• Journal of Oriental Neuropsychiatry
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• v.33 no.4
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• pp.485-495
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• 2022

The purpose of this study is to report a case of a patient with pattern identification of liver fire flaming upward and metabolic syndrome improved by Korean medicine. The patient felt completely lost. She was treated for headache, insomnia, and metabolic syndrome with Korean medicine and psychotherapy. Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pattern Identification Tool for Insomnia (PIT-Insomnia), Minnesota multiphasic personality inventory-2 (MMPI-2), and bioelectrical impedance analysis (BIA) were used for assessment. During treatment for six months, the patient stopped taking headache pills. Her blood pressure was stabilized. Her body weight, body fat, body mass index (BMI), and visceral fat decreased significantly. The sum of ISI, PSQI, PIT-insomnia also decreased significantly. Her Ego strength increased in the MMPI-2 supplementary scale. We assume that Korean medicine treatment through acupuncture, herbal medicine, and psychotherapy is effective in treating pattern identification of liver fire flaming upward and metabolic syndrome.

• Korean Journal of Psychosomatic Medicine
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• v.28 no.2
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• pp.168-176
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• 2020

Objectives : Loneliness and poor sleep quality are common phenomena in old age and are associated with negative physical and mental health. However, little is known regarding the relation between loneliness and sleep quality. The aim of this study was to examine the association of loneliness and sleep quality among the elderly living alone. Methods : This is a cross-sectional study that enrolled 1,090 subjects who are the community-residing elderly living alone. Sociodemographic status, medical condition, cognition, mood disorder, sleep quality and levels of loneliness were collected using a self-administered questionnaire and a specific semi-structured interview conducted by trained nurses. Descriptive statistics were used to analyze data regarding sociodemographic variable and loneliness. Univariate and Multivariate regression analyses were applied to examine the association between loneliness and sleep quality after adjustment for multiple confounding variables. Results : The Pittsburgh Sleep Quality Index (PSQI) mean score of "lonely group" (9.2±4.2) was significantly higher than that of "not lonely group" (7.3±3.7) (student-t test, p<0.001). Loneliness was significantly associated with PSQI (standardized β=0.065, p=0.025), sleep disturbance (standardized β=0.086, p=0.005), use of sleep medication (standardized β=0.065, p=0.034) after adjustment for possible confounding variables including sex and mood disorder. Conclusions : Loneliness was associated with sleep disturbance and this finding implied negative impact of loneliness on sleep quality of older adults. Public health promotion efforts to reduce loneliness may improve sleep quality and mental health in the elderly living alone.

• Sleep Medicine and Psychophysiology
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• v.28 no.2
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• pp.70-77
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• 2021

Objectives: Our study aims to investigate the clinical and polysomnographic variables associated with subjective sleep perception. Methods: Among the patients who underwent nocturnal polysomnography (PSG) at the Center for Sleep and Chronobiology of Seoul National University Hospital from May 2018 to July 2019, 109 diagnosed with insomnia disorder based on DSM-5 were recruited for the study, and their medical records were retrospectively analyzed. Self-report questionnaires about clinical characteristics including Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI), and Epworth sleepiness scale (ESS) were completed. Subjective sleep quality was measured using variables of subjective total sleep time (subjective TST), subjective sleep onset latency (subjective SOL), subjective number of awakenings, morning feeling after awakening, and sleep discrepancy (subjective TST-objective TST) the morning after PSG. Pearson and Spearman correlation analyses were used to determine the factors associated with subjective sleep perception. Results: In patients with insomnia, subjective TST was negatively correlated with Wake After Sleep Onset (WASO) (p = 0.001) and N1 sleep (p = 0.039) parameters on polysomnography. Also, it was negatively correlated with PSQI (p < 0.001) and BDI (p = 0.014) scores. Sleep discrepancy was negatively correlated with PSQI score (p = 0.018). Morning feeling was negatively correlated with PSQI (p = 0.019) and BDI (p < 0.001) scores. Conclusion: Our results demonstrated that subjective sleep perception is associated with PSG variables (WASO and N1 sleep) and with PSQI and BDI scores. In clinical practice, it is helpful to assess and manage insomnia patients in consideration of objective sleep variables, subjective sleep quality, and depressed mood, which can influence subjective sleep perception.

