• Sleep Medicine and Psychophysiology
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• v.3 no.1
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• pp.79-84
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• 1996

Kleine-Levin syndrome is a disorder characterized by recurrent episodes of hypersomnia, hyperphagia and hypersexuality that typically occur weeks or months apart. A 17-years-old male showed these episodes and took nocturnal polysomnography(NPSG) and multiple sleep latency test(MSLT). As results of NPSG, sleep latency was 82.5min, sleep efficiency was 82.5min, sleep efficiency was 82.5%, latency and percentage of REM sleep were 106.5min and 14.6% and percentage of slow wave sleep was 12.7%. In 4 times MLST, average of sleep latency and REM latency were 8min 7sec and 5min 20sec with 3 times sleep onset REM period(SOREMP). These findings are consistent with these of Keine-Levin syndrome. And the possible causes and classification of this syndrome were discussed.

• Annals of Clinical Neurophysiology
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• v.14 no.1
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• pp.7-11
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• 2012

Polysomnography is used to diagnose many types of sleep disorders including sleep apnea, periodic limb movement disorder, REM sleep behavior disorder, parasomnias, and narcolepsy. It is a comprehensive recording of the biophysiological changes that occur during sleep. The polysomnography monitors many body functions parameters including EEG, EOG, EMG, ECG, respiratory airflow, respiratory effort, and pulse oximetry during sleep. Multiple Sleep Latency Test (MSLT) is performed for diagnosing narcolepsy and excessive daytime sleepiness. It is usually to be done after an overnight polysomnography. The test consists of four or five 20-minute nap opportunities that are scheduled two hours apart.

• Sleep Medicine and Psychophysiology
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• v.11 no.2
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• pp.80-83
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• 2004

Objectives: The multiple sleep latency test (MSLT) is commonly used as a valid objective measure of sleepiness. The procedure of MSLT is well standardized but the sleep onset criterion is somewhat variable. One epoch of stage 1 sleep is the most commonly used criterion, and the criterion of three epochs of stage 1 sleep is also used. The purpose of this study was to compare the two criteria used to determine sleep onset. Methods: We retrospectively analyzed 60 consecutive MSLT that were performed according to a standaridized protocol. We scored each test using the two different criteria for sleep onset and then statistically analyed the results. Results: Using the different criteria, 20 patients among 60 showed changes in mean sleep latency (33.3%). The extent of change ranged from 1.3% to 38.5% (mean 15.9%). Non-narcoleptic patients showed a significantly higher incidence of change than other sleep disorder patients. Conclusion: Changes in mean sleep latency occurred according to the different criteria of sleep onset. But the difference arising from different criteria was statistically not significant in patients with moderate to severe sleepiness. Considering that 1 epoch criterion for sleep onset is more sensitive in detecting clinically significant sleepiness, the authors suggest that the 1 epoch criterion is more reliable than the 3 epochs criterion.

• Sleep Medicine and Psychophysiology
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• v.2 no.1
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• pp.91-96
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• 1995

A 24-year-old woman complained of recurrent episodes of hypersomnia lasting on the average about 15 days with mild mood alternation such as depression and irritability. During interepisode interval, she was free of any symptoms. Depending on the absence of excessive eating and hypersexuality, she was clinically diagnosed as recurrent monosymptomatic hypersomnia or the incomplete form of Kleine-Levin syndrome. When nocturnal polysomnography and multiple sleep latency test were performed 10 days after her recovery from a hypersomnic episode, reduced slow wave sleep % and pathologic daytime sleepiness were still noted. The authors suggest that the clinical recovery in recurrent monosymptomatic hypersomnia precede electrophysiological normalization by several days.

