{"title":"The Efficacy of Cognitive Behavioral Therapy for Insomnia and Factors Associated with Favorable Outcome","authors":"Ji-Hyun Jung, B. Lee, H. Moon, Y. Cho","doi":"10.13078/JKSRS.13008","DOIUrl":"https://doi.org/10.13078/JKSRS.13008","url":null,"abstract":"Objectives: Cognitive behavioral therapy for insomnia (CBT-I) is a treatment for chronic insomnia via psychological intervention. CBT-I is as effective as pharmacotherapy for insomnia patients. This study inves tigates the clinical efficacy of CBT-I and factors associated with good outcome. Methods: 27 patients were included in this study, who visited sleep center from October 2011 to June 2012. All patients underwent baseline polysomnography for diagnosis and completed at least three sessions of CBT-I. The sleep scales and sleep diary were done. The clinical efficacy of CBT-I were evaluated by comparing changes of sleep efficacy (SE) between before and after the treatment based on the sleep diary. We grouped these patients into higher SE group and lower SE group according to their final SE. Then we retrospectively reviewed clinical characteristics and polysomnographic parameters in both groups to elucidate the factors associated with favorable outcome of CBT-I. Results: After CBT-I all patients showed significant improvement of sleep parameters (total sleep time, 181 min vs. 308 min; SE, 40% vs. 74%; sleep latency, 100 min vs. 41 min, wakefulness after sleep onset, 185 min vs. 59 min). There were no differences in sleep scales except Beck Depression Inventory between the higher SE group and the lower SE group. There were no differences in subjective sleep parameters of sleep diary between two groups at baseline. Conclusions: At least three sessions of CBT-I at this center was effective. CBT-I was more effective in patients who were depressive. J Korean Sleep Res Soc 2013;10:39-44","PeriodicalId":243131,"journal":{"name":"Journal of Korean Sleep Research Society","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127654980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Ryu, Eun Mi Lee, Gha-Hyun Lee, Bomi Kim, Sang-Ahm Lee
{"title":"Prevalence and Predicting Factors of Complex Sleep Apnea in Patients with Obstructive Sleep Apnea Syndrome","authors":"H. Ryu, Eun Mi Lee, Gha-Hyun Lee, Bomi Kim, Sang-Ahm Lee","doi":"10.13078/JKSRS.13010","DOIUrl":"https://doi.org/10.13078/JKSRS.13010","url":null,"abstract":"Address for correspondence Sang-Ahm Lee, MD, PhD Division of Epilepsy and Sleep, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-3445 Fax: +82-2-474-4691 E-mail: salee@amc.seoul.kr Objectives: Some patients with obstructive sleep apnea syndrome (OSAS) experience development of central sleep apnea (CSA) during continuous positive airway pressure (CPAP) application (complex sleep apnea, compSA). We reviewed the prevalence and polysomnographic characteristics of compSA in patients with a primary diagnosis of OSAS. Methods: Total 198 patients with OSAS who performed CPAP titration at the Asan Medical Center were studied retrospectively from year 2006 to 2009. compSA was defined as presenting central sleep apnea ≥5 /h, during CPAP titration to eliminate upper airway obstruction. Demographic profiles and polysomnography (PSG) variables were compared between compSA and NoncompSA. Results: The prevalence of compSA was 17 of 198 (8.6%) with male predominance (n=17). Among compSA, 11 patients showed persistent CSA during entire titration and 6 patients showed newly developed CSA above certain pressure level (mean 7.2 cmH2O). At near optimized CPAP levels, obstructive sleep apnea index (OAI) was not significantly different between two groups (compSA; 0.52±0.74 /h vs. NoncompSA; 0.32±0.80 /h) but the level of apnea hypopnea index (AHI), mixed apnea index (MAI), central apnea index (CAI), and hypopnea index (HI) were greater in compSA than Non-compSA (compSA: AHI; 15.23±9.85 /h, MAI; 0.97±1.83 /h, CAI; 8.22±7.96 /h, HI; 5.52±4.98 /h vs. Non-compSA: AHI; 2.20±2.25 /h, MAI; 0.08±0.27 /h, CAI; 0.48±0.89 /h, HI; 5.52±4.98 /h). At baseline PSG, the value of CAI and MAI was higher in compSA (CAI; 3.78±3.92 /h vs. 1.03±1.97 /h, MAI; 6.71±7.50 /h vs. 4.33±9.59 /h) but there were no differences in AHI, OAI, HI, and demographic profiles between two groups. Conclusions: In this study, early indicators of developing compSA in baseline PSG was CAI and MAI. J Korean Sleep Res Soc 2013;10:51-55","PeriodicalId":243131,"journal":{"name":"Journal of Korean Sleep Research Society","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123820738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Jang, Bomi Kim, Ho-Sung Ryu, Gha-Hyun Lee, Sang-Ahm Lee
