• Sleep Medicine and Psychophysiology
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• v.27 no.1
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• pp.24-31
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• 2020

Objectives: Subjective-objective discrepancy of sleep (SODS) is a common symptom and one of the major phenotypes of insomnia. A distorted perception of sleep deficit might be related to abnormal brain reactivity to insomnia-related stimuli. We aimed to investigate differences in brain activation to insomnia-related stimuli vs. general anxiety-inducing stimuli among insomnia patients with SODS, insomnia patients without SODS, and healthy controls (HCs). Methods: All participants were evaluated for subjective sleep status using a sleep diary and questionnaires; occult sleep disorders and objective sleep status were assessed using polysomnography and actigraphy. Task functional magnetic resonance imaging was performed during insomnia-related stimuli (Ins) and general anxiety-inducing stimuli (Gen). Brain reactivity to Ins versus Gen was compared among insomnia with SODS, insomnia without SODS, and HC groups, and a combined insomnia disorder group (ID, insomnia with and without SODS) was also compared with HCs. Results: In the insomnia with SODS group compared to the insomnia without SODS group, the right precuneus and right supplementary motor areas showed significantly increased BOLD signals in response to Ins versus Gen. In the ID group compared to the HC group, the left anterior cingulate cortex showed significantly increased BOLD signals in response to Ins versus Gen. Conclusion: The insomnia with SODS and ID groups showed higher brain activity in response to Ins versus Gen, while this was not observed in the insomnia without SODS and HC groups, respectively. These results suggest that insomnia patients with sleep misperception are more sensitive to sleep-related threats than general anxiety-inducing threats.

• Sleep Medicine and Psychophysiology
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• v.21 no.1
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• pp.5-13
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• 2014

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 ($GDS{\leq}9$) when compared with mild ($10{\leq}GDS{\leq}16$) and severe ($17{\leq}GDS$) 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 $R^2$=35.6%, p<0.001) and BVRT-A score (adjusted $R^2$=28.3%, p<0.001). SCWT score was predicted by educational level, age, apnea-hypopnea index (AHI) and GDS score (adjusted $R^2$=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.

• Sleep Medicine and Psychophysiology
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• v.6 no.2
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• pp.126-132
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• 1999

Objectives: The purposes of this study were to investigate 1) the incidence of insomnia, 2) the clinical characteristics of the insomniacs, 3) the correlation of severity of insomnia with somatic complaints and psychological distresses, and 4) the beliefs and attitudes about sleep in patients with chronic renal failure on hemodialysis. Methods: The author evaluated 153 patients, receiving hemodialysis therapy at the four outpatients hemodialysis units in Pusan, Korea. The patients had completed a self-administered questionnaire package, which consisted of basic demographic findings, questions characterizing insomnia, Beck Depression Inventory(BDI), Spielburger's State-Trait Anxiety Inventory(STAI), and visual analogue scales measuring quantitatively the severity of the self-perceived psychological and somatic symptoms. And several laboratory data were collected. Diagnosis of insomnia was made in the base of insomnia criteria of DSM-IV and international classification of sleep disorders. Subjects were dichotomized into those who reported any characteristics of insomnia or those who had no insomnia during the preceding two weeks. Results: Insomnia was found in 100(65.4%) of 153 patients. No statistical differences were found between the patients with and without insomnia in terms of age, gender, education, marital status, mean duration of hemodialysis and all considered laboratory findings except serum albumin. The patients with insomnia had significantly higher BDI score and predialysis systolic blood pressure, and lower serum albumin as compared to non-insomnia group. Significant differences were found between two groups in terms of self-perceived distress such as sadness, anxiety, worry, pruritus, and dysfunction of daily life. The data showed statistically significant correlation between insomnia severity and some variables such as physical dysfunction, pruritus, bone pain, sadness, anxiety, worry, dysfunction of daily life and excessive daytime sleepiness. The patients with insomnia had significantly several dysfunctional beliefs and attitudes about sleep than those without insomnia. Conclusion: These results indicate that insomnia is very common in hemodialysis patients and likely contribute to the impaired quality of life experienced by many these patients. The author suggests that physical and psychological distresses would be reduced and the quality of life could be improved if their sleep disturbances are properly ameliorated in patients on hemodialysis.

• Sleep Medicine and Psychophysiology
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• v.7 no.2
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• pp.109-114
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• 2000

Objectives: This study was performed to examine the characteristic cardiovascular response patterns associated with the imagination and discussion of anger-provoked events in patients with hwa-byung. Methods: Forty-three female patients with hwa-byung were evaluated with the Korean version of the State-Trait Anger Expression Inventory, the State-Trait Anxiety Inventory, Hamilton Rating Scale for Anxiety, Beck Depression Inventory, and Hamilton Rating Scale for Depression just before the task. Subjective Units of Distress (SUDS) and Vividness of the event (VIVID) during the imagination and discussion of the event were evaluated immediately after tasks. Blood pressure (BP) and heart rate (HR) during baseline, rest, and tasks were also evaluated. Results: Both startle and recovery responses of BP, startle response of HR, SUDS, and VIVID in discussion task were significantly larger than in the imagination task. Conclusion: Results suggest that it is undesirable for the patients to excessively and repeatedly recall and talk about the anger events.