• Korean Journal of Clinical Laboratory Science
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• v.37 no.3
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• pp.216-219
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• 2005

We report a case of narcolepsy. A 25-year-old man has had excessive daytime sleepiness of about 10 years durations. He awakens daily feeling exhausted and continually falls asleep during the day while engaged in such situation like reading and watching television. He has exhibited cataplexy, a sudden loss of muscular tone, brought on by emotion, usually laughter. Polysomnogram revealed increased sleep stage 1, 2 and decreased deep sleep. Multiple sleep latency test (MSLT) showed that sleep latency was 1.33 minutes and there were 3 noted sleep onset rapid eye movement (SOREM) on 5 trials. The epworth sleepiness scale (ESS) was 17/24. Typing of HLA haplotype that was positive for the $DQB1^{\ast}0602$ allele, and hypocretin-1 (orexin A) could not be detected in cerebrospinal fluid (CSF). Brain MRI showed normal image. We diagnosed his case as narcolepsy based on history of cataplexy, and three occurances of SOREM, and positive of HLA haplotype.

• Sleep Medicine and Psychophysiology
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• v.5 no.2
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• pp.202-209
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• 1998

Authors report the findings of nocturnal polysomnography and multiple sleep latency test(MSLT) before and after morning light treatment in a winter depressive patient with hypersomnia. On polysomnographic recordings, the sleep pattern of this case before light treatment was similar to that of narcolepsy exhibited, sleep onset REM period(SOREMP). After treatment, the shortened REM latency changed to normal condition, but, deep sleep percentage did not changed, and stage 4 sleep percentage was decreased. Depressive symptoms were improved on clinical interview with Hamilton Depressive Rating Scale. Sleep log showed shortened sleep latency and reduced sleep duration. These findings suggest that although light treatment could alter the sleep structure in seasonal affective disorder with hypersomnia, it does not necessarily imply that antidepressant response of light treatment is result of change of sleep structure.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.19 no.4
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• pp.425-433
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• 2012

Purpose: The purpose of this study was to investigate sleep patterns and predictors of excessive daytime sleepiness (EDS) in university students. Methods: Participants were 120 university students who were attending two universities in S-city and C-city. Data were collected from May 20 to June 15, 2012 using self-report questionnaires which included Johns' Epworth Sleepiness Scale, Yi's Sleep Quality Scale, and Beck Depression Inventory. Data were digitalized and analyzed using frequency, percentages, means and standard deviations, Wilcoxon rank sum test, Chi-square test, Fisher's exact test, and multiple logistic regression with SAS 9.0. Results: Mean total sleep time was 6.6 hours on weekdays, 8.1 hours on weekends. Mean sleep latency was 19.1 minutes and the score for mean sleep quality was 22.6. Prevalence of EDS was 12.5%. Depression was significantly different between EDS and Non-EDS students (t=2.17, p=.030). Multiple logistic regression showed that the only factor associated with EDS was depression (adjusted odds ratio of depression=5.33, 95% Confidence Interval=1.49-19.04). Conclusion: Results of this study indicate that university students experience short sleep time, low sleep quality, and common EDS with depression, suggesting that students with complaints of EDS should be completely assessed for depression as well as sleep problems.

• Sleep Medicine and Psychophysiology
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• v.2 no.1
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• pp.44-54
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• 1995

It is very difficult to evaluate sleep disorders by simple history taking, because which covers very comprehensive areas such as psychobiosocial fields. Although polysomnography is used for the method of final diagnosis, systemic history taking and sleep question-aires are still critically important especially in evaluation of insomnia. Proper informations through sleep questionnaires can provide very precise data for effective treatment as well as exact diagnosis. Sleep questionnaires consist of largely four kinds of questionnaires, which are screening questionnaire of sleep disorders, sleep diary and questionnaire of sleep hygine, diagnostic questionnaire for specific sleep disorder and questionnaire of special symptoms of sleep disorders including insomnia, daytime sleepiness, cognitive function, mental symptom and personality, parasomnia, physical illness and sexual function. However, for more conclusive diagnosis especially in excessive daytime sleepiness nocturnal polysomnography and multiple sleep latency test should be performed.

