• Sleep Medicine and Psychophysiology
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• v.18 no.1
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• pp.40-44
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• 2011

Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/$m^2$. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 ${\mu}IU$/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 $^*0602$ type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatmen, and the cataplexy not supported by HLA DQB1 $^*0602$ should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.

• Sleep Medicine and Psychophysiology
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• v.18 no.2
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• pp.76-81
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• 2011

Objectives: This study aims to analyze the association between the severity of sleep apnea, sleep and mood related scales, and activity during sleep in obstructive sleep apnea syndrome (OSAS) patients. Methods: 176 drug-free male patients confirmed as OSAS (average age=$43{\pm}11$ years) were selected through nocturnal polysomnography (NPSG). OSAS was diagnosed with apnea-hypopnea index (AHI) >5, mean AHI was $39.6{\pm}26.0$. Sleep related scales were Stanford Sleepiness Scale (SSS), Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI) and Morningness-Eveningness Scale (MES). Mood related scales were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI) I, II and Profile of Mood States (POMS). NPSG was performed overnight with both wrist actigraphy (WATG). Parameters produced from WATG were total activity score, mean activity score and fragmentation index. We analyzed the correlation between each scale, AHI scored from NPSG and activity score analyzed from WATG. Results: ESS showed significant positive correlation with PSQI, BDI, BAI and STAI I, II, respectively (p<0.01). SSS showed significant positive correlation with PSQI and BAI (p<0.05, p<0.01). BAI showed significant positive correlation with total activity score, mean activity score and fragmentation index (p<0.05, p<0.01, p<0.05).Total activity score showed significant positive correlation with ESS and BAI, respectively (p<0.05). Fragmentation index showed significant positive correlation with ESS, PSQI and BAI (p<0.05, p<0.01, p<0.05). AHI, indicator of sleep apnea is showed no significant correlation with each sleep and mood related scale. Conclusion: The degree of daytime sleepiness tends to be associated with night sleep satisfaction, depression and anxiety, and the activity during sleep rather than the severity of sleep apnea.

• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.836-845
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• 1999

Background : Obesity is present in the majority of adult patients with obstructive sleep apnea(OSA) and is considered to be a major risk factor for its development. A reduction in body weight has been associated with substantial improvement in the severity of apnea. However, a variety of treatment strategies for obesity have yielded limited sucess. This study was done to determine resting energy expenditure(REE) in patients with obstructive sleep apnea and the correlation between the severity of sleep apnea and REE, and to investigate whether leptin influences REE and correlated with the severity of sleep apnea in 39 patients with OSA and 45 controls matched for obesity. Method : Overnight polysomnography was performed on all subjects using standard techniques. Measurements of REE were made using a Sensormedic Vmax 229 and a canopy system. Serum leptin concentration was measured by human leptin RIA kit of LINCO Research INC. Results : REE was greater in patients with OSA compared with controls, but there was no difference between the two groups on REE%. And also there was no significant correlation between anthropometric data, polysomnographic data and REE%. Serum leptin was linearly related to body mass index(BMI), apnea index, apnea hypopnea index and lowest arterial oxygen saturation($SaO_2$) but not related to REE%. Conclusion : This study suggests the followings. Firstly patients patients with sleep apnea have a pattern of obesity characterized by energy homeostasis at an elevated body weight set-point. In order to achieve a lower body weight in these patients, it may be necessary to increase energy expenditure by increasing physical activity. Secondly leptin level was not correlated with REE, suggesting that leptin may predominantly regulate body fat by altering eating behavior rather than calorigenesis. Lastly leptin level was significantly correlated with the severity of sleep apnea. These elevated level of leptin in patients of sleep apnea may be related to the obesity, however it needs further studies to determine the relationship between the severity of sleep apnea and serum leptin.

