It is a significant challenge for the clinician to make distinction between nocturnal epilepsy form non-epileptic sleep disorders. Although in some patients, diagnosis is easy to achieve but sometimes not. At times even with help of polysomnogram and electroencephalogram, diagnostic confusion remains. We present two cases of nocturnal paroaxysmal events, which still need elucidate diagnosis.
Diagnosis ; Electroencephalography ; Epilepsy ; Humans ; Motor Activity* ; Parasomnias ; Polysomnography ; Seizures ; Sleep Wake Disorders

Technological advances over the years have led to the widespread use and popularity of consumer wearable devices. Although polysomnography and actigraphy are standard tools for objective evaluation of sleep, common wearable devices that can be used daily can aid with diagnosis and management of sleep disorders. Accelerometer and photoplethysmography sensors are included both in actigraphy and wearable devices; therefore, the wearable device functions as an actigraphy tool to analyze sleep architecture. Easy accessibility, cost-effectiveness, and ease of long-term monitoring serve as advantages of this device; however, scientific validation is warranted to promote the use of the commercial apparatus as a medical device.

OBJECTIVES: Shift work in Korea is most prevalent in automobile system manufacturing industries. The subjective sleep complaints and individual chronotypes of shift worker was evaluated. METHODS: A cross-sectional study was conducted among single automobile system manufacturing industries in Korea. All participants completed questionnaires about the work schedule, duration of sustained employment and various division of work. And sleep questionnaires including: Epworth Sleepiness Scale, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Morningness-Eveningness Questionnaire. RESULTS: This study enrolled 208 participants [shift workers (SWs)=142, day workers (DWs)=66]. Insomnia symptoms were significantly worse in the SW group (p<0.001). Excessive daytime sleepiness was not significantly different between groups. The evening chronotype in DWs was related to both excessive daytime sleepiness (EDS) (p=0.008) and insomnia (p=0.034). On the other hand, chronotypes in SWs were not significantly different in terms of EDS and insomnia. CONCLUSIONS: Insomnia symptoms were significant in SWs compare to DWs. In DWs the evening types were sleepier and had more insomnia symptoms than other chronotypes. The sleep symptoms are prevalent in automobile industries workers, and in part it is related to work schedule and individual chronotype.
Anxiety ; Appointments and Schedules* ; Automobiles ; Cross-Sectional Studies ; Depression ; Employment ; Hand ; Korea ; Sleep Initiation and Maintenance Disorders

Alcohol withdrawal syndrome (AWS) is a common condition occurring after intentional or unintentional abrupt cessation of alcohol in an alcohol-dependent individual. AWS represents a major problem in our society and alcohol withdrawal seizure is the major cause of seizures encountered by neurology residents in the emergency department. Patients with AWS present with mild symptoms of tremulousness and agitation or more severe symptoms including withdrawal seizures and delirium tremens. Particularly, severe AWS can produce significant rates of the morbidity (complications) and mortality. When diagnosed and managed insufficiently, the morbidity and mortality rates increase. Nevertheless, patients with AWS may be neglected and are often marginalized and the teaching about AWS to neurology residents is usually minimal. Also, attending neurologists are often poorly informed on the topic. Although there is insufficient consensus about the optimal investigation and management, the purpose of this review is to serve as a summary of the appropriate identification and management of this important condition in a neurological setting.
Alcohol Withdrawal Delirium ; Alcohol Withdrawal Seizures* ; Consensus ; Dihydroergotamine ; Disease Management ; Emergency Service, Hospital ; Humans ; Mortality ; Neurology ; Seizures

Vertebrobasilar insufficiency (VBI) in rotatory vertebral artery occlusion syndrome can be caused by voluntary head turning in the yaw plane. We report a case of VBI for head tilting in the roll plane. Transcranial Doppler on left head tilting resulted in decreased blood flow in both vertebral arteries. A CT angiogram revealed that the stenotic left vertebral artery was very close to an enlarged thyroid gland, suggesting mechanical compression of the vertebral artery during head tilt.
Head ; Thyroid Gland ; Vertebral Artery ; Vertebrobasilar Insufficiency ; Vertigo

Background: and Purpose Obesity is known of one of the risk factors for obstructive sleep apnea (OSA). Although body mass index (BMI) can be an indicator for obesity, it does not represent the actual body composition of fat or muscle. We hypothesized that bioelectrical impedance analysis (BIA) can help analyze the fat and muscle distributions in males and females with OSA. Methods: This study screened subjects who visited the Department of Neurology, Samsung Medical Center, Seoul, Korea due to sleep disturbances with symptoms suggestive of OSA from December 2017 to December 2019. All subjects underwent overnight type I polysomnography (PSG) and BIA. Results: PSG and BIA were completed in 2,064 OSA patients who had an apnea-hypopnea index (AHI) of ≥5/hour (77.1% males and 22.9% females). The females had remarkably higher fat indicators and lower muscle indicators. The AHI was significant correlated with all BIA parameters in all OSA patients: body fat mass (ρ=0.286, p<0.001), percentage body fat (ρ= 0.130, p<0.001), visceral fat area (VFA) (ρ=0.257, p<0.001), muscle mass (ρ=0.275, p<0.001), and skeletal muscle mass (SMM) (ρ=0.270, p<0.001). The correlations in males were similar to those in all patients, where those in females were not. In females with OSA, all of the BIA fat indicators were correlated with AHI, whereas the muscle indicators were not. Adjusting age and BMI when analyzing the SMM/VFA ratio showed a strong correlation in males with OSA (p= 0.015) but not in females with OSA (p=0.354). Conclusions This study has revealed that the body composition of fat and muscle has different patterns in OSA patients. The SMM/VFA as measured using BIA is the factor most significantly associated with AHI in males but not in females after adjusting for age and BMI.

