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This study aimed to examine the types and characteristics of otorhinolaryngology examinations performed by clinical laboratory technologists and to investigate the working environment and scope of work of otorhinolaryngology laboratory personnel using online questionnaires. Based on the research results, constructive policy measures for the University-Association-Society were also presented. Most of the survey respondents were in their 40s (34.1%). Females accounted for 80.2% of respondents and 30.8% of them had a career spanning 15 years or more. We found that laboratory personnel had a wide scope of work, high work stress and frequently suffered occupational diseases. We observed that, to reduce stress and increase satisfaction, an expansion of the workforce was necessary. Compared to other occupations, 72% of clinical laboratory technologists occupied more senior positions, occupational distribution depended on senior positions (P

Background and Objectives Considering the prevalence and health effects of obstructive sleep apnea (OSA), early diagnosis and proper treatment are essential. Polysomnography (PSG) has limitations in diagnosing or tracking large-scale OSA patients. Smartwatches (SWs) can be equipped with a photoplethysmograph (PPG) that can indirectly measure heart rate and blood oxygen saturation by detecting the difference of light absorption through blood. The purpose of this study is to compare oxygen saturation parameters of PPG-based SWs with those of PSG to determine the diagnostic accuracy for OSA. Methods After obtaining voluntary consent from patients who were scheduled to undergo PSG in a sleep clinic due to suspected OSA, they were randomly assigned to wear a Galaxy watch4 (GW) or Apple watch7 (AW) on their wrist. The agreement rates between the oxygen saturation parameters of the two SW types and PSG were evaluated. The accuracy, sensitivity, and specificity of the oxygen saturation parameters for diagnosis of OSA (apnea-hypopnea index [AHI] ≥5/h) were compared between the two types of SW. Results A total of 133 patients underwent PSG while wearing an SW. Including duplicates, 109 patients wearing a GW and 69 wearing an AW were included. The diagnostic accuracy of AHI ≥5/h according to oxygen saturation time measured by a GW was less than 90%, the respective sensitivity and specificity were 82.9% and 75.8%. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.807 (p

Background and Objectives Measurement of sleep parameters in both supine and non-supine positions is important for the diagnosis of positional obstructive sleep apnea (OSA). However, the influence of right and left lateral decubitus positions (RLDP and LLDP, respectively) on sleep parameters is relatively unknown and has not been well investigated. This study was performed to verify the associations between sleep parameters and lateral decubitus sleep position. Methods A retrospective study was performed on 38 patients who were diagnosed with OSA and underwent surgical interventions from January 2014 to December 2016. Preoperative sleep parameters were evaluated with WatchPAT, and patients who slept sufficiently in both RLDP and LLDP to accurately analyze sleep parameters were enrolled in the study. Basic clinical data including body mass index (BMI) and nasal endoscopic findings of patients were assessed. Results The difference in peripheral arterial tonometry apnea-hypopnea index (pAHI) and PAT respiratory disturbance index (pRDI) between RLDP and LLDP showed no association with the side of deviated nasal septum. Patients with higher BMI showed higher pRDI in LLDP than RLDP (p=0.038). The difference in sleep position percentage between RLDP and LLDP was negatively correlated with the difference in pRDI (p=0.023). Conclusion Higher BMI patients with OSA might benefit more from sleeping in RLDP than LLDP. Patients slept longer in the lateral decubitus position that produced lower pRDI. Not only supine and non-supine positions, but also RLDP and LLDP need to be evaluated in patients with OSA.

Background Morvan syndrome is characterized by neuromyotonia, dysautonomia, and various neuropsychiatric symptoms, as well as sleep disturbances, although these are less common than neuromuscular symptoms. Herein, we report a case of Morvan syndrome with peculiar sleep disturbances, documented via polysomnography. Case Report We present herein the case of a 67-year-old man who developed agitation and severe insomnia after undergoing a thymectomy for the treatment of myasthenia gravis, which was subsequently diagnosed as agrypnia excitata due to Morvan syndrome, based on 24-hour polysomnography. Conclusion We presented the 24-hour polysomnographic findings of a case of agrypnia excitata in Morvan syndrome. An extended polysomnography, however, might be helpful in analyzing sleep disturbances in Morvan syndrome.

Benzodiazepines (BDZs) drugs act on the GABAA receptor, function as nerve suppressors, and are used to treat anxiety, insomnia, and panic disorder. We analyzed the data of 30 individuals to determine any differences in the sleep-electroencephalogram findings among individuals varying in age, benzodiazepine use, and duration of benzodiazepine use. Comparisons between users and non-users of benzodiazepines, short-term and long-term users, older and younger users, and older short-term and older long-term users, were achieved using electroencephalographic findings obtained through polysomnography. The parameters evaluated included sleep latency, sleep efficiency, sleep-stage percentages, number of sleep spindles, and average frequency of sleep-spindle. The difference between benzodiazepine users and non-users was significant with respect to sleep-stage percentages and average frequency of sleep-spindle. Older and younger users differed significantly with respect to sleep efficiency and sleep-stage percentages, whereas significant difference for sleep efficiency was obtained between long-term and short-term users. Taken together, our results indicate that BDZ consumption suppresses slow-wave sleep and increases the frequency of sleep spindles.

