Search

Abstract Detection and spatial distribution analyses of interictal epileptiform discharges (IEDs) are important for diagnosing, classifying, and treating focal epilepsy. This study proposes deep learning-based models to detect focal IEDs in electroencephalography (EEG) recordings of the frontal, temporal, and occipital scalp regions. This study included 38 patients with frontal (n = 15), temporal (n = 13), and occipital (n = 10) IEDs and 232 controls without IEDs from a single tertiary center. All the EEG recordings were segmented into 1.5-s epochs and fed into 1- or 2-dimensional convolutional neural networks to construct binary classification models to detect IEDs in each focal region and multiclass classification models to categorize IEDs into frontal, temporal, and occipital regions. The binary classification models exhibited accuracies of 79.3–86.4%, 93.3–94.2%, and 95.5–97.2% for frontal, temporal, and occipital IEDs, respectively. The three- and four-class models exhibited accuracies of 87.0–88.7% and 74.6–74.9%, respectively, with temporal, occipital, and non-IEDs F1-scores of 89.9–92.3%, 84.9–90.6%, and 84.3–86.0%; and 86.6–86.7%, 86.8–87.2%, and 67.8–69.2% for the three- and four-class (frontal, 50.3–58.2%) models, respectively. The deep learning-based models could help enhance EEG interpretation. Although they performed well, the resolution of region-specific focal IED misinterpretations and further model improvement are needed.

ObjectiveInterest in sleep disorders among the elderly, especially those in Korea, has increased. We aimed to describe the overall sleep status of the elderly population in Korea using survey data and to determine the risk factors concerning different aspects of sleep status.MethodsWe conducted a cross-sectional survey on 271 respondents aged 65–86 years old. We performed multistage clustered random sampling according to the population and socioeconomic distribution of all Korean territories. The survey questionnaire was used to perform a structural assessment of sociodemographic characteristics; medical comorbidities; psychiatric comorbidities; and sleep status, including sleep duration, sleep quality, presence of insomnia, excessive daytime sleepiness, sleep apnea, and restless legs syndrome.ResultsApproximately 12.5, 22.%, and 51.3% of the elderly population had poor sleep quality, excessive daytime sleepiness, and insomnia, respectively. Hypertension, dyslipidemia, insomnia, anxiety, and depression predicted poor sleep quality. Female sex, insomnia, and sleep apnea predicted excessive daytime sleepiness. Poor sleep quality and depression predicted insomnia.ConclusionA substantial proportion of the elderly Korean population have sleep problems, including poor sleep quality, excessive daytime sleepiness, and insomnia. Sleep status is influenced by various factors, including age, sex, and metabolic and psychiatric comorbidities.

Abstract Migraine neither presents with a definitive single symptom nor has a distinct biomarker; thus, its diagnosis is based on combinations of typical symptoms. We aimed to identify natural subgroups of migraine based on symptoms listed in the diagnostic criteria of the third edition of the International Classification of Headache Disorders. Latent class analysis (LCA) was applied to the data of the Korean Sleep-Headache Study, a nationwide population-based survey. We selected a three-class model based on Akaike and Bayesian information criteria and characterized the three identified classes as “mild and low frequency,” “photophobia and phonophobia,” and “severe and high frequency.” In total, 52.0% (65/125) of the participants were classified as “mild and low frequency,” showing the highest frequency of mild headache intensity but the lowest overall headache frequency. Meanwhile, “photophobia and phonophobia” involved 33.6% (42/125) of the participants, who showed the highest frequency of photophobia and phonophobia. Finally, “severe and high frequency” included 14.4% (18/125) of the participants, and they presented the highest frequency of severe headache intensity and highest headache frequency. In conclusion, LCA is useful for analyzing the heterogeneity of migraine symptoms and identifying migraine subtypes. This approach may improve our understanding of the clinical characterization of migraine.

