healthy comparison subjects(n=62) on the prevalence of Axis II disorders, as determined by both the Revised Diagnostic Interview for Personality Disorders(DIPD-R) and by the Personality Disorder Questionnaire-Revised(PDQ-R). Results: Subjects with bulimia nervosa had significantly greater prevalences of borderline personality disorder, Cluster B personality disorders, and any personality disorders compared to healthy comparison subjects(Fisher's exact test, p=0.044, p=0.020, p=0.024, respectively, by the DIPD-R ; p=0.034, p=0.015, p=0.007, respectively, by the PDQ-R). Conclusions: This study reports greater prevalences of specific personality disorders, especially, borderline and Cluster B personality disorders in Korean college females with bulimia nervosa compared to comparison subjects.
Characteristics of Physiological Variables(EDR, EMG) in Biofeedback Treatment
Seo, Man-Kil ; Han, Woo-Sang ; Lee, Kyung-Kyu ; Yu, Bum-Hee ; Lee, Yu-Ri ; Kim, E-Yong ; Kim, Hyun-Woo ;
Sleep Medicine and Psychophysiology, volume 6, issue 1, 1999, Pages 38~45
Objectives: We explored the characteristics of physiological variables such as electrodermal response(EDR) and electromyography(EMG) in patients with insomnia, panic disorder, and other anxiety disorders. we aimed to decide the minimum sessions in biofeedback treatment to make the treatment effective and examine the effects of long-term biofeedback treatment by measuring the physiological variables. Methods: Thirty seven outpatients who received biofeedback treatment were divided into 3 groups according to the number of biofeedback sessions(patients who received 4-5 sessions, who received 6-9 sessions, and who received more than 10 sessions). We measured mean and delta values of EDR and EMG levels, and the Hamilton Anxiety Rating Scale(HARS), and Slef-Relaxation Inventory(SRI) in all patients. Data were analyzed by t-test and repeated measures analysis of variance. Results: The mean and delta values of EDR and EMG levels were not different among the 3 groups during the first 4 biofeedback sessions. However, patients who received more than 10 biofeedback sessions had higher baseline mean EDR value(F=2.233, p=0.036) in the first session, compared with other patients. In patients who received more than 10 biofeedback sessions, mean EDR was significantly reduced after
session(F=10.41, p<0.01). They showed significant improvement in SRI scores at 12th biofeedback session(t=2.726, p<0.05) and in HARS scores at
(t=3.10, p<0.05) and
biofeedback session(t=10.93, p<0.001). Conclusions: Wesuggest that patients should receive more than 5 biofeedback sessions to experience internal cues and get a good clinical response to biofeedback treatment.
A Clinical Trial of Light Therapy on Patients with Premenstrual Dysphoric Disorder
Joe, Sook-Haeng ; Kim, Jin-Se ; Kim, Seung-Hyun ; Kim, Leen ;
Sleep Medicine and Psychophysiology, volume 6, issue 1, 1999, Pages 46~51
Objectives: Patients with premenstrual dysphoric disorder(or PMDD) have impairments of the social, occupational or academic function due to psychological or somatic symptoms, which have the characteristic pattern of symptom exacerbation in the week before menses begin and remission shortly after the onset of menses. In the chronobiological view, many researchers have assumed that the etiology of PMDD is the advanced circadian rhythm. It has been suggested that light has a therapeutic effect on PMDD, because evening light results in phase delay of circadian rhythm through the biochemical changes including melatonin. Methods: The authors investigated the therapeutic effect of light therapy on four patients with prospectively diagnosed PMDD by DSM-IV criteria using clinical psychiatric interview, Premenstrual Assessment Form(PAF) and Daily Rating Form(or DRF). In the evening(6:30pm-8:00pm), the 2,500 lux light administered for seven consecutive days during the symptomatic late luteal phase of menstrual cycle. Beck Depression Inventory(or BDI), Hamilton Rating Scale for Depression(or HAM-D), Spielberg State Anxiety Inventory(or SA), and DRF were evaluated before and after seven days of light therapy. Results: Premenstrual symptoms of PMDD could be effectively treated with the evening bright light therapy, especially in PMDD patients with atypical symptoms. In addition, the light therapy seemed to more effective on the psychologic symptoms than the somatic symptoms of PMDD. There was no significant side-effect of light therapy, except the transient and mild eye-strain in one case. Conclusions: In spite of the results of limited data from our clinical trial, the authors suggest that the potential use of light therapy as an alternative to the pharmacological management of patients with PMDD.
