• Sleep Medicine and Psychophysiology
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• v.4 no.2
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• pp.156-163
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• 1997

Objectives : The authors investigated the practice of sleep hygiene and its effectiveness in general population who had experienced insomnia. If we find the items which be little practiced but especially effective, we would establish empirical an and theoretical basis to design the treatment program for insomnia, therefore apply it in clinical practice. Methods : The 226 subjects who had experienced insomnia, were at the age above 18 in Seoul, Korea. The questionnaire included the demographic data, the experience of insomnia, and the practices and effects of sleep hygiene instruction. The interview was administered face to face by the investigators. Results : The subjects reported that they practiced many of the sleep hygiene items related with arousal in sleep setting, and that those items were effective. The items such as 'get regular exercise each day(H)', 'take a hot bath(H)', 'concentrate on the pleasant feeling of relaxation(A)' were not usually practiced, but these items were reported very effective for sleep. Conclusion : The findings suggested that there were sleep hygiene items which should be educated and directed to practice actively in treatment program for insomniacs. Some items, which were especially reported low practice but highly effective, would be recommended to be studied about each therapeutic effectiveness in follow-up studies.

• Sleep Medicine and Psychophysiology
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• v.25 no.2
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• pp.74-81
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• 2018

Objectives: Insomnia is one of the major concerns in the elderly population. Cognitive behavioral treatment for insomnia is the first line treatment option, but there are some limitations including time and cost burdens and the requirement for sufficient cognitive resources to obtain a proper treatment effect. The Brief intervention for insomnia (BII) is a treatment that focuses on behavioral aspects of insomnia in primary care practices. The purpose of this study was to evaluate the effects of BII in community-dwelling older adults. Methods: A total of 47 older adults with insomnia were enrolled from community centers between May 2016 and January 2018. They participated in the BII program for three weeks. We gathered sleep-related participant information with using the Pittsburgh sleep quality index (PSQI), the Sleep hygiene index, and a sleep diary. Clinical efficacy was evaluated by comparing total sleep time (TST), sleep latency (SL), waking after sleep onset (WASO), and sleep efficiency (SE) before and after the treatment. Results: There was significant improvement in sleep-related features after BII. Global score and sleep quality from the PSQI, freshness, and WASO from the sleep diary showed statistically significant improvement. Conclusion: We found BII showed positive clinical efficacy in community dwelling older adults, especially from the perspective of subjective sleep quality and WASO. This finding implies that BII can be effectively applied for the managment of elderly insomnia patients in a community setting.

• Journal of Naturopathy
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• v.11 no.2
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• pp.116-122
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• 2022

Background: Studies on the effect of abdominal or thoracic breathing therapy on sleep or blood oxygen concentration are still scarce. Purpose: This study was to examine the effect on blood oxygen saturation and pulse variability, changes in the severity of insomnia, changes in wakefulness before sleep, and dysfunctional beliefs and attitudes toward the Korean version of sleep in women in their 50s after healing with abdominal breathing and thoracic breathing. We investigated the effect. Methods: Subjects were investigated before and after the change of breathing (breathing) therapy for 12 weeks, 3 times a week, and 36 breaths perweek. Results: It wa evaluated respiratory healing as having no significance in the pulse rate change. However, oxygen saturation was significant in the experimental group, increasing to 93.60 SpO₂% before the respiratory rally and 96.5 SpO₂% after respiratory recovery (p < .002). In addition, the insomnia severity scale and dysfunctional beliefs about sleep significantly decreased after respiratory rally than before (p < .000). Conclusions: It evaluated that respiratory therapy for the subjects is beneficial to health as it is effective for insomnia, pulse, and oxygen saturation.

• Tuberculosis and Respiratory Diseases
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• v.47 no.6
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• pp.824-835
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• 1999

Background: Sleep-related breathing disorders are commonly found in patients with chronic renal failure and particularly, sleep apnea may have an influence on the long-term mortality rates in these patients. Maintenance hemodialysis is the mainstay of medical measures for correcting the metabolic derangements of chronic renal failure but it is uncertain whether it may alleviate sleep disorders including sleep apnea. Methods: Forty seven patients on maintenance hemodialysis were surveyed with the sleep questionnaire about their clinical symptoms related to sleep disorders. Among them, 15 patients underwent the polysomnography and their blood levels of urea nitrogen, creatinine, electrolytes and the arterial blood gases in the nights before and following hemodialysis were measured. Results: Forty(85.1%) of the 47 patients complained of the symptoms associated with sleep-wake cycle disturbances, 55.3% experienced snoring and 27.7% reported witnessed apneas. The duration of REM sleep increased significantly in the nights after hemodialysis compared to the nights without hemodialysis(p<0.05) and the percentage of total sleep time comprising NREM sleep decreased significantly in the nights following hemodialysis compared to the nights before hemodialysis(p<0.05). The percentage of total sleep time consisting of the stage 1 and 2 NREM sleep showed the trend for a decrease in the nights after hemodialysis(p=0.051), while the percentage of total sleep time comprising the stage 3 and 4 NREM sleep did not change between nights. The obstructive sleep apnea was more predominant type than the central one in both nights and there were no differences in the apnea index and the apnea-hypopnea index between the nights. The decrease in the blood level of urea nitrogen, creatinine, potassium and phosphorus was observed after hemodialysis(p<0.05), but the differences of parameters measured during polysomnography between the nights did not correlate with the changes of biochemical factors obtained on the two nights. Arterial blood gas analysis showed that pH was significantly greater in the nights after hemodialysis than in the nights before hemodialysis(p<0.05), but there were no correlations between the parameters examined during polysomnography and the parameters of arterial blood gas analysis(p<0.05). Conclusion: These results suggest that chronic renal failure is an important systemic disorder which is strongly associated with sleep disorders. Maintenance hemodialysis, although it is a widely accepted measure to treat chronic renal failure, did not significantly modulate the sleep architecture and the severity of sleep apnea. Thus, taking the patients with chronic renal failure into account, it is advisable to try not only to find a substantial way for correcting metabolic derangements but also to consider the institution of more effective treatments for sleep disorders.

