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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
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Volume & Issues
Volume 8, Issue 2 - Dec 2001
Volume 8, Issue 1 - Jun 2001
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The Neurobiology and Psychophysiology of Dreaming
Chung, Sang-Keun ;
Sleep Medicine and Psychophysiology, volume 8, issue 2, 2001, Pages 83~89
In all ages and countries, dreaming has always been a topic that has interested people. Throughout history, theories about dreaming have been heavily dependent on concurrent theories in related domains. Many researchers have claimed that dreaming occurs during REM and NREM sleep and have rejected the strict association between REM sleep mechanisms and dreams. Although dreams may occur in both REM and NREM periods, they are likely to be produced by different mechanisms during REM and NREM sleep. All physicians managing dreaming-related problems in clinical practice need to understand the multidimensional aspects of dreaming. Therefore, I have reviewed the literature on mechanisms generating and the meaning of dreaming in the neurobiological and psychophysiological perspectives.
The Meanings of Dream Contents in the Psychotherapeutic Perspective
Lee, Byung-Wook ;
Sleep Medicine and Psychophysiology, volume 8, issue 2, 2001, Pages 90~97
The reason for exploring dreams is to understand the of patient's conflicts and unconscious motivation. Even if the therapeutic value of dreams is considerably faded these days, I can not deny that dreams are still very useful. From the beginning of human history, dreams have been an appealing subject for many people. In the past, dreams chiefly had the value of prophetic meaning, and in our tradition attention was paid to dreams in terms of good and bad dichotomy. Freud's discovery of the Unconscious and technical development of its exploration is reinforced by dream interpretation. In contemporary terms, although dreams are not the royal road to the Unconscious, they surely present a short-cut. I suggest that dreams as a treasure island of the Unconscious have a useful therapeutic value, and that stressing the importance of dreams is by no means anachronistic. I believe that practical sessions without dreams are like a river without bridges.
Mechanism and Neuroanatomy of Auditory Hallucination
Lee, Seung-Hwan ; Suh, Kwang-Yoon ;
Sleep Medicine and Psychophysiology, volume 8, issue 2, 2001, Pages 98~106
Auditory hallucinations are cardinal feature of psychosis. But the mechanism of hallucinated speech is unknown. The hypothesis that these hallucinations arise from pathologically altered brain monitoring system underlying speech perception is influential. With the help of rapidly developing neuroimaging study technologies, many researchers have been finding new organic deficits in the hallucinated schizophrenic patient's brain. In this article, we reviewed the general appearance of hallucination, a computer simulation model of hallucination and several neuroimaging study findings on hallucinating schizophrenic patients. In conclusion, we presented the presumptive mechanism of hallucination based on the anatomical dysfunction of schizophrenia.
Expression of Human Leukocyte Antigen DQB1*0602 in Korean Patients with Narcolepsy
Hong, Seung-Chul ; Woo, Young-Sub ; Park, Soo-A ; Jeong, Jong-Hyun ; Han, Jin-Hee ; Kim, Leen ; Lee, Sung-Pil ;
Sleep Medicine and Psychophysiology, volume 8, issue 2, 2001, Pages 107~112
Introduction: Narcolepsy, a sleep disorder characterized by excessive daytime sleepiness and cataplexy, is known to be closely associated with the human leukocyte antigen (HLA) DQB1*0602. Several studies have suggested that HLA-DQB1*0602 is strongly linked with narcolepsy-cataplexy. However, no studies have yet been made on whether HLA DQB1*0602 is associated with Korean patients with narcolepsy. This study was designed to investigate the frequency of HLA-DQB1*0602 of Korean patients with narcolepsy. Methods: Twenty patients were selected (mean age:
, 11 men and 9 women). The patients were confirmed to have narcolepsy by the overnight polysomnography and multiple sleep latency test (MSLT) in addition to their clinical history and symptoms at St. Vincent's Hospital and Korea University Hospital Sleep Disorders Clinic. Any subjects co-morbid with other hypersomnic sleep disorders such as sleep apnea or periodic limb movements during sleep were excluded. Clinical data was collected through a semi-structured interview for narcoleptic patients. All patients and 21 control did HLA typing for the presence of DQB1*0602. Results Obtained were as Follows: 1) Mean sleep latency was 2.4 (
minutes) and mean frequency of sleep-onset REM period was 3.0 (
) by MSLT. 2) Characteristic symptoms of narcolepsy investigated were as follows: excessive daytime sleepiness (100%), cataplexy (100%), sleep paralysis (60%), hypnagogic hallucination (70%) and disrupted nocturnal sleep (75%). 3) Strong emotional expression such as laughing (80%) and joking (70%) triggered cataplexy which affects the knee and leg region (80%) and jaw region (30%). 4) HLA-DR2 was found in 90% of patients and 35% in controls. The frequency of HLA-DQB1*0602 in patients and controls was 90%, and 24%, respectively. Conclusions: These results, which exhibit high HLA-DQB1*0602 expression in Korean patients with narcolepsy, suggest that HLADQB1*0602 could be a strong genetic marker in narcolepsy.
