• The Journal of Internal Korean Medicine
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• v.25 no.1
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• pp.138-148
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• 2004

Objective : Insomnia is the disorder of initiation or maintenance in sleeping that results in daytime sleepiness and dysfunction, and it arises from multiple psychological, physiological and environmental factors. A number of stroke patients suffer from insomnia are classified as sleep disorder patients with physical illness. In addition, insomnia may have profound deleterious effects on the natural course of stroke. We are to assess the effectiveness of intradermal acupucture on stroke combined with insomnia. Methods : We recruited hospitalized patients with insomnia after stroke. Then, the subjects were allocated into a treatment group and a control group by randomization. The treatment group received intradermal acupuncture therapy at He-7(神門), EH-6(內關) correctly. However in control group, intradermal acupuncture were just attached to He-7(神門), EH-6(內關) without insertion. Treatment over time at first day and second day a various indexes were repeatedly checked such as sleep latency, total sleep time, sleep quality, condition on awakening, ability of concentration, morning sleepiness, Insomnia Severity Index, and Athens Insomnia Scale. In the second analysis, we divided the treatment group into a response and a non-response group by their response to intradermal acupuncture. With the acupuncture treatment, accompanied symptoms were checked Results : Among thirty two subjects, two of them were dropped out: One complained the pain from needle insertion, and the other underwent the change of his herbal medication. At baseline investigation with the residual 30 subjects, the control and the treatment group were assessed to have an equal comparability. In the treatment group, sleep latency, total sleeping time, a number of awakenings, sleep quality and ability of concentration showed improvement significantly compared with the control group. The non-response Group showed symptoms such as nausea and halitosis, belching and acid regurgitation, abundant expectoration, while Responder Group showed palpitation, oppressed feelings in chest and sleep disorder. Conclusions: The result of this clinical study suggests that the intradermal acupuncture at He-7(神門), EH-6(內關) is one of the effective treatments for the insomnia after stroke.

• The Journal of Korean Medicine
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• v.43 no.2
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• pp.75-91
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• 2022

Objectives: The purpose of this overview was to summarize the evidence regarding the effectiveness of Cognitive Behavioral Therapy (CBT) for sleep disorders through systematic reviews (SRs) and meta-analyses (MAs). Methods: An overview of systematic review was conducted according to the study protocol (reviewregistry1320). A comprehensive literature search was performed using three databases (Pubmed, Cochrane Central Register of Controlled Trials, and Web of Science) and three Korean databases (KoreaMed, KMbase, and ScienceON). Final studies were selected by three authors according to inclusion and exclusion criteria, and data needed for analysis were extracted by a pre-planned extraction framework. Methodological quality of systematic review was assessed using the 'Assessment of multiple systematic reviews 2 (AMSTAR2)'. Results: Fourteen SRs and MAs were included, of which eleven SRs were performed MAs. Twelve studies studied insomnia among sleep disorders, and the rest are nightmares and sleep disturbances with PTSD. Ten studies reported the effect of CBT on sleep disorders measured by insomnia severity index (ISI) and sleep onset latency (SOL), and all reported a significant improvement effect. Eight studies reported the effect of CBT on sleep disorders measured by wake time after sleep onset (WASO), and seven studies reported a significant improvement effect. The methodological quality of the studies evaluated with AMSTAR 2 was mainly low or very low because of omission of protocol registration and excluded study list. Conclusions: Practical guidelines and studies show that CBT is effective for sleep disorders, but access to CBT needs to be improved.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.170-178
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• 2014

Purpose: Delirium is a common and serious neuropsychiatric complication among terminally ill cancer patients. We investigated risk factors related to the development of delirium among hospice care patients. Methods: Between May 2011 and September 2012, we included patients who were mentally alert and had no psychiatric disease or drug addiction at the hospice ward of two local hospitals. Among them, participants who had been diagnosed with delirium by two doctors according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th edition) criteria were grouped as Delirium Group. We analyzed results of psychometric and other laboratory tests performed at the time of patient's admission - psychometric tests included cognitive function (mini-mental status examination, MMSE), depression (Beck Depression Inventory, BDI), anxiety, and insomnia (Insomnia Severity Index, ISI). Logistic regression analysis was used to compare delirium and the related factors. Cox's proportional hazard model was performed using significant factors of logistic regression analysis. Results: Of the 96 patients who met the inclusion criteria, 41 (42.7%) developed delirium. According to the logistic regression analysis, primary cancer site, cognitive impairment (MMSE < 24), depression ($BDI{\geq}16$), and insomnia ($ISI{\geq}15$) were significant factors related to delirium. Among the four factors, depression (OR 5.130; 95% CI, 2.009~13.097) and cognitive impairment (OR 5.130; 95% CI, 2.009~13.097) were found significant using Cox's proportional hazard model. Conclusion: The development of delirium was significantly related to depression and cognitive impairment among patients receiving hospice care. It is necessary to carefully monitor depression and cognitive function in hospice care.