• Sleep Medicine and Psychophysiology
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• v.21 no.1
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• pp.29-32
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• 2014

Objectives: The aim of current study is to evaluate the relationship between sleep, suicide and serotonin using some scales and loudness dependence of auditory evoked potentials (LDAEP). Methods: Total 65 patients who met the criteria for major depressive disorder were enrolled in current study. The patients were divided into two subgroups according to their insomnia and a history of suicide attempts. The auditory event-related potentials were measured to evaluate LDAEP before beginning antidepressants. Results: The scores of total Beck Depression Inventory (BDI) and BDI item 9 (suicide) were higher in insomnia subgroup than non-insomnia subgroup (respectively, p=0.0033 and p=0.03). However, LDAEP did not differ each other. The subgroup with a history of suicide attempts had a higher score of BDI item 9 than the subgroup without a history of suicide attempts (p=0.00012). There was a tendency for the LDAEP to be higher in the subgroup with a history of suicide attempts ($1.39{\pm}0.94{\mu}V$) than the sub-group without a history of suicide attempts ($1.05{\pm}0.75{\mu}V$), although the difference was not statistically significant (p=0.078). Conclusion: Suicidality was related to insomnia. In addition, there was a tendency for serotonin activity to be lower in the subgroup with a history of suicide attempts. In future, more studies are needed.

• Sleep Medicine and Psychophysiology
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• v.21 no.2
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• pp.61-68
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• 2014

Objective: The aim of the present study is to assess the prevalence and related risk factors of suicide ideation among middle and high school students in an urban area. Methods: We surveyed 3,691 middle and high school students (2,159 male, 1,532 female, 11-19 years of age) using a self-report questionnaire that covered basic socio-demographic data, academic achievements, presence of physical or psychiatric illness, sleep duration on weekdays, time spent at private academies on weekdays and weekends, and subjective needs for counseling. The Beck Depression Inventory (BDI) and Reynolds' Suicidal Ideation Questionnaire (SIQ) were included in the survey. Results: The prevalence of students with high suicide ideation ($SIQ{\geq}62$) was 4.6%. In a logistic regression model, female sex (p = 0.002), younger age (p < 0.001), poor academic achievement (p = 0.043) and higher score of BDI (p < 0.001) were associated with a higher SIQ score. In addition, younger age (p = 0.045) and a higher BDI score (p < 0.001) were associated with a higher SIQ score adolescents having high suicide ideation ($SIQ{\geq}62$). Conclusion: Related risk factors of suicide ideation in adolescents were female sex, younger age, poor academic achievement, and a depressive mood. It would be especially helpful to pay more attention to younger adolescents and a depressive mood as a high-risk group. The understanding of these factors will be helpful for providing an effective suicide screening and prevention program for adolescents.

• Korean Journal of Psychosomatic Medicine
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• v.13 no.2
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• pp.102-111
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• 2005

Objective : The purpose of this study was to investigate the quality of life and it's related factors in caregivers of attention deficit hyperactivity disorder patients. Methods : The subjects were 38 attention deficit hyperactivity disorder patients' caregivers(mean age : $37.5{\pm}6.5$, 38 women). Patients were diagnosed with DSM-IV-TR ADHD criteria. Korean version of WHOQOL-BREF(World Health Organization Quality of Life assessment instrument Abbreviated Version) was used for assessment. Results : 1) No significant differences were found in the score of WHOQOL-BREF, overall QOL, physical health domain, psychological domain, social relationships domain and environmental domain between caregiver and control group. 2) The score of Activity of daily living facet$(3.0{\pm}0.7\;vs.\;3.6{\pm}0.7)(p=0.008)$ and self-esteem facet $(2.8{\pm}0.7\;vs.\;3.3{\pm}0.7)(p=0.049)$ were significantly decreased in caregivers of ADHD. 3) Total score of WHOQOL-BREF(r=0.437, p=0.007) and physical health domain(r=0.370, p=0.024) were correlated with caregiver's educational age. 4) In the psychological domain, the score of self-esteem facet(r=-0.337, p=0.039) and thinking, learning, memory & concentration facet(r=-.341, p=0.036) were decreased with caregiver's age. 5) The score of environmental domain were significantly increased with caregiver's educational age (r=0.482, p=0.003), but decreased with patient's age(r=0.328, p=0.044). Conclusion : Although the quality of life in caregivers of ADHD patient had not significantly decreased than control, the quality of lift were positively correlated with educational age of caregives, and negatively correlated with chronological age of caregivers and children. Above results suggest that physicians should consider integrated approaches for caregiver's subjective quality of life in the management of ADHD.

