Objectives: To investigate whether a history of body injury is associated with obstructive sleep apnea (OSA) in patients with rapid eye movement (REM) sleep behavior disorder (RBD). Methods: We enrolled 56 consecutive patients with RBD, a history of dream-enacting behaviors, and polysomnographic evidence of REM sleep without atonia. Participants were asked whether they had any history of body injuries such as self-injury or bed-partner injury during sleep. The demographic characteristics and polysomnographic parameters of the groups with a history of injury (n=34, 60.7%) and without (n=22, 39.3%) were compared. The association between the history of injury and OSA was assessed. Results: OSA [apnea-hypopnea index (AHI) ≥5/h) was associated with a history of body injury [odds ratio (OR)=6.25, 95% confidence interval (CI)=1.64–23.84]. Additionally, the logistic regression analysis showed that insomnia severity index (OR=0.87, 95% CI=0.80–0.98) and AHI (OR=1.10, 95% CI=1.02–1.18) were associated with history of body injury. Conclusions Therefore, we can conclude that history of body injury is related to obstructive sleep apnea in patients with RBD.

Objectives: Split-night polysomnography (PSG) can be used for the diagnosis and treatment of obstructive sleep apnea (OSA). Recently, the American Academy of Sleep Medicine has broadened the indication of split-night PSG from severe to moderate OSA in a time window of 2 hours. However, majority pieces of evidence have been derived from the male predominant study population. The objective of this study was to investigate the diagnostic accuracy of split-night PSG in Korean women. Methods: This study included 122 adult women with OSA. Apnea-hypopnea index (AHI) from the first 120 minutes of clock time (T120-AHI) and full-night AHI (FN-AHI) were compared using the concordance correlation coefficient (CCC) method and Bland-Altman plot. Receiver operating characteristic (ROC) curves and the area under the ROC curves were plotted with various cut-off points of AHI. Results: The T120-AHI correlated with FN-AHI (CCC=0.77). The area under the ROC curve for T120-AHI with FN-AHI ≥15 was 0.865, with a sensitivity of 78.6% and specificity of 82.7%. Conclusions T120-AHI showed a significant correlation with the FN-AHI value in Korean female patients with OSA.

Patients often present with combinations of psychological disorders that manifest with neurological symptoms and/or signs that are not attributable to identifiable structural or functional etiology associated with the nervous system. We present the case of an elderly woman with functional weakness, which was documented using polysomnography with extended surface electromyography. Our findings show that polysomnography with extended surface electromyography may be a useful diagnostic tool for functional weakness in conversion disorder.

Patients often present with combinations of psychological disorders that manifest with neurological symptoms and/or signs that are not attributable to identifiable structural or functional etiology associated with the nervous system. We present the case of an elderly woman with functional weakness, which was documented using polysomnography with extended surface electromyography. Our findings show that polysomnography with extended surface electromyography may be a useful diagnostic tool for functional weakness in conversion disorder.

Objectives: To investigate whether a history of body injury is associated with obstructive sleep apnea (OSA) in patients with rapid eye movement (REM) sleep behavior disorder (RBD). Methods: We enrolled 56 consecutive patients with RBD, a history of dream-enacting behaviors, and polysomnographic evidence of REM sleep without atonia. Participants were asked whether they had any history of body injuries such as self-injury or bed-partner injury during sleep. The demographic characteristics and polysomnographic parameters of the groups with a history of injury (n=34, 60.7%) and without (n=22, 39.3%) were compared. The association between the history of injury and OSA was assessed. Results: OSA [apnea-hypopnea index (AHI) ≥5/h) was associated with a history of body injury [odds ratio (OR)=6.25, 95% confidence interval (CI)=1.64–23.84]. Additionally, the logistic regression analysis showed that insomnia severity index (OR=0.87, 95% CI=0.80–0.98) and AHI (OR=1.10, 95% CI=1.02–1.18) were associated with history of body injury. Conclusions Therefore, we can conclude that history of body injury is related to obstructive sleep apnea in patients with RBD.

Objectives: Split-night polysomnography (PSG) can be used for the diagnosis and treatment of obstructive sleep apnea (OSA). Recently, the American Academy of Sleep Medicine has broadened the indication of split-night PSG from severe to moderate OSA in a time window of 2 hours. However, majority pieces of evidence have been derived from the male predominant study population. The objective of this study was to investigate the diagnostic accuracy of split-night PSG in Korean women. Methods: This study included 122 adult women with OSA. Apnea-hypopnea index (AHI) from the first 120 minutes of clock time (T120-AHI) and full-night AHI (FN-AHI) were compared using the concordance correlation coefficient (CCC) method and Bland-Altman plot. Receiver operating characteristic (ROC) curves and the area under the ROC curves were plotted with various cut-off points of AHI. Results: The T120-AHI correlated with FN-AHI (CCC=0.77). The area under the ROC curve for T120-AHI with FN-AHI ≥15 was 0.865, with a sensitivity of 78.6% and specificity of 82.7%. Conclusions T120-AHI showed a significant correlation with the FN-AHI value in Korean female patients with OSA.