{"title":"Two Cases of REM Sleep Behavior Disorder Combined with Severe Obstructive Sleep Apnea: Misdiagnosed as “Pseudo-REM Sleep Behavior Disorder” by Diagnostic Polysomnography","authors":"H. Jang, Bomi Kim, Ho-Sung Ryu, Gha-Hyun Lee, Sang-Ahm Lee","doi":"10.13078/JKSRS.13013","DOIUrl":"https://doi.org/10.13078/JKSRS.13013","url":null,"abstract":"Received September 16, 2013 Revised December 8, 2013 Accepted December 9, 2013 Address for correspondence Sang-Ahm Lee, MD, PhD Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-3445 Fax: +82-2-474-4691 E-mail: salee@amc.seoul.kr REM sleep behavior disorder (RBD) is a sleep disorder characterized by loss of normal voluntary muscle atonia during REM sleep associated with complex motor behavior while dreaming. Dream-enacting behaviors can also occur in patients with other sleep disorders such as obstructive sleep apnea (OSA). This clinical situation has been termed “pseudo-RBD”. In contrast, OSA causes frequent arousal, which may consequently result in masking of RBD symptoms. We reported two patients with severe OSA, who were initially diagnosed with “pseudo-RBD” but on continuous positive airway pressure (CPAP) titration, rediagnosed with “true-RBD”. When RBD is clinically suspected but is not confirmed by diagnostic overnight polysomnography, we have to keep in mind that RBD could be detected during CPAP titration. J Korean Sleep Res Soc 2013;10:62-65","PeriodicalId":243131,"journal":{"name":"Journal of Korean Sleep Research Society","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129041830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Seo, Y. Choi, Dushin Jeong, Hyung-Kook Park, Y. Hwangbo, K. Yang
{"title":"Association between Sleep Quality and Non-Vertiginous Dizziness: A Hospital-Based Case-Control Study","authors":"I. Seo, Y. Choi, Dushin Jeong, Hyung-Kook Park, Y. Hwangbo, K. Yang","doi":"10.13078/JKSRS.13003","DOIUrl":"https://doi.org/10.13078/JKSRS.13003","url":null,"abstract":"Received April 18, 2013 Revised June 11, 2013 Accepted June 11, 2013 Address for correspondence Kwang Ik Yang, MD, PhD Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 330-721, Korea Tel: +82-41-570-2290 Fax: +82-41-592-3810 E-mail: neurofan@schmc.ac.kr Objectives: Poor sleep quality can impair daytime function and evoke fatigue and excessive daytime sleepiness. Dizziness is one of the common subjective complaints and attributed to various medical and neuropsychological disorders. But influence of poor sleep quality on dizziness has not been fully studied. We hypothesized the patients with poor quality of sleep might feel non-vertiginous dizziness (NVD). The aim of this study is to investigate the association between sleep quality and development of NVD. Methods: We recruited 106 patients who had presented NVD in neurology department of Soonchunhyang University Cheonan Hospital from July 1st, 2009 to June 30th, 2010. They completed the following questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Fatigue Severity Index, the Epworth Sleepiness Scale, Sleep Apnea scale of the Sleep Disorders Questionnaire and Beck Depression Inventory (BDI). 116 dizziness-free controls were recruited via Health Screening Center and also completed the same questionnaires. Results: Patient with NVD had significantly higher PSQI and ISI score compared with the controls (PSQI: 7.7±4.4 vs. 5.4±2.6, p<0.001, ISI: 9.7±7.0 vs. 6.8±4.4, p<0.001). In multiple logistic regression analysis adjusted for age, sex, body mass index, and BDI, poor sleep quality was significantly associated with NVD. Fully adjusted odds ratio (OR) for NVD associated with 1 unit increase in PSQI was 1.15 [95% confidence interval (CI): 1.04-1.26]. Insomnia (ISI≥15) was significantly associated with NVD (OR=4.43, 95% CI: 1.66-11.81). Conclusions: This study suggests that the poor quality of sleep is associated with NVD. J Korean Sleep Res Soc 2013;10:15-19","PeriodicalId":243131,"journal":{"name":"Journal of Korean Sleep Research Society","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131458489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Imaging the Sleep Deprived Brain: A Brief Review","authors":"M. Chee","doi":"10.13078/JKSRS.13001","DOIUrl":"https://doi.org/10.13078/JKSRS.13001","url":null,"abstract":"Functional magnetic resonance imaging (fMRI) is a highly versatile tool used to study neurobehavioral alterations associated with sleep deprivation (SD). Task-related fMRI is the most widely used technique and an impressive list of cognitive domains has been evaluated using this technique (Table 1). fMRI measures