• Sleep Medicine and Psychophysiology
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• v.24 no.2
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• pp.86-96
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• 2017

Objectives: This study aimed to analyze causality among sleep apnea, depression and cognitive function in patients with obstructive sleep apnea. Methods: We reviewed the medical records of 105 patients with sleep apnea and snoring who underwent overnight polysomnography (PSG). We analyzed various biological data, sleep variables (sleep duration and percentage) and respiratory variables [arousal index (AI), periodic leg movement index (PLM index), snoring Index (SI), mean SpO2, minimum SpO2, apnea-hypopnea index (AHI), and respiratory disturbance index (RDI)]. We also analyzed various data by sleep, cognition, and mood related scales: Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), snoring index by scale (SIS), Montreal Cognitive Assessment-Korean (Moca-K), Mini-mental State Examination-Korean (MMSE-K), clinical dementia rating (CDR), and Beck Depression Inventory (BDI). We analyzed causation among sleep, and respiratory, mood, and cognition related scales in obstructive sleep apnea patients. We analyzed the mediating effects of depression on sleep apnea patient cognition. Results: As Duration N1 increased and Total sleep time (TST) decreased, MOCA-K showed negative causality (p < 0.01). As BDI and supine RDI increased, causality was negatively related to MOCA-K (p < 0.01). As PSQI (p < 0.001) and SIS (p < 0.01) increased and as MMSE-K (p < 0.01) decreased, causality was positively related to BDI. BDI was found to mediate the effect of age on MOCA-K in patients with obstructive sleep apnea. Conclusion: Duration N1, total sleep time, BDI, and supine RDI were associated with cognitive function in obstructive sleep apnea patients. Depression measured by BDI partially mediated cognitive decline in obstructive sleep apnea patients.

• Sleep Medicine and Psychophysiology
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• v.27 no.1
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• pp.24-31
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• 2020

Objectives: Subjective-objective discrepancy of sleep (SODS) is a common symptom and one of the major phenotypes of insomnia. A distorted perception of sleep deficit might be related to abnormal brain reactivity to insomnia-related stimuli. We aimed to investigate differences in brain activation to insomnia-related stimuli vs. general anxiety-inducing stimuli among insomnia patients with SODS, insomnia patients without SODS, and healthy controls (HCs). Methods: All participants were evaluated for subjective sleep status using a sleep diary and questionnaires; occult sleep disorders and objective sleep status were assessed using polysomnography and actigraphy. Task functional magnetic resonance imaging was performed during insomnia-related stimuli (Ins) and general anxiety-inducing stimuli (Gen). Brain reactivity to Ins versus Gen was compared among insomnia with SODS, insomnia without SODS, and HC groups, and a combined insomnia disorder group (ID, insomnia with and without SODS) was also compared with HCs. Results: In the insomnia with SODS group compared to the insomnia without SODS group, the right precuneus and right supplementary motor areas showed significantly increased BOLD signals in response to Ins versus Gen. In the ID group compared to the HC group, the left anterior cingulate cortex showed significantly increased BOLD signals in response to Ins versus Gen. Conclusion: The insomnia with SODS and ID groups showed higher brain activity in response to Ins versus Gen, while this was not observed in the insomnia without SODS and HC groups, respectively. These results suggest that insomnia patients with sleep misperception are more sensitive to sleep-related threats than general anxiety-inducing threats.

• Sijohaknonchong
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• v.23
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• pp.71-105
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• 2005

Toson-Shibigok(Twelve Songs of Toson) which T'oegye, Yi Hwang, composed has received a lot of attention in terms of its educational implications. These implications have become the essential part of Gojeon Sigas(classic songs and poems), and solid evidence has also been accumulated in the literature. Therefore, the purposes of this study are twofold, that is 1) to explore the impact of T'oegye's fundamental structure of the first education at that time and 2) describe how these educational attitudes will eventually yield meta- educational values. What T'oegye meant by fundamental structure of the first education was that Sijos originated from his own experience should be the vital part of teaching method. One can say that T'oegye's teaching method is more integrative than that of modern literature education in that it includes songs. Not only using his own teaching method, but T'oegye tried to demonstrate his own literary structure to his colleagues and the future generations. In the end, Meta-Education which comprises the heart of recent educational theories well reflects Toegye's theoretical propositions. Rather than giving practical knowledge, his method offers the paradigms of thought patterns and shows the learners' attitudes in approaching the truth. Moreover, T'oegye's teaching method has become a good example to the future generations as well as his contemporary followers. In sum, although a lot of years have passed since he died, T'oegye's Sijo works and life still have invaluable impact on the field of education.