• Journal of Biomedical Engineering Research
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• v.25 no.1
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• pp.11-19
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• 2004

Stage 1 sleep provides important information regarding interpretation of nocturnal polysomnography, particularly sleep onset. It is a short transition period from wakeful consciousness to sleep. Lack of prominent sleep events characterizing stage 1 sleep is a major obstacle in automatic sleep stage scoring. In this study, we attempted to utilize simultaneous EEC and EOG processing and analyses to detect stage 1 sleep automatically. Relative powers of the alpha waves and the theta waves were calculated from spectral estimation. Either the relative power of alpha waves less than 50％ or the relative power of theta waves more than 23％ was regarded as stage 1 sleep. SEM (slow eye movement) was defined as the duration of both eye movement ranging from 1.5 to 4 seconds and regarded also as stage 1 sleep. If one of these three criteria was met, the epoch was regarded as stage 1 sleep. Results f ere compared to the manual rating results done by two polysomnography experts. Total of 169 epochs was analyzed. Agreement rate for stage 1 sleep between automatic detection and manual scoring was 79.3％ and Cohen's Kappa was 0.586 (p＜0.01). A significant portion (32％) of automatically detected stage 1 sleep included SEM. Generally, digitally-scored sleep s1aging shows the accuracy up to 70％. Considering potential difficulties in stage 1 sleep scoring, the accuracy of 79.3％ in this study seems to be robust enough. Simultaneous analysis of EOG provides differential value to the present study from previous oneswhich mainly depended on EEG analysis. The issue of close relationship between SEM and stage 1 sleep raised by Kinnariet at. remains to be a valid one in this study.

• Sleep Medicine and Psychophysiology
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• v.23 no.1
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• pp.16-24
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• 2016

Background and Objectives: Obstructive sleep apnea (OSA) is often undiagnosed but is an important risk factor affecting the health of an individual. The level of awareness of the illness among patients with OSA is low and is not correlated with severity of the illness. This study was conducted to compare awareness of OSA symptoms and illness between patients with OSA and simple snorers. Materials and Methods: Two hundred eighty-two patients who were suspected of having OSA participated in this study. All subjects underwent overnight polysomnography. Those with an apnea-hypopnea index (AHI) ${\geq}5$ were classified as the OSA group, while those with an AHI < 5 were classified as the simple snoring group. A sleep questionnaire, which included items on awareness of the illness, OSA, and sleep symptoms, was administered to all subjects and their bed-partners. Results: Simple snorers were much more aware of their symptoms such as snoring, irregular breathing, and apnea than were patients with OSA. Bed-partners of simple snorers were also more aware of the participants' sleep symptoms than were partners of patients with OSA. However, the duration of OSA symptoms was longer in the OSA group. In the correlation analysis, the level of awareness of OSA symptoms was negatively correlated with AHI, age, body mass index, and Epworth Sleepiness Scale score. Among the sleep questionnaire and polysomnography results, only Pittsburgh Sleep Quality Index was positively correlated with level of awareness of OSA symptoms. The minority of the respondents had heard about the treatment methods of continuous positive airway pressure and oral appliance and preferred them as treatment options. Conclusion: This study suggests that simple snorers are more aware of their symptoms than are patients with OSA. A higher severity of OSA, represented by a higher AHI, is correlated with lower awareness of one's OSA symptoms.

• Sleep Medicine and Psychophysiology
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• v.21 no.1
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• pp.21-28
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• 2014

