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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 9, Issue 2 - Dec 2002
Volume 9, Issue 1 - Jun 2002
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Stroke and Sleep
Jeong, Seung-Cheol ;
Sleep Medicine and Psychophysiology, volume 9, issue 1, 2002, Pages 5~8
Stroke is a leading cause of death in most developed countries and some developing countries including South Korea. It is well known that stroke has is related in some way with several sleep disorders. At first, the onset time of stroke varies according to circadian rhythm. Early morning is the most prevalent time and late evening the least. The changes of blood pressure, catecholamine level, plasminogen activity and aggregation of platelet during sleep have been suggested as possible mechanisms. Sleep apnea (SA), a representative disorder in the field of sleep medicine, is found in more than 70% of acute stroke patients compared to 2-5% of the general population. Various sleep related breathing disorders occur after stroke and snoring is a distinct risk factor for stroke. So the relationship between stroke and SA is obvious, but the cause and effect are still not clearly known. Also, stroke may cause many sleep related problems such as insomnia, hypersomnia, parasomnia and changes in sleep architecture. Patients, family members and even medical personnel often ignore stroke-related sleep problems, being concerned only about the stroke itself. The clinical impacts of sleep problems in stroke patients may be significant not only in terms of quality of life but also as a risk factor or prognostic factor for stroke. More attention should be paid to the sleep problems of stroke patients.
Alternation of Sleep Structure and Circadian Rhythm in Alzheimer's Disease
Sohn, Chang-Ho ;
Sleep Medicine and Psychophysiology, volume 9, issue 1, 2002, Pages 9~13
Alzheimer's disease (AD) is one of the most common and devastating dementing disorders of old age. Most AD patients showed significant alternation of sleep structure as well as cognitive deficit. Typical findings of sleep architecture in AD patients include lower sleep efficiency, higher stage 1 percentage, and greater frequency of arousals. The slowing of EEG activity is also noted. Abnormalities in REM sleep are of particular interest in AD because the cholinergic system is related to both REM sleep and AD. Several parameters representing REM sleep structure such as REM latency, the amount of REM sleep, and REM density are change in patients with AD. Especially, measurements of EEG slowing during tonic REM sleep can be used as an EEG marker for early detection of possible AD. In addition, a structural defect in the suprachiasmatic nucleus is suggested to cause various chronobiological alternations in AD. Most of alternations related to sleep make sleep disturbances common and disruptive symptoms of AD. In this article, the author reviewed the alternation of sleep structure and circadian rhythm in AD patients.
Epilepsy and Sleep
Lee, Il-Keun ;
Sleep Medicine and Psychophysiology, volume 9, issue 1, 2002, Pages 14~17
Epilepsy is a paroxysmal disorder caused by abnormal electrical discharges of the brain. As it is characterized by episodic seizures with intervening normal neurological states, some temporal patterns of seizure attacks can be traced. Sleep and wakefulness patterns are one of several factors influencing seizure occurrence. In this article, physiological and pathological influences of sleep on the seizure phenomenon were reviewed. Understanding this relationship between sleep and epilepsy might lead to better understanding of sleep and epilepsy themselves, thus leading to better diagnosis and treatment of each disease.
Alexithymia : Concept and Implications for Treatment
Ham, Byung-Joo ; Kim, Leen ;
Sleep Medicine and Psychophysiology, volume 9, issue 1, 2002, Pages 18~23
Alexithymia represents deficits in the cognitive processing and regulation of emotions. It is observed in many cases of psychosomatic disease, anorexia nervosa, panic disorder, depression etc. Many studies have shown that alexithymia is associated with maladaptive styles of emotion regulation, low emotional intelligence, interhemispheric transfer deficit, and reduced rapid eye movement density. Psychotherapies that enhance emotional awareness may be effective in alleviating the difficulties of alexithymic individuals. Aexithymia is useful for constructing the role of personality and emotions in the pathogenesis of psychiatric disorders. It may serve as a bridge between neurobiology and psychology. We review recent alexithymia theory and research and their implications for treatment of psychosomatic disorders.