• Sleep Medicine and Psychophysiology
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• v.11 no.1
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• pp.22-28
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• 2004

Objective: The purpose of this study is to investigate the prevalence rate of OSA in subjects whose main sleep complaint is insomnia and to find differential factors of OSA in these insomniac subjects. Method: We reviewed the medical records and polysomnographic findings of patients referred to the Sleep Laboratory at Seoul National University Hospital from January 1996 to December 2002. Four-hundred and seventy subjects complained of insomnia as their main sleep problem (235 males and 235 females, mean age $53.6{\pm}12.4\;years$). First, we investigated the prevalence rate of OSA in these insomniac patients. Second, we compared the clinical and demographic characteristics of the OSA-associated group with those of the non-associated group. Third, we examined whether the degree or presence of differential factors within the OSA group correlate with severity of OSA, as determined by the respiratory disturbance index (RDI). Results: Among 470 insomniac subjects, 125 subjects (26.6%) were diagnosed as OSA by nocturnal polysomnography. OSA-associated subjects were significantly older ($58.4{\pm}12.3\;years$ vs. $51.8{\pm}11.2\;years$, p<0.01), and had significantly higher body mass index (BMI) ($23.4{\pm}3.3\;kg/m^2$ vs. $22.5{\pm}3.1\;kg/m^2$, p=0.44) than non-associated subjects. The OSA-associated group had more subjects with male gender (64.0% vs. 44.9%, p<0.01), hypertension (20.0% vs. 9.3%, p<0.01) or snoring (96.0% vs. 63.5%, p<0.01). Within the OSA-associated group, age had a significant positive correlation with RDI (p=0.01). Conclusion: We found that a considerable portion of patients complaining of insomnia as their main sleep problem were diagnosed as OSA. Snoring, old age, male gender, obesity, and comorbid hypertension were found to be differential factors of OSA in insomniac patients. We suggest that diagnostic efforts including nocturnal polysomnography are needed for insomniac patients with any of the above risk factors of OSA.

• The Journal of Internal Korean Medicine
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• v.36 no.3
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• pp.400-409
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• 2015

Objectives The study aimed to evaluate the therapeutic effect of Hyungtonghaeul-tang along with Korean medicine treatment for fibromyalgia syndrome. Methods A patient with fibromyalgia syndrome was treated with Hyungtonghaeul-tang as well as Korean medical treatment including acupuncture, electro-acupuncture, bee venom therapy, chuna, aromatherapy, and physical therapy. The counts of tenderness points, widespread pain index (WPI), symptom severity scale score (SS scale score), digital infrared thermal imaging (DITI), Ryodoraku diagnosis, visual analogue scale (VAS), fibromyalgia impact questionnaire (FIQ), and beck depression inventory (BDI) were measured. Results After treatment, the counts of tenderness point, WPI, SS scale score, VAS, FIQ, and BDI were decreased. The DITI and the Ryodoraku pattern recovered normally. Conclusions Hyungtonghaeul-tang along with Korean medicine treatment can be used in the treatment of fibromyalgia syndrome.

• Journal of the Korean Physical Therapy Association
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• v.13 no.1
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• pp.5-17
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• 1992

Depression in Spinal Cord Injury Patients Kang, Soon Hee, M.Ed., R.P.T. Dept. of Rehabilitation Medicine, Kyung-Hee University Medical Center Depressions have the potential to affect adversely the rehabilitation of patients with spi-nal cord iniury. The present study examined depression, functional independence, and demographic and medical characteristics for 49 spinal cord injury(SCI) patients. This investigation involved the administration of the Beck Depression Inventory, the Modified Barthel Index, and aquestionnaire consisted of 14 items, The results were as follows .1. Compared to normal subjects, SCI patients had significantly higher BDI scores.2. When the cut-off point of HDI scores was assumed 21, 26.1% of normal subjeets and 75.5% of SCI patients appeared to be depressed. Depression in SCT patients were not related with age, sex, marital status, injury evel, severity, duration, pain, functional independence and medical charge. Depression in SCI patients were related with education level, economic level, age at injury, motivation. Depression in normal subjects were related with age, education level, economic level, but not related with sex, marital status. There were significant differences at 30 items of BDI between normal subjects and SCI patients. The items were as fellows . 1 sadness, 2 pessimism, 3 failure, 4 dissat-isfaction, 5 guilt, 6 punishment. 7 self-dislike 9 suicidal, 10 crying, 11 irritability, 12withdrawl, 13 indecisive, 14 self-image, IS work inhibition, 16 insomnia, 17 fatigue,18 anorexia, 19 weight loss, 20 hypochondria, 21 libido loss.

