• Sleep Medicine and Psychophysiology
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• v.25 no.2
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• pp.51-57
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• 2018

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 ($PLMI{\leq}15$) 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.

• 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.

• Sleep Medicine and Psychophysiology
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• v.21 no.1
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• pp.21-28
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• 2014

Objective: Few studies have evaluated the personality characteristics of patients with obstructive sleep apnea (OSA) and simple snoring. We investigated the personality characteristics of OSA and simple snoring patients and compared differences in personality between the two groups using the Eysenck Personality Questionnaire (EPQ). Materials and Methods: Two hundred and thirty-seven patients who were suspected to have OSA or simple snoring participated in this study. A self-questionnaire which included the EPQ was administered to all participants. All subjects underwent polysomnography in a sleep laboratory and those with an apnea-hypopnea index (AHI) ${\geq}5$ were included in the OSA group, while those with an AHI <5 were included in the simple snoring group. Results: OSA patients had significantly lower scores for Psychoticism (F=4.563, p=0.034) than simple snorers. There were no significant differences in Extraversion (F=3.029, p=0.083), Lie (F=0.398, p=0.529), or Neuroticism (F=3.367, p=0.068) scores between the two groups. In the correlation analysis of the OSA group, AHI was positively correlated with Extraversion score (r= 0.16, p=0.029) and negatively correlated with Lie score (B=-0.31, p<0.001). Using multiple stepwise linear regression analysis with the four EPQ parameter scores as dependent variables, Lie score was associated with older age (B=0.14, p<0.001) and lower AHI (B=-0.05, p<0.001), Psychoticism score was associated with higher Pittsburgh Sleep Quality Index (PSQI ; B=0.14, p<0.001), Neuroticism score was associated with higher PSQI (B=0.34, p=0.001) and female sex (B=3.15, p=0.003), and Extraversion score was associated with younger age (B=-0.08, p=0.020) and higher body mass index (B=0.26, p=0.023). Conclusion: This study suggests that patients with OSA are significantly less prone to psychotic personality characteristics than those with simple snoring. Among OSA patients, higher AHI was correlated with low falsehood and high extraversion tendencies.

• 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.

• The Journal of the Korea Contents Association
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• v.22 no.3
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• pp.165-178
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• 2022

In this study, to explore the psychological and biosocial characteristics of the temperament and character's latent profile group, first, the latent group was identified with the seven variables of the Temperament and Character Inventory(TCI), and second, the difference between the psychological and biosocial characteristics of three identified latent groups. A total of 287 university students participated, and the latent groups was identified through latent profile analysis, a human-centeted statistical method, using Cloninger's TCI, Cognitive Emotion Regulation Questionnaire(CERQ), Positive Affect and Negative Affect Schedule(PANAS), Composite Scale of Moriningness(CSM), Pittsburgh Sleep Qulity Index(PSQI), and Satisfaction With Life Scale(SWLS). As result, first, three latent groups were identified through latent profile analysis using the seven variables of TCI. second, significant differences were identified in CERQ, PANAS, which are psychological variables, CSM, PSQI, and SWLS, which are biosocial variables among the latent groups. In conclusion, the importance of Self-Directedness(SD), a character factor that can be developed rather than Harm-Avoidance(HA), a temperament factor from nature, was confirmed. And the necessity of follow-up studies on psychological and biosocial variables for adaptive and mature personality was discussed.

• Sleep Medicine and Psychophysiology
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• v.26 no.2
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• pp.111-124
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• 2019

