• 동의신경정신과학회지
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• 제32권2호
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• pp.95-109
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• 2021

Objectives: The coronavirus disease 2019 (COVID-19) has become a global pandemic. Mental sequelae occurring in patients with COVID-19 and the general population are important concerns. In Korea, herbal medicine is used nationwide to respond to this pandemic. It can be prescribed by COVID-19 telemedicine center of Korean medicine (KM). Among some herbal medicines, Gamiguibi-tang is the only herbal medicine prescribed for individuals with mental health, especially for those with insomnia. In this mini-review, the objective of this study was to summarize the evidence of some promising herbal medicines available for treating primary insomnia based on existing clinical and preclinical studies. Methods: A research team was formed for KM clinical practice guidelines for insomnia (version 1.0). Team members were provided with a list of references of relevant herbal medicines for insomnia. To gather evidence from clinical studies with appropriate sample sizes, among the list of references, randomized controlled trials for primary insomnia that included 50 subjects or more per arm and used herbal medicine were included in the final analysis. Moreover, pre-clinical studies examining the mechanism of action of each herbal medicine and studies on herb-drug interactions, were searched and summarized. Results: Four herbal medicines (Ondam-tang, Sanjoin-tang, Guibi-tang, and Hyeolbuchugeo-tang) were reviewed based on existing clinical and preclinical studies. Based on findings of existing studies, some suggestions of herbal medicines for insomnia in the COVID-19 era in Korea were suggested. Conclusions: Data of this study could be used to prepare a future revision of the manual of COVID-19 telemedicine center of KM.

• 수면정신생리
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• 제19권2호
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• pp.84-88
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• 2012

배 경: 본 연구에서는 주요 우울장애와 불면증이 각각 신체화 증상에 미치는 영향을 알아보려고 하였다. 방 법: 심각한 신체질환이 없는 181명의 성인(남자 73명, 여자 108명, 평균연령 $41.59{\pm}8.92$세)이 연구에 참여하였다. 정신과적 진단평가를 위한 구조화 면담과 불면증의 국제진단 분류를 근거로 주요우울장애와 불면증을 각각 진단하였다. 이를 기준으로 연구 대상을 1) 정상 대조군(n=127), 2) 일차성 불면증군(n=11), 3) 불면증상이 없는 우울증군(n=14), 4) 불면증상이 있는 우울증군(n=29) 이상 4개군으로 나누었다. 각 군의 신체화 증상 정도를 평가하기 위해 간이정신건강진단검사(Symptom Checklist-90, SCL-90)의 신체화 증상 차원의 12문항을 자가 작성하게 하였다. 결 과: 각 군의 신체화 증상 척도 점수는 서로 유의한 차이가 있었다(F=25.30, p<0.001). 불면증상이 있는 우울증군은 정상 대조군(p<0.001), 일차성 불면증군(p=0.01), 불면증상이 없는 우울증군(p<0.001)에 비해 모두 신체화 증상 척도 점수가 높았다. 일차성 불면증군은 정상 대조군에 비해 신체화 증상 척도 점수가 높았다(p<0.01). 그러나 불면증이 없는 우울증 환자의 신체화 척도 점수는 정상 대조군과 유의한 차이가 없었다. 다중 회귀분석에서 불면증은 신체화 증상척도 점수를 유의하게 예측하였으나(beta=0.44, p<0.001), 주요 우울증은 통계적으로는 유의하지 않은 경향성만을 보여주었다(beta=0.14, p=0.08). 결 론: 불면증은 주요 우울증 유무와 독립적으로 신체화 증상과의 관계를 보였다. 일차성 불면증이 있는 경우 신체화 증상이 심했으며, 우울증이 있는 환자에서도 불면증이 동반된 경우에만 신체화 증상이 심했다. 이러한 결과들은 불면증상이 신체화 증상과 매우 밀접한 관련이 있음을 시사한다.