Study objectives: Lemborexant (LEM) is a dual orexin receptor antagonist approved for treating adults with insomnia. We analyzed the efficacy (subjective sleep outcomes) and safety of LEM over 12 months in the subgroup of Asian subjects from Study E2006-G000-303 (Study 303). Methods: Study 303 was a 12-month, randomized, placebo-controlled (first 6 months), double-blind, parallel-group, phase 3 study of adults with insomnia disorder. During the 6-month Period 1, subjects were randomized (1:1:1) to placebo, LEM 5 mg (LEM5), or LEM 10 mg (LEM10); LEM subjects continued treatment in the following 6-month Period 2. Outcome measures included subject-reported (subjective) sleep onset latency (sSOL), sleep efficiency (sSE), wake after sleep onset (sWASO), total sleep time (sTST), Insomnia Severity Index (ISI), and Patient Global Impression–Insomnia version (PGI-I). Treatment-emergent adverse events (TEAEs) were assessed. Results: Overall, 178 Asian subjects (Japanese, n = 161; Chinese, n = 4; other Asian, n = 13) were included. Greater decreases in sSOL and sWASO and increases in sSE and sTST from baseline were observed with LEM vs placebo at 6 months; LEM benefits were sustained through 12 months. Greater decreases in ISI total score were seen with LEM vs placebo at 6 months; improvements from baseline with LEM continued through 12 months. For each PGI-I item, LEM-treated subjects had more positive medication effects than placebo-treated subjects at 6 months; these effects were maintained with LEM in Period 2. TEAEs were generally mild to moderate. Conclusions: LEM improved subjective sleep parameters and was well-tolerated in Asian subjects with insomnia disorder over 12 months. Clinical trial registration: ClinicalTrials.gov, NCT02952820; ClinicalTrialsRegister.eu, EudraCT Number 2015-001463-39.

Abstract Cutaneous allodynia (CA) is a pain in response to non-nociceptive stimulation and a marker of central sensitisation. Probable migraine (PM) is a migraine subtype that fulfils all but one criterion of migraine. Headache intensity and the disability of individuals with PM are similar or lower than individuals with migraine. This study compared CA prevalence and characteristics of PM and migraine using a nationally representative sample in Korea. The Allodynia Symptom Checklist-12 (ASC-12) was used to assess CA (ASC-12 score ≥ 3). PM and migraine prevalence were 11.6% and 5.0%, respectively. CA prevalence did not significantly differ between PM and migraine (14.5% vs. 16.0%, p = 0.701). Participants with PM with CA reported a higher monthly headache frequency (3.3 ± 4.3 vs. 1.8 ± 3.6, p = 0.044), more severe headache intensity (Visuals Analogue Scale, 6.0 [4.0–7.0] vs. 5.0 [3.0–6.0], p = 0.002), and higher impact of headache (Headache Impact Test-6, 56.3 ± 7.2 vs. 48.3 ± 8.0, p

Objective: Insomnia and depression are prevalent disorders that often co-occur. This study aimed to investigate the impact of clinically significant insomnia symptoms on the prevalence and clinical presentation of clinically significant depressive symptoms and vice versa.Methods: This study used data from the Korean Headache-Sleep Study (KHSS), a nationwide cross-sectional population-based survey regarding headache and sleep. Clinically significant insomnia symptoms were defined as Insomnia Severity Index (ISI) scores ≥ 10 and clinically significant depressive symptoms were defined as Patient Health Questionnaire-9 (PHQ-9) scores ≥ 10, respectively. We referred clinically significant insomnia symptoms and clinically significant depressive symptoms as insomnia symptoms and depressive symptoms, respectively.Results: Of 2,695 participants, 290 (10.8%) and 116 (4.3%) were classified as having insomnia and depressive symptoms, respectively. The prevalence of depressive symptoms was higher among participants with insomnia symptoms than in those without insomnia symptoms (25.9 vs. 1.7%, respectively, P < 0.001). Among participants with depressive symptoms, the PHQ-9 scores were not significantly different between participants with and without insomnia symptoms (P = 0.124). The prevalence of insomnia symptoms was significantly higher among participants with depressive symptoms than in those without depressive symptoms (64.7 vs. 8.3%, respectively, P < 0.001). The ISI scores were significantly higher among participants with insomnia and depressive symptoms than in participants with insomnia symptoms alone (P < 0.001).Conclusions: Participants with depressive symptoms had a higher risk of insomnia symptoms than did those without depressive symptoms. The severity of depressive symptoms did not significantly differ based on insomnia symptoms among participants with depressive symptoms; however, the severity of insomnia symptoms was significantly higher in participants with depressive symptoms than in those without depressive symptoms.