Objectives: Healthy sleep is important and can have a positive effect on resilience. The aim of the present study was to compare the differences in resilience between two group nurses in rotating shift and daytime fixed work schedules and to investigate stress perception, coping factors, social and psychological health, and sleep factors that may affect resilience. Methods: A total of 400 female nurses having rotating shift and daytime fixed work schedules at two hospitals was surveyed from June 12, 2017 to June 12, 2018. All participants completed perceived stress scale (PSS), stress coping short form (Brief COPE), psycho-social wellbeing Index short form (PWI-SF) or general health questionnaire-18 (GHQ-18), center for epidemiologic studies depression scale (CES-D), STAI-X-1 in state-trait anxiety inventory (STAI), Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), insomnia severity index (ISI), Conner Davidson resilience scale (CD-RISC). Independent t-test, paired t-test, Pearson correlation analysis, and multiple regression analysis were applied to the results of the final 373 questionnaires of 400 nurses in two general hospitals. Results: Comparing the variable statistics between the two groups of rotating shift and daytime fixed work nurses, showed statistically significant differences in all variables except perceived stress, sleep quality, and daytime sleepiness. Factors that had a significant correlation with resilience were stress coping strategies, depression, and insomnia severity (p < 0.001). In multiple regression analysis, larger positive reframing1 (β = 0.206, p < 0.001), severe less depression (β = -3.45, p < 0.001), and higher psychosocial health (β = 0.193, p < 0.001). As acceptance coping2 increased (β = 0.129, p < 0.05), as daytime sleepiness decreased (β = -1.17, p < 0.05), and as active coping2 increased (β = 0.118, p < 0.05), as the positive reframing2 increases (β = 0.110, p < 0.05), the resilience increased. Conclusion: This study, it was found that resilience was higher in daytime fixed workers than in shift workers. In addition, specific stress coping strategies, psycho-social health, sleep, and depression factors were associated with resilience.

• Sleep Medicine and Psychophysiology
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• v.20 no.1
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• pp.15-21
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• 2013

Objectives: Cognitive impairment in restless legs syndrome (RLS) patients can be affected by sleep deprivation, anxiety and depression, which are common in RLS. The objective of this study is to investigate relationship between cognitive impairment and RLS in the non-medicated Korean elderly with controlling for psychiatric conditions. Method: The study sample for this study comprised 25 non-medicated Korean elderly RLS patients and 50 age-, sex-, and education- matched controls. All subjects were evaluated with comprehensive cognitive function assessment tools- including the Korean version of Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K), severe cognitive impairment rating scale (SCIRS), frontal assessment battery (FAB), and clock drawing test (CLOX). Sleep quality and depression were also assessed with Pittsburgh sleep quality index (PSQI) and geriatric depression scale (GDS). Results: PSQI and GDS score showed no difference between RLS and control group. There was no significant difference between two groups in nearly all the cognitive function except in constructional recognition test, in which subjects with RLS showed lower performance than control group (t=-2.384, p=0.02). Subjects with depression ($GDS{\geq}10$) showed significant cognitive impairment compared to control in verbal fluency, Korean version of Mini Mental Status Examination in the CERAD-K (MMSE-KC), word list memory, trail making test, and frontal assessment battery (FAB). In contrast, no difference was observed between subjects who have low sleep quality (PSQI>5) and control group. Conclusions: At the exclusion of the impact of insomnia and depression, cognitive function was found to be relatively preserved in RLS patients compared to control. Impairment of visual recognition in RLS patients can be explained in terms of dopaminergic dysfunction in RLS.

• Sleep Medicine and Psychophysiology
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• v.23 no.1
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• pp.16-24
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• 2016

Background and Objectives: Obstructive sleep apnea (OSA) is often undiagnosed but is an important risk factor affecting the health of an individual. The level of awareness of the illness among patients with OSA is low and is not correlated with severity of the illness. This study was conducted to compare awareness of OSA symptoms and illness between patients with OSA and simple snorers. Materials and Methods: Two hundred eighty-two patients who were suspected of having OSA participated in this study. All subjects underwent overnight polysomnography. Those with an apnea-hypopnea index (AHI) ${\geq}5$ were classified as the OSA group, while those with an AHI < 5 were classified as the simple snoring group. A sleep questionnaire, which included items on awareness of the illness, OSA, and sleep symptoms, was administered to all subjects and their bed-partners. Results: Simple snorers were much more aware of their symptoms such as snoring, irregular breathing, and apnea than were patients with OSA. Bed-partners of simple snorers were also more aware of the participants' sleep symptoms than were partners of patients with OSA. However, the duration of OSA symptoms was longer in the OSA group. In the correlation analysis, the level of awareness of OSA symptoms was negatively correlated with AHI, age, body mass index, and Epworth Sleepiness Scale score. Among the sleep questionnaire and polysomnography results, only Pittsburgh Sleep Quality Index was positively correlated with level of awareness of OSA symptoms. The minority of the respondents had heard about the treatment methods of continuous positive airway pressure and oral appliance and preferred them as treatment options. Conclusion: This study suggests that simple snorers are more aware of their symptoms than are patients with OSA. A higher severity of OSA, represented by a higher AHI, is correlated with lower awareness of one's OSA symptoms.

