• 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.

• Journal of Oral Medicine and Pain
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• v.39 no.2
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• pp.35-45
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• 2014

Many therapeutic modalities including continuous positive airway pressure, surgery, and oral appliances are used to treat patients with sleep-disordered breathing. However, there are no definitive treatment modalities for individual patients due to various causes of sleep-disordered breathing. Clinicians should have select best options for individual patients and it is quite challenging process. Oral appliances attracted clinical attention for its convenience and safety. Several designs of oral appliances are introduces such as soft palate lifter, tongue retaining device, and various appliances which aimed to mandibular advancement. Among these oral appliances, mandibular advancement devices (MADs) are considered the most excellent based on their effectiveness and patient tolerance. Although MADs are not guarantee dramatic outcome and less consistent than continuous positive airway pressure, they offer several advantages over continuous positive airway pressure and surgical methods, including non-invasiveness, silence, portability, and tolerability, simplicity. Therefore, general dental practitioner who had passed sleep dental curriculum or coursework can treat the patients with sleep problems. This article reviews the history, clinical indications, suggested mechanism of actions, various positive effects and several side effects, factors predicting a favorable outcome, determining amounts of mandibular advancement, compliance and long-term efficacy of MADs use.

• 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.

• The Journal of Pediatrics of Korean Medicine
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• v.18 no.2
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• pp.77-91
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• 2004

Objectives : In evaluating a child with enuresis, an organized approach to the history leads to a working diagnosis and an appropriate treatment plan. but, there's no study about history taking in enuretic children. This article was undertaken to evaluate the enuretic child exactly and to study nocturnal enuresis systematically. Methods : It was conducted a computerized literature search in following database: Medline (via Pubmed), NDSL, EBSCO. Korean articles via oriental pediatric association homepage, KISS. Key words to search were 'nocturnal enuresis', 'bedwetting', 'enuresis', 'incontinence', 'management', 'evaluation', 'assessment', 'questionnaire', 'guideline', 'voiding dysfunction'. Results : Questions are grouped in eight categories: primary history(sex, age, height, weight), family history, enuresis history(primary/secondary, frequency, time of enuresis, nocturia), voiding history(average number, frequency, pattern, volume, posture, daytime enuresis), medical history, constipation/encopresis, sleep(OSA). Conclusion : A careful, complete history taking will help to plan treatment properly and to study.

• Clinical and Experimental Pediatrics
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• v.53 no.10
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• pp.863-871
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• 2010

The prevalence of pediatric obstructive sleep apnea syndrome (OSAS) is approximately 3% in children. Adenotonsillar hypertrophy is the most common cause of OSAS in children, and obesity, hypotonic neuromuscular diseases, and craniofacial anomalies are other major risk factors. Snoring is the most common presenting complaint in children with OSAS, but the clinical presentation varies according to age. Agitated sleep with frequent postural changes, excessive sweating, or abnormal sleep positions such as hyperextension of neck or abnormal prone position may suggest a sleep-disordered breathing. Night terror, sleepwalking, and enuresis are frequently associated, during slow-wave sleep, with sleep-disordered breathing. Excessive daytime sleepiness becomes apparent in older children, whereas hyperactivity or inattention is usually predominant in younger children. Morning headache and poor appetite may also be present. As the cortical arousal threshold is higher in children, arousals are not easily developed and their sleep architectures are usually more conserved than those of adults. Untreated OSAS in children may result in various problems such as cognitive deficits, attention deficit/hyperactivity disorder, poor academic achievement, and emotional instability. Mild pulmonary hypertension is not uncommon. Rarely, cardiovascular complications such as cor pulmonale, heart failure, and systemic hypertension may develop in untreated cases. Failure to thrive and delayed development are serious problems in younger children with OSAS. Diagnosis of pediatric OSAS should be based on snoring, relevant history of sleep disruption, findings of any narrow or collapsible portions of upper airway, and confirmed by polysomnography. Early diagnosis of pediatric OSAS is critical to prevent complications with appropriate interventions.

• The Journal of Pediatrics of Korean Medicine
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• v.22 no.2
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• pp.125-139
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• 2008

Objectives : The study was designed to find out the relationships between rhinitis, quality of sleep, growth among children with chronic rhinitis. Methods : This research was performed in 50 children from November 2007 to May 2008. We measured height, weight, body mass index of those children and asked to answer to the questionnaires that consist of nasal symptoms, period of time with rhinitis, sleep symptoms, parent's height, present illness, and medical history. We also analyzed correlations with this factors obtained from questionnaires. Results : 1. In 50 subjects, there were significant correlations between nasal obstruction, the quality of sleep, and the between quality of sleep and growth. But, there were not significant correlations between nasal symptoms and growth. 2. In 24 preschool children, frequency of waking up during sleeping and the number of snorers were higher and quality of sleeping was worse than those in the children who were attending school. And there were significant correlations between quality of sleep and nasal obstruction. An average of RH-MPH(Recent Height-Mid-Parental Height) is $-7.74{\pm}36.51(%)$ which means they aren't as tall as MPH(Mid-Parental Height). 3. In 26 school children, there were significant correlations between symptoms and period of rhinitis, quality of sleep and growth. Conclusions : Children with chronic rhinitis have low quality of sleep and low growth. But more studies are needed.

