Search

Background and Purpose: Excess or insufficient sleep, irregular sleep-wake patterns, and an extreme early or late chronotypes adversely impact physical and mental health. Changes in sleep characteristics should therefore be tracked, and factors that contribute to poor sleep should be identified. We investigated the changes in sleep patterns among South Korean adults during 2009-2018., Methods: Using data of a representative sample of South Korean adults from the 2009 ( n =2,658, 48.5% males; age=44.5±15.0 years old [mean±standard deviation], age range=19-86 years) and 2018 ( n =2,389, 49.1% males; age=47.9±16.3 years, age range=19-92 years) Korean Headache-Sleep Study, we explored changes in sleep timing, sleep duration, chronotype, and social jetlag (SJL). Logistic regression analysis was used to examine the association between average sleep duration and depression., Results: From 2009 to 2018, bedtimes were advanced by 10 and 25 min on workdays and free days, respectively. Meanwhile, wake-up times were advanced by 13 min and delayed by 12 min on workdays and free days, respectively. The average sleep duration significantly decreased from 7.45 h to 7.13 h. The prevalence of short sleep duration (<7 h) increased, whereas that of long sleep duration (≥8 h) decreased. A circadian preference toward eveningness and SJL increased. The prevalence of depression increased from 4.6% to 8.4%, and there were significant reverse J-shaped and U-shaped associations between average sleep duration and depression in 2009 and 2018, respectively., Conclusions: Changes in sleep patterns and the association between sleep duration and depressive mood were determined from a representative sample of the South Korean adult population. Interventions to modify sleep behaviors might improve public health., Competing Interests: Min Kyung Chu, a contributing editor of the Journal of Clinical Neurology, was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest., (Copyright © 2023 Korean Neurological Association.)

Background and Purpose: The relationship between napping and cognition remains controversial. This study aimed to investigate the association between napping and cognition according to sleep debt in the Korean adult population., Methods: A population-based nationwide cross-sectional survey was conducted in 2018. A two-stage stratified random sample of Koreans aged ≥19 years was selected and evaluated using questionnaires by trained interviewers. Cognitive function was assessed using the Mail-In Cognitive Function Screening Instrument (MCFSI). Sleep habits on weekdays and weekends, napping, and subjective sleep requirements were assessed using the questionnaires. Accumulated sleep debt was calculated by subtracting the weekly average sleep duration from subjective sleep requirements. Sleep quality, daytime sleepiness, insomnia, depression, demographics, and comorbidities were assessed. Participants were grouped into those with sleep debt ≤60 min and those with sleep debt >60 min. Multiple linear regression was used to estimate the independent association between the factors and cognition., Results: In total, 2,501 participants were included in the analysis. Naps were reported in 726 (29.0%) participants (nappers). The mean MCFSI score was higher in nappers (3.4±3.6) than in non-nappers (2.3±3.0) ( p <0.001). Multiple linear regression controlling for age, alcohol, smoking, depression, insomnia, daytime sleepiness, sleep quality, and education revealed that 30 to 60 min of napping was associated with worse cognitive function in participants with sleep debts ≤60 min, while >60 min of napping was associated with better cognitive function in participants with sleep debts >60 min., Conclusions: In general, naps are associated with worse cognitive function in the Korean adult population. However, for those with sleep debt of >60 min, naps for >60 min were associated with better cognitive function., Competing Interests: Min Kyung Chu, an associate editor of the Journal of Clinical Neurology, was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest., (Copyright © 2022 Korean Neurological Association.)

