Objective: This study investigated whether the discrepancy between desired time in bed and desired total sleep time (DBST) index could be a meaningful indicator for assessing insomnia severity in a clinical sample of patients with insomnia. Furthermore, we sought to identify the mediators of the association between DBST and insomnia severity in individuals with insomnia. Methods: We collected the medical records of 127 patients with insomnia. Each participant’s DBST index was calculated using sleep indices, including time and duration variables. Psychological symptoms were investigated using the Insomnia Severity Index (ISI), Patients Health Questionnaire-9 items (PHQ-9), Generalized Anxiety Disorder-7, Dysfunctional Beliefs and Attitudes about Sleep-16 items (DBAS-16), and Epworth Sleepiness Scale. Results: The DBST index was significantly correlated with the ISI (r=0.20, p<0.05), desired total sleep time (r=-0.52, p<0.001), and desired time in bed (r=0.32, p<0.01). Linear regression analysis revealed that insomnia severity was associated with age (β=-0.18, p=0.018), DBST (β=0.23, p=0.003), PHQ-9 (β=0.23, p=0.031), and DBAS-16 (β=0.42, p<0.001). The DBST directly influenced insomnia severity, although indirect effects of mediators were not significant. Conclusion The DBST index directly influenced insomnia severity regardless of the mediating effects of psychological factors among a clinical sample of patients with insomnia. This finding implies that the DBST index can be a simple measure of insomnia severity, even among patients with insomnia.

Objective: This study investigated whether the discrepancy between desired time in bed and desired total sleep time (DBST) index could be a meaningful indicator for assessing insomnia severity in a clinical sample of patients with insomnia. Furthermore, we sought to identify the mediators of the association between DBST and insomnia severity in individuals with insomnia. Methods: We collected the medical records of 127 patients with insomnia. Each participant’s DBST index was calculated using sleep indices, including time and duration variables. Psychological symptoms were investigated using the Insomnia Severity Index (ISI), Patients Health Questionnaire-9 items (PHQ-9), Generalized Anxiety Disorder-7, Dysfunctional Beliefs and Attitudes about Sleep-16 items (DBAS-16), and Epworth Sleepiness Scale. Results: The DBST index was significantly correlated with the ISI (r=0.20, p<0.05), desired total sleep time (r=-0.52, p<0.001), and desired time in bed (r=0.32, p<0.01). Linear regression analysis revealed that insomnia severity was associated with age (β=-0.18, p=0.018), DBST (β=0.23, p=0.003), PHQ-9 (β=0.23, p=0.031), and DBAS-16 (β=0.42, p<0.001). The DBST directly influenced insomnia severity, although indirect effects of mediators were not significant. Conclusion The DBST index directly influenced insomnia severity regardless of the mediating effects of psychological factors among a clinical sample of patients with insomnia. This finding implies that the DBST index can be a simple measure of insomnia severity, even among patients with insomnia.

Objective: This study investigated whether the discrepancy between desired time in bed and desired total sleep time (DBST) index could be a meaningful indicator for assessing insomnia severity in a clinical sample of patients with insomnia. Furthermore, we sought to identify the mediators of the association between DBST and insomnia severity in individuals with insomnia. Methods: We collected the medical records of 127 patients with insomnia. Each participant’s DBST index was calculated using sleep indices, including time and duration variables. Psychological symptoms were investigated using the Insomnia Severity Index (ISI), Patients Health Questionnaire-9 items (PHQ-9), Generalized Anxiety Disorder-7, Dysfunctional Beliefs and Attitudes about Sleep-16 items (DBAS-16), and Epworth Sleepiness Scale. Results: The DBST index was significantly correlated with the ISI (r=0.20, p<0.05), desired total sleep time (r=-0.52, p<0.001), and desired time in bed (r=0.32, p<0.01). Linear regression analysis revealed that insomnia severity was associated with age (β=-0.18, p=0.018), DBST (β=0.23, p=0.003), PHQ-9 (β=0.23, p=0.031), and DBAS-16 (β=0.42, p<0.001). The DBST directly influenced insomnia severity, although indirect effects of mediators were not significant. Conclusion The DBST index directly influenced insomnia severity regardless of the mediating effects of psychological factors among a clinical sample of patients with insomnia. This finding implies that the DBST index can be a simple measure of insomnia severity, even among patients with insomnia.