• Sleep Medicine and Psychophysiology
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• v.10 no.1
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• pp.52-60
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• 2003

Objectives: Stage 1 sleep provides important information regarding interpretation of nocturnal polysomnography, particularly sleep onset. It is a short transition period from wakeful consciousness to sleep. The lack of prominent sleep events characterizing stage 1 sleep is a major obstacle in automatic sleep stage scoring. In this study, utilization of simultaneous EEG and EOG processing and analyses to detect stage 1 sleep automatically were attempted. Methods: Relative powers of the alpha waves and the theta waves were calculated from spectral estimation. A relative power of alpha waves less than 50% or relative power of theta waves more than 23% was regarded as stage 1 sleep. SEM(slow eye movement) was defined as the duration of both-eye movement ranging from 1.5 to 4 seconds, and was also regarded as stage 1 sleep. If one of these three criteria was met, the epoch was regarded as stage 1 sleep. Results were compared to the manual rating results done by two polysomnography experts. Results: A total of 169 epochs were analyzed. The agreement rate for stage 1 sleep between automatic detection and manual scoring was 79.3% and Cohen’s Kappa was 0.586 (p<0.01). A significant portion (32%) of automatically detected stage 1 sleep included SEM. Conclusion: Generally, digitally-scored sleep staging shows accuracy up to 70%. Considering potential difficulty in stage 1 sleep scoring, accuracy of 79.3% in this study seems to be strong enough. Simultaneous analysis of EOG differentiates this study from previous ones which mainly depended on EEG analysis. The issue of close relationship between SEM and stage 1 sleep raised by Kinnari remains a valid one in this study.

• Sleep Medicine and Psychophysiology
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• v.23 no.2
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• pp.61-67
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• 2016

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.

• Journal of Biomedical Engineering Research
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• v.25 no.1
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• pp.11-19
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• 2004

Stage 1 sleep provides important information regarding interpretation of nocturnal polysomnography, particularly sleep onset. It is a short transition period from wakeful consciousness to sleep. Lack of prominent sleep events characterizing stage 1 sleep is a major obstacle in automatic sleep stage scoring. In this study, we attempted to utilize simultaneous EEC and EOG processing and analyses to detect stage 1 sleep automatically. Relative powers of the alpha waves and the theta waves were calculated from spectral estimation. Either the relative power of alpha waves less than 50％ or the relative power of theta waves more than 23％ was regarded as stage 1 sleep. SEM (slow eye movement) was defined as the duration of both eye movement ranging from 1.5 to 4 seconds and regarded also as stage 1 sleep. If one of these three criteria was met, the epoch was regarded as stage 1 sleep. Results f ere compared to the manual rating results done by two polysomnography experts. Total of 169 epochs was analyzed. Agreement rate for stage 1 sleep between automatic detection and manual scoring was 79.3％ and Cohen's Kappa was 0.586 (p＜0.01). A significant portion (32％) of automatically detected stage 1 sleep included SEM. Generally, digitally-scored sleep s1aging shows the accuracy up to 70％. Considering potential difficulties in stage 1 sleep scoring, the accuracy of 79.3％ in this study seems to be robust enough. Simultaneous analysis of EOG provides differential value to the present study from previous oneswhich mainly depended on EEG analysis. The issue of close relationship between SEM and stage 1 sleep raised by Kinnariet at. remains to be a valid one in this study.