Objective: Few studies have evaluated the personality characteristics of patients with obstructive sleep apnea (OSA) and simple snoring. We investigated the personality characteristics of OSA and simple snoring patients and compared differences in personality between the two groups using the Eysenck Personality Questionnaire (EPQ). Materials and Methods: Two hundred and thirty-seven patients who were suspected to have OSA or simple snoring participated in this study. A self-questionnaire which included the EPQ was administered to all participants. All subjects underwent polysomnography in a sleep laboratory and those with an apnea-hypopnea index (AHI) ${\geq}5$ were included in the OSA group, while those with an AHI <5 were included in the simple snoring group. Results: OSA patients had significantly lower scores for Psychoticism (F=4.563, p=0.034) than simple snorers. There were no significant differences in Extraversion (F=3.029, p=0.083), Lie (F=0.398, p=0.529), or Neuroticism (F=3.367, p=0.068) scores between the two groups. In the correlation analysis of the OSA group, AHI was positively correlated with Extraversion score (r= 0.16, p=0.029) and negatively correlated with Lie score (B=-0.31, p<0.001). Using multiple stepwise linear regression analysis with the four EPQ parameter scores as dependent variables, Lie score was associated with older age (B=0.14, p<0.001) and lower AHI (B=-0.05, p<0.001), Psychoticism score was associated with higher Pittsburgh Sleep Quality Index (PSQI ; B=0.14, p<0.001), Neuroticism score was associated with higher PSQI (B=0.34, p=0.001) and female sex (B=3.15, p=0.003), and Extraversion score was associated with younger age (B=-0.08, p=0.020) and higher body mass index (B=0.26, p=0.023). Conclusion: This study suggests that patients with OSA are significantly less prone to psychotic personality characteristics than those with simple snoring. Among OSA patients, higher AHI was correlated with low falsehood and high extraversion tendencies.

• Sleep Medicine and Psychophysiology
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• v.21 no.1
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• pp.14-20
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• 2014

Objectives: Several studies suggest that nocturia may be related to obstructive sleep apnea syndrome (OSAS). The mechanism by which OSAS develops nocturia has not been determined. The present study aimed to determine the prevalence of nocturia among adults with OSAS and to identify factors that may be predictive in this regard. Methods: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the sleep clinics of the St. Paul's Hospital between 2009 and 2012. The urinary symptoms were assessed on the basis of the International Prostate Symptom Score (IPSS). Pathologic nocturia was defined as two or more urination events per night. OSAS was defined as apnea-hypopnea index (AHI) ${\geq}5$. A multivariate analysis using logistic regression was performed to examine the relationship between polysomnographic variables and the presence of pathologic nocturia, while controlling for confounding factor. Results: A total of 161 men >18 years of age (mean age $46.7{\pm}14.1$), who had been referred to a sleep laboratory, were included in the present study. Among these, 27 patients with primary snoring and 134 patients with obstructive sleep apnea were confirmed by polysomnography. Nocturia was found in 53 patients with OSAS (39.6%) and 8 patients with primary snoring (29.6%). The AHI was higher in patients with nocturia than in those without nocturia (p=0.001). OSAS patients with nocturia had higher arousal index (p=0.044), and lower nadir oxyhemoglobin saturation (p=0.001). Multiple regression analysis showed that age (${\beta}$=0.227, p=0.003), and AHI (${\beta}$=0.258, p=0.001) were associated with nocturia, and that the presence of pathologic nocturia was predicted by age (OR 1.04 ; p=0.004) and AHI (OR 1.02 ; p=0.001). Conclusion: Nocturia is common among patients with OSAS. The strongest predictors of nocturia are age and AHI in patients with OSAS.

• Korean Journal of Soil Science and Fertilizer
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• v.36 no.3
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• pp.163-179
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• 2003

Multifunctionality of agriculture which is not traded on the market now has been an important international issue in that it environmental and public benefits. We carried out to modify and to update the function of upland farming on flood prevention and fostering water resources. Economic values of environmental benefits were evaluated by replacement cost methods. Models to evaluate the function of preventing flood were selected as: (1)precipitation(flood-inducing) - runoff(A), (2) soil depth ${\times}$ soil air phase, (3) precipitation (flood-inducing) - runoff(B), (4) soil depth ${\times}$ effective porosity of soil. Models to estimate the function of fostering water resources were (1) saturated hydraulic conductivity (Ks) ${\times}$ duration of saturation(days) ${\times}$ (1-ratio of water flow directly into river), (2) precipitation ${\times}$ ratio of water fostered by rain resources ${\times}$ (area of upland/total land area), and (3) soil water retention quantity(under standing crop or tree) - SWRQ(in bare soil). Function of preventing flood was $883Mg\;ha^{-1}$ of water per year and 645 million Mg for the whole upland area. Function of fostering water resources was $94.1Mg\;ha^{-1}$ of water per year and 69 million Mg for the whole upland area. The value of flood-preventing function evaluated by replacement cost methods was estimated 1,428 billion won per year as compared to the cost for dam construction. The value of water resource fostering were estimated 8.6 billion won in the price of living water.