Instantaneous drowsiness (i.e., lapse or micro-sleep) during various activities such as driving or construction causes enormous socioeconomic losses. Thus, a virtuous cycle system that monitors a subject's drowsiness can improve work efficiency and safety. We propose a novel framework to detect instantaneous drowsiness with only a two-second length of electroencephalography (EEG). To achieve reliable performance, we use multitaper power spectral density for feature extraction along with extreme gradient boosting as a machine learning classifier. In addition, we introduce a novel phenotype labeling of instantaneous drowsiness by combining both task dependent and independent measures of alertness (psychomotor vigilance task and electrooculography technique, respectively). The results show that our techniques outperform others used in previous studies. We also identified which spectral components (θ, α, and γ) and channels (Fp1, Fp2, T3, T4, O1, O2, and electrocardiogram) play important roles in our drowsiness detection framework. To verify the applicability for a mobile environment, we implemented our framework on a wireless EEG, as well as on a wired EEG. We hereby present our successful results.

A new concept of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep is proposed, that of multi-component integrative states that define stable and unstable sleep, respectively, NREMS, NREMUS REMS, and REMUS. Three complementary data sets are used: obstructive sleep apnea (20), healthy subjects (11), and high loop gain sleep apnea (50). We use polysomnography (PSG) with beat-to-beat blood pressure monitoring, and electrocardiogram (ECG)-derived cardiopulmonary coupling (CPC) analysis to demonstrate a bimodal, rather than graded, characteristic of NREM sleep. Stable NREM (NREMS) is characterized by high probability of occurrence of the

Abstract Background Insomnia and migraine are closely related; insomnia aggravates migraine symptoms. This study was conducted to investigate the impact of migraine on the clinical presentation of insomnia symptoms. Methods The data of the Korean Headache-Sleep Study (KHSS) were used in the present study. The KHSS is a nation-wide cross-sectional population-based survey regarding headache and sleep in Korean adults aged 19 to 69 years. If a participant’s Insomnia Severity Index (ISI) score ≥ 10, she/he was classified as having insomnia. The clinical presentation of insomnia symptoms was assessed using total and subcomponent scores of the ISI. Results Of 2695 participants, 290 (10.8%) and 143 (5.3%) individuals were assigned as having insomnia and migraine, respectively. The proportions of migraine (12.8% vs. 4.4%, p

Excessive daytime sleepiness (EDS) is a prevalent sleep-related complaint across the general population and has been reported to be associated with headache. Tension-type headache (TTH) is the most commonly encountered headache and accounts for a significant amount of disease burden. However, the association between EDS and TTH is currently scarce. In the present study, we investigated the impact of EDS on the prevalence and clinical presentation of TTH. We utilized data from the Korean Headache-Sleep Study, a national survey that sought to identify headache and sleep characteristics in Korean adults. Participants with an Epworth sleepiness scale score greater or equal to 11 were considered as having EDS. Of the 2,695 participants enrolled, 570 (21.2%) and 313 (11.6%) had TTH and EDS, respectively. EDS was highly prevalent in individuals with chronic tension-type headache (CTTH) than in those without headache (35.7 vs. 9.4%, p < 0.001). The prevalence of EDS in episodic tension-type headache (ETTH) individuals with a headache frequency