• Tuberculosis and Respiratory Diseases
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• v.49 no.6
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• pp.715-723
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• 2000

Background : Obstructive sleep apnea syndrome (OSAS) affects systemic blood pressure and cardiac function. The development of cardiovascular dysfunction including the changes of systemic blood pressure and cardiac rhythm, suggests that recurrent hypoxia and arousals from sleep may increase a sympathetic nervous system activity. Continuous positive airway pressure (CPAP) therapy has been found to be an effective treatment of OSAS. However, only a few studies have investigated the cardiovascular and sympathetic effects of CPAP therapy. We evaluated influences of nasal CPAP therapy on the cardiovascular system and the sympathetic activity in patients with OSAS. Methods : Thirteen patients with OSAS underwent CPAP therapy and were monitored using polysomnography, blood pressure, heart rate, presence of arrhythmia and the concentration of plasma catecholamines, before and with CPAP therapy. Results: The apnea-hypopnea index (AHI) was significant1y decreased (p<0.01) and the lowest arterial oxygen saturation level was elevated significantly after applying CPAP (p<0.01). Systolic blood pressure tended to decrease after CPAP but without statistical significance. Heart rates during sleep were not significantly different after CPAP. However, the frequency and number of types of arrhythmia decreased and sinus bradytachyarrhythmia disappeared after CPAP. Although there was no significant difference in the level of plasma epinephrine concentration, plasma norepinephrine concentration significantly decreased after CPAP (p<0.05). Conclusion : CPAP therapy decreased the apnea-hypopnea index, hypoxic episodes and plasma norepinephrine concentration. In addition, it decreased the incidence of arrhythmia and tended to decrease the systemic blood pressure. These results indicate that CPAP may play an important role in the prevention of cardiovascular complications in patients with OSAS.

• Sleep Medicine and Psychophysiology
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• v.27 no.2
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• pp.56-66
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• 2020

Objectives: In this study, the clinical characteristics of OSA patients and the quality of life before and after CPAP use were compared to determine the degree of improvement in quality of life according to CPAP use. Methods: Age, sex, height, weight, body mass index, Epworth Sleepiness Scale, Modified Mallampatti Score, Montreal Cognitive Assessment-Korean, and Pittsburgh Sleep Quality Index were compared between men and women through medical records. To understand the degree of improvement in quality of life resulting from use of CPAP, a personal telephone call was made to compare the VAS scores for quality of life before and after CPAP use. Results: In height (HT) (Z = -4.525, p < 0.001), weight (BW) (Z = -2.844, p < 0.05), sleep quality (PSQI) (Z = -2.671, p < 0.05), and arousal index (AI) (Z = -2.105, p < 0.05), there was a difference between men and women (p < 0.05). There was no difference in the remaining variables. Cross-analysis (Chi-square test) confirmed a difference between severity and sex of OSA. It has been found that there is no statistically significant order in size according to level-specific severity of OSA for PreCPAP QOL, PostCPAP QOL, CPAPUse Months, and CPAP4Hr/d (%) (p > 0.05). The difference between AHI before and after CPAP was 36.48 ± 21.54 (t = 11.609, p < 0.001) and the difference between QOL before and after CPAP was -25.43 ± 22.06 (t = -7.901, p < 0.001), both of which were significant (p < 0.001). Conclusion: Among OSA patients, there were differences in height (HT), weight (BW), sleep quality (PSQI), arousal index (AI), and severity of OSA between men and women, but the quality of life before and after CPAP was different. However, there was no difference between men and women in quality of life before and after CPAP. In addition, quality of life in OSA patients improved after using CPAP.

• Childhood Kidney Diseases
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• v.14 no.2
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• pp.210-217
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• 2010

Purpose : Diabetes mellitus (DM) is known as one of the common causes of secondary enuresis in children. However, enuresis in diabetic children is overlooked only as a symptom of polyuria due to hyperglycemia. We evaluated the prevalence of nocturnal enuresis in children with diabetes mellitus in this paper. Methods : Among children with diabetes in three hospitals in Daegu area, 117 agreed to 'Tele research by means of a questionnaire'. Results : Diabetic patients were divided into two groups: Nocturnal enuresis and nonnocturnal enuresis group. thirty-two of 117 (27.0%) patients were in enuresis group, with more daytime urination than non-nocturnal enuresis group ($4.2{\pm}1.6/3.6{\pm}1.2$ times, P=0.016). HbA1c at diagnosis was $12.0{\pm}2.3%/12.0{\pm}2.5%$, and at follow-up $9.3{\pm}2.3%/8.3{\pm}2.3%$ (P =0.042). Insulin was administered at $1.1{\pm}0.5/1.1{\pm}0.4$ units/kg/day. Ten children of enuresis (31.2%) group were monosymptomatic (MNE) and 22 (68.8%) children were non-monosymptomatic enuresis (non-MNE). Fourteen (43.8%) of enuresis group had persistent symptoms, with 5 MNE and 9 non-MNE each. HbA1c at diagnosis was $11.1{\pm}2.5$, $12.4{\pm}2.1$, higher in non-MNE (P=0.144). Average arousal during sleep was step $3.3{\pm}1.2$, $2.5{\pm}1.0$, higher in improved enuresis group (P=0.059). Conclusion : Nocturnal enuresis among DM patients is underestimated. However, considering psychological and social effects of enuresis in children, extensive and long-term studies are needed in the future to clarify relationship between prevalence and DM control.