• Sleep Medicine and Psychophysiology
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• v.13 no.2
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• pp.67-74
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• 2006

Introduction: Excessive daytime sleepiness and cataplexy are key features of narcolepsy. Modafinil is psychostimulant used in the treatment of narcolepsy. In this study, we evaluated effects of modafinil on nocturnal sleep structure and sleep latency in multiple sleep latency test and clinical features. Methods: Twelve narcoleptic patients (7 male, age: $22.9{\pm}2.6\;yrs$) were participated in the study. All of them had done nocturnal polysomnography (nPSG), multiple sleep latency test (MSLT), clinical symptoms scales and have repeated same procedure after taking 200 mg of modafinil. We have done linear mixed model analysis to describe effects of group, medication and nap time on these measures. Results: Modafinil did not affect clinical scales except PSQI which had been reduced after medication. In this study, Modafinil reduced total sleep time, sleep efficiency and increased wake after sleep onset and percent of arousal during sleep in nocturnal polysomnography and prolonged mean sleep latency in multiple sleep latency tests in both group. Discussion: Modafinil has stimulant effect of central nervous system but its effect on night sleep is less than other psychostimulants such as methylphenidate. We ascertained that modafinil affected total sleep time, sleep efficiency and percent of wake during sleep but did not effect on sleep structure. Modafinil was effective in the management of day time sleepiness. Modafinil can enhance alertness of control group without day time sleepiness.

• Sleep Medicine and Psychophysiology
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• v.3 no.1
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• pp.47-55
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• 1996

Narcolepsy is characterized by sleep attack with excessive daytime sleepiness(EDS), cataplexy, sleep paralysis, and hypnagogic hallucination. Paradoxically, narcoleptics tend to complain of frequent arousals and shallow sleep during the night time despite their excessive sleepiness. However, nocturnal sleep fragmentation in narcoleptics is relatively ignored in treatment strategies, compared with sleep attack/EDS and cataplexy. In our paper, we attempted to investigate further on the poor nocturnal sleep in narcoleptics and to discuss possible treatment interventions. Out of consecutively seen patients at Seoul National University Sleep Disorders Clinic and Division of Sleep Studies, we recruited 57 patients, clinically assessed as having sleep attack and/or EDS. Nocturnal polysomnography and multiple sleep latency test(MSLT) were done in each of the subjects. We selected 19 subjects finally diagnosed as narcolepsy(mean age $26.0{\pm}18.3$ years, 16 men and 3 women) for this study, depending on the nocturnal polysomnographic and MSLT findings as well as clinical history and symptomatology. Any subject co-morbid with other hypersomnic sleep disorders such as sleep apnea or periodic limb movements during sleep was excluded. Sleep staging was done using Rechtschaffen and Kales criteria. Sleep parameters were calculated using PSDENT program(Stanford Sleep Clinic, version 1.2) and were compared with the age-matched normal values provided in the program. In narcoleptics, compared with the normal controls, total wake time was found to be significantly increased with significantly decreased sleep efficiency(p<.01, p<.05, respectively), despite no difference of sleep period time and total sleep time between the two groups. Stage 2 sleep%(p<.05), slow wave sleep%(p<.05), and REM sleep%(p<.01) were found to be significantly decreased in narcoleptics compared with normal controls, accompanied by the significant increase of stage 1 sleep%(p<.01). Age showed negative correlation with slow wave sleep%(p<.05). The findings in the present study indicate significant fragmentation of nocturnal sleep in narcoleptics. Reduction of REM sleep% and the total number of REM sleep periods suggests the disturbance of nocturnal REM sleep distribution in narcoleptics. No significant correlations between nocturnal polysomnographic and MSLT variables in narcoleptics suggest that nocturnal sleep disturbance in narcoleptics may be dealt with, in itself, in diagnosing and managing narcolepsy. With the objective demonstration of qualitative and quantitative characteristics of nocturnal and daytime sleep in narcoleptics, we suggest that more attention be paid to the nocturnal sleep fragmentation in narcoleptics and that appropriate treatment interventions such as active drug therapy and/or circadian rhythm-oriented sleep hygiene education be applied as needed.