• Journal of Korean Biological Nursing Science
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• v.20 no.3
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• pp.187-195
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• 2018

Purpose: The purpose of this study was to identify associations among the sleep disturbance, fatigue, job stress, and blood and body fluid (BBF) exposure of shift-work nurses. Methods: A total of 299 shift-work nurses from two tertiary hospitals were enrolled in this study. We used the Insomnia Severity Index (ISI), and the Fatigue Severity Scale (FSS), and the Korean Occupational Stress Scale-Short Form (KOSS-SF) to evaluate sleep disturbance, fatigue, and job stress, respectively. The data were analyzed using t-test or chi-squared test and Logistic regression analysis using the SPSS 23.0 program. Results: We found that 43.8% of participants reported BBF exposure over the past year. Splash or exposure to broken skin of BBF were most frequent (56.9%), and followed by needlestick injuries (30.4%) and sharp injuries (12.8%). Age, hospital, working period, level of stress, sleep disturbance ($ISI{\geq}15$), fatigue (FSS $score{\geq}4$), job demand and organizational climate subset in KOSS-SF were significantly associated with BBF exposure in shift-work nurses. In multivariate analysis after adjusting age and hospital, the risk factors of BBF exposure in shift-work nurses were the level of stress and fatigue (FSS $score{\geq}4$). Conclusion: Fatigue and job stress were related to BBF exposure in shift-work nurses. Our results suggest that management of sleep disturbance, fatigue, and high job stress in shift-work nurses is needed to reduce risk of BBF exposure.

• Journal of Korean Academy of Nursing
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• v.50 no.5
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• pp.646-657
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• 2020

Purpose: The purpose of this study was to identify the quality of sleep in novice and experienced shift work nurses and compare the factors associated with their quality of sleep. Methods: We analyzed the data of 192 and 256 novice and experienced nurses, respectively. The quality of sleep, sleep hygiene, job stress, and fatigue were measured using Insomnia Severity Index, Sleep Hygiene Practice Scale, the Korean Occupational Stress Scale, and Fatigue Severity Scale. Data were analyzed using SPSS 25.0 to calculate descriptive statistics and logistic regression. Results: Sleep quality was lower in experienced nurses (12.55 ± 5.71) than in novice nurses (11.18 ± 5.78). Fatigue was more severe in experienced nurses (4.47 ± 1.13) than in novice nurses (4.23 ± 1.12). In the logistic regression, factors related to sleep quality in novice nurses were sleep hygiene (odds ratio; OR = 1.06, p < .001) and fatigue (OR = 2.49, p < .001). Factors related to sleep quality in the experienced nurses were also sleep hygiene (OR = 1.04, p = .001) and fatigue (OR = 1.53, p = .012). Conclusion: Sleep quality of experienced nurses is lower than those of novice nurses. Factors associated with sleep quality in novice and experienced nurses are equally identified as sleep hygiene and fatigue. Therefore, personal efforts to improve sleep hygiene, such as providing comfortable sleep environment, are needed. Furthermore, organized efforts to decrease fatigue, such as constructing a working environment with a bright light at night and providing a fatigue-decreasing program that includes meditation, are required.

• Sleep Medicine and Psychophysiology
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• v.19 no.2
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• pp.68-76
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• 2012

Objectives: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. Methods: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=$41.50{\pm}13.16$ yrs, AHI <5, n=20), Group 2 : mild OSAS (mean age=$43.67{\pm}12.11$ yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age $44.93{\pm}12.38$ yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age=$45.87{\pm}12.44$ yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. Results: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were $991.1{\pm}27.1$ and $875.8{\pm}22.0$ ms (p=0.016), standard deviation of NN interval (SDNN) was $85.4{\pm}6.6$ and $112.8{\pm}5.4$ ms (p=0.022), SDNN index was $57.5{\pm}5.2$ and $87.6{\pm}4.2$ (p<0.001), total power was $11,893.5{\pm}1,359.9$ and $18,097.0{\pm}1,107.2ms^2$(p=0.008), very low frequency (VLF) was $7,534.8{\pm}1,120.1$ and $11,883.8{\pm}912.0ms^2$ (p=0.035), low frequency (LF) was $2,724.2{\pm}327.8$ and $4,351.6{\pm}266.9ms^2$(p=0.003). Conclusions: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.

• Science of Emotion and Sensibility
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• v.25 no.4
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• pp.95-106
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• 2022

This study evaluated the effects of latex mattresses on sleep quality and comfort. The participants were 11 healthy adults (five males, six females, mean age 37.7 years, mean height 167.8 cm, and mean weight 67.0 kg) without severe insomnia or other disease that could affect sleep, examined by a clinician. In their personal living space, participants slept on a spring mattress for 7 days, with their sleep registered using a wearable device (Fitbit), a sleep log, the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and a satisfaction survey. The mattresses were then replaced with latex mattresses, which were used for 14 days. As a result, sleep time increased by 62.9 min on weekdays and 53.2 min on weekends after using the latex mattress, and a significant decrease, of 3.8, as seen on the ISI. As measured by the PSQI, the poor sleepers decreased from 10 to 7, but this was not statistically significant, and in the satisfaction survey, the comfort of the low back, neck, and shoulders was significantly increased. This suggests that changes to latex mattresses may positively affect objective and subjective sleep quality.