• Sleep Medicine and Psychophysiology
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• v.14 no.2
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• pp.86-91
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• 2007

Background: Actigraphy is a reliable and valid method for assessing sleep in normal, healthy populations, but it may be less reliable and valid for detecting disturbed sleep in patients. In this study, we attempted to assess the utility of actigraphy in the estimation of sleep quality in patients with obstructive sleep apnea syndrome (OSAS), a major sleep disorder. Method: We analyzed the data of patients who underwent polysomnography (PSG) and actigraphy simultaneously for one night at the Center for Sleep and Chronobiology, Seoul National University Hospital from November 2004 to March 2006. Eighty-nine subjects with OSAS alone and 21 subjects with OSAS and periodic limb movement disorder (PLMD) were included for final data analyses between groups. Polysomnographic and actigraphic data were also compared. Results: In subjects with mild OSAS (RDI<15), modretae ($15{\leq}RDI$<30), and OSAS with PLMD, PSG and actigraphy did not show significant difference in total sleep time and sleep efficiency. However in severe ($30{\leq}RDI$) OSAS subjects, PSG and actigraphy showed significant difference in total sleep time and sleep efficiency. In all patients, no correlations were found between sleep parameters from PSG and from those using actigraphy. Conclusions: We suggest that in severe OSAS patients, PSG is the diagnostic tool. In mild and moderate cases, actigraphy might be used as a screening tool.

• Proceedings of the ESK Conference
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• 1997.10a
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• pp.386-390
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• 1997

SAC 847 컴퓨터를 통해서 뇌파를 기본으로 턱과 다리의 근전도, 몸의 뒤척임, 심전도, 혈중 산소 농 도, 안전도 등을 동시에 기록하는 다원수면검사(polysomnogram)를 전자기가 차폐된 수면실에서 실시하 였고 수면단계기록 국제기준에 의한 수면단계와 최근 새롭게 제시되고 있는 수면의 경과에 따른 수면방 추파(sleep spindle)의 변동추적에 의한 수면단계 판정방법을 비교 분석하였다. 또한, 수면경과에 따른 .beta. .alpha. .theta. .delta. 파형의 발생빈도를 제시하고 평가하였다. 이러한 수면단계 분석은 종합 수면생리신호의 일환으로 인간공학적인 쾌적침대개발에 활용될 수 있을 것이다.

• Sleep Medicine and Psychophysiology
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• v.12 no.1
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• pp.32-38
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• 2005

Objectives: Obstructive sleep apnea syndrome (OSAS) has drawn increasing attention as medical community has become to be aware of its co-morbidities and complications, especially cardiovascular complications and excessive daytime sleepiness with accident proneness. As of now, polysomnography is the standard tool to diagnose sleep apnea and estimate the treatment validity. However, its being rather expensive and inconvenient, alternate diagnostic tools have been proposed including wrist actigraphy. So far, actigraphies have been adopted usefully to field-survey sleep apnea prevalence. In this study, we attempted in a sleep laboratory setting to assess the supplemental value of actigraphy in diagnosing OSAS. Methods: This study was done at the Division of Sleep Studies, the Seoul National University Hospital. Thirty-seven clinically suspected cases of OSAS underwent the one-night polysomnography, simultaneously wearing an actigraphy on non-dominant wrist. We analyzed the data of 27 polysomnographically-proven OSAS patients (male：female 20： 7；age $47.6{\pm}12.9$ years old；age range 23 to 72 years) with no other sleep disorders. We calculated RDI (respiratory disturbance index) from the polysomnography data and FI (fragmentation index) from the actigraphy data. Pearson correlation was calculated in order to compare FI with RDI and to evaluate the supplemental diagnostic value of the actigraphy. Results: Mean total sleep time on polysomnography was $401.4{\pm}57.8\;min$ (range of 274.0 to 514.1 min). Mean RDI was $21.7{\pm}20.4/hour$. Mean FI was $21.9{\pm}13.0/hour$. RDI and FI showed significant correlation (r=0.55, p<0.01). Conclusions: Wrist actigraphy in OSAS patients generates a comparable outcome to polysomnography, in measuring the nocturnal sleep fragmentation. The actigraphy could be used supplementally in inpatients, outpatients, and field survey subjects, if polysomnography is unavailable or impossible. In follow-ups related with nasal CPAP (continuous positive airway pressure), upper airway surgery, and oral appliance in OSAS patients, the actigraphy might play a more dominant role in the future.

