Sleep changes substantially with age. There is a phase advance in the circadian sleep cycle and increased waking after sleep onset. The elderly people wake more frequently during the night and experience fragmented sleep and excessive daytime sleepiness. The prevalence of sleep disorders increases with age, and the composition of sleep disorders in the elderly differs from that in the young. The most frequently encountered sleep disorders are psychophysiologic insomnia, sleep disturbance due to dementia, sleep-related respiratory disorder, restless legs syndrome and periodic limb movement disorder, and REM sleep behavior disorder. To treat the elderly sleep problem appropriately, it is important to know how sleep pattern changes as we age and to understand the cause of sleep-related symptoms. This article will review the sleep physiology and common sleep disorders in the elderly.
Aged* ; Dementia ; Humans ; Nocturnal Myoclonus Syndrome ; Physiology* ; Prevalence ; REM Sleep Behavior Disorder ; Restless Legs Syndrome ; Sleep Wake Disorders* ; Sleep Initiation and Maintenance Disorders

Excessive daytime sleepiness in childhood might be abnormal phenomenon and often related to the sleep disorders or insufficient sleep duration. The most common cause of excessive daytime sleepiness would be insufficient sleep. However, narcolepsy, idiopathic hypersomnia, circadian rhythm sleep disorders, medication, medical illness and other sleep disorders that could cause insomnia and poor quality of sleep also result in excessive daytime sleepiness. The misdiagnosed and untreated excessive daytime sleepiness in childhood can lead to serious developmental and educational problem.
Child ; Humans ; Hypersomnolence, Idiopathic ; Narcolepsy ; Sleep Wake Disorders ; Sleep Wake Disorders, Circadian Rhythm ; Sleep Initiation and Maintenance Disorders

PURPOSE: This study was designed to evaluate the usefulness of a technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) single photon emission computed tomography (SPECT) performed on transplanted kidney. MATERIALS AND METHODS: Thirty renal transplant patients were included in this study. Planar scan was performed for 30 minutes using 555 MBq Tc-99m MAG3. A post-voiding SPECT scan was acquired on the third, seventh, fourteenth and twenty eighth day after transplantation. RESULTS: SPECT scan showed interpretable image quality in 26 of 30 patients (86.7%) and 84 in 120 scans (70%). Fourteen of 26 patients with interpretable SPECT image showed decreased or increased radioactivity, but only 5 had abnormal findings on the planar scan. Focal SPECT defects were seen in allografts with normal function (n=3), acute tubular necrosis (n=3), and acute rejection (n=2). The defects are thought to reflect focally underperfused renal parenchyme or, in normal allografts, an artifact from uneven radioactivity distribution. Four of 10 patients with renal arterial variation showed focally decreased radioactivity and SPECT helped guide further studies that confirmed the exact cause. Five of 10 patients with acute tubular necrosis or acute rejection showed focally decreased radioactivity, but its relation to the patients' clinical course was not clear. Focally increased radioactivity was observed in 5 allografts with normal function and 1 with double ureter in which local clearance delay was observed. CONCLUSION: Tc-99m MAG3 SPECT renal scan can detect additional focal abnormalities compared to planar scan. Further study is necessary to elucidate the exact clinical significance of the SPECT findings.
Allografts ; Artifacts ; Humans ; Kidney* ; Necrosis ; Radioactivity ; Tomography, Emission-Computed, Single-Photon* ; Ureter

Circadian rhythms have been observed to be disturbed in mood disorders, especially seasonal affective disorder (SAD). Clock related gene variants also have been suggested to be associated with seasonality (seasonal variations in mood and behavior). This study tested the potential association between a length polymorphism of Period3 gene and seasonal variations in mood and behavior. 297 Korean college students were genotyped for the Period3 polymorphism and were for evaluated the seasonal variation by Seasonal Pattern Assessment Questionnaire (SPAQ). The genotype frequencies were 0.76 for 4R/4R, 0.22 for 4R/5R and 0.013 for 5R/5R. The global seasonality score was not different among Period3 gene variants (4R/4R, 4R/5R and 5R/5R) except for 'sleep length' subscore. The 5R/5R genotype showed the higher 'sleep length' subscore than others (p=0.024). The comparison between seasonals (syndromal plus subsyndromal SAD determined by SPAQ) and non-seasonals did not show any significant difference in frequencies of genotypes. These findings suggest that there is a possibility that the investigated Period3 polymorphism may play a partial role in the susceptibility of seasonal variations in a Korean population.
Circadian Rhythm ; Genotype ; Humans ; Mood Disorders ; Surveys and Questionnaires ; Seasonal Affective Disorder ; Seasons*

No abstract available.
Adolescent* ; Humans

No abstract available.
Carcinoma, Squamous Cell* ; Maxillary Sinus* ; Nose* ; Papilloma, Inverted*

