• 대한상한금궤의학회지
• /
• v.11 no.1
• /
• pp.63-71
• /
• 2019

Objective : This case report aimed to demonstrate the effect of Baekhogainsam-tang on hypersomnolence. Methods : A 33-year-old woman complained of hypersomnolence with fatigue and lack of concentration in the daytime. According to the diagnostic system based on Shanghanlun provisions (DPIDS), the patient was treated with Baekhogainsam-tang decoction. The result was evaluated by the Epworth Sleep Scale. Results : After administration of Baekhogainsam-tang decoction for 30 days, the Epworth Sleep Scale score was decreased from 15 (pathologic sleepiness) to 1 (no clinically significant sleepiness). Conclusions : The patient completely recovered from hypersomnolence and fatigue following treatment with Baekhogainsam-tang decoction according to DPIDS.

• The Journal of Internal Korean Medicine
• /
• v.41 no.2
• /
• pp.159-165
• /
• 2020

Introduction: We report a rare case in which the symptoms of hypersomnia were caused by cerebral infarction that occurred in the hypothalamus and hypothalamus. Case Presentation: The patient underwent Korean medicine treatments using Gami-seonghyangjeonggi-san, acupuncture, electroacupuncture, and physical therapy for 37 days. We evaluated the degree of improvement in hypersomnolence based on the amount of sleeping time and the degree of memory impairment with the patient's suggestive conditions as observed by the patient's guardian, and one-sided facial palsy using the Yanagihara Scale. As treatment was applied, sleeping time was decreased from 22 to 9 hours a day. Memory impairment did not show clear improvements as the patient could not recognize others when they visited during the period in which the patient underwent treatment. One-sided facial palsy showed no improvements and there were no changes in the Yanagihara Scale results. Conclusion: This case showed that Korean medicine treatment could be effective to relieve some of the symptoms of thalamus and hypothalamus infarction. Further research is needed to confirm the effectiveness of Korean medicine treatment.

• Sleep Medicine and Psychophysiology
• /
• v.30 no.1
• /
• pp.22-27
• /
• 2023

Objectives: The purpose of this study was to develop a screening tool that is simple and easy to use for assessing sleep problems, including hypersomnolence, restless legs syndrome, and insomnia. We also examined the reliability and validity of this tool. Methods: We developed the Sleep Problem Screening Questionnaire (SPSQ), which consists of three sub-sections: insomnia (SPSQi), hypersomnolence (SPSQh), and restless legs syndrome (SPSQr). Subsequently, the participants, consisting of 222 patients with insomnia disorder and 78 healthy individuals, completed both the SPSQ and the comparative scale (Korean version of the Insomnia Severity Index). The analysis was then conducted using this data. Results: The SPSQ demonstrated good convergent and discriminant validity, as well as satisfactory internal consistency. A cutoff score of 6 on the SPSQi was found to be optimal for distinguishing individuals with insomnia. Conclusion: The results of this study suggest that the SPSQ is a reliable and valid tool for screening sleep problems among general adult population. However, there is a limitation as a comparison and validation with scales related to restless legs syndrome and hypersomnolence were not conducted.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.31 no.2
• /
• pp.83-93
• /
• 2017

This study covers pattern differentiation based on Korean medical references, research trend and modern clinical applications about Sleep-Wake disorders of Diagnostic and Statistical Manual of Mental Disorders(DSM-V) published by American Psychiatric Association. Insomnia disorder is mostly caused by yin deficiency of liver-kidney or liver qi depression and main patterns are heart-kidney non-interaction, deficiency-excess complex pattern containing phlegm-heat due to qi stagnation and blood stasis. Hypersomnolence disorder is more due to yang deficiency rather than yin deficiency and it's major pattern is spleen-kidney yang deficiency. Cataplexy is main feature in narcolepsy and corresponds to depressive psychosis or fainting in terms of Korean Medicine and narcolepsy is assumed to be relevant to liver wind. Breathing-related sleep disorders are related with phlegm-fluid retention brought on spleen deficiency with dampness encumbrance. Pattern of circadian rhythm sleep-wake disorders is combined with yin deficiency of liver-kidney or liver qi depression of insomnia disorder and spleen-kidney yang deficiency or dampness-phlegm of hypersomnolence disorder. Yin deficiency with effulgent fire brought on drugs or alcohol is one of main patterns of substance/medication-induced sleep disorder and combined patterns with yin deficiency of liver-kidney and blood stasis or dampness-phlegm-heat are mostly applied clinically. This study drew major and frequently applied patterns of sleep-wake disorders based on Koran medical literature and modern clinical applications. And that can be the groundwork for the task ahead like clinical practice guideline of sleep-wake disorders containing pattern differentiation, diagnosis and prescriptions.

• Tuberculosis and Respiratory Diseases
• /
• v.42 no.2
• /
• pp.238-243
• /
• 1995

Sleep Apnea Syndrome is characterized by hypersomnolence, snoring, and sleep apnea. The symptoms of hypothyroidism include apathy, somnolence, lethargy, personality change, and intellectual deterioration and may be related to hypothyroid-related sleep disorders. Central, obstructive, and mixed patterns of sleep apnea may be observed in hypothyroidism. A 60-yr-old man was admitted due to hypersomnolence, snoring and generalized edema. Polysomnogram showed obstructive pattern of sleep apnea syndrome. Neck CT scan revealed narrowing of upper airway which is consistent with obstructive sleep apnea syndrome. Physical examination and hormonal study also disclosed the evidence of hypothyroidism. We report a case of sleep apnea syndrome due to primary hypothyroidism with review of literatures.

