• The Journal of Korean Medical History
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• v.27 no.2
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• pp.99-120
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• 2014

Purpose : There are two types of sleep disturbance: inability to sleep (不眠) and somnolence (多眠). This study is to examine treatments of the two types of sleep disturbance in the Books of Cold Damage and how those theories were established and formed. Methods : 1. Verses including the words related to inability to sleep and somnolence were extracted from "Treatise on Cold Damage Diseases" (傷寒論). 2. Among the Books on Cold Damages that are classified according to the symptoms, 17 books with contents related to inability to sleep and somnolence were selected to collect and classify data in three perspectives: mechanism of disease (病機), method of treatment (治法) and disease pattern (病證). 3. Data collected through the above methods were compared and diagramed. Results & Conclusions : 1. On Cold Damage, inability to sleep is mostly rooted when human body lacks yin energy while having excessive yang energy (陽盛陰虛) due to fire and heat (火熱). The reason could be misuse of perspiration inducing method (汗法) or purgation (下法) on the doctors' part. 2. On Cold Damage, somnolence is rooted when pathogen (邪氣) is spread to yin meridians (陰經) and the human body lacks yang while having excessive yin energy (陰盛陽虛) or when heat (熱邪) is invaded into interior parts (裏部). 3. Many scholars of Cold Damage in later periods had copied the "Treatise on Cold Damage Diseases" for treatments of sleep disturbance but many others have applied the verses from "Treatise on Cold Damage Diseases" or added new treatments. Do jeol-am (陶節庵) and Wang Geung-dang (王肯堂) particularly had deep understanding on "Treatise on Cold Damage Diseases" and utilized the content freely or suggested new remedies because they had thorough knowledge on relating formula as well.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.385-389
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• 1996

Background: Nowadays, epidural morphine is commonly used in postoperative pain control. But epidural morphine may produce some side-effects, e.g. pruritus, nausea, vomiting, urinary retention and respiratory depression. Especially, pruritus is the most common complaint in pain-controlled patients by epidural morphine. So we evaluated whether addition of epidural butorphanol affects the degree of pruritus and pain score in pain controlled patients who by epidural morphine after hysterectomy. Methods: Group 1(N=15) received postoperative epidural 0.1% bupivacaine 100ml plus morphine 10 mg, group 2(N=15) received the mixture of butorphanol 2 mg with same regime as in group 1, group 3(N=15) received the mixture of butorphanol 4 mg with same regime as in group 1. All of the three groups received these solutions by infusion pump, 1 ml/hour, for postoperative 4 days. all groups received additional morphine 1.2 mg in 0.2% bupivacaine 6ml epidurally when the peritoneum was closed under general anesthesia. The severity of pain, pruritus, nausea and vomiting was estimated by 10 cm VAS(visual analogue scale) and somnolence by positive or negative during postoperative 4 days. Results: Severity of pruritus, but not nausea and vomiting was decreased in group 2 and 3 compared with group 1(p<0.05). Pain score was increased in group 3 at postoperative day(POD) 0 and 2 compared with group 1(p<0.05). Incidence of somnolence in group 1, 2 and 3 were $2.7{\pm}0.7,\;5.3{\pm}0.7$ and $10.0{\pm}1.0$ respectively. Conclusion: These results suggest that butorphanol reduce the degree of pruritus, the most common side effect of morphine, but increase the incidence of somnolence.

• Journal of Korean Clinical Nursing Research
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• v.22 no.3
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• pp.249-256
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• 2016

Purpose: The purpose of this study was to examine the effect of leg raising and peripheral excercise on recovery of the patients who were applied with dexmedetomidine for their dental surgery. Methods: There were two groups, the experimental group (n=35) and control group (n=35), in this study. We checked blood pressure, pulse rate, oxygen saturation, sedation level and symptoms such as dizziness and somnolence every 30 minutes. These parameters were assessed throughout the participants' recovery room stay. Leg raising and peripheral excercise were conducted in the experimental group in the recovery room. We have conducted chi-square test, Fisher's exact test, t-test, ANOVA, and ANCOVA to compare the measured parameters in both groups. Results: The experimental group showed a significant elevation of mean arterial blood pressure, and mitigation of somnolence, sedation and dizziness compared to the control group. Conclusion: Leg raising and peripheral exercise is effective to expedite recovery in the patients who were applied with dexmedetomidine for their dental surgery.

• The Korean Journal of Pain
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• v.29 no.1
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• pp.40-47
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• 2016

Background: Neuropathic pain, including paresthesia/dysesthesia in the lower extremities, always develops and remains for at least one month, to variable degrees, after percutaneous endoscopic lumbar discectomy (PELD). The recently discovered dual analgesic mechanisms of action, similar to those of antidepressants and anticonvulsants, enable nefopam (NFP) to treat neuropathic pain. This study was performed to determine whether NFP might reduce the neuropathic pain component of postoperative pain. Methods: Eighty patients, who underwent PELD due to herniated nucleus pulposus (HNP) at L4-L5, were randomly divided into two equal groups, one receiving NFP (with a mixture of morphine and ketorolac) and the other normal saline (NS) with the same mixture. The number of bolus infusions and the infused volume for 3 days were compared in both groups. The adverse reactions (ADRs) in both groups were recorded and compared. The neuropathic pain symptom inventory (NPSI) score was compared in both groups on postoperative days 1, 3, 7, 30, 60, and 90. Results: The mean attempted number of bolus infusions, and effective infused bolus volume for 3 days was lower in the NFP group for 3 days. The most commonly reported ADRs were nausea, dizziness, and somnolence, in order of frequency in the NFP group. The median NPSI score, and all 5 median sub-scores in the NFP group, were significantly lower than that of the NS group until postoperative day 30. Conclusions: NFP significantly reduced the neuropathic pain component, including paresthesia/dysesthesia until 1 month after PELD. The common ADRs were nausea, dizziness, somnolence, and ataxia.