A Proposed Algorithm and Sampling Conditions for Nonlinear Analysis of EEG
Shin, Chul-Jin ; Lee, Kwang-Ho ; Choi, Sung-Ku ; Yoon, In-Young ;
Sleep Medicine and Psychophysiology, volume 6, issue 1, 1999, Pages 52~60
Objectives: With the object of finding the appropriate conditions and algorithms for dimensional analysis of human EEG, we calculated correlation dimensions in the various condition of sampling rate and data aquisition time and improved the computation algorithm by taking advantage of bit operation instead of log operation. Methods: EEG signals from 13 scalp lead of a man were digitized with A-D converter under the condition of 12 bit resolution and 1000 Hertz of sampling rate during 32 seconds. From the original data, we made 15 time series data which have different sampling rate of 62.5, 125, 250, 500, 1000 hertz and data acqusition time of 10, 20, 30 second, respectively. New algorithm to shorten the calculation time using bit operation and the Least Trimmed Squares(LTS) estimator to get the optimal slope was applied to these data. Results: The values of the correlation dimension showed the increasing pattern as the data acquisition time becomes longer. The data with sampling rate of 62.5 Hz showed the highest value of correlation dimension regardless of sampling time but the correlation dimension at other sampling rates revealed similar values. The computation with bit operation instead of log operation had a statistically significant effect of shortening of calculation time and LTS method estimated more stably the slope of correlation dimension than the Least Squares estimator. Conclusion: The bit operation and LTS methods were successfully utilized to time-saving and efficient calculation of correlation dimension. In addition, time series of 20-sec length with sampling rate of 125 Hz was adequate to estimate the dimensional complexity of human EEG.
The Psychophysicosocial Distresses in Nurses with Shift Work
Kang, Beom-Mo ; Yang, Chang-Kook ;
Sleep Medicine and Psychophysiology, volume 6, issue 1, 1999, Pages 61~67
Objectives: The aim of this study was to examine the impact of shift work on psychological, physical and social adjustment in nurses. Methods: Two hundred ninety-nine female nurses(179 shift worker, 120 non-shift worker) filled out a questionnaire, which consisted of fifty-six items including demographic characteristics. Subjective ratings of psychological, physical, social and sleeprelated distresses were assessed with a visual analogue scale(100mm). Results: Shift work exerted significantly negative impacts on all psychological, physical, social and sleep-related variables of the shift work nurses. The subjective perception about psychological and physical health of shift work nurses was significantly negative as compared to that of non-shift work nurses. Shift work nurses complained of more shift work related social dysfunction and limited social activity. Shift work nurses were also suffering from significant sleep difficulties as compared to non-shift work nurses. Conclusions: This study suggests that shift work can exert a negative impact on psychological and physical health of nurses as it can cause disturbances of the normal circadian rhythms of the psychophysiological functions, beginning with the sleep-wake cycle. Shift work can also cause difficulties in maintaining the usual relationships both at family and social levels. These results may suggest that we need appropriate coping strategies to overcome adverse effects of shift work.