Clinical Characteristic and Respiratory Disturbance Index as Correlates of Sleep Architecture in Obstructive Sleep Apnea Syndromes Diagnosed with Polysomnography
Kim, Seog-Joo ; Park, Doo-Heum ; Kim, Yong-Sik ; Woo, Jong-Inn ; Ha, Kyoo-Seob ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 8, issue 2, 2001, Pages 113~120
Objectives: Obstructive sleep apnea syndrome is common and may produce various symptoms and serious complications. A substantial number of research articles on obstructive sleep apnea syndrome have been published in Korea. However, we found such limitations as lack of sufficient sample size and lack of polysomnography-proven cases. Therefore, we aimed at studying clinical features and sleep structure in a sufficient number of Korean patients with obstructive sleep apnea syndrome diagnostically confirmed with polysomnography. Methods: We studied 801 subjects referred to the Division of Sleep Studies, Seoul National University Hospital, who were diagnosed as having obstructive sleep apnea syndrome with polysomnography. Subjects were excluded if they had central sleep apnea syndrome, periodic limb movement disorder, narcolepsy or REM sleep behavior disorder. Foreign patients were also excluded. First of all, we studied the clinical features of the subjects. Secondly, we compared sleep-related parameters of the study subjects with those of age/sex-matched normal values. Thirdly, correlations of respiratory disturbance index (RDI) with each of the sleep-related parameters were calculated. Results: Among the 801 subjects, 668 were male subjects (83.4%) and 133 female subjects (16.4%). Their mean age was 46.6 years (
). The mean body mass index (BMI) was 25.8 (
) and subjects with BMI was over 28.0 accounted for 22.8% of the total. Fifty subjects (6.2%) were found to take benzodiazepines. Mean RDI and mean nocturnal oxygen saturation of all subjects was 31.2 (
) and 94.5% (
), respectively. In comparison with normal values, the subjects showed longer sleep latency, lower sleep efficiency, decreased total slow wave sleep % (TSWS %), and decreased total REM sleep % (TREM %)(p<0.01 in all). RDI had a negative correlation with each TSWS % and TREM % (p<0.01, p<0.01). However, RDI did not have significant correlation with either sleep latency or sleep efficiency. Conclusion: In this study, 6.2% of patients diagnosed as having obstructive sleep apnea syndrome were found to take benzodiazepines, although they are generally considered to be of litte benefit or even dangerous because of the respiratory suppressing effect. The proportion of obese subjects was only 22.8% and Korean patients with obstructive sleep apnea syndrome seem to be less obese than those described in foreign journals. This study also suggests that the severity of obstructive sleep apnea syndrome may have a more significant effect on sleep architecture defined as TSWS % and TREM % than on sleep efficiency.
Changes of EEG Coherence in Narcolepsy Measured with Computerized EEG Mapping Technique
Park, Doo-Heum ; Kwon, Jun-Soo ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 8, issue 2, 2001, Pages 121~128
Objectives: In narcoleptic patients diagnosed with ICSD (international classification of sleep disorders, 1990) criteria, nocturnal polysomnography, and MSLT (multiple sleep latency test), we tried to find characteristic features of quantitative electroencephalography (QEEG) in a wakeful state. Methods: We compared eight drug-free narcoleptic patients with sex- and age-matched normal controls, using computerized electroencephalographic mapping technique and spectral analysis. Absolute power, relative power, interhemispheric asymmetry, interhemispheric and intrahemispheric coherence, and mean frequency in each frequency band (delta, theta, alpha and beta) were measured and analyzed. Results: Compared with normal controls, narcoleptic patients showed decrease in monopolar interhemispheric coherence of alpha frequency bands in occipital (
), parietal (
), and temporal (
) areas and beta frequency band in the occipital (
) area. Monopolar intrahemispheric coherences of alpha frequency bands in left hemispheric areas (
) decreased. Decrease of monopolar interhemispheric asymmetry of delta frequency band in the occipital (
) area was also noted. The monopolar absolute powers of beta frequency bands decreased in occipital (
) areas. Conclusion: Decreases in coherences of narcoleptic patients compared with normal controls may indicate fewer posterior neocortical interhemispheric neuronal connections, and fewer left intrahemispheric neuronal connections than normal controls in a wakeful state. Therefore, we suggest that abnormal neurophysiological sites of narcolepsy may involve complex areas such as neocortex and subcortex as well as the brainstem.