Purpose: This review aimed to explore current publication trends, major concepts, measurements, and intervention types regarding sleep-wake disturbance in cancer patients. Methods: Studies published up to 26 December, 2021 were examined through PubMed, EMBASE, The Cochrane Library, KMbase, CINAHAL, ScienceON and Google scholar using English and Korean keywords with appropriate definitions related to sleep-wake disturbances in cancer patients. A total of 3,542 articles were found and 73 articles introducing intervention to reduce sleep-wake disturbance were included in the final analysis. Results: Interventions for sleep-wake disturbance in cancer patients were classified into the following types: exercise interventions (38.1%), cognitive behavioral therapy (26.2%), complementary and alternative medicine intervention (19.0%), mindfulness-based stress reduction intervention (9.5%), herbal medication intervention (2.4%), dance intervention (1.2%), music intervention (1.2%) and mixed intervention (1.2%). Most of the interventions (52.1%) were performed on breast cancer patients. The Pittsburgh Sleep Quality Index was the most frequently used subjective measurement. Objective measurements to measure sleep quality or sleep disturbance included actigraphy and polysomnography. Sixty- four articles (87.7%) out of 73 found that interventions to reduce sleep-wake disturbance in cancer patients were effective. Conclusion: Nursing intervention to reduce sleep-wake disturbance is important in oncology nursing practice. This literature review emphasizes the need to develop more tailored and suitable interventions considering various cancer patients' characteristics. [ABSTRACT FROM AUTHOR]

Purpose: Patients with prostate cancer have high survival rates, but report low Quality of Life (QOL) due to sleep difficulties. This scoping review aimed to explore and identify current publication trends, major concepts, measurements, and interventions regarding sleep disturbance in patients with prostate cancer. Methods: Using the Arksey & O'Malley scoping review method, structured searches for articles published from 2000 to 2021 were conducted on six electronic databases using a combination of the terms "prostate cancer", "malignant neoplasm of prostate", "sleep*", "circadian rhythm", and "insomnia". Results: Thirty-one studies were reviewed. The publication rate has increased from 6.5% (2000~2005) to 51.6% (2016~2021). The Insomnia Severity Index (ISI) was the most frequently used subjective measurement. Objective measurements to measure sleep quality or sleep disturbance included actigraphy and Polysomnography (PSG). The incidence of sleep disturbance in patients with prostate cancer was 8.0% to 75.9%, and hormone and radiation therapy, hot flashes, and nocturia were identified as influencing factors. Intervention strategies presented were Cognitive Behavioral Therapy (CBT), Mindfulness-Based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT), and qigong or tai chi programs. Conclusion: Interest in sleep disturbance in patients with prostate cancer is increasing. Further studies are expected to measure the prevalence of sleep disturbance using objective and subjective measurements in various ways. Nurses must consider tailored interventions based on the individual characteristics of patients with prostate cancer. [ABSTRACT FROM AUTHOR]

Objectives: Our study aims to investigate the clinical and polysomnographic variables associated with subjective sleep perception. Methods: Among the patients who underwent nocturnal polysomnography (PSG) at the Center for Sleep and Chronobiology of Seoul National University Hospital from May 2018 to July 2019, 109 diagnosed with insomnia disorder based on DSM-5 were recruited for the study, and their medical records were retrospectively analyzed. Self-report questionnaires about clinical characteristics including Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI), and Epworth sleepiness scale (ESS) were completed. Subjective sleep quality was measured using variables of subjective total sleep time (subjective TST), subjective sleep onset latency (subjective SOL), subjective number of awakenings, morning feeling after awakening, and sleep discrepancy (subjective TST-objective TST) the morning after PSG. Pearson and Spearman correlation analyses were used to determine the factors associated with subjective sleep perception. Results: In patients with insomnia, subjective TST was negatively correlated with Wake After Sleep Onset (WASO) (p = 0.001) and N1 sleep (p = 0.039) parameters on polysomnography. Also, it was negatively correlated with PSQI (p < 0.001) and BDI (p = 0.014) scores. Sleep discrepancy was negatively correlated with PSQI score (p = 0.018). Morning feeling was negatively correlated with PSQI (p = 0.019) and BDI (p < 0.001) scores. Conclusion: Our results demonstrated that subjective sleep perception is associated with PSG variables (WASO and N1 sleep) and with PSQI and BDI scores. In clinical practice, it is helpful to assess and manage insomnia patients in consideration of objective sleep variables, subjective sleep quality, and depressed mood, which can influence subjective sleep perception. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder in which narrowing and obstruction of the upper airway lead to frequent arousal and decreased arterial oxygenation during sleep. OSA is more common in children with genetic disorders like achondroplasia compared to children without genetic disorders. Achondroplasia is genetic disorder characterized by hypoplasia of the facial bone and skull base with foramen magnum stenosis, resulting in exceedingly high frequency of OSA. The authors present a case of a patient with achondroplasia diagnosed with severe OSA through polysomnography after adenectomy showed little therapeutic effect and who was treated with continuous positive airway pressure. [ABSTRACT FROM AUTHOR]