• Sleep Medicine and Psychophysiology
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• v.12 no.1
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• pp.27-31
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• 2005

Objectives: We attempted to compare the performance of 2 commercially available actigraphies with focus on sleep parameters, using polysomnography as standard comparison tool. Methods: Fourteen normal volunteers (5 males and 9 females, mean age of $28{\pm}4.6\;years$) participated in this study. All the participants went through one night of polysomnography, simultaneously wearing 2 different kinds of actigraphies on each wrist. Polysomnographic and actigraphic data were stored, downloaded, and processed according to standard protocols and then statistically compared. Results: Both $ActiWatch^{(R)}$ and $SleepWatch^{(R)}$ tended to overestimate the total sleep time, compared to the polysomnography. $SleepWatch^{(R)}$ tended to underestimate the sleep latency. The two actigraphs and the polysomnograph did not show significant difference of sleep efficiency, when compared with one another. In addition, all of the sleep parameters from the instruments showed linear correlations except in $SleepWatch^{(R)}'s$ sleep latency. The sleep parameters from the two actigraphs did not show much noteworthy difference, and linear relationships were found between the sleep parameters from the two actigraphs. There was no significant distinction in the results of the two different actigraphs. Conclusion: The results of two actigraphies can be used interchangeably since the sleep parameters of the two different actigraphies do not show significant differences statistically. Overall, it is not legitimate to use actigraphy as a substitute for polysomnography. However, since sleep parameters except sleep latency show linear correlations, actigraphy might possibly be used to follow up patients after polysomnography.

• Sleep Medicine and Psychophysiology
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• v.5 no.1
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• pp.111-117
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• 1998

Objectives : 'First-night effect' has been a well-known concept since 1960's. It is important because it is one of the major factors to be considered in assessing the reliability of polysomnographic data. However, 'reverse first-night effect' has also been described, resulting in the inconsistency of conceptualization. We attempted to investigate on the first-night effect in adults by having each of them take two nights of polysomnography in a controlled environment. Young healthy adult volunteers were chosen as subjects in order to rule out age- or health-related confounders. Methods : Polysomnography was performed on eight male medical students (mean $age=23.5\;{\pm}\;0.9$) for two nights with Grass model 78 polysomnograph. We scored manually under the standard protocol each epoch of the sleep records. Sleep variables were obtained and compared between the two nights. Results : Sleep period time(SPT) and total sleep time(TST) of the third fraction of night were significantly longer on the first night than on the second night (p<0.05). However, other sleep variables such as percentage of each sleep stage, sleep latency, REM sleep latency, number of waking, and sleep efficiency were not different between the two nights. Conclusion : We could not confirm the existence of first-night effect in this study. In healthy young male adults, it may not happen at all or may happen to a very negligible degree. Young healthy adults may have more adaptability to a new sleep environment. Also, the provision of a reasonably comfortable sleep environment could have helped them with abolition of first-night effect.

• Sleep Medicine and Psychophysiology
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• v.14 no.2
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• pp.92-98
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• 2007

Objectives: Obstructive sleep apnea syndrome (OSAS) is the most common form of sleep-disordered breathing and often presents with comorbid depressive symptoms. In this study, we evaluated the relationship between depressive symptoms and sleep parameters as measured by nocturnal polysomnography (NPSG) and simultaneous wrist actigraphy. Methods: Two hundred sixty-four subjects with clinically suspected cases of OSAS underwent one-night polysomnography, while simultaneously wearing a wrist actigraphy device. They also completed two questionnaires；the Epworth Sleepiness Scale-Korean version (ESS-K) and the Beck Depression Inventory (BDI). Of the cases studied, 105 subjects were proven by NSPG to have OSAS without other sleep disorders. NPSG and wrist actigraphy data from the subjects were analyzed. Pearson correlation and paired t-test were used in order to evaluate the relationship between depressive symptoms and sleep-parameters. Results: Mean age of the subjects was $46.1{\pm}13.1$ years. Means of the ESS-K score and BDI scores were $10.9{\pm}4.7$ and $12.8{\pm}8.1$, respectively. NPSG sleep parameters significantly differed from those of wrist actigraphy. There was no correlation found between subjects' respiratory disturbance index (RDI) and BDI scores. When directly comparing sleep parameters between subjects who were more depressed versus subjects who were less depressed, both total sleep time and sleep efficiency were decreased in the more depressed. A correlation between RDI and ESS-K scores was also found in the more depressed group. Conclusions: Although our findings suggest that there is no relationship between RDI and depressive symptoms, there are other significant differences in the sleep parameters between subjects who are more depressed versus those without depression. We recommend that patients with depression should also be evaluated for clinical symptoms of OSAS.

• Sleep Medicine and Psychophysiology
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• v.7 no.1
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• pp.43-50
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• 2000

Objectives: Obstructive sleep apnea syndrome(OSAS) is known to be associated with the changes of autonomic nervous system (ANS). Nasal continuous positive airway pressure(nCPAP) treatment was found to correct abnormal ANS changes in OSAS but it remains to be further clarified. We aimed to assess the effects of nCPAP on ANS manifested on electrocardiogram, using spectrum analysis in the subjects with OSAS. Methods: Digital polysomnography was performed in 18 patients with OSAS(mean age $43.7{\pm}16.6$ years ; 17 males, 1 female ; mean respiratory disturbance index (RDI) $48.6{\pm}20.9$) for one baseline and another CPAP nights. From each night, 300 continuous beats of ECGs without artifact were chosen from both stage 2 sleep and REM sleep and they were used for power spectrum analysis. We compared between baseline and CPAP nights the heart rate variability including VLF(very low frequency power), LF (low frequency power), HF(high frequency power), R-R means, R-R variance, and LF/HF ratio, using Wilcoxon signed ranks test. Results: In all patients, nCPAP proved to be effective in relieving apneas and snoring. During nCPAP night compared with baseline night, decreases in VLF(p<0.05), LF(p<0.01), and R-R variance(p<0.05) were found in stage 2 sleep, and decreased LF(p<0.05) was found in REM sleep. No significant differences in each sleep stage were found in other variables between the two nights. Conclusion: Our findings suggest that OSAS increases the activity of sympathetic nervous system and nCPAP application effectively decreases the activity. And nCPAP does not appear to influence the parasympathetic nervous activity in OSAS.