Abstract Background Probable migraine (PM) is a subtype of migraine that is prevalent in the general population. Previous studies have shown that poor sleep quality is common among migraineurs and is associated with an exacerbation of migraine symptoms. However, information on the prevalence and clinical implication of poor sleep quality among individuals with PM is scarce. Thus, the aim of this study was to assess the prevalence and clinical impact of poor sleep quality in individuals with PM in comparison with those with migraine. Methods Two-stage cluster random sampling was used to perform the survey for sleep and headache in Korean general population. Participants with Pittsburgh Sleep Quality Index > 5 were considered as having poor sleep quality. Results Of 2695 participants, 379 (14.1%) had PM and 715 (26.5%) had poor sleep quality. Prevalence of poor sleep quality was 35.4% in the PM group, which was lower than that in the migraine group (47.6%, p = 0.011), but higher than that in the non-headache group (21.4%, p

Sleep, a vital process of human being, is carefully orchestrated by the brain and consists of cyclic transitions between rapid eye movement (REM) and non-REM (NREM) sleep. Autonomic tranquility during NREM sleep is characterized by vagal dominance and stable breathing, providing an opportunity for the cardiovascular-neural axis to restore homeostasis, in response to use, distress or fatigue inflicted during wakefulness. Abrupt irregular swings in sympathovagal balance during REM sleep act as phasic loads on the resting cardiovascular system. Any causes of sleep curtailment or fragmentation such as sleep restriction, sleep apnea, insomnia, periodic limb movements during sleep, and shift work, not only impair cardiovascular restoration but also impose a stress on the cardiovascular system. Sleep disturbances have been reported to play a role in the development of stroke and other cardiovascular disorders. This review aims to provide updated information on the role of abnormal sleep in the development of stroke, to discuss the implications of recent research findings, and to help both stroke clinicians and researchers understand the importance of identification and management of sleep pathology for stroke prevention and care.

Abstract Background Tension-type headache (TTH) represents the most common type of headache among the general population. Although such headaches are usually mild in severity, some individuals with TTH experience severe symptoms and psychiatric comorbidities. Such patients may also experience sleep disturbances, which have been associated with headache exacerbation. Nevertheless, information regarding the prevalence and impact of insomnia among individuals with TTH in a population-based setting is limited. Therefore, the aim of the present study was to evaluate the prevalence and impact of insomnia among individuals with TTH using data from the Korean Headache-Sleep Study (KHSS). Methods We analysed data from the KHSS—a nation-wide, cross-sectional, population-based survey on headache and sleep involving Korean adults aged 19 to 69 years. Insomnia was defined as an Insomnia Severity Index score ≥ 10. Results Among 2695 participants, 570 (21.2%) and 290 (10.8%) were classified as having TTH and insomnia, respectively. Among individuals with TTH, 113 (19.8%) met the criteria for probable migraine (PM). The prevalence of insomnia among individuals with TTH was significantly higher than that among individuals without headache (13.2% vs. 5.8%, p

Abstract Background The primary metric extracted from the polysomnogram in patients with sleep apnea is the apnea-hypopnea index (or respiratory disturbance index) and its derivatives. Other phenomena of possible importance such as periods of stable breathing, features suggestive of high respiratory control loop gain, and sleep fragmentation phenotypes are not commonly generated in clinical practice or research. A broader phenotype designation can provide insights into biological processes, and possibly clinical therapy outcome effects. Methods The dataset used for this study was the archived baseline diagnostic polysomnograms from the Apnea Positive Pressure Long-term Efficacy Study (APPLES). The electrocardiogram (ECG)-derived cardiopulmonary coupling sleep spectrogram was computed from the polysomnogram. Sleep fragmentation phenotypes used thresholds of sleep efficiency (SE) ≤ 70%, non-rapid eye movement (NREM) sleep N1 ≥ 30%, wake after sleep onset (WASO) ≥ 60 min, and high frequency coupling (HFC) on the ECG-spectrogram ≤ 30%. Sleep consolidation phenotypes used thresholds of SE ≥ 90%, WASO ≤ 30 min, HFC ≥ 50% and N1 ≤ 10%. Multiple and logistic regression analysis explored cross-sectional associations with covariates and across phenotype categories. NREM vs. REM dominant apnea categories were identified when the NREM divided by REM respiratory disturbance index (RDI) was > 1. Results The data was binned first into mild, moderate, severe and extreme categories based on the respiratory disturbance index of