Dumping syndrome has long been associated with gastric surgery. The authors experienced an adult patient presenting with dumping syndrome after meningitis without any previous surgical procedures on the stomach and small bowel. Dysfunction of the autonomic nervous system after infective meningitis may originate from postinfectious sequelae or an immunologic mechanism. A comprehensive study and proper management of autonomic symptoms of patients with a central nervous system infection are needed.

BACKGROUND: To investigate the sleep disorders related to chronic insomnia and compare the characteristics of each group. METHODS: We registered 191 patients (female 56.0%, age 61.7 years) who have complained about symptoms of insomnia for more than three months and assessed sleep disorders related chronic insomnia by analyzing their polysomnography (PSG) parameters, demographics, and questionnaires (Insomnia Severity Index, Beck Depression Inventory, Pittsburg Sleep Quality Index, and Epworth Sleepiness Scale, and World Health Organization Quality of Life Assessment Instrument abbreviated version). RESULTS: Patients were categorized into groups of primary insomnia (PI, 51.8%, n=99), comorbid insomnia with obstructive sleep apnea (CIO, 38.7%, n=74), and comorbid insomnia with periodic limb movement disorder (CIP, 9.4%, n=18). CIO was older and more obese than PI and CIP. The proportion of males was the highest in CIO. Arousal index of PSG was higher in CIO and CIP than in PI. Other parameters and the results of questionnaires were not different among groups. CONCLUSIONS: About a half of patients with chronic insomnia symptoms (48.2%) had considerable sleep disorders associated with insomnia. Our study suggests that the PSG as well as history taking and demographics are necessary to clarify the relevant conditions of chronic insomnia disorder for appropriate treatment.
Arousal ; Demography ; Depression ; Humans ; Male ; Nocturnal Myoclonus Syndrome ; Polysomnography ; Quality of Life ; Sleep Apnea, Obstructive ; Sleep Initiation and Maintenance Disorders ; Sleep Wake Disorders ; World Health Organization

OBJECTIVE: To investigate the relationship between serum creatine kinase (CK) level and pulmonary function in Duchenne muscular dystrophy (DMD). METHODS: A total of 202 patients with DMD admitted to the Department of Rehabilitation Medicine, Gangnam Severance Hospital were enrolled from January 1, 1999 to March 31, 2015. Seventeen patients were excluded. Data collected from the 185 patients included age, height, weight, body mass index, pulmonary function tests including forced vital capacity (FVC), peak cough flow, maximal expiratory pressure (MEP), and maximal inspiratory pressure (MIP), and laboratory measurements (serum level of CK, CK-MB, troponin-T, and B-type natriuretic peptide). FVC, MEP, and MIP were expressed as percentages of predicted normal values. RESULTS: Serum CK activities were elevated above normal levels, even in the oldest DMD group. Serum CK level was strongly correlated with pulmonary functions of sitting FVC (p<0.001), supine FVC (p<0.001), MIP (p=0.004), and MEP (p<0.001). CONCLUSION: Serum CK level is a reliable screening test even in patients with advanced DMD, and is a strong predictor of pulmonary functions.
Body Weight ; Cough ; Creatine Kinase* ; Creatine* ; Humans ; Mass Screening ; Muscular Dystrophy, Duchenne* ; Reference Values ; Rehabilitation ; Respiratory Function Tests ; Troponin T ; Vital Capacity

OBJECTIVE: To report the latest long-term outcome of amyotrophic lateral sclerosis (ALS) and to analyze the predictors of prognosis. METHODS: Subjects who were diagnosed with ALS between January 2005 and December 2009 at a single institute were followed up until death or up to December 2014. Data regarding age, sex, date of onset, date of diagnosis, presence of bulbar symptoms on onset, date of initiation of non-invasive ventilation (NIV), and the date of tracheostomy were collected. Survival was assessed using Kaplan-Meier curves and multivariate analyses of the risk of death were performed using the Cox proportional hazards model. RESULTS: Among 212 suspicious subjects, definite ALS was diagnosed in 182 subjects. The survival rate at 3 and 5 years from onset was 61.5% and 40.1%, respectively, and the survival rate at 3 and 5 years post-diagnosis was 49.5% and 24.2%, respectively. Further, 134 patients (134/182, 73.6%) were initiated on NIV, and among them, 90 patients (90/182, 49.5%) underwent tracheostomy. Male gender and onset age of ≥65 years were independent predictors of adverse survival. CONCLUSION: The analysis of long term survival in ALS showed excellent outcomes considering the overall poor prognosis of this disease.
Age of Onset ; Amyotrophic Lateral Sclerosis* ; Diagnosis ; Humans ; Male ; Multivariate Analysis ; Noninvasive Ventilation ; Prognosis ; Proportional Hazards Models ; Survival Rate ; Tracheostomy