OBJECTIVES: This study aims to analyze the association between the severity of sleep apnea, sleep and mood related scales, and activity during sleep in obstructive sleep apnea syndrome (OSAS) patients. METHODS: One hundred seventy six drug-free male patients confirmed as OSAS (average age=43+/-11 years) were selected through nocturnal polysomnography (NPSG). OSAS was diagnosed with apnea-hypopnea index (AHI) >5, mean AHI was 39.6+/-26.0. Sleep related scales were Stanford Sleepiness Scale (SSS), Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI) and Morningness-Eveningness Scale (MES). Mood related scales were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI) I, II and Profile of Mood States (POMS). NPSG was performed overnight with both wrist actigraphy (WATG). Parameters produced from WATG were total activity score, mean activity score and fragmentation index. We analyzed the correlation between each scale, AHI scored from NPSG and activity score analyzed from WATG. RESULTS: ESS showed significant positive correlation with PSQI, BDI, BAI and STAI I, II, respectively (p<0.01). SSS showed significant positive correlation with PSQI and BAI (p<0.05, p<0.01). BAI showed significant positive correlation with total activity score, mean activity score and fragmentation index (p<0.05, p<0.01, p<0.05). Total activity score showed significant positive correlation with ESS and BAI, respectively (p<0.05). Fragmentation index showed significant positive correlation with ESS, PSQI and BAI (p<0.05, p<0.01, p<0.05). AHI, indicator of sleep apnea is showed no significant correlation with each sleep and mood related scale. CONCLUSION: The degree of daytime sleepiness tends to be associated with night sleep satisfaction, depression and anxiety, and the activity during sleep rather than the severity of sleep apnea.
Actigraphy ; Anxiety ; Depression ; Humans ; Male ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Weights and Measures ; Wrist

Adult ; Alzheimer Disease ; Depression ; Depressive Disorder ; Humans ; Korea ; Logistic Models ; Long-Term Care ; Mental Health ; Prevalence ; Risk Factors ; Seoul ; Social Isolation ; Suicidal Ideation

OBJECTIVE: This study aims to analyze how much heart rate variability (HRV) indices discriminatively respond to age and severity of sleep apnea in the obstructive sleep apnea syndrome (OSAS). METHODS: 176 male OSAS patients were classified into four groups according to their age and apnea-hypopnea index (AHI). The HRV indices were compared via analysis of covariance (ANCOVA). In particular, the partial correlation method was performed to identify the most statistically significant HRV indices in the time and frequency domains. Stepwise multiple linear regressions were further executed to examine the effects of age, AHI, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and sleep parameters on the significant HRV indices. RESULTS: The partial correlation analysis yielded the NN50 count (defined as the number of adjacent R-wave to R-wave intervals differing by more than 50 ms) and low frequency/high frequency (LF/HF) ratio to be two most statistically significant HRV indices in both time and frequency domains. The two indices showed significant differences between the groups. The NN50 count was affected by age (p<0.001) and DBP (p=0.039), while the LF/HF ratio was affected by AHI (p<0.001), the amount of Stage 2 sleep (p=0.005), and age (p=0.021) in the order named in the regression analysis. CONCLUSION: The NN50 count more sensitively responded to age than to AHI, suggesting that the index is mainly associated with an age-related parasympathetic system. On the contrary, the LF/HF ratio responded to AHI more sensitively than to age, suggesting that it is mainly associated with a sympathetic tone likely reflecting the severity of sleep apnea.
Aging ; Blood Pressure ; Body Mass Index ; Heart ; Heart Rate ; Humans ; Linear Models ; Male ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive

GTP-Binding Proteins ; Receptors, Thyrotropin-Releasing Hormone ; Thyrotropin-Releasing Hormone*

OBJECTIVES: Elderly depression is often misdiagnosed as a dementing illness such as Alzheimer's disease (AD). Moreover, depressive symptoms often are presented in the early phase of AD. It is difficult to distinguish the difference between mild cognitive impairment (MCI) and depression. The purpose of this study is to explore neuropsychological characteristics of patients with amnestic MCI (aMCI) and depression. We hypothesized that there would be the difference in the cognitive function of those groups and this made clearer the nature of a depression and aMCI. METHODS: A community dwelling older people aged over 60 years were enrolled for the study. We compared 24 patients with aMCI, 23 with depression complaining subjective memory decline, and 26 normal elderly. Demographic and neuropsychological data were gathered and assessed by trained psychologist. RESULTS: Patients with aMCI and depression had significant differences separately from normal controls in particular cognitive function. Patients with aMCI showed more cognitive declines in learning than normal older people. Patients with depression had less performance in attention and executive function than normal controls. CONCLUSION: To understand the clinical difference and underlying pathophysiology of aMCI and depression, the precise criteria of aMCI gathering more homogeneous group of depression in severity and onset time will be needed.
Aged ; Alzheimer Disease ; Depression ; Executive Function ; Humans ; Learning ; Memory ; Mild Cognitive Impairment

The nationwide prevalence of major depressive disorder in Korea is lower than most countries, despite the high suicide rate. To explain this unexpectedly low prevalence, we examined the functional disability and quality of life in community-dwelling subjects with significant depressive symptoms not diagnosable as depressive disorder. A total of 1,029 subjects, randomly chosen from catchment areas, were interviewed with the Center for Epidemiologic Studies Depression scale, Mini International Neuropsychiatric Interview, WHO Quality of Life scale, and the WHO Disability Assessment Schedule. Those with scores over 21 on the depression scale were interviewed by a psychiatrist for diagnostic confirmation. Among community-dwelling subjects, the 1-month prevalence of major depressive disorder was 2.2%, but the 1-month prevalence of depressive symptoms not diagnosable as depressive disorder was 14.1%. Depressive disorders were the cause of 24.7% of work loss days, while depressive symptoms not diagnosable as depressive disorder were the cause of 17.2% of work loss days. These findings support the dimensional or spectrum approach to depressive disorder in the community and might be the missing link between the apparent low prevalence of depressive disorder and high suicide rate in Korea.
Adolescent ; Adult ; Analysis of Variance ; Depression/*diagnosis/epidemiology ; Female ; Humans ; Interviews as Topic ; Male ; Mental Health ; Middle Aged ; Prevalence ; *Quality of Life ; Young Adult