Abstract Background Sleep disorder and sleep complaints are common in subjects with migraine. Although the association between sleep disorders and migraine has been reported, the association between perceived insufficient sleep and migraine has rarely reported. The aim of this study is to evaluate the association between insufficient sleep and migraine using the data of the Korean Headache-Sleep Study (KHSS). Methods The KHSS is a nation-wide cross-sectional population-based survey regarding headache and sleep for Korean adults aged 19 to 69 years. A difference of one hour or more between sleep need and average sleep time indicated insufficient sleep. Results Of 2,695 participants, 727 (27.0%) individuals were classified as having insufficient sleep. The prevalence of insufficient sleep among individuals with migraine (45.5%) was significantly higher compared to that among individuals with non-migraine headache (32.9%, p = 0.004) or among non-headache (20.4%, p

Abstract Background Recent studies have shown a significant association between restless legs syndrome (RLS) and primary headache disorders. Nevertheless, information regarding the association between tension-type headache (TTH) and RLS is limited. This study aimed to investigate the association between RLS and TTH in a population-based sample. Methods We selected a stratified random population sample of Koreans aged 19–69 years and assessed them using a semi-structured interview designed to identify RLS, headache type, and clinical characteristics of TTH. We determined the prevalence and clinical impact of RLS in participants with TTH. Results Of the 2695 participants, 570 (21.2%) and 142 (5.3%) were classified as having TTH and RLS, respectively. Among the 570 individuals with TTH, 113 (19.8%) also met the criteria for probable migraine (PM). The prevalence of RLS was significantly higher among individuals with TTH than among those with non-headache (6.0% vs 3.6%, p = 0.018). The prevalence of RLS was significantly higher in subjects with TTH who fulfilled PM criteria than in those with non-headache participants (8.0% vs. 3.6%, p = 0.018). However, RLS prevalence in individuals with TTH who did not fulfil PM criteria did not differ from that of participants with non-headache (5.5% vs. 3.6%, p = 0.063). TTH participants with RLS had higher visual analogue scale scores for headache intensity (5.1 ± 2.0 vs. 4.3 ± 1.8, p = 0.038), and higher prevalence of anxiety (20.6% vs. 8.8%, p = 0.022) and depression (14.7% vs. 3.5%, p = 0.002) than TTH participants without RLS. Multivariable analyses revealed that headache aggravation by movement (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.1–5.2) and depression (OR = 3.5, 95% CI = 1.1–11.4) were significant indicators of RLS among individuals with TTH. Conclusions The prevalence of RLS was higher among individuals with TTH than among those with non-headache. Some clinical presentations varied in accordance with the presence of RLS among participants with TTH.

A smart city is a future city that enables citizens to enjoy Information and Communication Technology (ICT) based smart services with any device, anytime, anywhere. It heavily utilizes Internet of Things. It includes many video cameras to provide various kinds of services for smart cities. Video cameras continuously feed big video data to the smart city system, and smart cities need to process the big video data as fast as it can. This is a very challenging task because big computational power is required to shorten processing time. This paper introduces UTOPIA Smart Video Surveillance, which analyzes the big video images using MapReduce, for smart cities. We implemented the smart video surveillance in our middleware platform. This paper explains its mechanism, implementation, and operation and presents performance evaluation results to confirm that the system worked well and is scalable, efficient, reliable, and flexible.

