• Sleep Medicine and Psychophysiology
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• v.8 no.1
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• pp.30-36
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• 2001

Object: Diurnal variation is included in the diagnostic criteria of the major depressive disorder, melancholic specifier. But there has been controversy over whether diurnal variation is an unique depressive symptoms or a symptom related to a change of sleep patterns, or that of another mechanism, when the previous studies are reviewed. We investigated the existence of diurnal variation according to the subtype of depression and whether diurnal variation is charateristic of melancholic depression or not. We also compared sleep variables according to the existence of diurnal variation. Method: We examined diurnal variation, sleep patterns, severity of depression using the Visual Analogue Mood Scale, Pittsburgh Sleep Quality Index, and Hamilton Depression Rating Scale. Patients recorded their mood state on the Visual Analogue Mood Scale twice a day, morning and evening, for diurnal variation. We divided depressive patients into two groups,-diurnal variation group and nondiurnal variation group,-and compared the mood and sleep variables using SPSS. Results: The frequency of diurnal variation is not significantly different among the subtypes of depression. Significant differences between the diurnal variation group and the nondiurnal variation group existed in middle insomnia and sleep time (p<0.05). In melancholic type, al significant difference between the diurnal variation group and the nondiurnal variation group was noticed in PSQI total, sleep latency, sleep disturbances, daytime dysfunction as well as middle insomnia and sleep time (p<0.05). Conclusions: Diurnal variation existed in other types of depression as well as melancholic type. The results showed that diurnal variation was not a specific symptom of melancholic type, and existence of diurnal variation might be related to sleep patterns.

• Tuberculosis and Respiratory Diseases
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• v.60 no.1
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• pp.76-82
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• 2006

Background : The objective of this study was to understand sleep-related problems, and to determine whether the sleep questionnaires is a clinically useful method in patients who need polysomnography. Methods : Subjects were patients who performed polysomnography and who asked to answer a sleep questionnaires at the Sleep Disorders Clinic of St. Paul's Hospital, Catholic University of Korea. Baseline characteristics, past medical illness, behaviors during sleep-wake cycle, snoring, sleep-disordered breathing and symptoms of daytime sleepiness were analyzed to compare with data of polysomnography. Results : The study population included 1081 patients(849 men, 232 female), and their mean age was $44.2{\pm}12.8years$. Among these patients, 38.9% had an apnea-hypopnea index(AHI)<5, 27.9% had $5{\leq}AHI<20$, 13.2% had $20{\leq}AHI<40$, and 20.0% had $40{\leq}AHI$. The main problems for visiting our clinic were snoring(91.7%), sleep apnea(74.5%), excessive daytime sleepiness(8.0%), insomnia(4.3%), bruxism(1.1%) and attention deficit(0.5%). The mean value of frequency of interruptions of sleep was 1.6 and the most common reason was urination(46.3%). Epworth Sleepiness Scale(ESS) had a weak correlation with AHI(r=0.209, p<0.01). When we performed analysis of sleep questionnaires, there were significant differences in the mean values of AHI according to the severity of symptoms including snoring, daytime sleepiness, taking a nap and arousal state after wake(p<0.05). Conclusion : On the basis of statistical analysis of sleep questionnaires, the severity of subjective symptoms such as ESS, snoring, daytime sleepiness and arousal state after wake correlated with the AHI significantly. Therefore the sleep questionnaires can be useful instruments for prediction of the severity of sleep disorder, especially sleep-disordered breathing.

• Sleep Medicine and Psychophysiology
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• v.9 no.2
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• pp.106-114
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• 2002