• Korean Journal of Adult Nursing
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• v.20 no.1
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• pp.21-32
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• 2008

Purpose: This study was to identify the effects of the hand acupressure therapy on sleep quality and mood state of adults having insomnia. Methods: The study was a one group pretest-posttest design. The subjects for this study were 15 insomniac adults. All the subjects were assessed for their sleep quality and mood state using PSQI(Pittsburgh Sleep Quality Index) and POMS(Profile of Mood States). The pellet stimulating hand acupressure therapy was applied using New Seoam Press Pellets 1 Ho for 4 weeks. Data were analyzed by the SPSS 12.0 version program with descriptive statistics and wilcoxon signed-rank test. Results: The mean total score of PSQI was 6.67 and the POMS was 6.68. There were significant decreases in subject's total PSQI score(p=.000) and in total POMS score(p=.008) after the therapy. Conclusion: These results suggest that pellet stimulating hand acupressure therapy is effective for sleep quality and mood state of adults having insomnia.

• Journal of Korean Neurosurgical Society
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• v.63 no.2
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• pp.261-267
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• 2020

Objective : We investigated the effect of hypnotics on sleep quality, cognitive function, and depressive mood in patients with insomnia following brain tumor resection. Methods : From patients who underwent brain tumor resection, we recruited 10 patients with insomnia who received hypnotics for more than 1 week during a 3-week follow-up period (insomnia group). We also recruited 12 control patients with brain tumors but without insomnia (control group). We evaluated sleep quality at baseline and 3 weeks later using the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), the Stanford Sleepiness Scale (SSS), and the Epworth Sleepiness Scale (ESS) and investigated cognitive function and depression using the Computerized Neuropsychological Test and the Beck Depression Inventory (BDI). Results : At baseline, SSS, ISI, PSQI, and BDI scores were significantly higher and visual continuous performance test (VCPT) and auditory continuous performance test (ACPT) scores were significantly lower in the insomnia than in the control group. Three weeks later, the patients who had received hypnotics had significantly higher ISI, PSQI, ESS, VCPT, ACPT, visual span forward and backward, and visual recognition test scores, and significantly lower BDI scores. Conclusion : Quality of sleep in patients with insomnia following brain tumor resection was initially poor but improved significantly after taking hypnotic medication. Further, the hypnotic medications appeared to contribute to the amelioration of cognitive impairments and depressive moods in patients who previously underwent brain tumor resection. We thus recommend the use of hypnotics for patients with brain tumors with insomnia.

• The Journal of the Society of Stroke on Korean Medicine
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• v.19 no.1
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• pp.9-20
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• 2018

■ Objectives The purpose of this case report is to show the effect of Traditional Korean Medicine(TKM) on a patient with insomnia occurred after onset of thalamic hemorrhage. ■ Methods A patient with insomnia diagnosed as thalamic hemorrhage was treated with herbal medication, acupuncture, electro-acupuncture, cupping and moxibustion. Then we evaluated the improvement with the number of times the patient woke up, PSQI-K(Pittsburgh Sleep Quality Index-Korean), ISI-K(Insomnia Severity Index-Korean) and KESS(Korean version of Epworth sleepiness scale). ■ Results Decrease in scores of PSQI-K, ISI-K, KESS and the number of times the patients woke up were observed after the TKM treatment. ■ Conclusion This case showed the effect of TKM treatment on poststroke insomnia.

• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.47.1-47.14
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• 2023

Background: This study aimed to examine the impact of chronotype on depressive symptoms and explore the mediating effects of sleep quality, pre-sleep cognitive arousal, and social jetlag in a sample of wage earners. Methods: A total of 3,917 waged workers were surveyed online in July 2022. Logistic regression and mediation analysis were used to assess the relationship between chronotype (morningness, intermediate, and eveningness) and depressive symptoms (Patient Health Questionnaire ≥ 5), and the mediating effects of Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Pre-Sleep Arousal Scale (PSAS). All analyses were adjusted for age, education level, income level, marital status, coffee consumption, alcohol consumption, physical activity, occupation, employment status, and working hours to calculate odds ratios (ORs). Results: The chronotypes of all the participants were divided into morningness (4.7%), intermediate (93.5%), and eveningness (1.8%). Multiple logistic regression analysis showed an increased risk of depression in the eveningness chronotype (OR: 2.96; 95% confidence interval [CI]: 1.51, 5.86). Regarding the mediation analysis, ISI mediated 28.44% (95% CI: 16.39-40.5), PSQI for 31.25% (95% CI: 19.36, 43.15), and PSAS-Cognitive Score (PSAS-C) for 23.58% (95% CI: 10.66, 36.50) of the association between chronotype and depressive symptoms. However, social jetlag did not significantly mediate this relationship. (percentage mediated = 0.75%, 95% CI: -3.88, 5.39) Conclusions: Evening chronotypes exhibit an increased risk of depressive symptoms, which ISI, PSQI, and PSAS-C partially mediated. This suggests that interventions to improve sleep quality and maintain adequate sleep habits may effectively prevent and treat depression in employees with an eveningness chronotype.

• 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.

• Anxiety and mood
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• v.12 no.2
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• pp.97-102
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• 2016

Objective : This study aimed to quantify the degrees of insomnia, depression and anxiety felt by employees, and to understand which components of insomnia affect depression and anxiety. Methods : One thousand employees who had medical checkups from January to December 2014 in the Workplace Mental Health Institute of Kangbuk Samsung Medical Center were selected randomly. Sleep quality, depression, and anxiety were rated using the Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies Depression scale (CES-D), and the Beck Anxiety Inventory (BAI), respectively. Good and poor sleepers were divided into two groups according to their total PSQI score : ${\leq}5$ for good sleepers or >5 for poor sleepers. Results : Of 998 employees, 742 (74.35%) had PSQI total scores below 5, and 256 (25.65%) had scores over 5. Multivariate linear regression analysis using the 7 components of PSQI versus BAI, and CES-D scores revealed that subjective sleep quality, daytime dysfunction, sleep disturbance, sleep latency and sleep duration components were significantly associated with both BAI and CES-D. Conclusion : Among the components of insomnia, subjective sleep quality and daytime dysfunction were most strongly associated with depression and anxiety.

• Journal of Trauma and Injury
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• v.35 no.3
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• pp.202-208
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• 2022

Purpose: There is limited research on the effects of neuropathic pain (NP) on quality of life, depression levels, and sleep quality in patients with combat-related extremity injuries. This study evaluated whether patients with combat-related extremity injuries with and without NP had differences in quality of life, sleep quality, and depression levels. Methods: A total of 98 patients with combat-related extremity injuries, 52 with NP and 46 without, were included in this cross-sectional study. The presence of NP was determined using the Leeds Assessment of Neuropathic Symptoms and Signs questionnaire. The outcome measures were a visual analogue scale (VAS), the 36-Item Short Form Survey, the Beck Depression Inventory, and the Pittsburgh Sleep Quality Index (PSQI). Results: The VAS subparameter scores for pain (all P<0.05), PSQI sleep dur ation subscale scores (P=0.025), PSQI sleep disturbance subscale scores (P=0.016), and PSQI total scores (P=0.020) were significantly higher in patients with NP than those without. Logistic regression analysis showed that VAS scores of 5 and above for average pain during the previous 4 weeks contributed independently to the prediction of NP. Conclusions: Patients with combat-related extremity injuries with NP had more pain and poorer sleep quality than those without NP. Sleep quality should be evaluated as part of the diagnostic work-up in patients with combat-related extremity injury with NP, and interventions to improve sleep quality may help manage NP in this patient group.