To determine the prevalence, sleep characteristics, and comorbidities associated with a high risk for obstructive sleep apnea (OSA) in the Korean adult population.We analyzed data from 2,740 subjects who responded to a nationwide questionnaire survey of sleep characteristics. Those who qualified under two or more symptom categories of the Berlin questionnaire were defined as "at high risk for OSA". We investigated their socio-demographic information, sleep habits, and medical and psychiatric comorbidities. Logistic regression analyses were performed to identify factors and consequences significantly associated with a high risk for OSA.The prevalence of a high risk for OSA was 15.8% (95% confidence interval [CI] 14.5-17.2%). Multiple logistic regression analysis showed that old age (≥ 70 years, odds ratio [OR] 2.68) and body mass index ≥ 25 kg/m2 (OR 10.75) were significantly related with a high risk for OSA, whereas regular physical activity (OR 0.70) had a protective effect. Subjective sleep characteristics associated with a high risk for OSA were perceived insufficient sleep (OR 1.49), excessive daytime sleepiness (OR 1.88), and insomnia (OR 3.70). In addition, hypertension (OR 5.83), diabetes mellitus (OR 2.54), hyperlipidemia (OR 2.85), and anxiety (OR 1.63) were comorbid conditions independently associated with a high risk for OSA.This is the first study to demonstrate the prevalence of a high risk for OSA in a nationwide representative sample of the Korean adult population. These findings elucidate the epidemiology and clinical characteristics of those at high risk for OSA.

Disrupted circadian rhythms and reduced sleep duration are associated with several human diseases, particularly obesity and type 2 diabetes, but until recently, little was known about the genetic factors influencing these heritable traits. We performed genome-wide association studies of self-reported chronotype (morning/evening person) and self-reported sleep duration in 128,266 white British individuals from the UK Biobank study. Sixteen variants were associated with chronotype (P

Although tension-type headache (TTH) is a frequent type of headache disorder and imposes a significant burden, there is scant information about the prevalence and impact of comorbid anxiety and depression among individuals with TTH. We investigated the prevalence and clinical impact of anxiety and depression among patients with TTH in the general population. We recruited Korean participants aged 19-69 years using a two-stage clustered random sampling method. To identify the presence of headache type, anxiety, and depression, we used a semi-structured interview using certain questionnaires. To assess the level of anxiety and depression, we used the Goldberg Anxiety Scale and Patient Health Questionnaire-9, respectively. Among 2,695 participants, 570 people (21.2%) had TTH during previous 1 year. In participants with TTH, the prevalence of anxiety (9.5% vs. 5.3%, p = 0.001) and depression (4.2% vs. 1.8%, p = 0.001) was significantly higher than that of non-headache participants. The prevalence of anxiety among TTH participants with >15 attacks per month [21.4%, odds ratio (OR): 4.0] and 1-14 attacks per month (13.1%, OR: 2.2) was higher than that in those with

Background and Objective Although Cynanchum wilfordii Hemsley (C. wilfordii) has been widely used for treating insomnia in Korea, there are no objective data on its sleep-enhancing effects. Methods We examined the effects of this extract on sleep latency, sleep parameters, and NREM delta activity in rats administered several different dosages (300 mg/kg, 1 g/kg or 3 g/kg, p.o.) and compared them to valerian extract which is a popular natural hypnotic. Results We found no significant shortening of sleep latency was observed with any dosage of either C. wilfordii extract or with valerian. NREM sleep increased significantly at C. wilfordii dosages of 300 mg/kg and 1 g/kg but not for 3 g/kg. Only the 1 g/kg dosage significantly decreased the amount of wakefulness. Neither any of the C. wilfordii dosages nor valerian extract produced any effect on REM sleep amount. Conclusions Therefore, C. wilfordii could be a useful natural hypnotic with a sleep-enhancing effect.

