• 대한상한금궤의학회지
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• v.11 no.1
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• pp.63-71
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• 2019

Objective : This case report aimed to demonstrate the effect of Baekhogainsam-tang on hypersomnolence. Methods : A 33-year-old woman complained of hypersomnolence with fatigue and lack of concentration in the daytime. According to the diagnostic system based on Shanghanlun provisions (DPIDS), the patient was treated with Baekhogainsam-tang decoction. The result was evaluated by the Epworth Sleep Scale. Results : After administration of Baekhogainsam-tang decoction for 30 days, the Epworth Sleep Scale score was decreased from 15 (pathologic sleepiness) to 1 (no clinically significant sleepiness). Conclusions : The patient completely recovered from hypersomnolence and fatigue following treatment with Baekhogainsam-tang decoction according to DPIDS.

• Safety and Health at Work
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• v.11 no.2
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• pp.244-247
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• 2020

The occurrence of the shift work disorder (SWD) in health-care workers (HCWs) employed in 24/7 hospital wards is a major concern through the world. In accordance with literature, SWD is the most frequent work-related disturb in HCWs working on shift schedules including night shift. In agreement with the Luxembourg Declaration on workplace health promotion (WHP) in the European Union, a WHP program has been developed in a large Hospital, involving both individual-oriented and organizational-oriented measures, with the aim to prevent the occurrence of SWD in nurses working on shifts including night shift. The objective assessment of rotating shift work risk and the excessive sleepiness were detected before and after the implementation of the WHP program, by using the Rotating Shiftwork-questionnaire and the Epworth Sleepiness Scale. The findings of this study showed the effectiveness of the implemented WHP program in minimizing the impact of shift work on workers' health and in preventing the misalignment between sleep-wake rhythm and shift working.

• Sleep Medicine and Psychophysiology
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• v.22 no.1
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• pp.11-19
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• 2015

Objectives: Whether daytime sleepiness is proportional to the severity of sleep apnea in obstructive sleep apnea syndrome (OSAS) is controversial. In this study we investigated how insomnia severity affects the association between daytime sleepiness and sleep apnea severity in OSAS. Methods: The present study included 235 male subjects who were diagnosed with OSAS based on clinical history and nocturnal polysomnography. Pearson's correlation analysis was conducted among sleep and mood-related self-reported data, polysomnographic data and demographic data of all subjects. Based on Pittsburgh Sleep Quality Index (PSQI), the subjects were divided into 2 groups; group A (n = 75; $PSQI{\leq}5$) and group B (n = 160; PSQI > 5). Partial correlation analysis was performed between the Epworth Sleepiness Scale (ESS) and other data in both groups. Multiple linear regression analysis was conducted to investigate the factors which affected the ESS in group A. Results: Pearson's correlation analysis showed weak or non-existent correlations between ESS and apnea severity data such as apnea-hypopnea index (AHI) (r = 0.148, p = 0.023), apnea index (AI) (r = 0.137, p = 0.036), hypopnea index (HI) (r = 0.058, p = 0.377), oxygen desaturation index (ODI) (r = 0.149, p = 0.022) and arousal total index (ATI) (r = 0.129, p = 0.048). Positive correlations between ESS and apnea severity data such as AHI ($r_p=0.313$, p = 0.008), AI ($r_p=0.339$, p = 0.004), ODI ($r_p=0.289$, p = 0.015) and ATI ($r_p=0.256$, p = 0.031) were observed only in group A. Multiple regression analysis showed that AI (t = 2.996, p = 0.004) and BAI (t = 2.721, p = 0.008) were associated with ESS in group A. Conclusion: The correlation between daytime sleepiness and sleep apnea severity was shown only in group A. This result suggests that associations between daytime sleepiness in OSAS and sleep apnea severity will become prominent when controlling for insomnia-related variables.