relative change in blood oxygenation level dependant (BOLD) signal in capillaries and venules adjacent to neuronal clusters whose firing rate and consequently, synaptic potentials are modulated by task performance. An increase in MR signal occurs as a result of a relatively disproportionate elevation in blood flow relative to oxygen consumption in response to sensory stimulation and/or task performance. In addition to task-related activation, the evaluation of task-related deactivation where signal changes fall below baseline levels can be evaluated. Blood oxygenation level dependant imaging measures relative changes in blood flow, but does not ascertain absolute blood flow. Quantification of blood flow may occasionally be useful, for example, to study time-on-task effects, and other phenomena whose observation requires signal stability over several minutes as opposed to several seconds. Such measurements can be obtained using a variety of arterial spin labeling (ASL) techniques that have different levels of precision. A disadvantage of ASL is its inferior signal to noise ratio relative to BOLD imaging. Additionally, the requirement for block sampling also makes it impossible to perform event-related designs that are important in separating out trials where the subject may have been asleep. The evaluation of functional connectivity, conducted by assessing signal covariation in pairs of regions, or by determining the extent to which signal in a ‘target’ region interacts with that of a ‘seed’ region according to state/task context provides additional characterization of altered physiology. The latter method, known as psychophysiological Interaction-PPI has been applied in studies evaluating selective attention, the processing of emotional pictures as well as executive function/working memory. In addition to fMRI studies designed to evaluate signal changes in response to task performance, it may be informative to evaluate ‘resting-state’ activity or intrinsic functional connectivity. This refers to the identification of regions showing synchronous low frequency oscillations (0.1-0.01 Hz) in BOLD signal that are not time locked to task performance or sensory stimulation. Studies of this type in sleeping individuals have shown changes in connectivity within the default mode network (DMN) alluded to earlier. The first study evaluating resting state networks in the setting of SD found selective reductions in DMN functional connectivity and reduced anti-correlation with low frequency oscillations in the ‘task-positive’ network (Fig. 1). Analyses of resting state data hold promise of being informative of alterations in brain function without requ","PeriodicalId":243131,"journal":{"name":"Journal of Korean Sleep Research Society","volume":"15 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130068655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sleep Status of Residents in Neurology Department","authors":"Won-Joo Kim","doi":"10.13078/JKSRS.13004","DOIUrl":"https://doi.org/10.13078/JKSRS.13004","url":null,"abstract":"Received June 9, 2013 Revised June 13, 2013 Accepted June 13, 2013 Address for correspondence Won-Joo Kim, MD, PhD Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea Tel: +82-2-2019-3324 Fax: +82-2-3462-5904 E-mail: kzoo@yuhs.ac Objectives: For evaluating the work load for medical residents, it is important to search the work hours and sleep status. The purpose of this study was to evaluate the sleep status of residents in neurology department in Korea. Methods: We recruited neurological residents of 12 university hospitals. They completed questionnaires including their sleep and work hours, sleep habit, Stanford Sleepiness Scale (SSS), Epworth Sleepiness Scale (ESS), and health problems. Results: We excluded the residents who were previously diagnosed with sleep disorders. One hundred and three residents (male 67, female 36) were analyzed. Average sleep duration on off duty days was 5.8±0.9 hours, on duty days was 4.6±1.3 hours and mean work hours was 14.6±2.3 hours. Average SSS score was 2.6±1.0 and ESS was 10.6±5.1. Group analyzed by training years showed short sleep duration in first and second years of training. ESS score was higher in first and second years compare to other years. Conclusions: Most neurological residents were suffering from sleep deprivation especially first and second years of training. They also reported more sleepiness and drowsiness during the daytime. J Korean Sleep Res Soc 2013;10:20-24","PeriodicalId":243131,"journal":{"name":"Journal of Korean Sleep Research Society","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127134501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jin San Lee, R. Yoo, Hyo Jung Nam, Young Nam Kwon, M. Sung, Han A Cho, H. Cha, Won Chul Shin