Sleep apnea is a sleep disorder that includes symptoms such as snoring and apnea during sleep and daytime drowsiness. This disorder reduces a person's quality of life and can also cause serious problems that interfere with one's social life. Both non-surgical, such as positive pressure treatment, and surgical treatments can be performed to improve sleep apnea. Polysomnography is first needed to confirm the degree of sleep apnea before surgery and should be conducted in certified facilities according to strict regulations. While appropriate treatment for sleep apnea can be implemented based on polysomnography results, it is burdensome for patients to obtain a polysomnography examination because of the high cost. To increase the accessibility of polysomnography to patients, the government has implemented an insurance program for patients who meet certain criteria. Recently, these criteria have been revised. The purpose of this paper is to provide information on the latest health insurance criteria for polysomnography. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have shown that periodic limb movements in sleep (PLMS) could be one of risk factors for cardiovascular morbidity. The purpose of this study was to investigate the association between PLMS and blood pressure changes during sleep. Methods: We analyzed data from 358 adults (176 men and 182 women) aged 18 years and older who were free from sleep apnea syndrome (Respiratory Disturbance Index < 5) and sleep disorders such as REM sleep behavior disorder or narcolepsy. Demographic characteristics, polysomnography records, and clinical variable data including blood pressure, body mass index, alcohol, smoking, and current medications were collected. In addition, self-report questionnaires including the Beck Depression Index, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index were completed. Blood pressure change from bedtime to awakening was compared between the two periodic limb movement index (PLMI) groups [low PLMI (PLMI ≤ 15) and high PLMI (PLMI > 15)]. Blood pressure change patterns were compared using repeated measures analysis of variance. Results: Systolic blood pressure in the high PLMI group was lower than that in the low PLMI group (p = 0.036). These results were also significant when adjusted for gender and age, but were not statistically significant when adjusted for BMI, alcohol, smoking, anti-hypertension medication use and sleep efficiency (p = 0.098). Systolic blood pressure dropped by 9.7 mm Hg in the low PLMI group, and systolic blood pressure in the high PLMI group dropped by 2.9 mm Hg. There was a significant difference in delta systolic blood pressure after sleep between the two groups in women when adjusted for age, BMI, alcohol, smoking, antihypertensive medication use and sleep efficiency (p = 0.023). Conclusion: PLMS was significantly associated with a decreasing pattern in nocturnal BP during sleep, and this association remained significant in women when adjusted for age, BMI, alcohol, smoking, antihypertension medication use and sleep efficiency related to blood pressure. We suggest that PLMS may be associated with cardiovascular morbidity. [ABSTRACT FROM AUTHOR]