Objective: This study investigated whether the discrepancy between desired time in bed and desired total sleep time (DBST) index could be a meaningful indicator for assessing insomnia severity in a clinical sample of patients with insomnia. Furthermore, we sought to identify the mediators of the association between DBST and insomnia severity in individuals with insomnia. Methods: We collected the medical records of 127 patients with insomnia. Each participant’s DBST index was calculated using sleep indices, including time and duration variables. Psychological symptoms were investigated using the Insomnia Severity Index (ISI), Patients Health Questionnaire-9 items (PHQ-9), Generalized Anxiety Disorder-7, Dysfunctional Beliefs and Attitudes about Sleep-16 items (DBAS-16), and Epworth Sleepiness Scale. Results: The DBST index was significantly correlated with the ISI (r=0.20, p<0.05), desired total sleep time (r=-0.52, p<0.001), and desired time in bed (r=0.32, p<0.01). Linear regression analysis revealed that insomnia severity was associated with age (β=-0.18, p=0.018), DBST (β=0.23, p=0.003), PHQ-9 (β=0.23, p=0.031), and DBAS-16 (β=0.42, p<0.001). The DBST directly influenced insomnia severity, although indirect effects of mediators were not significant. Conclusion The DBST index directly influenced insomnia severity regardless of the mediating effects of psychological factors among a clinical sample of patients with insomnia. This finding implies that the DBST index can be a simple measure of insomnia severity, even among patients with insomnia.

objectives: ：The aim of this study was to identify the factors affecting ideas of persecution in post-traumatic stress disorder (PTSD) patients who underwent Clinician-Administered PTSD Scale (CAPS) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Methods: ：We retrospectively reviewed 116 patients who underwent CAPS and MMPI 2 between May 2013 and April 2020 at Veteran Health Service Medical Center. Based on the CAPS score, the patients were divided into the PTSD group (n=63, age: 58.16±17.84) and the trauma exposed without PTSD group (n=53, age: 67.34± 12.05). After checking the correlation between Ideas of persecution, CAPS, and MMPI-2 scales, linear regression analysis was performed to identify the risk factors for clinically relevant symptoms. Results: ：The PTSD group showed significant differences in Schizophrenia, Ideas of persecution, Dysfunc-tional negative emotions, Aberrant Experiences, Psychoticism, Negative Emotionality/Neuroticism, Anxiety, Depression, and Anger scales compared to the trauma-exposed without PTSD group. When analyzing the correlation between Idea of persecution, CAPS and MMPI-2 scales, there was a strong association with most of the scales in MMPI-2 and Idea of persecution except Disconstraint. Multiple linear regression analysis performed in PTSDgroup identified that risk factors for Idea of persecution were Dysfunctional negative emotions and Anger scale. Conclusions ：The PTSD group had increased idea of persecution compared to the trauma exposed without PTSD group. Dysfunctional negative emotions and anger may be risk factors for idea of persecution in trauma exposed population.

REM sleep behavior disorder is parasomnia characterized by unpleasant dreams and dream-enactment behaviors associated with excessive electromyography activity in REM sleep. This may appear idiopathic or secondary to other neurological or medical conditions. REM sleep behavior disorder, which appears to be idiopathic, most often implies the possibility of later neurodegenerative diseases due to synucleinopathy, so accurate diagnosis is important in predicting prognosis. For the diagnosis of REM sleep behavioral disorder, REM sleep without atonia, which appears in the polysomnography, is essential. Obstructive sleep apnea, trauma-related sleep disorders, and vigorous periodic leg movements during sleep are known as diseases that show dream enactment behavior in elderly patients. Considering that it may be accompanied by other sleep disorders that can mimic REM sleep behavioral disorders, it is important to differentiate sleep

Objective: Positive airway pressure (PAP) compliance is important in treating obstructive sleep apnea. Previous studies have suggested that patients with economic burdens, discomfort using machines, and insufficient education have difficulty tolerating PAP machines. This study explored the factors affecting short-term adherence to PAP in a veterans medical center. Methods: The medical records of patients who underwent polysomnography at the Veterans Health Service Medical Center, Seoul, Republic of Korea, between July 2018 and January 2021 were reviewed retrospectively. Patients with an apnea-hypopnea index (AHI) ≥15 were included (n=579). PAP adherence was defined as continuous use for ≥21 days for ≥4 hours daily for 30 consecutive days for 90 days from the date of PAP prescription. Results: The PAP-adherent group (n=265, age 66.16±11.28 years) was younger and had more years of education, higher body mass indices, and lower scores in the Insomnia Severity Index and Beck Depression Inventory-II (BDI-II) than those of the PAP-nonadherent group (n=314, age 68.93±10.91 years). Patients who tolerated PAP had a higher AHI, longer duration of oxygen desaturation (less than 90%), and less dream enactment behavior (DEB) than that in those who did not. After adjusting for age, years of education, BDI-II, duration of oxygen desaturation, and presence of DEB, there were more patients with National Health Insurance (NHI) in the PAP-adherent group than in the PAP-nonadherent group (p<0.001). Conclusion We showed that patients with NHI recorded significantly higher adherence compared to that in patients without NHI, among other factors.