• Sleep Medicine and Psychophysiology
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• v.8 no.2
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• pp.107-112
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• 2001

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: $28.2{\pm}3.0$, 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 (${\pm}2.0$ minutes) and mean frequency of sleep-onset REM period was 3.0 (${\pm}1.6$) 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.

• Sleep Medicine and Psychophysiology
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• v.8 no.2
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• pp.121-128
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• 2001

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 ($O_1/O_2$), parietal ($P_3/P_4$), and temporal ($T_5/T_6$) areas and beta frequency band in the occipital ($O_1/O_2$) area. Monopolar intrahemispheric coherences of alpha frequency bands in left hemispheric areas ($T_3/T_5$, $C_3/P_3$ & $F_3/O_1$) decreased. Decrease of monopolar interhemispheric asymmetry of delta frequency band in the occipital ($O_1/O_2$) area was also noted. The monopolar absolute powers of beta frequency bands decreased in occipital ($O_2,\;O_z$) 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.

• Sleep Medicine and Psychophysiology
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• v.19 no.2
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• pp.77-83
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• 2012

Objectives: Recent studies have reported a correlation between obstructive sleep apnea syndrome (OSA) and depression. In attempt to verify the suggestion that eveningness is related to depression, we examined the effect of morningness-eveningness on their depressive mood in patinets with OSA. Methods: The examination was based on the medical records and polysomnography reports of 211 OSA patients. Information was gathered from the patients who filled out the H$\ddot{o}$rne and Ostberg questionnaire (HOQ), profile of mood states-Korean version (K-POMS), and Epworth sleepiness scale (ESS). We compared mean values of K-POMS total, subscales of K-POMS, ESS, and OSA severity variables among the 3 morningness-eveningness groups (morningness, eveningness, and neither groups). Partial correlation analysis was performed between variables and ANCOVA was performed among the 3 groups after adjustment with age and weight. Results: There were significant negative correlations between HOQ and the followings : K-POMS total, POMS-T (tension-anxiety), POMS-D (depression-dejection), POMS-A (anger-hostility), POMS-F (fatigue-inertia), POMS-C (confusion-bewilderment), spontaneous arousal index, average O2 saturation. There were significant positive correlations between HOQ and the followings : POMS-V (vigor-activity), apnea-hypopnea index, respiratory arousal index, snore time. There were significant negative correlations between POMS-D and the followings : HOQ, POMS-V, stage 1 sleep (%), AHI, TAI (total arousal index), oxygen desaturation index, respiratory arousal index, neck circumference, average O2 desaturation, snore time (%). There were significant positive correlations between POMS-D and K-POMS total, POMS-T, POMS-A, POMS-F, POMS-C, sleep latency, stage 2 sleep (%), heart rate, spontaneous arousal index. There were significant differences in K-POMS total, POMS-T, POMS-D, POMS-F, POMS-C, spontaneous arousal index among the three HOQ groups in ANCOVA. Conclusion: The depressive correlates of OSA patients might be affected, not by excessive daytime sleepiness or OSA severity indexes, but by eveningness circadian characteristics. It would be important to take into account the morningness-eveningness tendency when we manage the depressive mood of OSA patients.

• Sleep Medicine and Psychophysiology
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• v.14 no.1
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• pp.20-25
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• 2007

The present study compared the actigraphic indices between both wrist actigraphies (WATGs), and the sleep estimates between each WATG and nocturnal polysomnography (NPSG) to assess their differences and consistencies. We studied 22 right-handed subjects (mean age $43.9{\pm}13.3\;years$, M：F=14：8) with untreated primary sleep disorders (primary insomnia=8, simple snorer=2, obstructive sleep apnea=12) undergone by overnight both WATGs and NPSG, simultaneously. Comparison and correlation were analyzed between right and left wrist actigraphic data. In the sleep estimates of both WATGs and NPSG, each WATG was compared and correlated with NPSG in sleep period time (SPT), total sleep time (TST), sleep latency (SL), sleep efficiency (SE) and wake time (WT). Sleep indices between both WATGs showed significant positive correlations with no correlations in SL and fragmentation index (FI). There were no differences in sleep indices between both WATGs. SPTs of both WATGs, SL of left WATG, and TST of right WATG showed positively significant correlations, and SE of right WATG did negatively significant correlation in sleep indices between each WATG and NPSG. As each WATG was compared to PSG, SPTs of both WATGs and WT of right WATG were decreased, and TST and SE of right WATG and SL of left WATG were increased. Inconsistent SL and FI between both WATGs indicate that the activities between both WATGs can differentially happen during wake or arousal. Inconsistent sleep estimates between each WATG and NPSG may indicate the limited usefulness in measuring and analyzing one-night sleep by using WATG.