• Sleep Medicine and Psychophysiology
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• v.11 no.2
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• pp.73-79
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• 2004

Digital polysomnography was developed to overcome the limitations of Rechtschaffen and Kales rule and to compensate the shortcomings of paper polysomnography. It enables easy access to and secure preservation of sleep records, and provides various displays of sleep data to enhance efficiency of visual scoring of sleep records. Rechtschaffen and Kales rule had been criticized for its ambiguity and lack of considerations in spatial information of EEG. As sleep records are acquired and processed in digital mode, they can be analyzed at microscopic and macroscopic levels. Digital analysis of sleep records provides the basis for development of new sleep measures. Sleep staging in digital polysomnography is based on the various analyses of EEG. Sleep apnea, hypopnea and periodic limb movement are detected automatically by digital analysis of respiratory signals and leg EMG. Digital polysomnography plays a complementary role to visual scoring and compensates the limitations of paper polysomnography. Digital polysomnography, including acquisition, processing and analysis of sleep records in digital mode, can be a great help in the development of sleep medicine, enabling the development of new sleep measures and the exchange of sleep records between sleep laboratories.

• Proceedings of the ESK Conference
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• 1997.10a
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• pp.381-385
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• 1997

수면생리신호는 ${\mu}V ~ {\mu}V$ 급으로서 미소하므로 고이득 증폭기를 이용하여 기록하는데 이때 외부에서의 전기적 잡음이 혼입된 경우 그 잡음까지 기록되어 기록 파형으로 부터의 수면단계 해석에 오류를 초래한다. 일반적으로 수면기록장치에는 주관심 주파수대역이 낮으므로 하드웨어에서 기본적으로 저역필터링을 수행할뿐아니라 소프트웨어에서 전원잡음을 필터링하는 기능을 제공한다. 그렇지만 이러한 필터링에도 불구하고 실제에는 예기치 못하는 전기적 잡음이 혼입되어 있을 수 있으므로 본 연구에서는 Medilog SAC847(Sleeping Analysing Computer) 다원수면기록장치(Polysomnograph)를 이용하여 수면생리신호들을 측정한 뒤 SAC847 본체에 기록 저장된 raw signal을 자체 제작한 Data Acquisition System으로 읽어들여 Matlab 으로 FFT 시켜본 결과 여전히 전원잡음이 관측되어 60 Hz notch 필터를 설계하여 완전히 제거할 수 있었다.

• Sleep Medicine and Psychophysiology
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• v.9 no.2
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• pp.106-114
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• 2002

Objectives: Daytime sleepiness is a common symptom and is associated with sleep behavior, sleep deprivation, and night shift, etc. It is also one of the most important symptoms of sleep disorders like obstructive sleep apnea (OSA). According to our survey on Korean literature, a few studies have dealt with daytime sleepiness, and we have not been able to locate any study comparing normal subjects with polysomnography-proven sleep disorder patients regarding daytime sleepiness. We aimed at comparing daytime sleepiness among normal healthy daytime workers, medical students being expected to have daytime sleepiness due to chronic sleep deprivation, and patients having sleep disorders diagnosed with polysomnography. We also studied the association between subjective daytime sleepiness and objective polysomnographic findings in patients with sleep disorders. Methods: One hundred three hospital workers, 137 medical students, and patients with sleep disorders were studied. Sleep disorders included OSA, periodic limb movements in sleep (PLMS), insomnia, and narcolepsy. The degree of subjective sleepiness in each group was measured by the Korean version of Epworth sleepiness scale and compared. The relationship between polysomnographic findings reflecting severity of sleep disorder in each patient group and subjective sleepiness was analyzed. As for patients with narcolepsy, the relationship between the mean sleep latency and subjective sleepiness was studied. Results: There was a significant difference of ESS score (F=68.190, dF=5.752, p<0.001) among daytime workers, medical students, and sleep disorder patients. In OSA patient group, the degree of the sleepiness had no significant correlation either with mean O2 satuaration (p=0.062) or with RDI (p=0.807). In PLMS patient group, there was no correlation between periodic limb movement index (PLMI) and subjective sleepiness (p=0.761). In narcolepsy patient group, the subjective sleepiness had no correlation with mean sleep latency measured with MSLT (p=0.055). Conclusion: We found a significant difference of subjective sleepiness among daytime workers, medical students, and patients with sleep disorders. However, no consistent correlation was found between severity of subjective sleepiness and objective polysomnographic findings reflecting severity of each sleep disorder. This research confirms that the evaluation of subjective sleepiness is important clinically, but it cannot substitute the objective measures such as nocturnal polysomnography and MSLT.