BACKGROUND AND PURPOSE: Obstructive sleep apnea (OSA) is more severe during rapid eye movement (REM) sleep than during non-REM sleep. We aimed to determine the features of patients with OSA who experience little REM sleep. METHODS: Patients with a chief complaint of sleep-disordered breathing were enrolled. All subjects underwent overnight polysomnography (PSG) and completed questionnaires on sleep quality. Patients were divided into the following three groups according to the proportion of REM sleep detected in overnight PSG: little REM sleep [REM sleep <20% of total sleep time (TST)], normal REM sleep (20–25% of TST), and excessive REM sleep (>25% of TST). Multiple logistic regression analyses were applied to the data. The success rate of continuous positive airway pressure (CPAP) titration was estimated in these groups. RESULTS: The age and body mass index of the patients were 47.9±15.9 years (mean±SD) and 25.2±4.1 kg/m², respectively. The 902 patients comprised 684 (76%) men and 218 (24%) women. The apnea-hypopnea index (AHI) in the little-REM-sleep group was 22.1±24.4 events/hour, which was significantly higher than those in the other two groups (p<0.05). Multiple logistic regression showed that a higher AHI (p<0.001; odds ratio, 1.512; 95% confidence interval, 1.020–1.812) was independently predictive of little REM sleep. The titration success rate was lower in the little-REM-sleep group than in the normal-REM-sleep group (p=0.038). CONCLUSIONS: The AHI is higher and the success rate of CPAP titration is lower in OSA patients with little REM sleep than those with normal REM sleep.
Body Mass Index ; Continuous Positive Airway Pressure ; Female ; Humans ; Logistic Models ; Male ; Odds Ratio ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Sleep, REM*

No abstract available.
Amnesia, Transient Global* ; Humans ; Writing*

Sleep is a highly organized and complicated state that is fundamental to life. We have an absolute need to sleep during about one-third of our lives. There are two types of sleep, non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep is divided into stages 1, 2, and 3 which is representing a degree of relative depth in sleep. Each sleep stage shows unique features including some variations in electroencephalographic waves, eye movements, and muscle tone. Although sleep pattern changes are associated with aging, how sleep physiology and sleep patterns change over an individual's life span is not well-defined. Circadian rhythms, which are the daily rhythms in physiology and behavior, regulate the sleep-wake cycle. Comprehensive understanding of normal sleep physiology should be very important to better understand not only the effects of sleep related diseases but also the impacts of pathological sleep on various diseases of other systemic organs. This review aims to enhance knowledge focused on normal sleep physiology and its regulation.
Aging ; Circadian Rhythm ; Eye Movements ; Muscles ; Neurobiology ; Physiology* ; Sleep Stages ; Sleep, REM

No abstract available.
Hemorrhoidectomy* ; Hemorrhoids* ; Ligation* ; Rubber*

Objectives: Functional dyspepsia is one of the most common functional gastrointestinal disorders. We aimed to investigate the relationship between obstructive sleep apnea (OSA) and functional dyspepsia in patients with the complaint of sleep-disordered breathing. Methods: We prospectively recruited patients who visited the institute for the evaluation of sleep-disordered breathing. All patients underwent overnight polysomnography and submitted their responses to sleep questionnaires. A validated Korean version of the Rome III criteria was used to estimate functional dyspepsia. Functional dyspepsia was classified into two subtypes of epigastric pain syndrome and postprandial distress syndrome. Results: Out of 130 subjects with sleep disturbances, a total of 79 patients (60 men, 19 women) were enrolled. The mean (±standard deviation) age was 46.9±13.4 years. Functional dyspepsia was diagnosed in 8 (10%) patients. Patients with functional dyspepsia showed significantly higher values of Stanford Sleepiness Scale, the proportion of N1 sleep, arousal index, and apnea-hypopnea index compared to patients without functional dyspepsia (p=0.018, p=0.021, p=0.041, and p=0.039, respectively). With respect to OSA severity, 12% of patients with moderate OSA and 22% patients with severe OSA had functional dyspepsia. Severe OSA was significantly associated with a higher proportion of postprandial distress syndrome (p=0.030). Conclusions Our patients with snoring or OSA revealed that functional dyspepsia is associated with more severe daytime sleepiness and apnea-hypopnea index compared to those without functional dyspepsia. In addition, postprandial distress syndrome was a prevalent subtype of functional dyspepsia in patients with severe OSA.