OBJECTIVE: Diurnal preference is an attribute reflecting whether people are alert and preferring to be active either early or late in the day. It also referred to as chronotype or morningness-eveningness trait. The PER3 genes have been known to influence diurnal preference. In this study, we have investigated the associations between the PER3 gene polymorphisms and diurnal preference in a healthy young population, controlling for the social and environmental confounding factors. METHODS: The participants in this experiment included 299 unrelated medical college students (M=191, F=108), with a mean age of 22.9 years. Diurnal preference was measured by a single administration of the 13-item Composite Scale for Morningness (CSM). Genotyping of the PER3 VNTR (rs57875989) was performed using polymerase chain reaction. A two-tailed alpha of 0.05 was chosen. RESULTS: The mean+/-SD score on the CSM scale for all subjects was 31.90+/-6.39. There was no significant difference in total CSM score between gender groups, although females showed a trend towards higher morningness score. Although PER3 5R/5R showed the tendency towards high CSM scores, there were no significant differences on CSM scores among genotypes and allele status of PER3 VNTR (rs57875989). CONCLUSIONS: We could not confirm that the PER3 VNTR is associated with diurnal preference in a Korean healthy young population. The future studies need to investigate the association between diurnal preference and other polymorphisms of PER3 gene in larger sample of Korean young healthy population.
Alleles ; Female ; Genotype ; Humans ; Polymerase Chain Reaction

PURPOSE: Retinal neovascularization in diabetes has been thought to follow the release of local angiogenic factors in the retina. We hypothesized that neovascularization of diabetic retinopathy is a systemic vasculogenesis rather than a local angiogenesis. Thus, we evaluated the concentrations of circulating endothelial progenitor cells (EPCs) and stem cell modulation factors such as vascular endothelial growth factor (VEGF), erythropoietin (EPO), and substance p (SP) in the peripheral blood of diabetic retinopathy patients. METHODS: We studied 15 normal controls and 45 Type 2 diabetic patients [non-DR group (n=15), NPDR group (n=15), and PDR group (n=15)]. We measured circulating CD34+mononuclear cells (CD34+MNCs) and c-Kit+mononuclear cells (c-Kit+MNCs) by flow cytometry. VEGF, EPO and SP in the peripheral blood were measured by ELISA. RESULTS: The circulating CD34+MNCs and c-Kit+MNCs increased in the NPDR and PDR groups compared with the control group (P<0.01). The serum level of VEGF was increased in the NPDR and PDR groups compared with the control group (P<0.05). The level of EPO was exclusively elevated in the non-DR group compared with the other three groups (P<0.01). The circulating SP level increased in the NPDR and PDR groups compared with the control group (P<0.05). CONCLUSIONS: The present study is the first to demonstrate that CD34+MNCs, c-Kit+MNCs and their modulator are elevated in diabetic retinopathy patients. Therefore, it is possible that circulating EPCs and serum VEGF, EPO and SP may be involved in the progression of diabetic retinopathy.
Angiogenesis Inducing Agents ; Diabetic Retinopathy* ; Enzyme-Linked Immunosorbent Assay ; Erythropoietin ; Flow Cytometry ; Humans ; Retina ; Retinal Neovascularization ; Stem Cells ; Substance P ; Vascular Endothelial Growth Factor A

OBJECTIVES: Ginseng has a long history of being used in insomnia treatment and there is some evidence from animal studies of its sleep-enhancing property. From this, it can be assumed that ginseng has sleep-promoting effect in humans. The purpose of this study was to investigate the effect of Korean red ginseng on change of sleep architecture in humans. METHODS: A total of 20 healthy young males with regular sleep and wake habits and without any psychiatric nor cognitive problems were selected based on review of sleep questionnaires and sleep diaries they completed followed by an interview with a board-certified psychiatrist. The subjects were randomly assigned to red ginseng or placebo for 2 weeks of trial. The total daily dose of ginseng was 4,500 mg. The polysomnographic recordings were made at baseline and at 2 weeks after. The effects of red ginseng and placebo on sleep were assessed by comparing the changes in polysomnographic variables between the two groups. RESULTS: A total of 15 subjects, 8 from red ginseng group and 7 from placebo group, were included to undergo polysomnographic procedures. The red ginseng group showed tendencies to increase stage 3 sleep (p=0.087) and to decrease stage 2 sleep (p=0.071) from the baseline compared with the placebo group. CONCLUSION: Korean red ginseng tends to increase deep sleep and decrease shallow sleep. Our result is in line, at least in part, with previous findings that Korean red ginseng increased total and NREM sleep in rats. Further studies with higher ginseng dosage, larger sample size and longer trial duration should be conducted to confirm the sleep stabilizing and balancing effects of Korean red ginseng.
Animals ; Humans ; Male ; Panax ; Polysomnography ; Psychiatry ; Surveys and Questionnaires ; Rats ; Sample Size ; Sleep Initiation and Maintenance Disorders

We experienced a case of Cesarean section of Marfan syndrome under the general anesthesia. Marfan syndrome is an autosomal dominant trait characterized by generalized defect of connective tissue, which is mediated by a structural deficiency in Type 1 collagen. Its prevalence has been estimated at 1 to 5 in 100,000. Expression of the trait is variable but the most common diagnostic signs are disproportionate length of long bones, hypermobility of joints, prolapsed lens, and cardiac murmurs, most often the systolic click-murmur of mitral valve prolapse. The importance in anesthetic management of these patients should be chosen to prevent any hypertension in response to intubation and surgery, and handled very gently, with minimal stress placed on the connective tisues.
Anesthesia, General* ; Cesarean Section ; Collagen Type I ; Connective Tissue ; Female ; Heart Murmurs ; Humans ; Hypertension ; Intubation ; Joints ; Marfan Syndrome* ; Mitral Valve Prolapse ; Pregnancy ; Prevalence