Objectives: Daytime sleepiness is a common symptom and is associated with sleep behavior, sleep deprivation, and night shift, etc. It is also one of the most important symptoms of sleep disorders like obstructive sleep apnea (OSA). According to our survey on Korean literature, a few studies have dealt with daytime sleepiness, and we have not been able to locate any study comparing normal subjects with polysomnography-proven sleep disorder patients regarding daytime sleepiness. We aimed at comparing daytime sleepiness among normal healthy daytime workers, medical students being expected to have daytime sleepiness due to chronic sleep deprivation, and patients having sleep disorders diagnosed with polysomnography. We also studied the association between subjective daytime sleepiness and objective polysomnographic findings in patients with sleep disorders. Methods: One hundred three hospital workers, 137 medical students, and patients with sleep disorders were studied. Sleep disorders included OSA, periodic limb movements in sleep (PLMS), insomnia, and narcolepsy. The degree of subjective sleepiness in each group was measured by the Korean version of Epworth sleepiness scale and compared. The relationship between polysomnographic findings reflecting severity of sleep disorder in each patient group and subjective sleepiness was analyzed. As for patients with narcolepsy, the relationship between the mean sleep latency and subjective sleepiness was studied. Results: There was a significant difference of ESS score (F=68.190, dF=5.752, p<0.001) among daytime workers, medical students, and sleep disorder patients. In OSA patient group, the degree of the sleepiness had no significant correlation either with mean O2 satuaration (p=0.062) or with RDI (p=0.807). In PLMS patient group, there was no correlation between periodic limb movement index (PLMI) and subjective sleepiness (p=0.761). In narcolepsy patient group, the subjective sleepiness had no correlation with mean sleep latency measured with MSLT (p=0.055). Conclusion: We found a significant difference of subjective sleepiness among daytime workers, medical students, and patients with sleep disorders. However, no consistent correlation was found between severity of subjective sleepiness and objective polysomnographic findings reflecting severity of each sleep disorder. This research confirms that the evaluation of subjective sleepiness is important clinically, but it cannot substitute the objective measures such as nocturnal polysomnography and MSLT.

• Journal of Oriental Neuropsychiatry
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• v.27 no.3
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• pp.131-146
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• 2016

Objectives: This study was performed to determine the correlation between Instrument on Pattern Identification for Depression and Psychological tests by Pearson Correlation Coefficient and Regression analysis.Methods: Two assessors carried out the evaluation using the instrument on pattern identification for depression. They also performed the following psychological tests: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), State-Trait Anger Expression Inventory (STAXI), the Temperament and Character Inventory (TCI), Insomnia Severity Index (ISI_Total), Self-disclosure Inventory, subjective well-being Inventory, Health perception Inventory, and Personality Assessment Inventory (PAI). A total of 167 participants who got HAM-D score over 12 were targeted for the evaluation. Our research team carried out Pearson correlation coefficient analyses and regression analysis between pattern identification for depression and Psychological tests. We listed the results by descending order and interpreted the results.Results: Pearson correlation analysis revealed the following results: 1) Stagnation of Liver Gi was associated with BDI (0.60) and STAI (0.55); 2) Dual Deficiency of the Heart and Spleen was associated with BDI (0.60), ISI_Total (0.52), and STAI (0.42); 3) Relieving stagnation of Phlegm-Gi was associated with BDI (0.65), STAI (0.54), and Subjective well-being inventory (−0.52); 4) Gi-deficiency Mingled with sputum was associated with BDI (0.50), ISI_Total (0.40), and STAI (0.395); 5) Stagnant Gi transforming into fire was associated with BDI (0.56), STAI_TR (0.51), and Health perception Inventory (−0.458); 6) Yin-Deficiency with Effulgent Fire was associated with BDI (0.55), ISI_total (0.54), and STAI (0.41).Conclusions: Through correlation analysis between Instrument on Pattern Identification for Depression and Psychological tests, we could suggest a System for Oriental Medical Diagnosis for Depression.