• Sleep Medicine and Psychophysiology
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• v.12 no.2
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• pp.117-121
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• 2005

Objectives: The purpose of this study was to assess the difference of subjective daytime sleepiness level between primary insomnia patients and healthy control subjects. We also investigated the relationship between subjective daytime sleepiness level and variables of nocturnal polysomnograghic sleep architecture of insomnia patients. Method: Total subjects were 87 patients with primary insomnia diagnosed with polysomnography and 88 normal controls. The daytime sleepiness level in each group was measured by Korean version of Epworth Sleepiness Scale (ESS). The correlations of ESS score and nocturnal polysomnographic variables were calculated in the patient group. Results: Patients with insomnia had the lower ESS scores than the control group. In patients group, the ESS score showed significant negative correlations with total sleep time, sleep efficiency%, and stage 2 sleep time%. The ESS score also showed significant positive correlations with number of awakenings, number of awakenings more than 2 minutes, and wake after sleep onset time. Conclusions: Insomnia patients showed lower level of subjective daytime sleepiness that may indicate their higher alertness comparing to control subjects. Daytime sleepiness of patients with insomnia was associated with polysomnographic variables including total sleep time, sleep efficiency%, stage 2 sleep time% and disrupted continuity of nocturnal sleep.

• Sleep Medicine and Psychophysiology
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• v.6 no.1
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• pp.76-84
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• 1999

Objectives: A number of studies have shown that sleep deprivation results in reduced vigilance and increased negative affects such as tension, depression and anger. However there are few studies about effects of sleep deprivation on anxiety. The purpose of this study was to investigate the effects of 40 hour sleep deprivation on state anxiety, affects, sleepiness and fatigue. The authors also intended to study the effect of trait-anxiety on these psychological variables after sleep deprivation. Methods: Twenty nine subjects(22 men, 7 women, $24.59{\pm}1.35$ years of age) participated in this study. Subjects had no past history of psychiatric disorders and physical illnesses, and had normal sleep-waking cycle without current sleep disturbances. All of the subjects completed sleep dairy for two weeks to exclude some who suffered from chronic sleep deprivation or sleep disturbances. Subjects were instructed to get a normal sleep as usual at night before the study. After awakening, subjects remained awake for 40 hours under continuous surveillance. They completed State-Trait Anxiety Inventory, Index of General Affect, Stanford Sleepiness Scale and Fatigue Questionnaire every three hours, therefore they completed the scales 14 times totally. Subjects were dictated not to take caffeine, alcohol, or any medications on the day of the study. Heavy exercises and naps were restricted too. Results: Sleep deprivation resulted in increased state anxiety, negative general affects, and increased sleepiness and fatigue(p<.001). Dividing into high trait-anxiety group and low trait-anxiety group, there was significant sleep deprivation x traitanxiety interaction effect on general affect(p<.05). But, there was no significant sleep deprivation x trait-anxiety interaction effect on state-anxiety, sleepiness and fatigue. During sleep deprivation, the highest ratings of scales on anxiety, negative affect, sleepiness and fatigue occurred between 4 : 00AM and 7 : 00AM. Conclusions: These results show that sleep deprivation results in increased anxiety, mood state disturbance and increment of sleepiness and fatigue. These findings also suggest that trait-anxiety is a factor that influences the degree of worsening in general affect caused by sleep deprivation. During sleep deprivation, the rating curves of anxiety, affect, sleepiness and fatigue show rhythmicity that may be related to circadian rhythm.

• Sleep Medicine and Psychophysiology
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• v.5 no.1
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• pp.71-79
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• 1998