Laryngotracheal injury following endotracheal intubation has been extensively described in the literature, but most discussion has centered around the sequela of prolonged intubation. Little however, has been reported regarding the lesions from short-term endotracheal intubation to ensure the safe practice of anesthesia. In this regard, 72 healthy, male patients undergoing general anesthesia for surgical procedures were randomly assigned to have an endotracheal tube of 7.0, 8.0, or 9.0 mm in internal diameter and were evaluated for the upper airway symptoms by questionnaire within 4-8 hours following extubation. The larynx and trachea were examined and scored for extent and severity of lary- ngotracheal damage by fiberoptic laryngotracheoscopy, and risk factors causing laryngotracheal injury were studied. The results were as follows; The incidence of upper airway symptoms were 13 of 72 (18.1%), of which 10 (13.9%) were throat discomfort and 3 (4.2%) were sore throat. The incidence of laryngeal and tracheal injury was 52 of 72 (72.2%) and 20 of 72 (27.8%), respectively. 20 patients (27.8%) did not reveal any lesion in the laryngotracheal system. The common sites of intubation injury were vocal cords (65.3%, all erythema) and arytenoids (44.4%, erythema 37.5%, edema 6.9%). No correlation could be drawn between the injured and uninjured groups with respect to smoking and length of intubation. However, bucking was associated with severity and extent of laryngeal damage (p<0.05), and with the extent of tracheal damage only (p<0.05). Also, the increase in internal diameter of the tube used was associated with severity and extent of laryngeal damage (p<0.05), but not with tracheal damage.
Anesthesia ; Anesthesia, General ; Edema ; Erythema ; Humans ; Incidence ; Intubation ; Intubation, Intratracheal* ; Larynx ; Male ; Pharyngitis ; Pharynx ; Surveys and Questionnaires ; Risk Factors ; Smoke ; Smoking ; Trachea ; Vocal Cords

BACKGROUND AND PURPOSE: We aimed to determine the effectiveness of intraoperative neurophysiological monitoring focused on the transcranial motor-evoked potential (MEP) in patients with medically refractory temporal lobe epilepsy (TLE). METHODS: We compared postoperative neurological deficits in patients who underwent TLE surgery with or without transcranial MEPs combined with somatosensory evoked potential (SSEP) monitoring between January 1995 and June 2018. Transcranial motor stimulation was performed using subdermal electrodes, and MEP responses were recorded in the four extremity muscles. A decrease of more than 50% in the MEP or the SSEP amplitudes compared with baseline was used as a warning criterion. RESULTS: In the TLE surgery group without MEP monitoring, postoperative permanent motor deficits newly developed in 7 of 613 patients. In contrast, no permanent motor deficit occurred in 279 patients who received transcranial MEP and SSEP monitoring. Ten patients who exhibited decreases of more than 50% in the MEP amplitude recovered completely, although two cases showed transient motor deficits that recovered within 3 months postoperatively. CONCLUSIONS: Intraoperative transcranial MEP monitoring during TLE surgery allowed the prompt detection and appropriate correction of injuries to the motor nervous system or ischemic stroke. Intraoperative transcranial MEP monitoring is a reliable modality for minimizing motor deficits in TLE surgery.
Electrodes ; Epilepsy, Temporal Lobe ; Evoked Potentials, Somatosensory ; Extremities ; Humans ; Intraoperative Neurophysiological Monitoring ; Monitoring, Intraoperative ; Muscles ; Nervous System ; Stroke ; Temporal Lobe

BACKGROUND AND PURPOSE: Discrepancies between objectively measured sleep and subjective sleep perception in patients with insomnia have been reported. However, few studies have investigated sleep-state misperception in patients with obstructive sleep apnea (OSA). We designed this study to 1) delineate the factors that could affect this discrepancy and 2) infer an underlying mechanism in patients with OSA. METHODS: We recruited patients who visited our sleep clinic for the evaluation of their snoring and/or observed OSA. Participants completed a structured questionnaire and underwent overnight polysomnography. On the following day, five sessions of the multiple sleep latency test (MSLT) were applied. We divided the patients into two groups: normal sleep perception and abnormal perception. The abnormal-perception group included patients whose perceived total sleep time was less than 80% of that measured in polysomnography. RESULTS: Fifty OSA patients were enrolled from a university hospital sleep clinic. Excessive daytime sleepiness, periodic limb movement index (PLMI), and the presence of dreaming were positively associated with poor sleep perception. REM sleep near the sleep termination exerted important effects. Respiratory disturbance parameters were not related to sleep perception. There was a prolongation in the sleep latency in the first session of the MSLT and we suspected that a delayed sleep phase occurred in poor-sleep perceivers. CONCLUSIONS: As an objectively good sleep does not match the subjective good-sleep perception in OSA, physicians should keep in mind that OSA patients who perceive that they have slept well does not mean that their OSA is less severe.
Dreams ; Extremities ; Humans ; Polysomnography* ; Sleep Apnea, Obstructive* ; Sleep Initiation and Maintenance Disorders ; Sleep, REM ; Snoring