Background and Objectives: Sleep disturbances and excessive daytime sleepiness (EDS) are the major symptoms of obstructive sleep apnea (OSA). This study aimed to investigate clinical implications of insomnia and EDS in patients with OSA using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Materials and Method: We evaluated 131 subjects with suspected OSA who were undergoing polysomnography (PSG) and performing the PSQI and ESS surveys. OSA was diagnosed when the apnea-hypopnea index was five or more. EDS was defined when ESS score was 11 points or higher. Detailed history and questionnaire were used to categorize insomnia. We compared clinical variables and PSG results in subgroups with or without insomnia and EDS. Results: There were no significant differences of PSQI and ESS score between controls and OSA. OSA with insomnia had significantly increased total score (p<0.001) and decreased total sleep time (p=0.001) and sleep efficiency (p=0.001) on the PSQI compared to those without insomnia. OSA with EDS showed significantly increased PSQI score (p=0.022) and decreased total sleep time (p=0.018) on PSG compared to those without EDS. Neither PSQI nor ESS score had a correlation with respiratory variables such as AHI and oxygen saturation. Total sleep time had a significant effect on both insomnia and EDS in patients with OSA. Conclusion: Decreased total sleep time had important effects on subjective symptoms of OSA and comorbid insomnia. Therefore, restoration of decreased sleep time is important in the management of OSA. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to analyze causality among sleep apnea, depression and cognitive function in patients with obstructive sleep apnea. Methods: We reviewed the medical records of 105 patients with sleep apnea and snoring who underwent overnight polysomnography (PSG). We analyzed various biological data, sleep variables (sleep duration and percentage) and respiratory variables [arousal index (AI), periodic leg movement index (PLM index), snoring Index (SI), mean SpO2, minimum SpO2, apnea-hypopnea index (AHI), and respiratory disturbance index (RDI)]. We also analyzed various data by sleep, cognition, and mood related scales: Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), snoring index by scale (SIS), Montreal Cognitive Assessment-Korean (Moca-K), Mini-mental State Examination-Korean (MMSE-K), clinical dementia rating (CDR), and Beck Depression Inventory (BDI). We analyzed causation among sleep, and respiratory, mood, and cognition related scales in obstructive sleep apnea patients. We analyzed the mediating effects of depression on sleep apnea patient cognition. Results: As Duration N1 increased and Total sleep time (TST) decreased, MOCA-K showed negative causality (p ＜ 0.01). As BDI and supine RDI increased, causality was negatively related to MOCA-K (p ＜ 0.01). As PSQI (p ＜ 0.001) and SIS (p ＜ 0.01) increased and as MMSE-K (p ＜ 0.01) decreased, causality was positively related to BDI. BDI was found to mediate the effect of age on MOCA-K in patients with obstructive sleep apnea. Conclusion: Duration N1, total sleep time, BDI, and supine RDI were associated with cognitive function in obstructive sleep apnea patients. Depression measured by BDI partially mediated cognitive decline in obstructive sleep apnea patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Positional therapy is a therapeutic method for obstructive sleep apnea (OSA). However, little is known about the effectiveness of positional OSA treatment based on meta-analysis. Therefore, we undertook a review and meta-analysis of studies to assess the effect of positional therapy on OSA. Subjects and Method: We searched PubMed (Medline), OVID Medline, EMBASE, Cochrane Library, SCOPUS, KoreaMed, MedRIC, and KSI KISS using the key words "obstructive sleep apnea" and "positional therapy". To estimate the effect of positional OSA therapy, we analyzed the ratio of means (ROM) for pre- and post-treatment polysomnographic data including apnea-hypopnea index (AHI), lowest oxygen saturation, arousal index, and sleep efficiency. Results: Finally, twenty two studies from 21 papers were included in the meta-analysis. Positional therapy significantly decreased AHI by 54.1% [ROM, 0.459; 95% confidence interval (CI), 0.394 to 0.534] and increased lowest oxygen saturation by 3.3% (ROM, 1.033; 95% CI, 1.020 to 1.046). However, positional therapy did not significantly change arousal index (ROM, 0.846; 95% CI, 0.662 to 1.081) or sleep efficiency (ROM, 1.008; 95% CI, 0.990 to 1.027). Conclusion: Positional therapy significantly improves respiratory parameters including AHI and lowest oxygen saturation in patients with OSA. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many critically ill patients treated in the intensive care unit (ICU) experience sleep disruption. Midazolam is commonly used for the sedation of critically ill patients. This pilot study is aimed to identify the optimal dose of midazolam for achieving sound sleep in critically ill patients. METHODS: This prospective study was conducted in the medical ICU of a tertiary referral hospital. Polysomnography recording was performed over 24 hours to assess the quantity and quality of sleep in patients sedated with midazolam. RESULTS: A total of five patients were enrolled. Median total sleep time was 494.0 (IQR: 113.5-859.0) min. The majority of sleep was stage 1 (median 82.0 [IQR 60.5-372.5] min) and 2 (median 88.0 [60.5-621.0] min) with scant REM (median 10.0 [6.0-50.5] min) and no stage 3 (0.0 min) sleep. The median number of wakings in 1 hour was 16.1 (IQR: 7.6-28.6). The dose of midazolam showed a positive correlation with total sleep time (r = 0.975, p = 0.005). CONCLUSIONS: The appropriate quantity of sleep in critically ill patients was achieved with a continuous infusion of 0.02-0.03 mg/kg/h midazolam. However, the quality of sleep was poor. Further study is required for the promotion of quality sleep in such patients.

Fatigue of crew member occurs as a result of sleep loss or extended wakefulness, change of circadian rhythm, workload. Fatigue impairs crew member's alertness, it therefore has implications for safety related duties. It is required to monitor and regularly evaluate the fatigue management system to mitigate fatigue related risks. To do this, it is necessary to observe the sleep state directly affecting the crew member's fatigue. Since the incident of 'fell asleep' during flight in 2008, there are increased interest of obstructive sleep apnea which is the reduced sleep quality, and polysomnography which is the standard method to confirm the diagnosis of obstructive sleep apnea. The purpose of this article is to review the efficacy of the polysomnography in terms of the FRMS. [ABSTRACT FROM AUTHOR]