Blood Pressure Reactivity during Nasal Continuous Positive Airway Pressure in Obstructive Sleep Apnea Syndrome
Park, Doo-Heum ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 9, issue 1, 2002, Pages 24~33
Objectives: Nasal continuous positive airway pressure (CPAP) corrected elevated blood pressure (BP) in some studies of obstructive sleep apnea syndrome (OSAS) but not in others. Such inconsistent results in previous studies might be due to differences in factors influencing the effects of CPAP on BP. The factors referred to include BP monitoring techniques, the characteristics of subjects, and method of CPAP application. Therefore, we evaluated the effects of one night CPAP application on BP and heart rate (HR) reactivity using non-invasive beat-to-beat BP measurement in normotensive and hypertensive subjects with OSAS. Methods: Finger arterial BP and oxygen saturation monitoring with nocturnal polysomnography were performed on 10 OSAS patients (mean age
; 9 males, 1 female; respiratory disturbance index (RDI)>5) for one baseline night and another CPAP night. Beat-to-beat measurement of BP and HR was done with finger arterial BP monitor (
) and mean arterial oxygen saturation (
) was also measured at 2-second intervals for both nights. We compared the mean values of cardiovascular and respiratory variables between baseline and CPAP nights using Wilcoxon signed ranks test. Delta (
) BP, defined as the subtracted value of CPAP night BP from baseline night BP, was correlated with age, body mass index (BMI), baseline night values of BP, BP variability, HR, HR variability, mean
and respiratory disturbance index (RDI), and CPAP night values of TWT% (total wake time%) and CPAP pressure, using Spearman's correlation. Results: 1) Although increase of mean
(p<.01) and decrease of RDI (p<.01) were observed on the CPAP night, there were no significant differences in other variables between two nights. 2) However, delta BP tended to increase or decease depending on BP values of the baseline night and age. Delta systolic BP and baseline systolic BP showed a significant positive correlation (p<.01), but delta diastolic BP and baseline diastolic BP did not show a significant correlation except for a positive correlation in wake stage (p<.01). Delta diastolic BP and age showed a significant negative correlation (p<.05) during all stages except for REM stage, but delta systolic BP and age did not. 3) Delta systolic and diastolic BPs did not significantly correlate with other factors, such as BMI, baseline night values of BP variability, HR, HR variability, mean SaO2 and RDI, and CPAP night values of TWT% and CPAP pressure, except for a positive correlation of delta diastolic pressure and TWT% of CPAP night (p<.01). Conclusions: We observed that systolic BP and diastolic BP tended to decrease, increase or remain still in accordance with the systolic BP level of baseline night and aging. We suggest that BP reactivity by CPAP be dealt with as a complex phenomenon rather than a simple undifferentiated BP decrease.
Diagnosis of Obstructive Sleep Apnea Syndrome Using Overnight Oximetry Measurement
Youn, Tak ; Park, Doo-Heum ; Choi, Kwang-Ho ; Kim, Yong-Sik ; Woo, Jong-Inn ; Kwon, Jun-Soo ; Ha, Kyoo-Seob ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 9, issue 1, 2002, Pages 34~40
Objectives: The gold standard for diagnosing obstructive sleep apnea syndrome (OSAS) is nocturnal polysomnography (NPSG). This is rather expensive and somewhat inconvenient, however, and consequently simpler and cheaper alternatives to NPSG have been proposed. Oximetry is appealing because of its widespread availability and ease of application. In this study, we have evaluated whether oximetry alone can be used to diagnose or screen OSAS. The diagnostic performance of an analysis algorithm using arterial oxygen saturation (
) base on 'dip index', mean of
, and CT90 (the percentage of time spent at
<90%) was compared with that of NPSG. Methods: Fifty-six patients referred for NPSG to the Division of Sleep Studies at Seoul National University Hospital, were randomly selected. For each patient, NPSG with oximetry was carried out. We obtained three variables from the oximetry data such as the dip index most linearly correlated with respiratory disturbance index (RDI) from NPSG, mean
, and CT90 with diagnosis from NPSG. In each case, sensitivity, specificity and positive and negative predictive values of oximetry data were calculated. Results: Thirty-nine patients out of fifty-six patients were diagnosed as OSAS with NPSG. Mean RDI was 17.5, mean
was 94.9%, and mean CT90 was 5.1%. The dip index [4%-4sec] was most linearly correlated with RDI (r=0.861). With dip index [4%-4sec]
as diagnostic criteria, we obtained sensitivity of 0.95, specificity of 0.71, positive predictive value of 0.88, and negative predictive value of 0.86. Using mean
, we obtained sensitivity of 0.95, specificity of 0.41, positive predictive value of 0.79, and negative predictive value of 0.78. Using
, we obtained sensitivity of 0.28, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of 0.38. Conclusions: The dip index [4%-4sec] and mean
obtained from nocturnal oximetry data are helpful in diagnosis of OSAS. CT90
5% can be also used in excluding OSAS.
Effect of Bright Light Exposure on Adaptation to Rapid Night Shift : A Field Study of Shift Work Nurses in Psychiatric Ward
Ko, Young-Hoon ; Joe, Sook-Haeng ;
Sleep Medicine and Psychophysiology, volume 9, issue 1, 2002, Pages 41~47
Objectives: In a number of simulated night shift studies, timed exposure to bright light improves sleep quality and work performance. We evaluated the effect of bright light on adaptation to night shift work with a field study. Methods: Five female nurses working shifts at Korea University Hospital were recruited for participation in this study. We investigated two series of six consecutive shift rotations comprising three day and three night shifts, using wrist Actigraphy, the Stanford Sleepiness Scale, Visual-analogue scales, STIM and tympanic membrane temperature for daytime sleep quality, alertness, subjective feeling, attention performance, and temperature rhythm. The subjects were exposed to bright light (2,500 lux) from 24:00 to 04:00 a.m. on three consecutive night shifts during the second series, whereas they worked under normal lightening (650 lux) conditions during the first series. Results: Actigraphic assessment of daytime sleep showed no significant difference between the first and third night shift in both baseline and light exposure phase. The mean lowest temperature shifted earlier during baseline phase but not during the light exposure phase. Also, the score for subjective feelings of depression, anxiety, physical discomfort and sleepiness was significantly higher in the third night shift than the first during baseline phase but not during the light exposure phase. Attention and attention switching ability was significantly improved in the third night shift compared to the first night during the light exposure phase but there were no significant changes during the baseline phase. Conclusion: This result suggests that there were no significant differences between the two phases in measures of quality of daytime sleep, but subjective feelings, attention and alertness were enhanced during light exposure. Although some placebo effects and learning effects might influence this result, bright light exposure between midnight and 4:00 a.m. may improve adaptation to night shift. In future, further controlled studies with a larger sample size, including melatonin measurement, are needed for real shift workers.