• 생물정신의학
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• 제24권4호
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• pp.204-211
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• 2017

Objectives In this study, we identified the symptoms of insomnia, anxiety, and depressed mood in newly diagnosed women breast and thyroid cancer patients. Methods The subjects of this study were 1794 women patients who visited the Ewha Womans University Cancer Center for Women. They included 1119 newly diagnosed primary breast cancer patients and 675 newly diagnosed primary thyroid cancer patients. The patients completed the National Cancer Center Psychological Symptom Inventory (NCC-PSI) during their first follow-up visit after surgery, before starting chemotherapy or radiotherapy. The NCC-PSI is composed of the modified distress thermometer (MDT) and the modified impact thermometer (MIT) for insomnia, anxiety, and depressed mood. Results Anxiety severity was found to be greater in breast cancer patients than in thyroid cancer patients. Significant levels of anxiety, depressed mood and insomnia were present in 28, 24.5, and 20.7% in all the subjects, respectively. Moreover, anxiety symptoms, depressed mood and insomnia interfered with the daily lives of 20, 18.4, and 14.2% of all the subjects, respectively. Dealing with anxiety (18.8%) was found to need the most help, followed by dealing with insomnia (8.9%) and depressed mood (8.7%). Conclusions A significant level of distress was found in about 40% of the total subjects. Nearly 30% of newly diagnosed breast cancer patients reported significant anxiety symptoms and interferences with daily living caused by anxiety, which most commonly needed special care. Early assessment and management of psychological distress, especially anxiety, in breast and thyroid cancer treatment are very important to establish integrated cancer care.

• 중환자간호학회지
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• 제1권1호
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• pp.19-31
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• 2008

Purpose: This study was conducted to exam the effects of the Abbreviated Cognitive Behavioral Therapy(ACBT) on chronic insomnia. Methods: Study was one-group interrupted time series study that involved 13 adults(mean age=51.7, aged 25-77 years) with chronic primary insomnia who visited sleep disorder clinic of S Hospital from November 2004 to October 2005. The subjects received 2-session individual ACBT with 2 week-interval($1^{st}$: 1.5- 2hrs, $2^{nd}$: 20-30min). To measure the subjective insomnia severity and sleep patterns, 3 times of insomnia severity index and sleep logs were completed(before ACBT, after ACBT, and 3-month after ACBT). The main outcomes were subjective insomnia severity and sleep patterns(sleep onset latency, waking after sleep onset, and total sleep time, sleep efficiency). The data were analyzed with SPSS 10.0 version program by Friedman test, Wilcoxon signed rank test with Bonferroni correction. Results: There were statistically significant decrease in insomnia severity index, sleep onset latency, and waking after sleep onset, and increase total sleep time and sleep efficiency. Conclusion: ACBT was effective in reducing subjective insomnia severity and improving sleep patterns. Sleep improvement was better sustained over time with ACBT.

• 수면정신생리
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• 제17권1호
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• pp.21-27
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• 2010

목 적: 일차성 불면증(primary insomnia)은 자율신경계에도 영향을 주는 것으로 알려져 있는데 심박동률변이도 (heart rate variability: HRV)를 이용하여 일차성 불면증에서 심박동률변이도 지수와 수면구조(sleep structure) 관련 변인 간의 연관성을 분석하여 일차성 불면증의 야간수면 동안 자율신경계 변화의 특징을 연구하고자 하였다. 방 법: 일차성 불면증 33명(평균연령: 36.2${pm}$14.2세, 남:여=15:18)을 대상으로 1일밤 야간수면다원검사(nocturnal polysomnography:NPSG)를 시행하여 HRV 지수 중 저주파수/고주파수 비(high frequency/low frequency ratio:LF/HF ratio)와 NPSG에서 산출된 수면구조 관련변인 간의 상관관계를 분석하였다. 결 과: 연령과 성별을 통제한 상태에서 LF/HF ratio와 서파수면(slow wave sleep)의 시간과 분율, 2단계수면시간 (stage 2 sleep)과 분율이 각각 음의 상관관계($r_p$=-0.37, p=0.04, $r_p$=-0.4, p=0.02; $r_p$=-0.42, p=0.02, $r_p$=-0.43, p=-0.01)를 가지는데 비해 각성지수(arousal index)와는 양의 상관관계($r_p$=0.65, p<0.001)를 보였다. 결 론: 일차성 불면증에서 수면구조 변화에 따라 자율신경계가 반응하고 있으며, 특히 비렘수면(Non-REM sleep)의 구성요소인 서파수면과 2단계수면의 감소와 각성 횟수의 증가가 교감신경 항진을 유발하여 불면증의 전형적인 수면 구조 변화가 심혈관계에 부정적 영향을 줄 수 있다는 것을 보여준다.