Background and Objective The association of sleep disturbance (SD) with cardiovascular disease is through its induction of autonomic dysregulation and inflammation, which also could be important pathophysiological mechanisms responsible for atrial fibrillation (AF). However, no study has fully elucidated the causal relationship between SD and AF. We investigated whether SD influences AF vulnerability in an in vivo rat model. Methods We divided 8-week-old Wister rats into 5 groups: 1) control, 2) 3-day SD, 3) 7-day SD, 4) 3-day sham SD, and 5) 7-day sham SD (n = 5 in each group), using the multiple platform method to create SD. We measured baseline heart rate, blood pressure (BP), and AF inducibility via burst atrial pacing (30 mA, 40 Hz, 30 seconds) by means of a transoesophageal electrode and used Sirius red staining to assess collagen deposition in the atriums. Results Baseline heart rate, diastolic BP and AF inducibility were significantly higher in the SD groups than in the control and sham condition groups (p < 0.05). However, there were no differences between the 3- and 7-day SD groups. Systolic BP and induced AF duration did not statistically differ among any of the experimental groups. The Sirius red staining showed no differences in collagen deposition among any of the experimental groups. Conclusions SD resulted in increase of AF inducibility in SD rats, suggesting that SD provides an atrial substrate for AF vulnerability, regardless of the disturbance period. However, induced AF duration showed no significant differences in SD rats.

Background and Objective Simulated altitude as a model for hypoxia has shown inconsistent results in terms of impaired cognition. We hypothesized that preserved periods of stable sleep even under hypoxia could explain stable cognitive function. Delta spectral power on electroencephalography during stable sleep as well as high frequency coupling on the electrocardiogram-based spectrogram was adopted as measures of sleep quality. Methods Eleven healthy, non-smoking subjects (7 men, 27 ± 1.5 years) were exposed to 9 hours of continuous hypoxia for 13 consecutive nights. Polysomnography was done at baseline and during 3 time points, at night 3, 7, and 14. In each study, delta spectral power was obtained during stable N2 and N3 sleep. Stable sleep was defined when there was no significant fragmentation in electroencephalography and fluctuation in electromyography and cardiorespiratory signals. The time threshold was 2 or 5 continuous minutes for N2 and 2 minutes for N3. The amount of high frequency coupling for the sleep period on the electrocardiogram-based spectrogram was computed. Randomized block ANOVA was used with electroencephalography delta power and high frequency coupling as dependent variables with post hoc Tukey test. Results Delta spectral power during stable sleep was not significantly different across the entire hypoxic exposures (p = 0.98 for N2; p = 0.32 for N3). High frequency coupling was different between pre-exposure and mid-exposure (night 7; 52.5 ± 23.6% vs. 39.0 ± 16.7%, p = 0.02) but returned to the baseline level at the post-exposure (night 14; 45.4 ± 18.2%, p = 0.39). Conclusions Both preservation of the proportion of stable sleep and unchanged delta power during these periods may help explain maintained cognition in conditions of chronic nocturnal hypoxic exposures.

Gastroesophageal reflux disease (GERD) is a common disorder that is associated with many esophageal syndromes and complications. Most cases of reflux event occur during the day, but reflux during sleep can cause not only esophageal problems, but also sleep problems, such as arousal and poor sleep quality. We report the case of a 17-year-old man who had been referred to us with frequent arousal following sudden dyspnea. On polysomnography, no respiratory disturbances and periodic limb movements were found during the sleep study, but frequent events of arousal were reported (arousal index: 12.3/h). On a 24-hr esophageal pH monitoring test, his DeMeester score was 176.43 and the total reflux time was 1120.9 min (76.9%), indicating the presence of significant acid reflux. After treatment with a proton-pump inhibitor, the arousals following nocturnal dyspnea and fatigue in the morning disappeared in the patient. GERD should be considered as a cause of spontaneous arousal or awakening not accompanying respiratory disturbances.

Treatment-emergent central sleep apnea has been referred to as ‘complex sleep apnea’, where apparently obstructive respiratory events convert to central apneas with application of positive airway pressure. Potential contributing factors may include increased propensity for arousals and positive airway pressure-induced reductions in CO2 which amplifies unstable ventilatory control. Here we demonstrate the dramatic beneficial effects of zolpidem and enhanced expiratory rebreathing space on complex sleep apnea, which helps to elude the mechanism of complex sleep apnea.