Effects of Minor Stressful Events on Sleep in College Students
Kang, Seung-Gul ; Yoon, Ho-Kyoung ; Ham, Byung-Joo ; Choi, Yun-Kyeung ; Kim, Seung-Hyun ; Joe, Sook-Haeng ; Suh, Kwang-Yoon ; Kim, Leen ;
Sleep Medicine and Psychophysiology, volume 9, issue 1, 2002, Pages 48~55
Objective: Stress is known to be a common cause of short-term insomnia and insomniacs often complain that stress induces sleep problems. However, previous studies on the correlation between stress and sleep do not show consistent results. We aimed to investigate the effects of minor stressful events on sleep among college students. Method: Physically and mentally healthy college student volunteers filled out a self-assessment questionnaire to evaluate their stress and sleep. To find out the status of average stress and sleep, the volunteers filled out K-DSI and daily sleep assessments on three consecutive days. In addition, we surveyed the amount of caffeine beverage intake and assessed the degree of depression and anxiety. Results: The total number of students participating in this study was 202, 101 men and 101 women. Minor stress turned out to significantly affect non-restorative sleep and secondary symptoms of insomnia (awakening difficulty, displeasure, feeling of dissatisfaction with sleep, physical uneasiness or pain at awakening, daytime sleepiness, depressive moods, tiredness and concentration difficulty). However, global PSQI score, self-reported sleeping hours, sleep latency, awakening frequency, frequency and duration of napping, were not explained by stress scores. Conclusion: In this study, minor stresses seemed to affect sleep, especially secondary symptoms caused by non-restorative sleep. We can thus infer that minor stresses impair the restorative effects of sleep by inducing arousal, and the direct relationship the two can be confirmed by polysomnogram.
Alexithymia in Patients with Tension-Type Headache
Shin, Dong-In ; Ham, Byung-Joo ; Kwon, Ho-In ; Park, Gun-Woo ; Kim, Leen ; Suh, Kwang-Yun ;
Sleep Medicine and Psychophysiology, volume 9, issue 1, 2002, Pages 56~60
Objective: Various psychological factors influence the occurrence of tension-type headaches. The aim of this study is to compare the level of alexithymia between tension-type headache patients and normal controls. Methods: Sixty-six subjects with tension-type headaches and 59 controls were studied. The Beck Depression Inventory and Toronto Alexithymia Scale (TAS-20K) were administered to the tension-type headache group and TAS-20K to the normal control group. Results: Compared with normal controls, the tension-type headache group had significantly higher alexithymia scores. There was also significant association between the level of alexithymia and the severity of the depression in tension-type headache patients. Conclusions: These findings suggest that patients with tension-type headaches have difficulty in expressing their emotions. And in patients with tension-type headaches, the more alexithymic they are, the more depressive.
Psychophysiological Response Patterns Measured by a Biofeedback System in Healthy People
Kim, Youl-Li ; Koo, Moon-Sun ; Kim, Eui-Jung ; Yu, Bum-Hee ;
Sleep Medicine and Psychophysiology, volume 9, issue 1, 2002, Pages 61~67
Objectives: This study is aimed at measuring psychophysiological responses using a biofeedback system in healthy people to obtain basic normative data for biofeedback research and treatment. Methods: Ninety-six healthy volunteers (55 males and 41 females : average age
) without any history of major medical or psychiatric illnesses participated in this study. Psychophysiological responses were assessed using the ProComp+ and BioGraph program (ver. 2.1) with regard to forearm and frontal electromyography (EMG), electrodermal response (EDR), and skin temperature. They were measured in 3 phases (baseline, stress, and recovery phases), respectively. Beck depression inventory and Spielberger state and trait anxiety inventory were used to measure mood states. We compared psychophysiological responses according to age and gender differences, respectively and examined the relationship between mood states and psychophysiological measures. Results: People in their twenties showed higher EDR levels in the 3 phases than those of other age groups. Female subjects showed higher frontal EMG levels in the 3 phases compared with male subjects. There was no significant correlation between biofeedback measures and mood states in these subjects. Conclusion: We present normative data of psychophysiological responses measured by a biofeedback system in healthy people. These results suggest that gender and age should be considered as important variables in assessing psychophysiological responses using a biofeedback system.