No abstract available.
Disorders of Excessive Somnolence* ; Pituitary Neoplasms*

Sleepwalking is a rare parasomnia in the elderly. We report two cases of the patients who presented complex motor behaviors during sleep triggered by hypoglycemia. A 76-year-old male patient with diabetes mellitus presented to the sleep clinic for recurrent sleepwalking with amnesia. Night polysomnogram showed REM sleep without atonia with sleep talking and distal arm movements. While taking clonazepam, he had a few more episodes of sleepwalking. The last episode finally revealed severe hypoglycemia when he was found very far from his house. The second patient, a 67-year-old male showed four episodes of nocturnal confusion and sleepwalking lasting 20 minutes during sleep. His blood glucose and HbA1c were low. After decrease of the dose of oral hypoglycemic agent, no more recurrent sleepwalking occurred. Our cases showed hypoglycemia can induce sleepwalking in the older adults, rather than decreased mentality. Metabolic workup should perform for evaluation of sleepwalking, especially in the elderly.
Adult ; Aged ; Amnesia ; Arm ; Blood Glucose ; Clonazepam ; Diabetes Mellitus ; Humans ; Hypoglycemia* ; Male ; Parasomnias ; Polysomnography ; Sleep, REM ; Sleep-Wake Transition Disorders ; Somnambulism*

A condition of underestimation of sleep is classified as paradoxical insomnia or sleep state misperception. However, overestimation of sleep, so called positive sleep state misperception has not been clearly described. Here we report a middle-aged woman with positive sleep state misperception who presented excessive sleepiness mimicking hypersomnia.
Disorders of Excessive Somnolence* ; Female ; Humans ; Sleep Disorders, Intrinsic* ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: Obstructive sleep apnea-hypopnea syndrome (OSAHS) and insomnia are two of the most common sleep disorders in the general population. Because OSAHS patients with insomnia may have difficulty in adapting to the sleep breathing medical equipment, it is necessary to pay special attention to the diagnosis and treatment of comorbid insomnia. This study is to investigate the emotion and personality in OSAHS patients with insomnia complaints by using Minnesota Multiphasic Personality Inventory-2 (MMPI-2). METHODS: We reviewed the results of the standardized questionnaires assessing sleep-related variables, MMPI, and polysomnographic findings of the patients diagnosed as OSAHS. RESULTS: 145 subjects were 49.05+/-11.83 years of age. The mean Respiratory Disturbance Index was 33.57+/-19.91 and the mean score of Insomnia Severity Index (ISI) was 11.52+/-6.49. The mean scores of the Beck Depression Inventory (BDI) and MMPI-2 were within normal ranges. We divided the patients into two groups based on the scores of the ISI, OSAHS with insomnia (n=109) and OSAHS without insomnia (n=36). OSAHS patients with insomnia symptoms had significantly higher scores of hypochondriasis, hysteria, psychasthenia, schizophrenia, paranoia and psychopathic deviate scales and BDI than those without insomnia. CONCLUSIONS: Our results suggest that insomnia complaints are very common in OSAHS patients and the psychological problems are more frequently found in OSAHS patients with insomnia symptom than those without it.
Depression ; Diagnosis ; Humans ; Hypochondriasis ; Hysteria ; Minnesota* ; MMPI* ; Paranoid Disorders ; Polysomnography ; Reference Values ; Respiration ; Schizophrenia ; Sleep Apnea, Obstructive* ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders* ; Weights and Measures