• Journal of Sleep Medicine
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• 제15권2호
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• pp.37-42
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• 2018

Objectives: To assess the effect and safety of transcranial direct-current stimulation (tDCS) in primary chronic insomnia. Methods: A one-month, double-blind, randomized, sham-controlled trial was performed. A total of 7 patients with primary chronic insomnia received tDCS using anodal (n=3), cathodal (n=2), or sham stimulation (n=2). They were followed up at 1 week and 1 month after treatment. The primary outcome measures included improvement in total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) at 1 month follow-up. Results: TST and SE were improved with tDCS at 1 month follow-up in all patients (100%) of the anodal group, one (50%) of the cathodal group, and one (50%) of the sham group. tDCS improved SL at 1 month follow-up in two patients (67%) of the anodal group, one (50%) of the cathodal group, and none (0%) of the sham group. With respect to adverse events, transient itching sensation occurred in one patient of the anodal group. None of the other groups reported adverse events. Conclusions: Our results suggest that tDCS may be effective and safe for treatment of primary chronic insomnia. A larger controlled study needs to be further investigated.

• 대한약침학회지
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• 제25권3호
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• pp.186-198
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• 2022

Objectives: This overview summarizes the evidence for the effectiveness and safety of complementary therapies for insomnia through systematic reviews (SRs) and meta-analyses (MAs). Methods: A comprehensive literature search on SRs and MAs for complementary therapies for insomnia was conducted using six databases. Results: This overview included 30 SRs/MAs. The Pittsburgh Sleep Quality Index (PSQI) analysis of insomnia included 383 randomized controlled trials and 31,748 participants. Twenty-four SRs/MAs (80%) out of 30 SRs/MAs reported a positive result, and six SRs/MAs reported a partially positive result. The most frequently used form of acupuncture reported a positive effect in 89.5% (17/19) of SRs/MAs and a superior effect to western medicine, sham/placebo, and no treatment. The lack of protocol registration and the excluded studies list resulted in generally poor methodological and reporting quality in SRs/MAs with AMSTAR 2. Conclusion: This overview confirmed that complementary therapies positively affected the PSQI scores in patients with insomnia. However, better-designed primary studies are needed to strengthen the relevant evidence in the future. A more stringent assessment of multiple systematic reviews 2 must be followed when performing SR and MA.

• 동의신경정신과학회지
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• 제34권3호
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• pp.163-179
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• 2023

Objectives: The purpose of this study was to provide evidence for the clinical effects of foot bath therapy for insomnia disorder through a systematic review and meta-analysis. Methods: Studies were selected from seven domestic and international literature databases. Data on diagnostic tools, pattern identification, sample size, intervention methods, outcome measurements, results, and adverse events were extracted. The quality of the selected literature was assessed using Cochrane's risk of bias (RoB) assessment tool. Results: A total of 11 studies were included in this study. The primary diagnostic tool for insomnia dis- order was the criteria for the diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine (CDTDSTCM), along with the Chinese classification of mental disorders-3 (CCMD-3). Treatment effects were mainly evaluated by the effective rate and the Pittsburgh Sleep Quality Index (PSQI). The meta-analysis results showed statistically higher effectiveness rates for treating insomnia disorder in the experimental groups receiving herbal medicine foot bath therapy with sleeping or herbal medication compared to the control group. The PSQI was lower in the treatment group receiving herbal medicine foot bath therapy with sleeping medication. The herbal materials used in herbal medicine foot bath therapy mainly included Radix Angelicae Sinensis, Polygonum Multiflorum, Ziziphi Spinosae Semen, Rhizoma Coptidis, Radix Salviae Miltiorrhizae, and Cortex Albizziae. The quality of the included studies was generally poor. Conclusions: This study found that foot bath therapy had clinical efficacy for treating insomnia disorder. The research findings could provide foundational evidence for establishing the clinical basis of foot bath therapy in the treatment of insomnia.