Background and Purpose: While excessive daytime sleepiness can predate Parkinson's disease in late-life, its association with parkinsonian-like (P-L) symptoms in middle age are unknown. Since neurodegeneration can appear decades before a diagnosis of Parkinson's disease, identifying clinical features associated with this early progression is important. The purpose of this study was to determine the association of daytime sleepiness with P-L symptoms in a population-based sample of middle-aged Korean adults., Methods: During 2013 and 2014, daytime sleepiness and P-L symptoms were assessed in 2,063 males and females aged 50-64 years who were participating in the Korean Genome and Epidemiology Study. The severity of daytime sleepiness was quantified by the score on the Epworth Sleepiness Scale (ESS). Self-reported P-L symptoms included nine motor disorders commonly associated with Parkinson's disease. Participants with parkinsonism and related conditions are excluded., Results: The prevalence of excessive daytime sleepiness (ESS score >10) was 7.0%. The frequencies of P-L symptoms ranged from 0.5% (for "trouble buttoning buttons") to 18.4% (for "handwriting smaller than it once was"). After adjustment for covariates and multiple testing, the relative odds of P-L symptoms comparing the 80th and 20th percentiles of ESS scores was 1.6 ( p =0.001) for "voice is softer than it once was," 2.1 ( p <0.001) for "balance when walking is poor," and 1.5 ( p =0.002) for "loss of facial expression." The prevalence of excessive daytime sleepiness increased from 6.3% to 19.8% when the number of symptoms increased from zero to three ( p =0.004)., Conclusions: In Korean adults aged 50-64 years, daytime sleepiness is significantly associated with P-L symptoms. Whether coexisting daytime sleepiness and P-L symptoms predate extrapyramidal and other impairments in later life warrants further investigation., Competing Interests: Robert J. Thomas is co-inventor and patent holder of the ECG-derived sleep spectrogram, which may be used to phenotype sleep quality and central/complex sleep apnea. The technology is licensed by Beth Israel Deaconess Medical Center to MyCardio, LLC. Dr. Thomas is also co-inventor and patent holder of the Positive Airway Pressure Gas Modulator, being developed for treatment of central/complex sleep apnea. He is a consultant to Jazz Pharmaceuticals and GLG Councils and was a consultant in software development for DeVilbiss-Drive. There are no other disclosures or conflicts of interest to report., (Copyright © 2022 Korean Neurological Association.)

Background and Purpose: Identifying changes in the prevalence, disability, and management patterns of migraine is important for reducing the burden of this disease. However, data on the changes in these variables are scarce., Methods: We compared data obtained in the 2009 Korean Headache Survey and the 2018 Korean Sleep-Headache Survey., Results: The 1-year migraine prevalence did not differ significantly between 2018 and 2009 [5.2% (114/2,200) vs. 6.0% (91/1,507), p =0.492]. The number of days with missed activity due to headache during the previous 3 months was larger in the 2018 survey than in the 2009 survey [1.1±2.9 vs. 0.3±1.0 days (mean±standard deviation), p =0.013]. The number of days with reduced productivity during the previous 3 months did not differ significantly between the two surveys (0.8±2.8 vs. 1.4±1.4 days, p =0.679). The proportion of subjects with a substantial-to-severe headache impact (Headache Impact Test-6 score ≥56) was marginally larger in the 2018 survey than in the 2009 survey [42.1% (48/114) vs. 29.7% (27/91), p =0.066]. The rate of lifetime medical consultations did not differ between the 2018 and 2009 surveys [34.2% (39/114) vs. 30.8% (28/91), p =0.615]., Conclusions: Migraine prevalence was stable over the 9-year period between the surveys, but disability due to missed activity was greater in 2018 than in 2009 in Korea., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SJC was involved as a site investigator of a multicenter trial sponsored by Otsuka Korea, Eli Lilly and Company, and Novartis and worked as an advisory member for Teva, and received research support from Hallym University Research Fund 2016 and a grant from Korean Neurological Association (KNA-16-MI-09). MKC was a site investigator for a multicenter trial sponsored by Otsuka Korea, Novartis International AG, and Eli Lilly and Company. He worked as an advisory member for Teva, and received lecture honoraria from Allergan Korea, Handok-Teva, and Yuyu Pharmaceutical Company in the past 24 months. He received grants from Yonsei University College of Medicine (2018-32-0037) and National Research Foundation of Korea (2019R1F1A1053841). The other authors have no potential conflicts of interest to disclose., (Copyright © 2021 Korean Neurological Association.)

Background and Purpose: Nonketotic hyperglycemia often causes transient visual field defects, but only scattered anecdotes are available in the literature., Methods: We report a patient with homonymous superior quadrantanopsia due to nonketotic hyperglycemia and provide a systematic literature review of the clinical features of 40 previously reported patients (41 in total, including our case) with homonymous visual field defects in association with nonketotic hyperglycemia., Results: The typical visual field defect was congruous (84.6%), homonymous hemianopsia (87.8%) with macular splitting (61.5%) or sparing (38.5%). It was transient and repetitive in 54.5% of the patients, but it developed as a persistent form in the remainder. Positive visual symptoms such as hallucinations and phosphenes developed in 73.2% of patients. Brain MRI revealed corresponding abnormalities in most patients (84.8%), characterized by a low-intensity white-matter signal or a high-intensity gray-matter signal on T2-weighted or fluid-attenuated inversion recovery images with diffusion restriction or gadolinium enhancement. Most (97.0%) patients recovered completely, with 48.5% treated by glycemic control alone and the remainder also receiving antiepileptic agents., Conclusions: Nonketotic hyperglycemia should be considered a possible cause of transient visual field defects, especially when it is associated with repetitive positive visual symptoms and typical MRI findings in hyperglycemic patients., Competing Interests: Drs. SU Lee, J Lee, JE Yoon, HJ Kim, JY Choi, and CH Yun report nothing to disclose. Dr. JS Kim serves as an associate editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, Journal of Neurology, and Medicine., (Copyright © 2020 Korean Neurological Association.)