Background: To evaluate the therapeutic effectiveness and safety of a neurofeedback wearable device for stress reduction. Methods: A randomized, double-blind, controlled study was designed. Participants had psychological stress with depression or sleep disturbances. They practiced either neurofeedback-assisted meditation (n = 20; female, 15 [75.0%]; age, 49.40 ± 11.76 years) or neurofeedback non-assisted meditation (n = 18; female, 11 [61.1%]; age, 48.67 ± 12.90 years) for 12 minutes twice a day for two weeks. Outcome variables were self-reported questionnaires, including the Korean version of the Perceived Stress Scale, Beck Depression Inventory-II, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and State Trait Anxiety Index, quantitative electroencephalography (qEEG), and blood tests. Satisfaction with device use was measured at the final visit. Results: The experimental group had a significant change in PSS score after two weeks of intervention compared with the control group (6.45 ± 0.95 vs. 3.00 ± 5.54, P = 0.037). State anxiety tended to have a greater effect in the experimental group than in the control group (P = 0.078). Depressive mood and sleep also improved in each group, with no significant difference between the two groups. There were no significant differences in stress-related physiological parameters, such as stress hormones or qEEG, between the two groups.Subjective device satisfaction was significantly higher in the experimental group than in the control group (P = 0.008). Conclusion Neurofeedback-assisted meditation using a wearable device can help improve subjective stress reduction compared with non-assisted meditation. These results support neurofeedback as an effective adjunct to meditation for relieving stress.

Objective: Among veterans, the prevalence of rapid eye movement sleep behavior disorder (RBD) is higher than among the general population, and some evidence suggests that this is related to post-traumatic stress disorder (PTSD). The purpose of this study was to determine whether the frequency of RBD differs depending on the presence of PTSD or trauma. Methods: Patients who underwent nocturnal polysomnography (PSG) and sleep-related questionnaire surveys at the Veteran Health Service Medical Center were reviewed retrospectively. Based on patients with PTSD (n=20; 100% male; 67.9±8.5 years of age), we matched patients exposed to trauma without PTSD (n23; 100% male; age 64.0±13.4) and patients without trauma (n=21; 100% male; age 59.86±10.9). Results: PTSD patients reported dream enactment behavior more than the trauma-exposed group without PTSD or the control group (p=0.006). After adjusting for age, there were more RBD patients in the PTSD group than in the trauma exposed group (p=0.049). Conclusion The results showed that RBD occurred significantly more in veterans with PTSD than those exposed to trauma, which suggests that there may be a pathophysiological association between PTSD and RBD.

Objective: To identify the factors affecting anger in post-traumatic stress disorder (PTSD) patients who underwent Clinician-Administered PTSD Scale (CAPS) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Methods: We retrospectively reviewed patients who underwent CAPS and MMPI-2 at Veteran Health Service Medical Center, Seoul, Korea. Based on the CAPS score, the patients were divided into the PTSD group (n=46) and the trauma exposed without PTSD group (n=29). After checking the correlation between anger, CAPS, and MMPI-2 scales, logistic regression analysis was performed to identify the risk factors for clinically relevant symptoms. Results: The PTSD group showed significant differences in schizophrenia-related symptoms, ideas of persecution, aggressiveness, psychoticism, and anger scales compared to the trauma-exposed without PTSD group. There was a significant correlation between anger, CAPS, and MMPI-2 except masculinity/femininity, disconstraint, and MacAndrew Alcoholism-Revised. In particular, anger has been shown to have a substantial connection with paranoia, schizophrenia-related symptoms, ideas of persecution, aberrant experiences, and psychoticism. Multiple regression analysis identified that the only significant risk factor for anger was the negative emotionalityeuroticism scale (odds ratio=1.152, p<0.001). Conclusion The PTSD group had increased anger compared to the trauma-exposed without PTSD group, and that negative emotions may be a risk factor for PTSD.