Objectives : This study was to evaluate sleep patterns and daytime sleepiness resulting from rotating shiftwork. The authors, also, tried to find out the relationship between the severity of daytime sleepiness and personality factors. Methods : The subjects consisted of 41 female rotating shiftwork nurses and the control group consisted of 39 female day timeworkers. All of them completed the Sleep questionnaire of Korea University Sleep Disorder Clinic, the Epworth Sleepiness Scale(ESS), the 16 Personality Factors(16PF), the Beck Depression Inventory(BDI) and the State Trait Anxiety Inventory(STAI). Multiple regression analysis of 16PF of the rotating shiftwork nurses was done to find out possible predictors of the severity of daytime sleepiness. Results : The mean duration of deprived sleep due to rotating shiftwork was $64.26\;{\pm}\;14.54\;min$. The frequency of sleep difficulty($1.24\;{\pm}\;1.17\;day/week$ vs $0.67\;{\pm}\;1.31\;day/week$, p < 0.05), time needed to fall asleep($103.05\;{\pm}\;73.48\;min$. vs $70.00\;{\pm}\;60.08\;min$, p < 0.05), sleep duration when having some difficulties in sleep ($204.25\;{\pm}\;79.90\;min$. vs $280.44\;{\pm}\;111.59\;min$., p < 0.001), recent changes in energy($x^2\;=\;4.16$, p < 0.05), worrying about sleep($x^2\;=\;11.08$, p < 0.05), and taking naps($x^2\;=\;4.98$, p < 0.05) showed significant differences between rotating shiftworkers and normal controls. The ESS socre of shiftworkers ($8.68\;{\pm}\;3.04$) was greater than that of normal controls ($6.86\;{\pm}\;3.04$)(p < 0.01). Personality factors such as C factor($R^2\;=0.283$), I factor($R^2\;=0.358$) and G factor($R^2\;=0.470$) were related with the severity of the daytime sleepiness(p < 0.001). Conclusions : The rotating shiftwork nurses had more difficulties in sleep such as having difficulties in falling asleep and in maintaining sleep, and showed lowered energy, decreased senses of well-being and so on. The rotating shiftwork nurses experienced more severe daytime sleepiness than controls did. Personality factors, such as C factor, I factor, and G factor of 16PF were suggested to be useful for predicting the severity of daytime sleepiness resulting from rotating shiftwork.

• Journal of the Korean Society of Safety
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• v.30 no.2
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• pp.56-62
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• 2015

The purpose of this study was to identify the relationship between the index of Electrocardiography(LF/HF) and the occurrence of drowsiness driving while driving in a simulated situation. Participants were 31 undergraduate students with an experience in driving and they participated 30 minutes driving under enough sleep condition and 1 hour under the sleep deprivation condition. The Euro Truck Simulator II was used for driving simulation task and ECG and perceived drowsiness of each participants were measured during two driving conditions. Perceived sleepiness recorded by the checklist every 10 minutes and ECG data extracted before and after 15 seconds of every 10 minutes to verify the relationship between two variables. The results showed that the level of perceived sleepiness under sleep deprivation condition was higher than that under the enough sleep condition, and the level of LF/HF under sleep deprivation condition was lower than that under the enough sleep condition. In addition, the result of analysis of repeated measure ANOVA for ECG indicated that authentic sleepiness revealed in 20 minutes after the start of driving under the sleep deprivation condition. However, the result of perceived drowsiness indicated that authentic sleepiness revealed in 30 minutes after the start of driving. These result suggest that the time difference between biological and perceived response on drowsiness may be exist. Finally, the significant negative correlation between the LF/HF level and perceived drowsiness was observed. These findings suggest that ECG(LF/HF) can be an possible index to measure drowsiness driving.

• Journal of East-West Nursing Research
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• v.17 no.2
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• pp.81-86
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• 2011

Purpose: The purpose of this study was to examine job involvement according to working pattern and daytime sleepiness in hospital nurses. Methods: At 2 hospitals in affiliation of university, after obtaining participant's consent form, data were collected from October to November, 2007. Twohundred fifty nurses participated in the study. Questionnaire consisted of Epworth Sleepiness Scale (ESS), Job Involvement. Collected data was analyzed with SPSS 14.0 program, which was used for frequency, percentage, mean, standard deviation, t-test and Pearson correlation coefficients. Results: Major findings of this study were as follows 1) The nurses for 3 shift work was 172 (68.8%), the nurses for 2 shift work was 3 (1.2%) and the nurses for day fixation was 75 (30.0%). 2) Mean of ESS was 5.94 (3.28), daytime sleepiness was 13.2% and Job involvement had a mean of $21.27.{\pm}4.61.3$) There were significant differences between shift work and day fixed work on ESS (t=4.33, p<.001), job involvement (t=6.54, p<.001). Higher ESS were significantly related to lower job involvement (r=-.185, p=.003). Conclusion: The finding of this study gives useful informations about sleep and work involvement of hospital nurses. It is need to develop systemic management for shift work nurses by hospital, nurse organization, and government.