• 한국산학기술학회논문지
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• 제17권9호
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• pp.407-421
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• 2016

본 연구는 만성 일차성 불면증 환자에게 적용한 인지행동중재의 효과를 평가하는 16개의 논문을 메타분석한 것이다. PubMed, Cochrane Library, EMBASE, CINAHL와 여러 개의 국내 데이타 베이스를 통해 2015년 1월부터 2015년 6월까지 자료검색이 이루어졌다. 주요 검색전략은 인지행동중재와 불면증을 병합하여 이루어졌다. 논문의 방법론적 질 평가는 코크란의 RoB(The Cochrane's Risk of Bias)를 사용하였다. 자료는 Cochrane Library의 RevMan 5.3 프로그램으로 분석하였다. 최종 16편의 논문, 1503명의 대상자가 선정기준에 부합되었다. 자극조절요법, 수면제한법, 수면위생교육과 인지적 재구성이 인지행동중재의 주요 치료적 구성요소였다. 인지행동 중재의 적용 주수는 평균 5.4주, 적용횟수 평균 5.5회, 1회 평균 중재시간 90분으로 조사되었다. 인지행동중재의 효과는 총 수면시간(d=-0.31), 수면 잠복기(d=-0.29), 입면 후 각성시간(d=-0.55), 수면효율성(d=-0.70), 불면증 심각성(d=-0.77)과 수면에 대한 신념 및 태도(d=-0.64)에 유의하였다. 전반적으로 작은 효과크기에서 중간 정도의 효과크기를 나타냈다. 인지행동중재는 불안(d=-0.30)과 우울(d=-0.35)에도 효과적이었다. 이러한 결과는 인지행동중재가 불면증이 있는 환자들의 수면의 질과 수면시간을 증진시키는 것으로 나타났다.

• Clinical and Experimental Pediatrics
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• 제60권5호
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• pp.158-165
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• 2017

Purpose: To investigate the frequency of childhood sleep problems at pediatric clinics in Seoul and Gyeonggi provinces. Methods: Children (n=936) and their parents who visited 5 primary and 1 secondary pediatric outpatient clinics were invited to complete a Pediatric Sleep Questionnaire. Results: Among patients, 901 (96.3%) answered questionnaires in sufficient detail for evaluation. The participant's mean age was $4.35{\pm}3.02years$ (range, 0-18 years). The male to female ratio was 1:0.93 (466 boys, 435 girls). Habitual snoring (>3 day/week) was reported in 16.9% of the participants. The prevalence of habitual snoring in children <2 years and those between 2-5 years was 9% and 18%, respectively. Sleep disordered breathing was found in 15.1% (106 of 700) of children >2 years. Insomnia was reported in 13.2% of children. The prevalence of sleepwalking, night terrors, and bruxism, is 1.6%, 19%, and 21.1%, respectively. Snoring was associated with increased incidence of sleepwalking, night terrors, and bruxism. Age was associated with insomnia and habitual snoring (P<0.05). Insomnia was more prevalent in younger (21%) than in older children (6%). Snoring was more frequent in both preschool (34%) and school-aged children (33%). The frequency of sleep disordered breathing and insomnia did not vary significantly with gender. However, snoring was more prevalent in boys. Conclusion: Sleep problems are frequent among children in Korea. Children with snoring have an increased risk of sleepwalking, night terror, and bruxism. Primary clinicians should consider children's sleep habits to improve their health.