OBJECTIVES: A few studies have compared REM sleep-dependent obstructive sleep apnea syndrome (REM-OSA) with sleep stage non-dependent apnea syndrome (SND-OSA). Despite that REM-OSA might be more common in women than men, no studies have examined the probable characteristics of women patients with obstructive sleep apnea syndrome (OSAS). This study aimed at finding out the characteristics of REM-OSA in women by comparing it with SND-OSA. METHODS: Fifty-three subjects diagnosed as OSAS (AHI>5; AHI: apnea-hypopnea index) with nocturnal polysomnography at the Center for Sleep and Chronobiology of the Seoul National University Hospital between October 2004 and February 2006 were studied. Of them, 44 subjects with OSAS severity of mild (52 and AHI-NR<15 (AHI-R: AHI during REM sleep, AHI-NR: AHI during non-REM sleep). We compared REM-OSA group with SND-OSA as well as the criteria-determined REM-OSA cases with the visually-determined ones. RESULTS: Among 44 subjects, 28 persons (63.6%) turned out to have REM-OSA by our criteria and 24 persons (54.5%) by visual determination. Statistically significant differences (p<0.05) were found between REM-OSA and SND-OSA groups in AHI, hypopnea index, total sleep time, total wake time, sleep efficiency index, percents of stage 1, 2 and REM sleep, and REM latency. Percent of stage REM sleep (%REM) turned out to have influence on AHI ratio (AHI-R/AHI-NR) (B=0.537, p=0.002). REM-OSA was likely to be diagnosed in milder severity of OSAS (chi-square=13.117, p<0.001) and those with higher %REM (chi-square=11.325, p=0.001). There was no significant difference between the criteria-determined and the visually-determined cases of REM-OSA. CONCLUSION: We suggest that REM-OSA and SND-OSA patients be differentiated in terms of pathophysiology and treatment strategies. Visual determination of REM-OSA might be useful as the screening procedure of REM-OSA. Further studies on women with OSAS and REM-OSA need to be done.
Apnea ; Female ; Humans ; Male ; Mass Screening ; Polysomnography ; Sleep Apnea, Obstructive ; Sleep Stages ; Sleep, REM

Digital polysomnography was developed to overcome the limitations of Rechtschaffen and Kales rule and to compensate the shortcomings of paper polysomnography. It enables easy access to and secure preservation of sleep records, and provides various displays of sleep data to enhance efficiency of visual scoring of sleep records. Rechtschaffen and Kales rule had been criticized for its ambiguity and lack of considerations in spatial information of EEG. As sleep records are acquired and processed in digital mode, they can be analyzed at microscopic and macroscopic levels. Digital analysis of sleep records provides the basis for development of new sleep measures. Sleep staging in digital polysomnography is based on the various analyses of EEG. Sleep apnea, hypopnea and periodic limb movement are detected automatically by digital analysis of respiratory signals and leg EMG. Digital polysomnography plays a complementary role to visual scoring and compensates the limitations of paper polysomnography. Digital polysomnography, including acquisition, processing and analysis of sleep records in digital mode, can be a great help in the development of sleep medicine, enabling the development of new sleep measures and the exchange of sleep records between sleep laboratories.
Brassica ; Electroencephalography ; Extremities ; Leg ; Polysomnography* ; Sleep Apnea Syndromes

The reciprocal interaction between sleep and pain has been reported by numerous studies. Patients with acute or chronic pain often complain of difficulty falling asleep, frequent awakenings, shorter sleep duration, unrefreshing sleep, and poor sleep quality in general. According to the majority of the experimental human studies, sleep deprivation may produce hyperalgesic changes. The selective disruption of slow wave sleep has shown this effect more consistently, while results after selective REM sleep deprivation remain unclear. Patients with chronic pain have a marked alteration of sleep structure and continuity, such as frequent sleep-stage shifts, increased nocturnal awakenings, decreased slow wave sleep (SWS), decreased rapid eye movement (REM) sleep, and alpha-delta sleep. Many analgesic medications can alter sleep architecture in a manner similar to the effects of acute and chronic pain, suppressing SWS and REM sleep.
Chronic Pain ; Humans ; Sleep Deprivation ; Sleep, REM

No abstract available.
Anxiety* ; Hypochondriasis*

Sleep-related behaviors observed in parasomnias can result in serious injuries of patients and/or spouses. Parasomnia is defined as undesirable physical or behavioral phenomenon occurring during sleep. If these disorders are accurately diagnosed, effective treatments are available. Often, these disorders can be even cured. Environmental management for patient and/or spouse safety and good sleep hygiene are the most recommended for individuals behaving abnormally during sleep. The aim of this article is to review the clinical features, diagnosis and treatment of several sleep-related behavior disorders.
Diagnosis ; Humans ; Hygiene ; Mental Disorders ; Parasomnias ; Spouses