• Journal of Oriental Neuropsychiatry
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• v.23 no.4
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• pp.133-152
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• 2012

Objectives : The purpose of this study is to investigate the effect of Sihogayonggolmoryeo-tang on the anxiety of Hwa-byung. Methods : In this randomized, double blinded, placebo-controlled study, we planned to give Sihogayonggolmoryeo-tang or controlled medication for anxiety of Hwa-byung. Hamilton Anxiety Scale (HAM-A) was measured as the 1st evaluative instrument, and Korean State-Trait Anxiety Inventory (STAI-K), Likert scale for major symptom of Hwa-byung, Hwa-Byung Scale Score, Korean Beck's Depression Inventory (BDI-K), Korean State-Trait Anger Expression Inventory (STAXI-K), Insomnia severity Index (ISI), Instrument of Oriental Medical Evaluation for Hwa-Byung, WHO Quality of Life Avvreviated (WHOQOL-BREF), genral self-Efficacy Scale (GSES), Rosenberg Self-Esteem Inventory (SRE) and Heart Rate Variability (HRV) were also measured as the 2nd evaluative instrument before treatment. Results : Clinical characteristics-vital signs and demographic characteristics showed no significant difference between both groups. The characteristics of disease-chief complaint, pattern Identification, period, etiological factor, and etc, also showed similarity of distribution in both groups. The results of Chest PA, EKG and clinicopathologic examination showed no significant difference between both groups. There were no significant difference between both groups in all valuation scales; HAM-A was measured as the first evaluative instrument, and STAI-K, Likert scale for major symptom of Hwa-byung, Hwa-Byung Scale Score, BDI-K, STAXI-K, ISI, Instrument of Oriental Medical Evaluation for Hwa-Byung, WHOQOL-BREF, GSES, SRE and HRV. Conclusions : We considered that establishment of the experimental group and controlled group was objective and worth conducting this research. In addition, this methodology is expected to be applied to the subsequent research. Further, we hope to make up for this study through various study and discussion.

• Sleep Medicine and Psychophysiology
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• v.9 no.2
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• pp.115-121
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• 2002

Objectives: Although sleep paralysis (SP) has been known as one of the symptoms of narcolepsy, recently it has become recognized as occurring frequently in the general population. However, the prevalence of SP and its associated factors in patients with major psychiatric disorders remain unknown. This study investigated the prevalence of SP and a variety of associated experiences in those patients. Methods: The subjects were 160 psychiatric patients and 143 age- and sex-matched controls. The Korean version SP questionnaire as well as the Sleep-Wake Schedule, Epworth Sleepiness Scale and Insomnia Severity Index were administered to all the subjects. The patients were referred from Dong-A University Hospital and consisted of 74 diagnosed as schizophrenia (47.7%), 26 as bipolar disorder (16.8%) and 55 as major depression (35.5%). Results: Nearly 42% of the patient group and 39% of the control group had experienced at least one episode of SP in their lifetime, with no significant difference between the groups. However, the patient group had experienced SP more frequently than the control group. Among all subjects, no gender difference in SP incidence was found. The peak age of onset was in the range of 16-25 years for both groups. Over eight tenths of both groups reported hallucinations and over seven tenths of both groups experienced fear accompanying SP. Conclusion: This study shows that there is no difference in the lifetime prevalence of SP between psychiatric patients and the general population, whereas frequency of SP experience is higher in psychiatric patients. Terrifying hallucinations and fearful feelings frequently accompany SP in both groups.

• Sleep Medicine and Psychophysiology
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• v.21 no.2
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• pp.80-84
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• 2014

Introduction: Sleep has numerous important physiological and cognitive functions that may be particularly important to elite athletes. Sleep deprivation can have significant effects on athletic performance. However, there are few published data related to the amount of sleep obtained by elite athletes. We investigated sleep patterns of Korean women golfers using sleep-related questionnaires. Methods: For this study, 98 Korean university women golfers and 46 age- and sex-matched controls were recruited. All subjects were asked to complete the self-administered sleep questionnaire consisting of questions about habitual sleep patterns (sleep onset time, sleep latency, awakening time in the morning, day time napping time), exercise habits, Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISS), Pittsburgh Sleep Quality Index (PSQI), validation of the Perceived Stress Scale (PSS), and Beck Anxiety Inventory (BAI). Results: The sleep onset time was significantly earlier (pm 23 : $05{\pm}00$ : 52 and 00 : $14{\pm}00$ : 51 ; t = 5.287, p < 0.001), the waking time was later (am 07 : $21{\pm}01$ : 09 and 6 : $35{\pm}00$ : 32; t = -2.715, p = 0.008), the weekday total sleep time was greater ($417.77{\pm}78.18$ minute and $351.52{\pm}77.83$ minute ; t = 4.406, p = 0.001), and the daytime nap time was greater ($77.73{\pm}41.28$ minute and $20.22{\pm}33.03$ minute ; t = 7.623, p < 0.001) in the golf athletes compared to the controls. The PSQI scores were significantly lower, but estimated sleep latency and ESS, ISS, PSS, and BAI scores were not different among the two groups. Conclusion: This study suggests that Korean university women golfers have good sleep patterns resulting in no difference in sleep-related stress compared to age- and sex-matched control students.