• Korean Journal of Health Psychology
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• v.16 no.3
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• pp.557-575
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• 2011

This study tried to examine the characteristics of attention deficits in patients with Obstructive Sleep Apenea(OSA) with different age levels, and to examine which indices of polysomnograms might be related to the indices of attention deficits in OSAs. Two age-level groups and a normal control group were subjected to two computerized attention tests, including a continuous performance test(CPT) and a change blindness task(CBT). In addition, the three groups were subjected to a Polysomnography to extract several sub-indicators of polysomnogram, and an Epworth Sleepiness Scale which measures subjective sleepiness. As results, the OSAs showed significantly more omission and commission errors in CPT, and they showed lower accuracy in CBT compared to the normal group. The results of a correlational analysis showed that attention deficits in OSA are significantly correlated with arterial oxygen saturation among sub-indicators of polysomnograms. In conclusion, OSAs seems to be less attentive, having difficulties in response inhibition, and having deficiencies in noticing important environmental changes. Age seems to make these deficiencies even worse. Especially, the relationship between attention deficiency and hypoxia which could cause irreversible cerebrum damage has an implication in cognitive impairment prevention through early treatment.

• Sleep Medicine and Psychophysiology
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• v.24 no.2
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• pp.106-117
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• 2017

Objectives: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is characterized by repetitive collapse or partial collapse of the upper airway during sleep in spite of ongoing effort to breathe. It is believed that OSA is usually worsened in REM sleep, because muscle tone is suppressed during REM sleep. However, many cases showed a higher apnea-hypopnea index (AHI) during NREM sleep than during REM sleep. We aimed here to determine the characteristics of REM sleep-dependent OSA (REM-OSA) and NREM sleep-dependent OSA (NREM-OSA). Methods: Five hundred sixty polysomnographically confirmed adult OSA subjects were studied retrospectively. All patients were classified into 3 groups based on the ratio between REM-AHI and NREM-AHI. REM-OSA was defined as REM-AHI/NREM-AHI > 2, NREM-OSA as NREM-AHI/REM-AHI > 2, and the rest as sleep stage-independent OSA (IND-OSA). In addition to polysomnography, questionnaires related to subjective sleep quality, daytime sleepiness, and emotion were completed. Chi-square test, ANOVA, and ANCOVA were performed. Results: There was no age difference among subgroups. The REM-OSA group was comprised of large proportions of mild OSA and female OSA patients. These patients experienced poor sleep and more negative emotions than other two groups. The AHI and oxygen desaturation index (ODI) were lowest in REM-OSA. Sleep efficiency and N3 percentage of REM-OSA were higher than in NREM-OSA. The percentage of patients who slept in a supine position was higher in REM-OSA than other subgroups. IND-OSA showed higher BMI and larger neck circumference and abdominal circumference than REM-OSA. The patients with IND-OSA experienced more sleepiness than the other groups. AHI and ODI were highest in IND-OSA. NREM-OSA presented the shortest total sleep time and the lowest sleep efficiency. NREM-OSA showed shorter sleep latency and REM latency and higher percentage of N1 than those of REM-OSA and the highest proportion of those who slept in a lateral position than other subgroups. NREM-OSA revealed the highest composite score on the Horne and ${\ddot{O}}stberg$ questionnaire. With increased AHI severity, the numbers of apnea and hypopnea events during REM sleep decreased, and the numbers of apnea and hypopnea events during NREM sleep increased. The results of ANCOVA after controlling age, sex, BMI, NC, AC, and AHI showed the lowest sleep efficiency, the highest AHI in the supine position, and the highest percentage of waking after sleep onset in NREM-OSA. Conclusion: REM-OSA was associated with the mild form of OSA, female sex, and negative emotions. IND-OSA was associated with the severe form of OSA. NREM-OSA was most closely related to position and showed the lowest sleep efficiency. Sleep stage-dependent characteristics could provide better understanding of OSA.

• 한국노년학
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• v.28 no.4
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• pp.991-1007
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• 2008

Purpose: The purpose of this study was to compare depression and quality of life(QOL) according to the severity of insomnia in elderly. Method: The survey participants were 463 community-dwelling adults aged 65 or older. Severity of insomnia was measured by assessing a time-length to get to sleep, the number of breaks in sleep, a time-length to get to sleep after awakening, and a usual sleep pattern. Depression and QOL was measured, respectively, a modified Zung's depression scale and SF-36. The data were collected from May to June in 2005 and analyzed using the SPSS program for descriptive statistics, ${\chi}^2$-test, t-test, and ANOVA with Scheffe test. Results: A majority of the participants(75.6%) presented mild(65.0%) or severe(10.6%) insomnia. Severity of insomnia was different depending on sex, a marriage status, and sleep patterns such as hours of sleep on average, time to go to bed, and time of awakening(p<0.05). Depression and QOL were related to the severity of insomnia(p<0.05). The elderly suffering from insomnia needs nursing interventions considering demographics and sleep patterns in oder to prevent depression and to improve QOL. Future research is in need for predicting and preventing depression and QOL in elderly.