Background and Purpose: Sufficient sleep is an essential part of good health and well-being. Tension-type headache (TTH) is the most common type of primary headache and has negative impacts on the quality of life and work performance. We aimed to determinethe relationship between TTH and insufficient sleep in the general population., Methods: This study used data from the Korean Headache Sleep Study, which was a population-based survey about headache and sleep among Korean adults. Insufficient sleep was defined when the discrepancy between sleep need and average sleep duration was at least 1 hour., Results: Among the 2,695 included subjects, 570 (21.2%) and 727 (27.0%) were classified as having TTH and insufficient sleep, respectively. The prevalence of insufficient sleep was significantly higher among subjects with TTH than among those without headaches (28.8% vs. 20.4%). For subjects with TTH, the scores on a visual analogue scale (4.7±1.8 vs. 4.3±1.9, mean±SD) and the Headache Impact Test-6 (44.9±7.0 vs. 43.6±6.1) were much higher in subjects with insufficient sleep than in those without insufficientsleep. Multivariable analyses revealed that insomnia [odds ratio (OR)=2.1], poor sleep quality (OR=1.7), and short sleep duration (OR=6.9) were significantly associated with insufficient sleep in subjects with TTH., Conclusions: Our findings suggest that insufficient sleep is prevalent among subjects with TTH and is linked to an exacerbation of TTH. Therefore, the proper evaluation and management of sleep may lead to the better management of TTH., Competing Interests: Jung-Hwan Oh, Won-Joo Kim, Kwang Ik Yang, and Chang-Ho Yun declare that they have no conflicts of interest. Soo-Jin Cho was involved as a site investigator of a multicenter trial sponsored by Korea Otsuka Pharmaceutical Co., Ltd., Eli Lilly & Co., Ltd., Korea BMS Co., Ltd., and Parexel Korea Co., Ltd.; worked as an advisory member for Teva Co., Ltd.; and received research support from Hallym University Research Fund in 2016, an academic award from Myung In Pharm Co., Ltd., and lecture honoraria from Yuyu Pharmaceutical Co., Ltd. and Allergan Korea Ltd.. Min Kyung Chu was involved as a site investigator for a multicenter trial sponsored by Eli Lilly & Co., Ltd.; worked as an advisory member for Teva Co., Ltd.; and received lecture honoraria from Yuyu Pharmaceutical Co., Ltd. and Allergan Korea Ltd. during the previous 24 months., (Copyright © 2018 Korean Neurological Association.)

Background and Purpose: Sleep need differs between individuals, and so the same duration of sleep will lead to sleep insufficiency in some individuals but not others. The aim of this study was to determine the separate and combined associations of both sleep duration and unmet sleep need with excessive daytime sleepiness (EDS) in Korean adults., Methods: The participants comprised 2,769 Korean adults aged 19 years or older. They completed questionnaires about their sleep habits over the previous month. The question regarding sleep need was "How much sleep do you need to be at your best during the day?" Unmet sleep need was calculated as sleep need minus habitual sleep duration. Participants with a score of >10 on the Epworth Sleepiness Scale were considered to have EDS., Results: The overall prevalence of EDS was 11.9%. Approximately one-third of the participants (31.9%) reported not getting at least 7 hours of sleep. An unmet sleep need of >0 hours was present in 30.2% of the participants. An adjusted multivariate logistic regression analysis revealed a significant excess risk of EDS in the groups with unmet sleep needs of ≥2 hours [odds ratio (OR), 1.80; 95% confidence interval (CI), 1.27-2.54] and 0.01-2 hours (OR, 1.42; 95% CI, 1.02-1.98). However, habitual sleep duration was not significantly related to EDS., Conclusions: EDS was found to be associated with unmet sleep need but not with habitual sleep duration when both factors were examined together. We suggest that individual unmet sleep need is more important than habitual sleep duration in terms of the relation to EDS.