• The Korean Journal of Pain
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• v.12 no.2
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• pp.250-252
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• 1999

A 77-year-old male patient was admitted to the hospital with acute appendicitis and underwent emergency appendectomy under inhalation anesthesia without any complications. After the operation, the patient was placed on epidural analgesia with the mixture of fentanyl-bupivacaine and scopolamine patch for nausea and vomiting. The patient experienced central anticholinergic syndrome (CAS) with hallucination, confusion, somnolence, dysarthria and delirium at 20 hours after patch placement and recovered from all symptoms of CAS in 24 hours after the removal of the patch. The CAS occurs when central cholinergic sites are occupied by specific drugs and also as a result of an insufficient release of acetylcholine. The diagnosis of CAS is often determined by a process of exclusion and not actually made until a positive therapeutic response to physostigmine, a centrally active anticholiesterase agent, has taken place. Treatment of CAS includes prompt removal of the patch, cleansing of the area, and physostigmine administration. The scopolamine patch should be used with extreme caution in elderly patient.

• Sleep Medicine and Psychophysiology
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• v.1 no.2
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• pp.117-124
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• 1994

Obstructive Sleep Apnea Syndrome(OSAS), that is a complex disease of neuromuscular, respiratory and cardiovascular system, can be cured by various treatment such as weight control, medical and surgical intervention. As most of OSAS may be caused by various anatomical abnormalities, preoperative evaluation for exact anatomical site of obstruction must be needed. And various diagnostic procedures such as fiberoptic nasopharyngoscopy, Mueller test, cinefluoroscopy, cephalometry, computerized tomography, polysomnography would be used for this purpose. Uvulopalotopharyngplasty is currently the most popular method for the patient with OSAS among various surgical maneuvers and is very effective for the relieving the symptoms as like snoring, daytime somnolence, and nocturnal restlessness etc. Although subjective improvement is not compatible with it's objective assessment in postoperative evaluation for it's results, uvulopalatopharyngoplasty could be a recommandable surgical procedure because of it's ample effectiveness in promoting symptom improvement without any risk of serious complications.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.643-646
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• 2016

Chordoid glioma of the third ventricle is a rare and challenging tumor to surgery because of its unique anatomical location and its close juxtaposition to the neurovascular structures and hypothalamus. The authors report a case of chordoid glioma of the third ventricle in a 43-year-old woman, who presented with headache and somnolence. The tumor was approached by endoscopic transnasal technique with a favorable result. Histopathologic examination disclosed a neoplastic tissue composed of eosinophilic epithelioid cells, mucinous, periodic acid Schiff-diastase positive, extracellular matrix, and scattered lymphoplasmacytic infiltrates. The best treatment option remains controversial. Customarily, the surgical route to remove chordoid glioma is transcranial; however, the undersurface of the optic chiasm and optic nerves preclude an adequate surgical visualization. In contrast, an expanded endoscopic transnasal approach provides a direct midline corridor to this region without any brain retraction.

• The Korean Journal of Pain
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• v.26 no.3
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• pp.277-285
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• 2013

Background: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. Methods: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. Results: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). Conclusions: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.

• Journal of Korean Academy of Nursing
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• v.36 no.5
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• pp.829-836
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• 2006

Purpose: The purpose of the present study was to identify prevalence of excessive daytime sleepiness(EDS) and its associations with sleep habits, sleep problems, depression, subjective health status and obesity in community dwelling adults. Method: Data was collected from adults aged 20-59 years by random sampling. Subjects completed a questionnaire which was composed of the Epworth Sleepiness Scale, Center for Epidemiologic Studies Depression Scale, and questions that included items about sleep habits, sleep problems, subjective health status and sociodemographic characteristics. Height and weight were measured for calculation of body mass index. The statistical analyses was based on 3,302 adults (51.5% males and 48.5% females). Descriptive statistics, univariate logistic regression and multiple logistic regression were used. Result: The prevalence of EDS was 17.1% Multiple logistic regression showed that the associated factors of EDS were depression, obesity, dissatisfaction with sleep time, irregular sleep, and habitual snoring. Depression was the most significant associated factor(adjusted odds ratio for severe depression=2.27, 95% Confidence Interval=1.73-2.96). Conclusion: EDS is a common symptom in adults. Our finding suggested that persons with a complaint of EDS should be completely assessed for depression and obesity as well as sleep problems.

• Sleep Medicine and Psychophysiology
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• v.16 no.2
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• pp.61-64
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• 2009

Obstructive sleep apnea (OSA) has been definitively shown to be a risk factor for the development of cardiovascular disease and mortality. Recent reports have indicated that obstructive sleep apnea is associated with insulin resistance and impaired glucose metabolism, also have type 2 diabetes. The potential mechanisms leading to the development of type 2 diabetes in OSA patients are likely to be various. Reduced physical activity resulting from daytime somnolence, sympathetic nervous system activation, intermittent hypoxia, sleep fragmentation and sleep loss, dysregulation of the hypothalamic-pituitary axis, alteration in adipokine profiles, and activation of inflammatory pathways have been proposed. Based on the current evidence, clinicians should assess the risk of OSA in patients with type 2 diabetes and, conversely, consider that possibility of glucose intolerance in patients with OSA. Further large-scale and long-term follow-up studies in patient populations with selected by reliable but inexpensive diagnostic measures, controlled for potential confounder factor, are needed.