OBJECTIVES: To characterize sleep of subjects with obstructive sleep apnea syndrome (OSA) with insomnia compared to OSA without insomnia in terms of polysomnography (PSG) and cardiopulmonary coupling (CPC) analysis. METHODS: Subjects with OSA (apnea-hypopnea index, AHI > or =5 /h, n=200) were enrolled and divided into subjects OSA with insomnia (OSA-I) and subjects with OSA only (OSA-O). OSA-I complained of difficulty falling and/or staying asleep at an initial interview in clinic. We compared demographics including mood states, daytime sleepiness, PSG, and CPC parameters between groups, and performed correlation analyses between PSG and CPC parameters for each group. RESULTS: Female ratio was higher in OSA-I than OSA-O. OSA-I were older and slimmer than OSA-O. OSA-O were much drowsier (Epworth Sleepiness Scale 10.0 vs. 6.8). However, mood states were not different between two groups. OSA-I showed significantly longer sleep latency and lower sleep efficiency than OSA-O. Despite of higher arousal index (AI) and AHI of OSA-O, wakefulness after sleep onset was greater in OSA-I. There was no significant difference of CPC parameters between two groups after adjustment of AHI. In correlation analyses, low frequency coupling and high frequency coupling duration were associated with AHI, AI, and lowest SaO2 in both groups. CONCLUSIONS: OSA-I demonstrated more fragmented sleep architecture and disruptive sleep in spite of lower sleep-disordered breathing related distress than OSA-O. CPC analysis is unable to differentiate sleep patterns of OSA subjects with or without insomnia. It is needed to explore factors causing fragmented sleep architecture and disruptive sleep rather than respiratory disturbances in OSA subjects complaining of insomnia.
Arousal ; Demography ; Female ; Humans ; Polysomnography* ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Sleep Initiation and Maintenance Disorders ; Wakefulness

OBJECTIVES: The aim of this study is to analyze dream-enacting behaviors (DEB) using video REM sleep behavior disorder severity scale (RBDSS) during night polysomnography (PSG) and compare them between in patients with idiopathic RBD (iRBD) and patients with symptomatic RBD (sRBD). METHODS: 21 consecutive patients with either iRBD or sRBD were recruited (15 female and 10 male, mean age 63.6+/-13.86 years). Video analysis of DEB in all the REM sleep during their night PSGs was retrospectively performed using RBDSS. According to the clinical history depicting behaviors were also categorized by RBDSS-C to compare with the video RBDSS. Comparison of difference of RBDSS in between patients with iRBD and in those with sRBD was done. The frequency of DEB during the night PSG was measured as RBD density. RESULTS: iRBD patients had higher RBD density than sRBD despite the same disease duration. iRBD patients also tended to have higher RBDSS than sRBD, compatible with higher prevalence of injury history. Night-night variability was observed in the patients comparing RBDSS and RBDSS-C. CONCLUSIONS: RBDSS is an easy tool to analyze severity of DEB in patients with RBD. Analysis of clinical feature of DEB may give a clue to differentiation of RBD patients as well as the alarm for the treatment of RBD to prevent potential injury.
Female ; Humans ; Male ; Polysomnography ; Prevalence ; REM Sleep Behavior Disorder* ; Retrospective Studies ; Sleep, REM*

OBJECTIVES: A majority of South Korean adolescents experience chronic sleep-deprivation due to social jet lag. In this study, we investigated gender differences in the relationship between social jet lag, depression, and obesity in Korean children and adolescents. METHODS: Our sample consisted of 4,380 adolescents (elementary school cohort n=2,141, middle school cohort n=2,239) who participated in the Korean Children and Youth Panel Survey. In order to analyze the gender differences in the relationship between sleep time difference, obesity and depression, t-test and chi-square test were utilized. RESULTS: Both cohorts revealed that the difference in weekday/weekend sleep duration (2.19+/-1.42 vs. 1.68+/-1.36, p<0.001) and depression levels (20.77+/-6.29 vs. 18.87+/-6.06, p<0.001) was significantly higher in girls than boys. However, body mass index was higher in boys than girls (20.86+/-3.42 vs. 20.04+/-2.51, p<0.001). Chi-square test revealed there was a significant difference between gender and weekday/weekend sleep discrepancy group (cutoff >2 hours). Both elementary school [chi2 (1)=8.73, p<0.05] and middle school cohorts [chi2 (1)=61.29, p<0.001] showed significant gender differences. CONCLUSIONS: There were especially more girls who reported a discrepancy of 2 or more hours of weekday/weekend sleep duration. In summary, intervention for social jet lag may be important to consider in adolescents.
Adolescent* ; Body Mass Index ; Child* ; Cohort Studies ; Depression* ; Female ; Humans ; Obesity*