Background and Purpose: Endothelial impairment is a linking mechanism between obstructive sleep apnea (OSA) and cardiovascular diseases. Profiles of endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs) reflect the degree of endothelial impairment. The aims of this study were to measure the levels of EMPs and progenitor cells in OSA, determine the correlations between these factors and OSA severity and the degree of atherosclerosis, and document any changes in these factors after therapy., Methods: Subjects with (n=82) and without (n=22) OSA were recruited prospectively. We measured the number of colony-forming units (CFU) in cell culture as the endothelial progenitor cell index, and the number of EMPs using flow cytometry with CD31 [platelet endothelial cell adhesion molecule (PECAM)], CD42 (platelet glycoprotein), annexin V, and CD62E (E-selectin) antibodies at baseline and after 4-6 weeks of continuous positive airway pressure (CPAP) therapy. Carotid intima-media thickness (IMT) was regarded as a marker of atherosclerosis., Results: The levels of PECAM(+)CD42(-) (p<0.001), PECAM(+)annexin V(+) (p<0.001), and E-selectin(+) microparticles (p=0.001) were higher in OSA subjects than in non-OSA subjects. The number of CFU did not differ between the two groups. OSA severity independently predicted the levels of PECAM(+)CD42(-) (p=0.02) and PECAM(+)annexin V(+) (p=0.004). Carotid IMT was correlated with OSA severity (p<0.001), PECAM(+)CD42(-) (p=0.03), and PECAM(+)annexin V(+) (p=0.01). Neither OSA severity nor carotid IMT was correlated with either the number of CFU or E-selectin(+). CPAP therapy decreased the occurrence of E-selectin(+) (p<0.001) in 21 of the OSA subjects, but had no effect on the other microparticles of the number of CFU., Conclusions: OSA led to the overproduction of EMPs, which moderately correlated with OSA severity and the degree of atherosclerosis, and partly responded to therapy. The endothelial impairment might contribute to future cardiovascular events.

Background and Purpose: Insomnia is a common complaint in adults. However, large epidemiologic studies of insomnia involving Asian populations are rarely reported. We performed an epidemiologic study of insomnia in a large Korean adult population., Methods: A total of 5,000 subjects (2,470 men and 2,530 women) were interviewed by telephone. A representative sample of subjects aged 20 to 69 years was constituted according to a stratified, multistage random sampling method. Insomnia was defined as either any difficulty getting to sleep or getting back to sleep after waking in the night., Results: More than one fifth (n=1,141, 22.8%) of the 5,000 subjects complained of insomnia, with the prevalence being significantly higher in women (25.3%) than in men (20.2%, p<0.001). Logistic regression revealed that the prevalence of insomnia increased significantly with age (p<0.001), being higher in those aged 60-69 years than in those aged 20-29 years (OR=2.368, 95% CI=1.762-3.182, p<0.001), and was lower in those with a monthly income of >4.5 million Korean won than in those with an income of <1.5 million Korean won (OR=0.689, 95% CI=0.523-0.906, p<0.01)., Conclusions: Insomnia is a common complaint in Korean adults, and its prevalence is similar to that in adults in Western countries.

Background and Purpose: This study aimed to determine whether there are clinicoelectrical differences between anterior lateral temporal lobe epilepsy (ALTLE) and posterior lateral temporal lobe epilepsy (PLTLE), taking medial temporal lobe epilepsy (MTLE) as a reference., Methods: We analyzed the historical information, ictal semiologies, and ictal EEGs of temporal lobe epilepsy patients with a documented favorable surgical outcome (Engel class I or II) at follow-up after more than one year. LTLE was defined when a discrete lesion on MRI or an ictal onset zone in invasive study was located outside the collateral sulcus. LTLE was further divided into ALTLE and PLTLE by reference to the line across the cerebral peduncle. Total 107 seizures of 13 ALTLE, 8 PLTLE and 21 MTLE patients were reviewed., Results: Initial hypomotor symptom was frequently observed in PLTLE (P<0.001). Oroalimentary automatism (OAA) was not observed initially in PLTLE. Generalized tonic-clonic seizures occurred significantly earlier in PLTLE than in ALTLE or MTLE (P< 0.001). Ictal scalp EEG was not helpful in differentiating between ALTLE and PLTLE., Conclusions: Frequent hypomotor onset, the absence of initial oroalimentary automatism, and early generalization are characteristic findings of PLTLE, although they are insufficient to differentiate it from ALTLE or MTLE.