• Sleep Medicine and Psychophysiology
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• v.8 no.2
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• pp.138-143
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• 2001

Sleepiness is associated with many different conditions and, as a neglected topic, it can be the cause of serious psychological and social disadvantages. In the aspect of learning, additional problems may arise from poor progress in school caused by the effect of sleepiness on concentration, memory, and other cognitive functions. Narcolepsy is by no means the most common cause of excessive sleepiness. Nonetheless, it is not a rarity, especially in young people. The non-specific nature of early features of narcolepsy, combined with very limited awareness that the condition can start in various ways, leads to many misinterpretations. Misinterpretation of narcolepsy symptoms is not confined to the medical profession. Teachers may well be critical of a student with narcolepsy because of their perception of narcolepsy symptoms as laziness, poor motivation, or difficult behavior and dull learning ability. Inappropriate reactions by parents, teachers, and peers, based on misinterpretation of narcolepsy symptoms or the patient's reactions to them, make a difficult situation worse. Especially in Korea, where schooling is focused on college entrance examinations, the problem is very serious and intensified by inappropriate or delayed diagnosis and treatment. Therefore, psychiatrists should be aware that narcolepsy in young adolescents is not rare and that they need to be familiar with its clinical features in both its classic and less obvious forms. Narcolepsy should be suspected if a adolescent's excessive sleepiness can not be explained in other ways. Therefore, we report on two patients who portray the tendency of dull learning ability and are mistaken as idle students. We diagnosed narcolepsy through polysomnography and multiple sleep latency testing. We treated the students with methylphenidate and pemolin. The students showed improvement in learning ability and were able to adapt better to school.

• Journal of Oral Medicine and Pain
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• v.33 no.2
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• pp.205-218
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• 2008

Interaction between pain and sleep has long been proved through many researches, and various studies are being conducted to identify its mechanism. However, these studies have targeted on patients with systemic disease, such as rheumatic disease and fibromyalgia. There are few researches on patients with orofacial pain including temporomandibular disorder(TMD). In this study, we studied interaction between pain aspect and sleep quality in 229 patients with TMD, who visited the TMJ and Orofacial pain clinic. Pittsburgh Sleep Quality Index(PSQI), Epworth sleepiness scale(ESS) questionnaire were surveyed and sleep-screening device was operated. PSQI showed that sleep quality in TMD patients with pain was poorer than that in TMD patients without pain. The ratio of poor sleeper was higher in TMD patients with pain. Especially, TMD patients with chronic pain showed obviously poorer sleep quality than TMD patients with acute pain. The result of ESS showed that patients with painful TMD showed more daytime sleepiness than painless TMD patients. The ratio of TMD patients with chronic pain who had daytime sleepiness was higher than TMD patients with acute pain, and the amount of daytime sleepiness was higher in the group of chronic pain. In TMD patients with chronic pain, only the poor sleeper(PSQI>5) presented mean ESS>10(diagnostic criteria of daytime sleepiness). There was no correlation between pain intensity and sleep quality or daytime sleepiness. The result of ApnealinkTM for screening of sleep related breathing disorder showed that only 1 patient presented AHI>5 among 19 participants. TMD patients with chronic pain presented poor sleep quality and excessive daytime sleepiness similar to other chronic pain patients. Evaluation of sleep state by questionnaire might be useful for diagnosis and management of TMD, because sleep disturbance decreases pain threshold and pain disturbs sleep. In addition, sleep-screening device would be useful for screening sleep related breathing disorder in dental clinic.