• Tuberculosis and Respiratory Diseases
• /
• v.51 no.6
• /
• pp.590-596
• /
• 2001

The hallmarks of sleep apnea syndrome include daytime hypersomnolence, snoring, obesity, disturbed nocturnal sleep, and apneic episodes. Thyroid deficiency states are now a well recognized cause of sleep apnea. Central, obstructive, and mixed patterns of sleep apnea may be observed in hypothyroidism. A-33-yr-old man was admitted complaining of daytime hypersomnolence, snoring, sleep apnea and obesity. A polysomnogram showed obstructive pattern of sleep apnea syndrome. Physical examination and hormonal study revealed a narrowing of the upper airway and primary hypothyroidism. Dilated cardiomyopathy was diagnosed by echocardiogram. The poctients was treated for obstructive sleep apnea syndrome with nasal continuous positive airway pressure(CPAP) for 2 months and the underlying hypothyroidism with thyroid hormone therapy. This successfully controlled the snoring, sleep apnea, and other apnea-related symptoms. Here, we describe our experience of nasal CP AP and thyroid hormone therapy in a patient with primary hypothyroidism associated with obstructive sleep apnea syndrome and dilated cardiomyopathy with review of the relevant literature.

• Sleep Medicine and Psychophysiology
• /
• v.22 no.1
• /
• pp.30-34
• /
• 2015

Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.

• Tuberculosis and Respiratory Diseases
• /
• v.40 no.5
• /
• pp.501-508
• /
• 1993

Background: Sleep apnea syndrome is a common disorder which is estimated to affect about 1~4% of adult male population. And if untreated, sleep apnea can cause significant sequelae, such as hypertension, nocturnal cardiac arrhythmia, daytime hypersomnolence, and cognitive impairment. Various kinds of treatment for obstructive sleep apnea (OSA) have been developed. Among them nasal CPAP, first introduced by Sullivan et al in 1981, has received widespread interest and acclaim as a treatment of OSA, and is currently recommended as first-line treatment for OSA. We evaluated the effect of nasal CPAP in OSA and the side effects of nasal CPAP hindering patients from using nasal CPAP. Methods: We performed sleep studies in 20 OSA patients at 2 consecutive nights; baseline night at first day and CPAP night at second day. We compared apnea index, lowest oxygen concentration during apnea, maximal apnea time, and total apnea duration per total sleep time before and after CPAP. We also evaluated the side effects of CPAP with inquiry to the patients. Results: 1) Apnea index was significantly decreased after CPAP in 17 out of 20 OSA patients (85%) and increased in 3 patients (15%). 2) Average apnea index was significantly decreased after CPAP ($34.1{\pm}18.9/h{\rightarrow}15.4{\pm}10.3/h$, p<0.01). 3) Total apnea duration per total sleep time was also significantly decreased after CPAP ($28.5{\pm}16.0%{\rightarrow}11.9{\pm}9.3%$, p<0.05). 4) The lowest oxygen satuation and maximal apnea time were not significantly changed after CPAP. 5) The most frequent side effect of nasal CPAP was mask discomfort (80%), and the next was drying of nasal passages (65%). Conclusion: Nasal CPAP is an effective treatment for OSA. Futher studies should be concentrated on long term follow up of nasal CPAP for its therapeutic effects and the study of methods to enhance patients' compliance.

• Tuberculosis and Respiratory Diseases
• /
• v.45 no.2
• /
• pp.404-415
• /
• 1998

Background: Sleep apnea syndrome, which occurs in 1~4 % of the adult population, frequently has different cardiovascular complications such as hypertension, ischemic heart disease, cardiac arrythmia as well as sleep-wake disorder such as excessive daytime hypersomnolence or insomnia. Mortality and vascular morbidity are reported to be significantly higher in sleep apnea syndrome patients than in normal population. According to the recent studies, autonomic dysfunction as well as hypoxemia, hypercapneic acidosis, and increased respiratory effort, may playa role in the high prevalence of cardiovascular complications in patients with sleep apnea syndrome. However the cause and mechanism of autonomic neuropathy in patients with sleep apnea syndrome are not well understood. We studied the existence of autonomic neuropathy in patients with sleep apnea syndrome and factors which influence the pathogenesis of autonomic neuropathy. Method: We used the cardiovascular autonomic neuropathy(CAN) test as a method for evaluation of autonomic neuropathy. The subjects of this study were 20 patients who diagnosed sleep apnea syndrome by polysomnography and 15 persons who were normal by polysomnography. Results: Body mass index and resting systolic blood pressure were higher in sleep apnea group than control group. Apnea index(Al), respiratory disturbance index(RDI) and snoring time percentage were significantly higher in sleep apnea group compared with control group. But there were no significant differences in saturation of oxygen and sleep efficiency in two groups. In the cardiac autonomic neuropathy test, the valsalva ratio was significantly low in sleep apnea group compared with control group but other tests had no differences between two groups. The CAN scores and corrected QT(QTc) interval were calculated significantly higher in sleep apnea group, but there were no significant correlations between CAN scores and QTc interval. There were no significant data of polysomnography to correlate to the CAN score. It meant that the autonomic neuropathy in patients with sleep apnea was affected by other multiple factors. Conclusion: The cardiovascular autonomic neuropathy test was a useful method for the evaluation of autonomic neuropathy in patients with sleep apnea syndrome and abnormalities of cardiovascular autonomic neuropathy were observed in patients with sleep apnea syndrome. However, we failed to define the factors that influence the pathogenesis of autonomic neuropathy of sleep apnea syndrome. This study warrants futher investigations in order to define the pathogenesis of autonomic neuropathy in patients with sleep apnea syndrome.