• Sleep Medicine and Psychophysiology
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• v.21 no.2
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• pp.74-79
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• 2014

Objectives: Shift work is a stressful situation. It is important to know the factors associated with the ability to adapt to a shift work schedule. The aim of the present study was to investigate the association between sleep, as well as personality variables, and the resilience of shift work nurses. Method: Self-report questionnaires were administered to 95 nurses who worked in one national university hospital. Connor-Davidson resilience scale, hospital anxiety and depression scale, morningness-eveningness scale, Pittsburgh sleep quality index, other sleep-related questionnaires, and Korean defense style questionnaires were used. Results: Age, shift work duration, off-day oversleep, depression, anxiety, adaptive defense style, and self-suppressive defense style were significantly associated with resilience (p < 0.05). Multiple regression analysis showed that age (${\beta}=0.34$, p < 0.05), depression (${\beta}=-0.25$, p < 0.05), adaptive defense style (${\beta}=0.45$, p < 0.001), and self-suppressive defense style (${\beta}=-0.19$, p < 0.05) significantly predicted the resilience of shift work nurses. Concerning individual defense mechanisms, resignation (${\beta}=-0.20$, p < 0.05), sublimation (${\beta}=0.19$, p < 0.05), omnipotence (${\beta}=0.19$, p < 0.05), and humor (${\beta}=0.20$, p < 0.05) significantly predicted the resiliency. Conclusion: The findings indicate that a specific defense style and other mechanisms were associated with the resilience of shift work nurses. A future prospective study with more participants could further clarify the relationship between sleep-related variables, as well as personality factors, and resilience of shift work nurses.

• The Journal of Internal Korean Medicine
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• v.44 no.4
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• pp.726-740
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• 2023

Objectives: This review investigated the research on warm herbal foot bath therapy (WHFT) for insomnia. Methods: A search was conducted on the China National Knowledge Infrastructure (CNKI) database to collect relevant studies published up to August 29, 2023. Randomized controlled trials (RCTs) comparing WHFT and sleeping pills in patients with insomnia were included. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias assessment tool. The results of the meta-analysis were presented as risk ratios (RRs) or mean differences (MDs) and their 95% confidence intervals (CIs). Results: A total of 11 RCTs were included. WHFT as monotherapy resulted in a significantly higher total effective rate (TER) (RR, 1.25; 95% CI, 1.15 to 1.36; I²=25%) and an improved Pittsburgh Sleep Quality Index (PSQI) global sore (MD, -3.10; 95% CI, -4.24 to -1.95; I²=73%) compared to benzodiazepines. Additionally, WHFT as a combined therapy with benzodiazepines resulted in a significantly higher TER (RR, 1.15; 95% CI, 1.04 to 1.27; I²=0%) and an improved PSQI global score (MD, -2.23; 95% CI, -4.09 to -0.38; I²=80%) compared to benzodiazepines alone. In network analysis visualizing the components of HWFT, four clusters were discovered, and Polygoni Multiflori Ramuls and Ziziphi Spinosae Semen were the key herbs used in WHFT. Overall, the methodological quality of the included studies was poor. Conclusions: There was limited evidence that WHFT as a monotherapy or combined therapy was effective in improving insomnia. The findings can be used as basic data for future WHFT research in South Korea.