• Korean Journal of Heritage: History & Science
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• v.37
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• pp.91-120
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• 2004

The Yan mountain area of the northern part of Hebei province and its local neighbor area is categorized main-distribution area of the northern bronze culture of the Eastern Zhou period(770bc~221bc). Recently, it was discovered the concrete character of the culture by a large scale excavation of the Yuhuangmiao cemetery at Jundu mountain. In the chinese scholarship, the cultural character of this area has established the independent cultural type that is distinguished from the Bronze culture of existing. In this paper, I have as a target of analysis remains relate to the Yuhuangmiao culture of the mountain area of northern Hebei in the Eastern Zhou period. And I would like to judge about diverse infuluential relationships of the character of the Yuhuangmiao curture and the Bronze culture, especially burials, burial customs and the characters of the excavated article. In particular, diverse infuluential relationships of the upper Xiajiadian culture Ordos bronze culture and The Central Plains cultural from The Yan state have a important meaning to understand about the character of the Yuhuangmiao culture and the beginning development process. Ultimately, it is peculiar characters of the Yuhuangmiao culture that a shaft gave with stone compartment protecting a coffin as a symbolic form, mask-burial customs such as mainly burials of the living with the dead dogs, a drum shaped jar, a tripod jar with two handles, a short bronze sword with circle hilt, Central Plains cultural bronze containers, bronze halberd and horse-shaped accessories of cartage horse trapping are distinguished from a local neighbor, the bronze culture from northern. The territory of time-space of The Yuhuangmiao culture can be dominately recognized bewteen the upper Xiajiadian culture and Ordos bronze culture. It is the Yan culture after the middle Warring States Period considering with the peculiar chacters which reflected by burials and bural customs and diverse infuluential relationships with peripheral cultures.

• Journal of the Daesoon Academy of Sciences
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• v.33
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• pp.63-90
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• 2019

In pluralistic political realities that have been exposed as antagonistic relationships between self and others, the principle of 'Coincidentia Oppositorum' in Daesoon Thought emphasizes the complementarity between self and others and presents us with a new form of cognition and attitude which can overcome pluralistic political realities. Though solipsism that objectificates others on the basis of the self, the principle of 'Coincidentia Oppositorum' presents us a new form of cognition and attitude with which we can approach others. The principle of 'Coincidentia Oppositorum' is based on the logic that we can secure and extend ourselves only in relation between self and others. Self is not fully formed or perfected without others. Previous discussions on the principle of 'Coincidentia Oppositorum' as it is exists within Daesoon Thought have been limited to Eastern Philosophy. On one hand, this inclination may be due to a narrow understanding of Western Philosophy. The flow of Modern Western Philosophy can at times be a self-reflective output for solipsism. On the other hand, the understanding of the principle of 'Coincidentia Oppositorum in context of a dualistic contrast between Eastern Philosophy and Western Philosophy is not concordant with the principle of 'Coincidentia Oppositorum' which emphasizes the creation of harmony between self and others. This paper aims to investigate avenues to create harmony between Eastern Philosophy and Western Philosophy regarding the principle of 'Coincidentia Oppositorum' in Daesoon Thought. Specifically, attention will be paid to 'flesh' as used by Merleau-Ponty. In his writings, flesh is the matrix which activates the fundamental involvement between self and others. Self is a being of flesh and an ambiguous being which is formed in a double position (seeing and being seen). Flesh can secure and extend the self only through its relationship to an other or multiple others. Restoring the other that has been excluded from modern Western Philosophy, Merleau-Ponty's flesh call for contemplation into the meaning of the other and of otherness.