Surgical tissue damage induces dual phenomenon of peripheral and central sensitization. Postoperative pain could be partially explained by neuronal hyperexcitability. As a postoperative pain model, formalin test, subcutaneous injection of formalin in the rat hind paw, results in initial vigorous flinching(phase 1), depends on acute chemical stimulation, followed by cessation of activity, and then resumption of flinching(phase 2), which depends on central sensitization. Pre-emptive analgesia, given before the onset of a painful stimuli, reduces or ptevents postoperative pain by preventing this central sensitization. This study was performed to evaluate the effect of local infiltration of lidocaine as a pre-emptive analgesia in the formalin test. Forty experimental rats were divided four groups; CONTROL group(without any treatment), POST group(0.04 mL of 1% lidocaine injection 5 min after formalin injection), PRE group(0.04mL of 1% lidocaine 5 min before formalin injection), and SHAM group(injection of normal saline 5 min before formalin injection). All animals received inhalation anesthesia for 15 min before and 5 min after formalin injection. Under halothane inhalation anesthesia, all were injected subcutaneously 0.04 mL of 5% formalin in the distal plantar area of right hind paw. After recovery of anesthesia, the formalin-induced flinching behavior was observed during only the phase 2 period(10-60 min) after formalin injection. The time to first flinching, the mean number of flinches per min, and the mean number of total flinches during phase 2 expressed as a percent of the values of the CONTROL group were compared between the groups with an t-test or an ANOVA. The first flinching was appeared before recovery of anesthesia in CONTROL and SHAM groups. The time to first flinching after formalin injection was 21.2+/-3.4, 16.6+/-3.1 min respectively in PRE and POST groups. It was significantly longer in PRE group than in POST group(P<0.05), despite of 10 min earlier injeetion of lidocaine in PRE group. The mean number of flinches per min was significantly lower in PRE and POST groups(P<0.05) until 25 min after formalin injection, and after that time the difference between PRE group and POST group was significant(P<0.05). The means of the total number of flinches during phase 2, expressed as a percent of the values of the CONTROL poup, were 100+/-17.2%, 31.8+/-13.1%, 76.9+/-14.5% respectively in SHAM, PRE and POST groups. Those in PRE and POST groups were significantly lower than that of CONTROL group(P<0.001), and the difference between PRE group and POST group was significant(P<0.05). In summary, pre-emptive infiltration of lidocaine on formalin test prolongs the duration of analgesia and reduces the severity of formalin pain in rat. Therefore, the infiltration of lidocaine before formalin test is really provided pre-emptive analgesia.
Analgesia ; Anesthesia ; Anesthesia, Inhalation ; Animals ; Central Nervous System Sensitization ; Formaldehyde* ; Halothane ; Injections, Subcutaneous ; Lidocaine* ; Neurons ; Pain Measurement ; Pain, Postoperative ; Rats* ; Stimulation, Chemical

BACKGROUND: There are many factors which cause postoperative hepatic dysfunction. Anesthetic agents are not the most common factor and there aremany other factors such as preoperative condition of the patients, site and duration of the operation, operation per se and so on. The purposeof this study is to evaluate postoperative liver function with respect to different types of surgery. METHOD: Fourty three patients were classified into three groups; 11 patients for tympanoplasty with mastoidectomy (Group 1), 16 patients for total abdominal hysterectomy (Group 2), 15 patients for subtotal gastrectomy (Group 3). All patients were anesthesized with about 2 vol% of enflurane combined with 50% nitrous oxide. Serum glutamic oxalacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and alkaline phosphatase (ALP) were measured before anesthesia, 1, 3 and 7 days after surgery in all group, respectively. RESULT: In Group 1 and 2, postoperative SGOT and SGPT levels were maintained with preoperative level during the 7days, but in Group 3, those levels were increased in the 1st day but below upper limit (p<0.05) and decreased thereafter. Alkaline phosphatase level was maintained within the normal range for all the group during the 7 days. CONCLUSION: We consider that postoperative liver functioin may be influenced by different types of surgery, and also may be influenced by anesthetic time.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia ; Anesthesia, Inhalation* ; Anesthetics ; Aspartate Aminotransferases ; Enflurane* ; Gastrectomy ; Humans ; Hysterectomy ; Inhalation* ; Liver* ; Nitrous Oxide ; Reference Values ; Tympanoplasty