• Sleep Medicine and Psychophysiology
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• v.17 no.2
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• pp.85-90
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• 2010

Objectives: Ginseng has a long history of being used in insomnia treatment and there is some evidence from animal studies of its sleep-enhancing property. From this, it can be assumed that ginseng has sleep-promoting effect in humans. The purpose of this study was to investigate the effect of Korean red ginseng on change of sleep architecture in humans. Methods: A total of 20 healthy young males with regular sleep and wake habits and without any psychiatric nor cognitive problems were selected based on review of sleep questionnaires and sleep diaries they completed followed by an interview with a board-certified psychiatrist. The subjects were randomly assigned to red ginseng or placebo for 2 weeks of trial. The total daily dose of ginseng was 4,500 mg. The polysomnographic recordings were made at baseline and at 2 weeks after. The effects of red ginseng and placebo on sleep were assessed by comparing the changes in polysomnographic variables between the two groups. Results: A total of 15 subjects, 8 from red ginseng group and 7 from placebo group, were included to undergo polysomnographic procedures. The red ginseng group showed tendencies to increase stage 3 sleep (p=0.087) and to decrease stage 2 sleep (p=0.071) from the baseline compared with the placebo group. Conclusion: Korean red ginseng tends to increase deep sleep and decrease shallow sleep. Our result is in line, at least in part, with previous findings that Korean red ginseng increased total and NREM sleep in rats. Further studies with higher ginseng dosage, larger sample size and longer trial duration should be conducted to confirm the sleep stabilizing and balancing effects of Korean red ginseng.

• Safety and Health at Work
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• v.7 no.2
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• pp.111-119
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• 2016

Background: Shift work and/or sleep quality may affect health. We investigated whether shift work and sleep quality, separately and jointly, were associated with abnormal levels of triglycerides, total cholesterol (TC), and low-and high-density lipoprotein cholesterol in 360 police officers (27.5% women). Methods: Triglycerides, TC, and high-density lipoprotein were analyzed on the Abbott Architect; low-density lipoprotein was calculated. Shift work was assessed using City of Buffalo payroll work history records. Sleep quality (good, ${\leq}5$; intermediate, 6-8; poor, ${\geq}9$) was assessed using the Pittsburgh Sleep Quality Index questionnaire. A shift work + sleep quality variable was created: day plus good sleep; day plus poor sleep; afternoon/night plus good; and poor sleep quality. Mean values of lipid biomarkers were compared across categories of the exposures using analysis of variance/analysis of covariance. Results: Shift work was not significantly associated with lipids. However, as sleep quality worsened, mean levels of triglycerides and TC gradually increased but only among female officers (age- and race-adjusted p = 0.013 and 0.030, respectively). Age significantly modified the association between sleep quality and TC. Among officers ${\geq}40$ years old, those reporting poor sleep quality had a significantly higher mean level of TC ($202.9{\pm}3.7mg/dL$) compared with those reporting good sleep quality ($190.6{\pm}4.0mg/dL$) (gender- and race-adjusted p = 0.010). Female officers who worked the day shift and also reported good sleep quality had the lowest mean level of TC compared with women in the other three categories (p = 0.014). Conclusion: Sleep quality and its combined influence with shift work may play a role in the alteration of some lipid measures.

• Sleep Medicine and Psychophysiology
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• v.16 no.2
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• pp.65-73
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• 2009

Objectives: The purpose of this study was to assess the clinical and polysomnographic characteristics of Korean patients with obstructive sleep apnea syndrome (OSAS), especially in relation to differences due to age and gender. Methods: All subjects were consecutive patients who were proven to have OSAS with nocturnal polysomnography. They were interviewed with a structured interview format including sociodemographic information, past medical history, medication, and sleep-related history. Simultaneously, they were also given Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) to answer in order to check subjective sleep quality and subjective sleepiness. Results: Mean age of the 308 subjects was $49.5{\pm}$13.3 years, with 77.6% of the subjects being males and 22.4% of the subjects being females. The aging effects on the sleep architecture in Korean OSAS corresponded with normal aging, but with the effect of OSAS itself superimposed, the extent of aging effects was more marked than that of normal aging. The severity of Korean patients of OSAS was not correlated with age. When divided into age subgroups, significant correlation was found between RDI and BMI in patients of each subgroup of those in the 4th to 7th decades. The oldest subgroup (>70 years) described their subjective sleep quality as poorer than any other age subgroups, despite of less subjective drowsiness. The severity of OSAS and the change of sleep architecture of male subjects turned out to be severer than those of female ones. The female/male ratio of the subjects tended to increase with aging. Conclusions: The aging effect on the sleep architecture in Korean OSAS seems to be a mixture of the changes by normal aging and sleep disorder per se. The severity of OSAS was not correlated with age, but highly correlated with BMI. The severity of OSAS and the change of sleep architecture of male patients were severer than those of female ones.

• Sleep Medicine and Psychophysiology
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• v.21 no.1
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• pp.29-32
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• 2014

Objectives: The aim of current study is to evaluate the relationship between sleep, suicide and serotonin using some scales and loudness dependence of auditory evoked potentials (LDAEP). Methods: Total 65 patients who met the criteria for major depressive disorder were enrolled in current study. The patients were divided into two subgroups according to their insomnia and a history of suicide attempts. The auditory event-related potentials were measured to evaluate LDAEP before beginning antidepressants. Results: The scores of total Beck Depression Inventory (BDI) and BDI item 9 (suicide) were higher in insomnia subgroup than non-insomnia subgroup (respectively, p=0.0033 and p=0.03). However, LDAEP did not differ each other. The subgroup with a history of suicide attempts had a higher score of BDI item 9 than the subgroup without a history of suicide attempts (p=0.00012). There was a tendency for the LDAEP to be higher in the subgroup with a history of suicide attempts ($1.39{\pm}0.94{\mu}V$) than the sub-group without a history of suicide attempts ($1.05{\pm}0.75{\mu}V$), although the difference was not statistically significant (p=0.078). Conclusion: Suicidality was related to insomnia. In addition, there was a tendency for serotonin activity to be lower in the subgroup with a history of suicide attempts. In future, more studies are needed.