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 ± 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 ≤ 5), group 2 (5 < PLMI ≤ 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. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea syndrome (OSAS) has negative effects on health, including increased mortality, risk of cardiovascular disease, and neurocognitive difficulties. OSAS is common in obese patients and obesity is an important risk factor of OSAS. A 41-year-old female OSAS patient with severe obesity (body mass index [BMI] ↓ 35) who failed dietary weight loss underwent bariatric surgery. After surgery, there were improvements in BMI (from 36.9 to 31.7 kg/m2) and polysomnographic data, including the apnea-hypopnea index (from 25.1 to 11.2 events/hr) and minimum SaO2 (from 69 to 82%). This case demonstrates that bariatric surgery may be an effective therapeutic option to reduce sleep-disordered breathing in severely obese patients with moderate OSAS. Bariatric surgery as a treatment option for OSAS should be considered in OSAS patients with severe obesity who failed dietary weight loss. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate the effects of mattress type on both objective and subjective sleep quality in healthy good sleepers. Methods: Fifteen healthy good sleepers with a mean age of 30.8 years participated in this study. A randomized crossover trial was carried out using two different mattress types: a standard mattress and a contour coil mattress. After a night of adaptation, all participants were randomized to either a standard mattress or a contour coil mattress. Then, nocturnal polysomnography was conducted for two consecutive nights. Subjective evaluations were obtained using a self-report questionnaire before and after the polysomnographic recording sessions. Results: The polysomnographic showed no differences in total sleep time, sleep stage, or wake time after sleep onset between the two mattress conditions. Of the polysomnographic variables, only sleep onset latency was significantly reduced for the contour coil mattress. Additionally, participants reported better subjective sleep quality when sleeping on the contour coil mattress, according to the questionnaires. Conclusion: The type of mattress might affect not only subjective, but also objective sleep quality, including sleep onset latency. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study was to evaluate the relationship between salivary alpha-amylase (sAA) and heart rate variability (HRV) indices in SDB children based on objective parameters of polysomnography (PSG). Materials and Method: This prospective study enrolled 67 children who underwent a physical examination and full-attended in-lab PSG with continuous electrocardiographic signal. The sAA were measured at night before PSG and in the early morning after PSG. Results: The subjects were divided into control [n=26, apnea-hypopnea index (AHI)≤1] and obstructive sleep apnea syndrome (OSAS, n=41, AHI＞1) groups; the OSAS group was subdivided into mild (1＜AHI≤5), moderate (5＜AHI≤10), and severe (10＜AHI) groups. The severe OSAS group was significantly different from the control and other OSAS subgroups in terms of the ratio between the low- and high-frequency components (LF/HF ratio) among the HRV indices. The LF/HF ratio was positively correlated with the sAA ratio and sAA subtraction (r=0.271; r=0.347). Conclusion: TAlthough both HRV and sAA were useful methods of predicting severe OSAS in children, a weak correlation between HRV and sAA was shown in pediatric OSAS subjects. Therefore, HRV and sAA may be independent parameters revealing different aspects of pediatric OSAS. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this study were to identify the characteristics of sleep disorders in children with epilepsy complaining of sleep problems, and to find out sleep-related factors that influence on the prognosis of epilepsy. Methods: We retrospectively reviewed medical records and polysomnographic data of 94 children (mean age 13.7±3.8 years), who visited our hospital for epilepsy between March 2001 and December 2014. The patients were evaluated with polysomnography and a questionnaire about sleepiness. We compared clinical characteristics between patients with and without sleep disorders. We analyzed the differences of sleep parameters between the prognostic groups of epilepsy. Results: The patients enrolled in this study complained of various sleep problems, such as snoring, apnea, mouth-breathing, excessive daytime sleepiness, and insomnia. Sleep disorders were diagnosed in 46 patients (48.9%). Obstructive sleep apnea was the most common sleep disorder (n=26), followed by narcolepsy (n=8) and periodic limb movement disorder (n=8). Patients with poor prognosis showed decrease of stage 3-4 sleep (P=0.010). There was no significant correlation between the presence of sleep disorders and seizure control (P=0.053). Conclusion: Various sleep complaints and sleep disorders are commonly found in children with epilepsy. Polysomnographic analysis of patients with uncontrolled seizure indicates a decline in sleep quality. Screening sleep problems and performing diagnostic test with polysomnography in patients with sleep problems is recommended in pediatric patients with epilepsy. [ABSTRACT FROM AUTHOR]

Background and Objectives: Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing and affects quality of life. Several questionnaires have been developed for screening OSA. The aim of this study was to compare the anthropometric measurements of OSA patients using sleep questionnaires as a tool to screen patients with OSA. Materials and Method: This study enrolled 126 adult OSA patients. All subjects underwent overnight polysomnography (PSG) and were measured for body mass index (BMI), neck circumference, waist circumference, and tonsil size. Patients were screened using the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire (Berlin Q), and STOP questionnaire (STOP Q). Correlation and multiple regression analyses were conducted to determine the predictive value of the anthropometric measurements of OSA patients. Results: ESS, Berlin Q, and STOP Q results were associated with apnea hypopnea index (AHI), minimal oxygen saturation of PSG and BMI, neck circumference, waist circumference, and hip circumference of OSA patients. However, facial contour did not significantly influence the results of sleep questionnaires. Conclusion: Some anthropometric characteristics are associated with sleep questionnaire results. Not only sleep questionnaires, but also anthropometric data can be used as predictive tools of OSA. [ABSTRACT FROM AUTHOR]