OBJECTIVES: It is a paradox that sleep technicians are at risk of shift work sleep disorder to help diagnose other people's sleep disorder. Until now, there have been no guidelines for scheduling shifts for sleep technicians. The purpose of this study was to survey the current shift schedule of sleep technicians. METHODS: We performed a nationwide survey of work schedules for sleep laboratories. We sent email questionnaires to sleep technicians working in university-affiliated hospitals. Information regarding starting time and duration of shift, duty on-duty off pattern for the past month, and rotation and number of sleep technicians in the sleep labs were collected. RESULTS: We received responses from 29 sleep labs. Among the 25 labs which had designated sleep technicians, three labs had night shift schedules mixed with day work on a weekly basis and the remaining 22 labs had night only shift schedule. In cases of night only shift schedules, 11 labs alternated from night shift to day shift works or vice versa every 3 months to 3 years, while the remaining 11 labs had fixed schedules without daytime rotation. Number of night shift was four or less per week, with shift durations of 9–19 hours. CONCLUSIONS: The current policies regarding scheduling shifts varied vastly depending on individual sleep labs. We found that some labs had shift schedules with long work time, quick returns, or permanent night shifts, which are generally not recommended. Further studies are needed to develop consensus guidelines for scheduling shift of sleep technicians.
Appointments and Schedules ; Consensus ; Electronic Mail ; Korea ; Sleep Disorders, Circadian Rhythm ; Sleep Wake Disorders

Background: and Purpose Obesity is known of one of the risk factors for obstructive sleep apnea (OSA). Although body mass index (BMI) can be an indicator for obesity, it does not represent the actual body composition of fat or muscle. We hypothesized that bioelectrical impedance analysis (BIA) can help analyze the fat and muscle distributions in males and females with OSA. Methods: This study screened subjects who visited the Department of Neurology, Samsung Medical Center, Seoul, Korea due to sleep disturbances with symptoms suggestive of OSA from December 2017 to December 2019. All subjects underwent overnight type I polysomnography (PSG) and BIA. Results: PSG and BIA were completed in 2,064 OSA patients who had an apnea-hypopnea index (AHI) of ≥5/hour (77.1% males and 22.9% females). The females had remarkably higher fat indicators and lower muscle indicators. The AHI was significant correlated with all BIA parameters in all OSA patients: body fat mass (ρ=0.286, p<0.001), percentage body fat (ρ= 0.130, p<0.001), visceral fat area (VFA) (ρ=0.257, p<0.001), muscle mass (ρ=0.275, p<0.001), and skeletal muscle mass (SMM) (ρ=0.270, p<0.001). The correlations in males were similar to those in all patients, where those in females were not. In females with OSA, all of the BIA fat indicators were correlated with AHI, whereas the muscle indicators were not. Adjusting age and BMI when analyzing the SMM/VFA ratio showed a strong correlation in males with OSA (p= 0.015) but not in females with OSA (p=0.354). Conclusions This study has revealed that the body composition of fat and muscle has different patterns in OSA patients. The SMM/VFA as measured using BIA is the factor most significantly associated with AHI in males but not in females after adjusting for age and BMI.

Background: and Purpose Epidemiological data on narcolepsy are rare in South Korea.We aimed to provide an overview of the burden of narcolepsy and its temporal trend in South Korea. Methods: Patients with narcolepsy were identified by their registration in the Rare and Intractable Disease (RID) register and the Health Insurance Review and Assessment database.Individuals registered in the RID program with the code V234 were considered as having ‘definite narcolepsy’, while those who claimed health insurance with G47.4 as the primary diagnostic code were considered as having ‘probable narcolepsy’. We estimated the annual prevalence, incidence, and medical costs of narcolepsy between 2010 and 2019. Results: The prevalence of definite narcolepsy was 8.4/100,000 in 2019, peaking at 32.0/100,000 in those aged 15–19 years. The prevalence was higher in males, with a relative risk of 1.72. The prevalence has increased over the past 6 years, with an average annual growth rate (AAGR) of 12.2%. The prevalence of probable narcolepsy was 10.7/100,000 in 2019. The incidence of definite narcolepsy increased up to 1.3/100,000 in 2019 with an AAGR of 7.1%. Annual medical expenditure for definite narcolepsy gradually increased up to 4.1 billion KRW in 2019, with a compound annual growth rate of 11.9%. Conclusions This study has provided the first nationwide estimates for narcolepsy in South Korea. The prevalence of diagnosed narcolepsy in South Korea was at the low end of the range of narcolepsy prevalence rates reported for other countries. However, the prevalence and incidence have been steadily increasing over the past decade.

Neuromyelitis optica spectrum disorder (NMOSD) may present with area postrema syndrome, which is characterized by intractable vomiting and hiccups. Hyponatremia is common in NMOSD and is mostly associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). In contrast to SIADH, cerebral salt wasting syndrome (CSWS) causes hyponatremia, which is associated with severe natriuresis and extracellular volume depletion in patients with cerebral disease. To our knowledge, hyponatremia associated with CSWS has not been reported in a patient with NMOSD. Here, we describe a NMOSD presenting with hyponatremia, which may be caused by CSWS following area postrema syndrome.
Area Postrema ; Hiccup ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Natriuresis ; Neuromyelitis Optica* ; Vomiting ; Wasting Syndrome*