OBJECTIVES: Documented risk factors for obstructive sleep apnea include advanced age, male gender, hypertension, large neck circumference, and obesity; but some controversy remains regarding the risk factors, especially in Asians. In this study, we evaluated the risk factors for obstructive sleep apnea in snoring patients, and also analyzed the risk factors that could predict the severity of obstructive sleep apnea. METHODS: The inclusion criteria were patients 1) who visited our hospital with a chief complaint of snoring as witnessed by a sleep partner and 2) who underwent overnight polysomnography. The primary endpoint was the presence of obstructive sleep apnea as a dependent variable. RESULTS: One hundred forty-seven patients met the inclusion criteria. Of the 147 patients, 109 patients were diagnosed with obstructive sleep apnea. Multivariate analysis showed that old age and large neck circumference were significant independent variables for predicting the presence of obstructive sleep apnea, whereas hypertension and large neck circumference were independent variables for predicting the severity of obstructive sleep apnea. CONCLUSIONS: We demonstrated that neck circumference can be used to predict the presence as well as the severity of obstructive sleep apnea in snoring Asian patients.
Asian Continental Ancestry Group ; Humans ; Hypertension ; Male ; Multivariate Analysis ; Neck* ; Obesity ; Polysomnography ; Risk Factors ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring*

Rapid eye movement sleep behavior disorder (RBD) is currently considered as a prodromal stage of alphasynucleinopathies neurodegeneration. The update data suggested that over 80% patients with idiopathic RBD eventually developed neurodegenerative disease after a mean of 14 years interval from the onset of RBD. A series of potential biomarkers have been identified to predict the development of neurodegeneration in idiopathic RBD, including olfactory loss, color vision deficit, depression, mild cognitive impairment, excessive daytime sleepiness, dopamine dysfunction, and tonic electromyographic activity. Early recognition of the predictive markers of neurodegeneration in idiopathic RBD is essential for development of intervention or prevention strategies at the presymptomatic stage. Nonetheless, the current literature is lacking biomarkers that might reflect the alpha-synuclein neuropathology at the earliest stages. Future studies with large samples and systematic follow-up are needed to confirm more potential markers of neurodegeneration at its early stages.
alpha-Synuclein ; Biomarkers* ; Color Vision ; Depression ; Dopamine ; Follow-Up Studies ; Humans ; Mild Cognitive Impairment ; Neurodegenerative Diseases ; Parkinson Disease ; Prodromal Symptoms ; REM Sleep Behavior Disorder* ; Sleep, REM*

The symptoms of restless legs syndrome usually involve legs, but can extend to other body parts. However, isolated body parts other than the leg are rarely involved. A 36-year-old woman presented for evaluation with a tingling and burning sensation in the both hands for one year. These abnormal sensations appeared in the evening and night, resulting in difficulty in falling asleep. The symptoms were relieved by shaking and bending of hands and wrists. Pramipexole was increased to 0.375 mg, and 75 mg of pregabalin was added, but her abnormal nocturnal sensation was not improved. Overt hyperthyroidism was revealed by thyroid function test: free thyroxin 2.99 ng/dL and thyroid-stimulating hormone 0.009 µIU/mL. One month later, her symptom showed much improvement after taking methimazole 5 mg twice a day. We report a case of abnormal nocturnal sensation of hands in the patient with hyperthyroidism who responded with methimazole.
Accidental Falls ; Adult ; Burns ; Female ; Hand* ; Human Body ; Humans ; Hyperthyroidism* ; Leg ; Methimazole ; Pregabalin ; Restless Legs Syndrome ; Sensation* ; Thyroid Function Tests ; Thyrotropin ; Thyroxine ; Wrist