• Management & Information Systems Review
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• v.31 no.4
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• pp.57-82
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• 2012

The purpose of the study is to suggest the measure for the improvement of job satisfaction and level of empowerment of sanatoriums' social workers by analyzing factors of empowerments' effect on the job satisfaction, and investigating level of empowerment and job satisfaction of social workers of sanatoriums for the elderly and the handicapped. The result of investigation and analysis on subjects of 420 social workers of sanatoriums for the elderly and the handicapped in Youngnam area for this is as follows: First, job characteristic that is empowerments' influence factor of sanatoriums' social workers is appeared in order of feedback, and function variety, and in organization characteristic is appeared in order of leadership, reward, and employee development. Second, level of empowerment that is recognized by sanatoriums' social workers is appeared a little higher than normal level and significance is appeared highest, and next are capability, self-determination ability, and influence. Third, features that showed significant difference with significance in general characteristic of sanatoriums' social workers were 'sex', 'marital status', and 'religion', and features that showed significant difference with capability were sex, age, marital status, academic background, and employment history. And features that showed significant difference with self-determination ability were sex, age, marital status, and employment history, and features that showed significant difference with influence were sex, age, employment history and types of facilities. Fourth, the whole average of job satisfaction of sanatoriums' social workers was 3.82 out of 5, which is generally high, features that showed significant difference statistically were age, marital status, academic background, employment history, and types of facilities. Thus, job satisfaction was appeared as high as 'more than age of thirty' in age, 'married' in marital status, 'under graduates of colleges' in academic background, and 'less than three years' in employment history. Fifth, as for factors that had influence on job satisfaction, the indirect effect with empowerment was appeared that had significant effect in organization characteristic, and had few effect in organization features. On these results, practical measures to increase job satisfaction of sanatoriums' social workers are as follows: First, political approach is required to standardize duty system(by various types of facilities and clients' characteristic) of social workers of sanatoriums for elderly and the handicapped, and help to do the role as professionals with giving better treatment and building self-respect by enough reward. Second, to suggest chances to perform the responsibility for the duty of the scenes by the regular supervision, establish regular supervision system of social workers of sanatoriums for the elderly and the handicapped, and the extension of duty to increase the functional varieties. Third, it is required to motivate to have self confidence for the work and to use potential ability with transforming leadership, and to have more chances of education for the self-development. To increase job satisfaction of sanatoriums' social workers who give direct services in sanatoriums for the elderly and the handicapped, more active and positive empowerment's level improvement is in need by improvement of empowerment for them.

• Sleep Medicine and Psychophysiology
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• v.5 no.1
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• pp.88-102
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• 1998

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.

• Journal of Genetic Medicine
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• v.8 no.2
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• pp.119-124
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• 2011

Purpose: Supernumerary marker chromosome (SMC) could be associated with various phenotypic abnormalities based on the chromosomal origin of SMCs. The present study aimed to determine the genomic contents of SMCs using chromosomal microarray and to analyze molecular cytogenetic characterizations and clinical phenotypes in patients with SMCs. Materials and Methods: Among patients with SMCs detected in routine chromosomal analysis, SMCs originating from chromosome 15 were excluded from the present study. CGH-based oligonucleotide chromosomal microarray was performed in 4 patients. Results: The chromosomal origins of SMCs were identified in 3 patients. Case 1 had a SMC of 16.1 Mb in 1q21.1-q23.3. Case 2 showed 21 Mb gain in 19p13.11-q13.12. Case 3 had a 4.5 Mb-sized SMC rearranged from 2 regions of 2.5 Mb in 22q11.1-q11.21 and 2.0 Mb in 22q11.22-q11.23. Conclusion: Case 1 presented a wide range of phenotypic abnormalities including the phenotype of 1q21.1 duplication syndrome. In case 2, Asperger-like symptoms are apparently related to 19p12-q13.11, hearing problems and strabismus to 19p13.11 and other features to 19q13.12. Compared with cat-eye syndrome type I and 22q11.2 microduplication syndrome, anal atresia in case 3 is likely related to 22q11.1-q11.21 while other features are related to 22q11.22-q11.23. Analyzing SMCs using high-resolution chromosomal microarray can help identify specific gene contents and to offer proper genetic counseling by determining genotype-phenotype correlations.