Effects of Total Sleep Deprivation on Fine Motor Performance
Lee, Heon-Jeong ; Song, Hyung-Seok ; Ham, Byung-Joo ; Suh, Kwang-Yoon ; Kim, Leen ;
Sleep Medicine and Psychophysiology, volume 8, issue 2, 2001, Pages 129~137
Objectives: The purpose of this study is to investigate the effects of 38-hour sleep deprivation on fine motor performance. The Motor Performance Series (MPS) in the Vienna Test System (computerized neurocognitive function tests) was used in this study. Methods: Twenty four subjects participated in this study. Subjects had no past history of psychiatric disorders and physical illness. Subjects had normal sleep-waking cycle without current sleep disturbances and were all right-handed (Annett's Hand Preference Questionnaire: above +9 points). To minimize the learning effects, familiarization with the Vienna Test System was performed one day before the study. Subjects were to get up at 6:00 in the morning after getting enough sleep according to his or her usual sleep-wake cycle. After awakening, subjects remained awake for 38 hours under continuous surveillance. During two consecutive study days, the subjects tested MPS at 7 AM and 7 PM each day, which means the MPS was done four times in total. During the experiment, anything that could affect the subjects' sleep such as coffee, tea, alcohol, a nap, tiring sports, and all medications were prohibited. Results: In MPS, the fine motor functions of both hands decreased after 38 hours of sleep deprivation. The decrement in motor performance was prominent in the dominant right hand. In the right hand, the total number of tapping was reduced (p<.005), and the number of misses (p<.05) and the length of misses (p<.05) of line tracking, the total length of inserting a short pin (p<.01), the total length of inserting a long pin (p<.05), and the number of misses in aiming (p<.05) increased. Such performance decrement was distinct in the morning sessions. Conclusions: These results suggest that fine motor performance decrement during sleep deprivation is predominant in the right hand, which exerts maximal motor function. The finding of decrement in motor function in tapping during sleep deprivation also suggested that the time required for exhaustion of muscles is shortened during sleep deprivation. More deterioration of motor performance was shown in the morning, which could be explained as circadian rhythm effects.
Two Cases of Narcolepsy Patient Portraying a Tendency of a Dull Learning Ability and Mistaken as an Idle Student
Lee, Seung-Hwan ; Kim, Sun-Kook ; Kim, Leen ; Chung, Young-Cho ; Suh, Kwang-Yoon ;
Sleep Medicine and Psychophysiology, volume 8, issue 2, 2001, Pages 138~143
Sleepiness is associated with many different conditions and, as a neglected topic, it can be the cause of serious psychological and social disadvantages. In the aspect of learning, additional problems may arise from poor progress in school caused by the effect of sleepiness on concentration, memory, and other cognitive functions. Narcolepsy is by no means the most common cause of excessive sleepiness. Nonetheless, it is not a rarity, especially in young people. The non-specific nature of early features of narcolepsy, combined with very limited awareness that the condition can start in various ways, leads to many misinterpretations. Misinterpretation of narcolepsy symptoms is not confined to the medical profession. Teachers may well be critical of a student with narcolepsy because of their perception of narcolepsy symptoms as laziness, poor motivation, or difficult behavior and dull learning ability. Inappropriate reactions by parents, teachers, and peers, based on misinterpretation of narcolepsy symptoms or the patient's reactions to them, make a difficult situation worse. Especially in Korea, where schooling is focused on college entrance examinations, the problem is very serious and intensified by inappropriate or delayed diagnosis and treatment. Therefore, psychiatrists should be aware that narcolepsy in young adolescents is not rare and that they need to be familiar with its clinical features in both its classic and less obvious forms. Narcolepsy should be suspected if a adolescent's excessive sleepiness can not be explained in other ways. Therefore, we report on two patients who portray the tendency of dull learning ability and are mistaken as idle students. We diagnosed narcolepsy through polysomnography and multiple sleep latency testing. We treated the students with methylphenidate and pemolin. The students showed improvement in learning ability and were able to adapt better to school.
Acute Respiratory Distress due to Rapid Tranquilization in a Bipolar Patient with Sleep Apnea
Ham, Byung-Joo ; Seo, Yong-Jin ; Kim, Leen ;
Sleep Medicine and Psychophysiology, volume 8, issue 2, 2001, Pages 144~147
Chemical restraint or "rapid tranquilization" is another option in treating patients who are a danger to themselves or others and struggle violently once physically restrained. The most commonly used drugs are benzodiazepines and antipsychotics. The use of benzodiazepines, either alone or in combination with high potency neuroleptics, has increased in recent years. Benzodiazepines are extremely safe but may cause respiratory depression and hypotension. Respiratory depression is more likely with intravenous administration, therefore these medications should be given slowly and titrated to the desired effect. Special care should be taken when sedating patients who are under the influence of alcohol or narcotics and are sleep apneic patients. This report deals with a case of respiratory distress in a patient with sleep apnea syndrome after the rapid tranqulization. All patients receiving chemical restraint must be carefully monitored. For critically ill patients who require sedation or chemical restraint, the constant attendance of a physician may be warranted.