• Sleep Medicine and Psychophysiology
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• v.24 no.1
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• pp.24-31
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• 2017

Objectives: Periodic limb movement disorder (PLMD) has been debated with regard to its clinical significance and diagnostic criteria. The current diagnostic criterion for PLMD in adults has been changed from periodic limb movement index (PLMI) > 5/hour to PLMI > 15/hour by the International Classification of Sleep Disorders (ICSD). In this study, we aimed to investigate the changes in polysomnographic sleep variables according to PLMI and to determine the relevance of the diagnostic criterion for PLMD. Methods: Out of 4195 subjects who underwent standard polysomnography, we selected 666 subjects (370 males and 296 females, aged $47.1{\pm}14.8$) who were older than 17 years and were not diagnosed with primary insomnia, sleep apnea, narcolepsy, or REM sleep behavior disorder. Subjects were divided into three groups according to PLMI severity: group 1 ($PLMI{\leq}5$), group 2 (5 < $PLMI{\leq}15$), and group 3 (PLMI > 15). Demographic and polysomnographic sleep variables and Epworth sleepiness scale (ESS) were compared among the three groups. Results: There were significant differences among the three groups in age and gender. Sleep efficiency (SE) and stage 3 sleep percentage in group 1 were significantly higher than those in groups 2 and 3. The wake after sleep onset (WASO) score in group 1 was significantly lower than those in groups 2 and 3. However, there were no significant differences in SE, stage 3 sleep percentage, or WASO between groups 2 and 3. Sleep latency (SL) in group 1 was significantly lower than that in group 3, but there was no difference in SL between group 2 and group 3. ESS score in group 1 was significantly higher than that in group 3, but there was no difference between group 2 and group 3. Partial correlation analysis adjusted by age showed that PLMI was significantly related to SE and WASO. Conclusion: This study suggests that PLMI influences polysomnographic sleep variables. In addition, we found the individuals who did not have PLMD but had PLMI > 5 were not different in polysomnographic sleep variables from the individuals who had PLMD according to the current criterion. These results raise questions about the relevance of the current diagnostic criterion of PLMD.

• Sleep Medicine and Psychophysiology
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• v.29 no.1
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• pp.21-28
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• 2022

Objectives: Our study aimed to investigate the relationship between the anxiety at first year and chronotype and sleep quality at third year in medical students. We also investigated the association between sleep quality, chronotype, depression and resilience at third year. Methods: Fifty two medical students (36 males, 69%, aged 21 ± 0.93) in first year, and forty four medical students (31 males, 70.5%, aged 23.05 ± 0.99) at third year answered Beck Depression Inventory 2, Beck anxiety inventory, Insomnia severity index-K, Composite scale of morningness and Conner-Davidson Resilience scale-10. Multiple linear regression analysises were performed to identify predictors of chronotype, sleep quality and resilience. Results: Higher anxiety (β = -0.434, p = 0.006) at first year was significant predictor of eveningness at third year, while lower anxiety score (β = 0.606, p < 0.001) at first year was significant predictor of sleep quality at third year. Lower sleep quality (β = -0.314, p = 0.042) and eveningness (β = 0.315, p = 0.041) were associated with low resilience at third year. Also, Lesser depression (β = -0.717, p < 0.001) was associated with higher resilience at third year. Conclusion: Our study showed that higher anxiety in first year had significantly related with eveningness and poor sleep quality at third year. In addition, higher sleep quality, morningness and less depression had significantly associated with better resilience at third year.