Changes in Sleep Patterns and Mood States of Shift Workers Following Nocturnal Light Exposure
Kwon, Ki-Bum ; Yoon, In-Young ; Kang, Sang-Bum ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 6, issue 1, 1999, Pages 68~75
Objectives: We intended to observe changes in sleep patterns and mood states of night-shift workers following light exposure. We also estimated the degree of tolerance of light exposure. By studying these, we investigated the possibility of applying light therapy to night-shift workers for improving their adaptation. Methods: Twelve night-shift nurses working at Yong-In Mental Hospital volunteered to participate in this study. The study consisted of 3 parts: 1) night-shift control study; 2) light exposure study; 3) day-shift control study. All the nurses accomplished 3 parts of the study, each of which continued for 3 days, except one nurse who did not participate in day-shift control study. During light exposure study, nurses were exposed to bright light for 4 hours from 1AM to 5AM. Sleep patterns were evaluated with wrist actigraphy and automatic sleep analysis program. Mood states and side effects of light exposure were assessed with self-report scales. Results: Sleep period time, total sleep time, and sleep efficiency were increased following light exposure compared with night-shift control study. Light exposure study showed no difference from day-shift control study in above-mentioned sleep parameters. Daily fluctuation of sleep efficiency was less prominent during light exposure study than during night-shift control study. During light exposure study, the subjects felt more elated and energetic in the evening after daytime sleep than during night-shift control study. None of the subjects complained of severe side effects related to light exposure on the third day of light exposure. Tolerance of side effects was noted to develop with the repetition of light exposure. Conclusion: Light exposure improved the daytime sleep of night-shift workers to the level of normal nighttime sleep, making the subjects more elated and energetic. Side effects of light exposure were found to be tolerable. Light exposure seems to be safely applicable to night-shift workers for their adaptation.
The Effects of Total Sleep Deprivation on Anxiety, Mood, Sleepiness and Fatigue
Lee, Heon-Jeong ; Kim, Leen ; Joe, Sook-Haeng ; Suh, Kwang-Yoon ;
Sleep Medicine and Psychophysiology, volume 6, issue 1, 1999, Pages 76~84
Objectives: A number of studies have shown that sleep deprivation results in reduced vigilance and increased negative affects such as tension, depression and anger. However there are few studies about effects of sleep deprivation on anxiety. The purpose of this study was to investigate the effects of 40 hour sleep deprivation on state anxiety, affects, sleepiness and fatigue. The authors also intended to study the effect of trait-anxiety on these psychological variables after sleep deprivation. Methods: Twenty nine subjects(22 men, 7 women,
years of age) participated in this study. Subjects had no past history of psychiatric disorders and physical illnesses, and had normal sleep-waking cycle without current sleep disturbances. All of the subjects completed sleep dairy for two weeks to exclude some who suffered from chronic sleep deprivation or sleep disturbances. Subjects were instructed to get a normal sleep as usual at night before the study. After awakening, subjects remained awake for 40 hours under continuous surveillance. They completed State-Trait Anxiety Inventory, Index of General Affect, Stanford Sleepiness Scale and Fatigue Questionnaire every three hours, therefore they completed the scales 14 times totally. Subjects were dictated not to take caffeine, alcohol, or any medications on the day of the study. Heavy exercises and naps were restricted too. Results: Sleep deprivation resulted in increased state anxiety, negative general affects, and increased sleepiness and fatigue(p<.001). Dividing into high trait-anxiety group and low trait-anxiety group, there was significant sleep deprivation x traitanxiety interaction effect on general affect(p<.05). But, there was no significant sleep deprivation x trait-anxiety interaction effect on state-anxiety, sleepiness and fatigue. During sleep deprivation, the highest ratings of scales on anxiety, negative affect, sleepiness and fatigue occurred between 4 : 00AM and 7 : 00AM. Conclusions: These results show that sleep deprivation results in increased anxiety, mood state disturbance and increment of sleepiness and fatigue. These findings also suggest that trait-anxiety is a factor that influences the degree of worsening in general affect caused by sleep deprivation. During sleep deprivation, the rating curves of anxiety, affect, sleepiness and fatigue show rhythmicity that may be related to circadian rhythm.