Objectives: Several studies suggest that nocturia may be related to obstructive sleep apnea syndrome (OSAS). The mechanism by which OSAS develops nocturia has not been determined. The present study aimed to determine the prevalence of nocturia among adults with OSAS and to identify factors that may be predictive in this regard. Methods: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the sleep clinics of the St. Paul’s Hospital between 2009 and 2012. The urinary symptoms were assessed on the basis of the International Prostate Symptom Score (IPSS). Pathologic nocturia was defined as two or more urination events per night. OSAS was defined as apnea- hypopnea index (AHI) ≥5. A multivariate analysis using logistic regression was performed to examine the relationship between polysomnographic variables and the presence of pathologic nocturia, while controlling for confounding factor. Results: A total of 161 men ＞18 years of age (mean age 46.7±14.1), who had been referred to a sleep laboratory, were included in the present study. Among these, 27 patients with primary snoring and 134 patients with obstructive sleep apnea were confirmed by polysomnography. Nocturia was found in 53 patients with OSAS (39.6%) and 8 patients with primary snoring (29.6%). The AHI was higher in patients with nocturia than in those without nocturia (p=0.001). OSAS patients with nocturia had higher arousal index (p=0.044), and lower nadir oxyhemoglobin saturation (p=0.001). Multiple regression analysis showed that age (β= 0.227, p=0.003), and AHI (β=0.258, p=0.001) were associated with nocturia, and that the presence of pathologic nocturia was predicted by age (OR 1.04 ; p=0.004) and AHI (OR 1.02 ; p=0.001). Conclusion: Nocturia is common among patients with OSAS. The strongest predictors of nocturia are age and AHI in patients with OSAS. [ABSTRACT FROM AUTHOR]

Objectives: Depression, sleep complaints and cognitive impairments are commonly observed in the elderly. Elderly subjects with depressive symptoms have been found to show both poor cognitive performances and sleep disturbances. However, the relationship between sleep complaints and cognitive dysfunction in elderly depression is not clear. The aim of this study is to identify the association between sleep disturbances and cognitive decline in late-life depression. Methods: A total of 282 elderly people who underwent nocturnal polysomnography in a sleep laboratory were enrolled in the study. The Korean version of the Neuropsychological Assessment Battery developed by the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K) was applied to evaluate cognitive function. Depressive symptoms were assessed with the geriatric depression scale (GDS) and subjective sleep quality was measured using the Pittsburg sleep quality index (PSQI). Results: The control group (GDS≤9) when compared with mild (10≤GDS≤16) and severe (17≤GDS) depression groups, had significantly different scores in the Trail making test part B (TMT-B), Benton visual retention test part A (BVRT-A), and Stroop color and word test (SCWT)(all tests p＜0.05). The PSQI score, REM sleep duration, apnea-hypopnea index and oxygen desaturation index were significantly different across the three groups (all indices, p＜0.05). A stepwise multiple regression model showed that educational level, age and GDS score were predictive for both TMT-B time (adjusted R2=35.6%, p＜0.001) and BVRT-A score (adjusted R2=28.3%, p＜0.001). SCWT score was predicted by educational level, age, apnea-hypopnea index (AHI) and GDS score (adjusted R2=20.6%, p＜0.001). Poor sleep quality and sleep structure alterations observed in depression did not have any significant effects on cognitive deterioration. Conclusion: Older adults with depressive symptoms showed mild sleep alterations and poor cognitive performances. However, we found no association between sleep disturbances (except sleep apnea) and cognitive difficulties in elderly subjects with depressive symptoms. It is possible that the impact of sleep disruptions on cognitive abilities was hindered by the confounding effect of age, education and depressive symptoms. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to evaluate the polysomnographic characteristics and prescription status of restless legs syndrome (RLS) patients in naturalistic setting. Methods: We reviewed medical record of the patients over 18 years olds who (i) satisfied the clinical RLS diagnostic criteria and (ii) had the polysomnography and got treatment related thereto. As a baseline, we evaluated the four diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG) and the International Restless Legs Scale (IRLS) of the subjects. Then the polysomnography and the suggested immobilization test (SIT) were conducted and, after one month of pharmacotherapy using dopamine agonist, the IRLS was evaluated again. Results: A total of 211 subjects participated in this analysis and 94 (44.5%) of them were male and the other 117 (55.5%) were female and the average age of the 211 subjects was 46.9±14.2. Out of such 211 subjects, 136 subjects (64.5%) also had the obstructive sleep apnea (OSA), and 53 subjects (25.1%) also had the periodic limb movement disorder (PLMD). 185 subjects (87.7%) out of the 211 subjects had some other sleep disorders except RLS. The results of the polysomnography were as follows : 78.0% of sleep efficiency, 86.8 min of wake after sleep onset, and 3.4% of N3. More specifically, 12.4/h of the average apnea hypopnea index, 14.8/h of the periodic limb movement during sleep (PLMS), 41.2/h of the periodic limb movement during wake during SIT and 21.6/h of total arousal index during sleep. Out of the total subjects, 149 (70.6%) of them took the ropinirole and 47 (22.3%) of them took the pramipexole, and the average dosage of ropinirole was 0.9mg(dosage range 0.125-5 mg) while the average dosage of pramipexole was 0.5 mg (dosage range 0.125-4 mg). The dosage of the ropinirole showed a significant positive correlation with the age (r=0.25, p=0.002) and also with the IRLS (r=0.23, p=0.038). The IRLS at the baseline was 24.9 while the same was decreased down to 13.4 after one month. Conclusions: Analyzing the result of this study, a majority of clinical RLS subjects demonstrated comorbidity with some other sleep disorder such as the OSA or PLMD. 25.1% of the subjects showed a PLMD, which was less than in previous researches and the average PLMS was not very high as 14.8/h. The dosage of dopamine agonist taken was often a bit more than the amount recommended in Korea. A prospective research using a large scale controlled subjects will be necessary with respect to this topic. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the differences in patients with positional dependent sleep apnea according to their non-supine apnea-hypopnea index (AHI, ≥5 vs. <5). Methods: 92 patients with positional sleep apnea were evaluated. The patients were divided into two groups : group I was non- supine AHI having ≥5; group II was non-supine AHI having less than 5. Statistical analysis was performed to find the difference between two groups. Results: In 92 patients, the number of group I patients was 11 (12%) and the number of group II patients was 81 (88%). In the severe AHI group, percentage of group I was dominated (70%) and showing a significant difference compared with the mild and moderate AHI groups (p<.05). In the severe body mass index (BMI) group, percentage of group I was dominated (54.5%) and showing a significant difference compared with of the mild and moderate BMI groups (p<.05). The percentage of group I was significantly higher than group II (p<.05) in the AHI, supine AHI, non-supine AHI and snore time. Conclusions: In patients with positional sleep apnea, severe OSA and high BMI are more common in patients with non-supine AHI≥5 than non-supine AHI<5. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study is to find the influential clinical and physical characteristics which affect apnea-hypopnea index (AHI) in suspected obstructive sleep apnea (OSA) patients. Methods We evaluated the comprehensive factors including sleep related symptoms, clinical scales, medical history, substance use, and anthropometric data of the 119 participants who complained of the symptoms of OSA. All the participants underwent attended-full night laboratory polysomnography. The correlation and multiple regression analysis were conducted to find the influential and predictive factors of AHI. Results A multiple linear regression model 1 showed that higher AHI was associated with higher body mass index (BMI)(p < 0.001) and higher frequency of observed apnea (p = 0.002). In multiple linear regression model 2, AHI was associated with higher BMI (p < 0.001) and loudness of snoring (p = 0.018). Conclusions The present preliminary results suggest that BMI and observed apnea are most influential factors that affect AHI in suspected OSA patients. In the future study we will design the prediction formula for the OSA and AHI, which is useful in the clinical medical field. [ABSTRACT FROM AUTHOR]