OBJECTIVES: Obstructive sleep apnea syndrome (OSAS) not only causes respiratory disturbances during sleep but also decreases the quality of nocturnal sleep through sleep fragmentation and sleep structure change. We aimed at comparing the changes in sleep fragmentation and structure between baseline (diagnostic) nocturnal polysomnography (NPSG) and nCPAP (nasal continuous positive airway pressure) titration trial. METHODS: One hundred and three patients with a baseline night of respiratory disturbance index (RDI) of 5 or greater and reduced RDI score during nCPAP titration night were retrospectively selected for the study. Sleep fragementation and sleep structure between baseline NPSG and the NPSG during nCPAP titration were compared. Sleep fragmentation index (SFI) was defined as the total number of awakenings and shifts to stage 1 sleep divided by the total sleep time in hour. SFI and other polysomnographic parameters were statistically compared between the two nights. RESULTS: SFI during baseline NPSG and nCPAP titration nights were 29.0+/-13.8 and 15.2+/-8.8, respectively, indicating a significant SFI decrease during nCPAP titration (t=9.7, p<0.01). SFI showed significant negative correlations with sleep efficiency (r=-0.60, p<0.01) and total sleep time (r=-0.45, p<0.01) and a positive correlation with RDI (r=0.28, p<0.01). CONCLUSION: Use of nCPAP, even during the titration, significantly decreases sleep fragmentation and improves sleep structure in OSAS patients. We suggest that SFI may be utilized as a measure of assessing OSAS severity and nCPAP efficacy.
Humans ; Polysomnography ; Retrospective Studies ; Sleep Apnea, Obstructive ; Sleep Deprivation

Adenotonsillar hypertrophy is the leading cause of childhood obstructive sleep apnea. Obstructive sleep apnea syndrome in child-hood, however, can occur from various causes such as obesity or craniofacial abnormalities. Childhood obstructive sleep apnea syndrome can be accompanied by enuresis, parasomnias and behavior problems. For patients with the symptoms of snoring and apnea, obstructive sleep apnea should be suspected and diagnosed properly. In addition, the evaluation of complications and proper treatment are indispensable. When the cause of childhood obstructive sleep apnea is adenotonsillar hypertrophy, symptoms can be improved by surgical methods. If the cause is other than adenotonsillar hypertrophy, such as obesity, it should be treated with other therapeutic modalities, like nasal continuous positive airway pressure (nCPAP), weight reduction and modification of life style. This paper reports a case of nCPAP used to manage severe sleep apnea when it was not resolved after adenoidectomy and tonsillectomy. Differential diagnosis of narcolepsy in a case with excessive daytime sleepiness and reflections on accompanying enuresis and parasomnia were also described.
Adenoidectomy ; Apnea ; Child ; Continuous Positive Airway Pressure ; Craniofacial Abnormalities ; Diagnosis, Differential ; Enuresis ; Humans ; Hypertrophy ; Life Style ; Narcolepsy ; Obesity ; Parasomnias ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring ; Tonsillectomy ; Weight Loss

No abstract available.
Organization and Administration* ; Psychotherapy*

INTRODUCTION: Excessive daytime sleepiness and cataplexy are key features of narcolepsy. Modafinil is psychostimulant used in the treatment of narcolepsy. In this study, we evaluated effects of modafinil on nocturnal sleep structure and sleep latency in multiple sleep latency test and clinical features. METHODS: Twelve narcoleptic patients (7 male, age: 22.9 +/- 2.6 yrs) were participated in the study. All of them had done nocturnal polysomnography (nPSG), multiple sleep latency test (MSLT), clinical symptoms scales and have repeated same procedure after taking 200 mg of modafinil. We have done linear mixed model analysis to describe effects of group, medication and nap time on these measures. RESULTS: Modafinil did not affect clinical scales except PSQI which had been reduced after medication. In this study, Modafinil reduced total sleep time, sleep efficiency and increased wake after sleep onset and percent of arousal during sleep in nocturnal polysomnography and prolonged mean sleep latency in multiple sleep latency tests in both group. DISCUSSION: Modafinil has stimulant effect of central nervous system but its effect on night sleep is less than other psychostimulants such as methylphenidate. We ascertained that modafinil affected total sleep time, sleep efficiency and percent of wake during sleep but did not effect on sleep structure. Modafinil was effective in the management of day time sleepiness. Modafinil can enhance alertness of control group without day time sleepiness.
Arousal ; Cataplexy ; Central Nervous System ; Humans ; Male ; Methylphenidate ; Narcolepsy* ; Polysomnography ; Weights and Measures

The authors studied 5 cases of idiopathic CNS hypersomnia who visited Division of Sleep Studies, Seoul National University Hospital in 1995. Detailed medical history was taken and nocturnal polysomnography(NPSG), multiple sleep latency test(MSLT)and human leukocyte antigen(HLA) typing were performed. Neither cataplexy nor hypnagogic hallucination was reported in all cases and in NPSGs, there were tendencies of increased sleep period time and decreased slow wave sleep time. In MSLT, all the subjects showed average sleep latencies less than 8 minutes without sleep-onset rapid eye movement period(SOREMP). In HLA typing, some correlation between idiopathis CNS hypersomnia and HLA DR4 was observed. in contrast to previous reports, overall treatment response with methylphenidate was remarkable. Therefore, the authors suggest that patients suspected of idiopathic CNS hypersomnia be actively evaluated and treated with rather optimistic perspective.
Cataplexy ; Central Nervous System* ; Disorders of Excessive Somnolence* ; Hallucinations ; Histocompatibility Testing ; Humans ; Leukocytes ; Methylphenidate ; Seoul ; Sleep, REM