{"title":"Clinical Characteristics of Elderly Patients Aged over 65 Years with Insomnia Symptoms","authors":"Jin San Lee, R. Yoo, Hyo Jung Nam, Young Nam Kwon, M. Sung, Han A Cho, H. Cha, Won Chul Shin","doi":"10.13078/JKSRS.13005","DOIUrl":"https://doi.org/10.13078/JKSRS.13005","url":null,"abstract":"Address for correspondence Won Chul Shin, MD Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea Tel: +82-2-440-6166 Fax: +82-2-440-7262 E-mail: shinwc@khu.ac.kr Objectives: Sleeping problems and disorders generally increase with aging, and these changes influence elderly functioning and well-being. We studied the clinical characteristics of the elderly patients with insomnia symptoms for the appropriate diagnosis in Korea. Methods: Patients aged over 65 years with insomnia symptoms were recruited from Sleep Center of Kyung Hee University Hospital at Gangdong, from January 2010 to April 2013. General characteristics of sleep patterns, past medical history, previous medication related sleep, sleep diary, and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were analyzed to understand the sleep pattern and the clinical characteristics in the elderly patients with insomnia symptoms. Results: The study population included 143 patients (45 men, 98 female), and their mean age was 71.41±5.32 years. These patients were classified according to the cause of insomnia symptoms, the primary cause was 39.1% (92.8% psychophysiological insomnia, 7.2% paradoxical insomnia), the secondary cause was 34.2% (depression, anxiety, associated medical illness, obstructive sleep apnea syndrome, restless legs syndrome), and circadian rhythm sleep disorder was 26.6%. The MMPI-2 profiles were not significant differences in the study population. Conclusions: The clinical characteristics in our study population were different in variable parameters from the general population. It is necessary to understand these differences in the elderly patients for approaching the appropriate diagnosis and medical care. J Korean Sleep Res Soc 2013;10:25-30","PeriodicalId":243131,"journal":{"name":"Journal of Korean Sleep Research Society","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131699363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ju Young Do, C. Yoon, Won-Joo Kim, K. Yang, S. Park, M. Chu
{"title":"Prevalence of Restless Legs Syndrome in Korean Adult Population: Comparison between International Restless Legs Syndrome Study Group Criteria and Cambridge-Hopkins Diagnostic Questionnaire","authors":"Ju Young Do, C. Yoon, Won-Joo Kim, K. Yang, S. Park, M. Chu","doi":"10.13078/JKSRS.13002","DOIUrl":"https://doi.org/10.13078/JKSRS.13002","url":null,"abstract":"Ju Young Do, Chang-Ho Yoon, Won-Joo Kim, Kwang Ik Yang, Seong-Ho Park, Min Kyung Chu Department of Neurology, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Department of Neurology, Bundang Clinical Neurosience Institute, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea","PeriodicalId":243131,"journal":{"name":"Journal of Korean Sleep Research Society","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130599208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sun-Jae Hwang, Ki-tae Kim, S. Kim, Kyung-Ha Noh, D. Kim, J. Cho
{"title":"A Case of Hypnic Headache Responded to Indomethacin","authors":"Sun-Jae Hwang, Ki-tae Kim, S. Kim, Kyung-Ha Noh, D. Kim, J. Cho","doi":"10.13078/JKSRS.13006","DOIUrl":"https://doi.org/10.13078/JKSRS.13006","url":null,"abstract":"Received April 30, 2013 Revised June 18, 2013 Accepted June 18, 2013 Address for correspondence Jae Wook Cho, MD Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea Tel: +82-55-360-2122 Fax: +82-55-360-2451 E-mail: sleep.cho@gmail.com Hypnic headache (HH) is a primary headache disorder occurring exclusively during sleep in the elderly. Although pathophysiology of HH is still unknown, the association with chronobiological perspective and rapid eye movement sleep has been suggested. Lithium has been reported to be the most effective drug for HH. However, its usage may be limited because of its toxicity. Indomethacin could be alternative treatment option, which has better safety profile. We report a case of HH, which was successfully treated with indomethacin. J Korean Sleep Res Soc 2013;10:31-33","PeriodicalId":243131,"journal":{"name":"Journal of Korean Sleep Research Society","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128521716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}