Purpose: This study was done to test structural equation modeling of health-related quality of life (QOL) of men with obstructive sleep apnea in order to identify parameters affecting QOL and provide guidelines for interventions and strategies to improve QOL in these patients. Methods: Model construction was based on 'The conceptual model of patient outcome in health-related QOL' by Wilson and Cleary, using the variables; age, physiological factors, social support, cognitive appraisal, symptoms and QOL. Participants were 201 adult male patients recruited at a tertiary university hospital in Seoul. Data were collected via questionnaires, polysomnography, and clinical records. Results: Age and symptoms directly influenced QOL. Social support and cognitive appraisal about sleep did not have a direct influence on QOL, but indirectly affected it via symptoms. QOL was lower in patients who were younger and had more severe symptoms. Symptoms were more severe for patients with lower social support and more dysfunctional cognitive appraisal. When social support was lower, cognitive appraisal was more dysfunctional. Conclusion: These results suggest it is necessary to not only manage symptoms, but also apply interventions to increase social support and cognitive appraisal about sleep in order to increase QOL in patients with obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

Objectives: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS.Methods: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=41.50±13.16 yrs, AHI <5, n=20), Group 2 : mild OSAS (mean age=43.67±12.11 yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age 44.93±12.38 yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age=45.87±12.44 yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test.Results: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were 991.1±27.1 and 875.8±22.0 ms (p=0.016), standard deviation of NN interval (SDNN) was 85.4±6.6 and 112.8±5.4 ms (p=0.022), SDNN index was 57.5±5.2 and 87.6±4.2 (p<0.001), total power was 11,893.5±1,359.9 and 18,097.0±1,107.2 ms2 (p=0.008), very low frequency (VLF) was 7,534.8±1,120.1 and 11,883.8±912.0 ms2 (p=0.035), low frequency (LF) was 2,724.2±327.8 and 4,351.6±266.9 ms2 (p=0.003). Conclusions: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is characterized by identity and interpersonal problem, affective dysregulation and pervasive severe impulsivity. Although sleep disturbances are not primary symptoms of BPD, they are important aspects of this disorder. However, clinicians and researchers did not give much attention to the sleep symptoms of BPD yet. Measured by nocturnal polysomnography, increased sleep latency as well as reduced total sleep time and sleep efficiency, and 'depression-like' REM abnormalities (i.e., reduced REM latency and increased REM density) are found in BPD patients. Co-morbid sleep disorders such as chronic insomnia, nightmare disorder or circadian rhythm sleep disorder associated with BPD have been reported. Clinicians should focus on the sleep complaints of BPD patients, and carefully manage such symptoms with sleep hygiene education, cognitive psychotherapy or light therapy. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder which is characterized by intermittent hypoxia and frequent arousals because of partial or complete upper airway obstruction during sleep. This condition may be associated with various clinical sequelae such as hypertension, cardiovascular disorders, and metabolic syndrome in adults, and failure to thrive, deformity of dentofacial structures, behavioral problems, impairment of sleep-related quality of life, and enuresis in children. Although technician-attended, in-laboratory, overnight standard polysomnography (PSG) is considered a basic and important diagnostic test to classify the severity of respiratory disturbance and define the proper treatment modality in adults and children with OSA, it is too expensive and complicated to perform. Recently, in order to overcome the disadvantages of standard PSG in the clinical field, a portable sleep monitoring device has been introduced as an alternative to standard PSG in selected patients. The purpose of this article is to elucidate the clinical indications of polysomnography in OSA, to define the differential characteristics of polysomnographic indices between children and adults with OSA, and to introduce the clinical efficacy of a portable sleep monitoring device. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to perform gender-wise analysis of the related cephalometric factors affecting Korean patients with obstructive sleep apnea (OSA). Methods: We examined 118 adults who had visited the Sleep Disorder Clinic Center in Keimyung university, Daegu, Korea, and evaluated them by using polysomnography (PSG) and lateral cephalograms. The patients were divided into 4 groups (male simple snorers, male OSA patients, female simple snorers, and female OSA patients) according to AHI (apnea-hypopnea index) and sex. Results: The position of the hyoid bone in the female OSA group was inferior to that in the female simple snorer group. Multiple regression analysis showed that tongue length and soft palate width were significant determinants for the severity of AHI in male OSA patients. However, inferior position of the hyoid was a significant determinant only in women. Conclusions: From a cephalometric point of view, OSA in male and female adult patients may be characterized by different pathogeneses. In particular, in female OSA patients, they might be managed by individualized treatments such as hormone replacement therapy in addition to conventional treatment. (Korean J Orthod 2011;41(3):164-173) [ABSTRACT FROM AUTHOR]

Purpose: This study was done to test structural equation modeling of health-related quality of life (QOL) of men with obstructive sleep apnea in order to identify parameters affecting QOL and provide guidelines for interventions and strategies to improve QOL in these patients., Methods: Model construction was based on 'The conceptual model of patient outcome in health-related QOL' by Wilson and Cleary, using the variables; age, physiological factors, social support, cognitive appraisal, symptoms and QOL. Participants were 201 adult male patients recruited at a tertiary university hospital in Seoul. Data were collected via questionnaires, polysomnography, and clinical records., Results: Age and symptoms directly influenced QOL. Social support and cognitive appraisal about sleep did not have a direct influence on QOL, but indirectly affected it via symptoms. QOL was lower in patients who were younger and had more severe symptoms. Symptoms were more severe for patients with lower social support and more dysfunctional cognitive appraisal. When social support was lower, cognitive appraisal was more dysfunctional., Conclusion: These results suggest it is necessary to not only manage symptoms, but also apply interventions to increase social support and cognitive appraisal about sleep in order to increase QOL in patients with obstructive sleep apnea.

Purpose: The purpose of this study was to identify the effects of hand acupuncture therapy on sleep quality by means of a sleep questionnaire, polysomnography and a cerebral blood flow test in 30-59 year old adults., Methods: The study was a sham controlled design. Twenty-two adults were assigned to the pellet stimulating group (11) or sham group (11). The pellet stimulating group received hand acupuncture therapy using New Seoam Press Pellets number 1 for 4 weeks. On the other hand, the sham group used the same Adhesive tape in terms of shape, size and quality as New Seoam Press Pellets number 1 for 4 weeks. A Transcranial Doppler Ultrasonography and Carotid Duplex Ultrasonography examination were used for evaluating cerebral blood flow. Data was analyzed using the SPSS 12.0 version program with chi(2)-test, Fisher's exact test and Mann Whitney U-test., Results: In the pellet stimulating group, subjective sleep quality significantly improved more than that of the sham group. Among the sleep indices of the polysomnography, total sleep time and sleep latency of the sham group significantly improved. The cerebral blood flow test didn't show any differences., Conclusion: These results suggest that hand acupuncture therapy is effective for subjective sleep improvement only, not polysomnographical sleep indices and cerebral blood flow.