PURPOSE: The purpose of the study was to evaluate the effect of preoperative magnetic resonance imaging (MRI) on survival outcomes for breast cancer. METHODS: A total of 954 patients who had T1–2 breast cancer and received breast-conserving therapy (BCT) between 2007 and 2010 were enrolled. We divided the patients according to whether they received preoperative MRI or not. Survival outcomes, including locoregional recurrence-free survival (LRRFS), recurrence-free survival (RFS), and overall survival (OS), were analyzed. RESULTS: Preoperative MRI was performed in 743 of 954 patients. Clinicopathological features were not significantly different between patients with and without preoperative MRI. In the univariate analyses, larger tumors were marginally associated with poor LRRFS compared to smaller tumors (hazard ratio [HR], 3.22; p=0.053). Tumor size, histologic grade, estrogen receptor (ER), progesterone receptor (PR), hormonal therapy, and adjuvant chemotherapy status were associated with RFS. Larger tumor size, higher histologic grade, lack of ER and PR expression, and no hormonal therapy were associated with decreased OS. Tumor size was associated with LRRFS in the multivariate analyses (HR, 4.19; p=0.048). However, preoperative MRI was not significantly associated with LRRFS, RFS, or OS in either univariate or multivariate analyses. CONCLUSION: Preoperative MRI did not influence survival outcomes in T1–2 breast cancer patients who underwent BCT. Routine use of preoperative MRI in T1–2 breast cancer may not translate into longer RFS and OS.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Estrogens ; Humans ; Magnetic Resonance Imaging* ; Mastectomy, Segmental ; Multivariate Analysis ; Receptors, Progesterone

PURPOSE: The optimum local surgical strategy regarding breast-conserving therapy (BCT) for triple-negative breast cancer (TNBC) is controversial. To investigate whether BCT is appropriate for patients with TNBC, we evaluated the clinical outcomes of BCT in women with TNBC compared to those of women without TNBC, using a large, single-center cohort. MATERIALS AND METHODS: We performed a retrospective analysis of 1533 women (TNBC n=321; non-TNBC n=1212) who underwent BCT for primary breast cancer between 2000 and 2010. Clinicopathological characteristics, locoregional recurrence-free survival (LRFS), and overall survival (OS) were analyzed. RESULTS: Tumors from the TNBC group had a higher T stage (T2 37.4% vs. 21.0%, p<0.001), a lower N stage (N0 86.9% vs. 75.5%, p<0.001), and a higher histologic grade (Grade III 66.8% vs. 15.4%, p<0.001) than the non-TNBC group. There were no differences in 5-year LRFS rates between the TNBC and non-TNBC groups (98.7% vs. 97.8%, p=0.63). The non-TNBC group showed a slightly better 5-year OS than the TNBC group; however, the difference was not significant (96.2% vs. 97.3%, p=0.72). In multivariate analyses, TNBC was not associated with poor clinical outcomes in terms of LRFS and OS [hazard ratio (HR) for LRFS=0.37, 95% confidence interval (CI): 0.10-1.31; HR for OS=1.03, 95% CI: 0.31-3.39]. CONCLUSION: TNBC patients who underwent BCT showed non-inferior locoregional recurrence compared to non-TNBC patients with BCT. Thus, BCT is an acceptable surgical approach in patients with TNBC.
Adult ; Aged ; Breast Neoplasms/mortality/pathology/*surgery ; Disease-Free Survival ; Female ; Humans ; *Mastectomy, Segmental ; Middle Aged ; *Neoplasm Recurrence, Local/mortality/pathology ; Proportional Hazards Models ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Triple Negative Breast Neoplasms/mortality/pathology/*surgery

The authors report a case of 5-Fluorouracil (5-FU) induced manic episode in an elderly female without any previous psychiatric history. The patient presented manic symptoms after 4th cycle of 5-FU chemotherapy after surgery of rectal cancer. After cessation of chemotherapy and administration of olanzapine and divalproex sodium, symptoms were subsided within 10 days.
Aged ; Benzodiazepines ; Colonic Neoplasms ; Female ; Fluorouracil ; Humans ; Rectal Neoplasms ; Valproic Acid

OBJECTIVES: Neuropsychiatric symptoms (NPS) are common in dementia and in mild cognitive impairment (MCI). They might be a predictor of progression to dementia. This study aimed to investigate the effects of NPS on the natural course in MCI. METHODS: 306 community-dwelling Korean elderly with MCI from local dementia center were assessed for NPS using Neuropsychiatric Inventory (NPI). Subjects were assessed again after more than a year from baseline. 52 subjects (17.0%) were progressed to dementia. We compared baseline NPI scores between stable and deteriorated groups. RESULTS: Subjects progressing to dementia had a significantly higher prevalence of NPS (45.3% vs. 65.4%) than subjects who remained stable. Delusion (2.8% vs. 9.6%), agitation/aggression (14.6% vs. 26.9%), depression (21.7% vs. 40.4%) and disinhibition (4.3% vs. 19.2%) were more common in deteriorated group. After adjustment for other variables, on logistic regression analysis, only disinhibition at baseline was shown to be a risk factor for progression to dementia (OR=4.88, 95% CI=1.37-17.36, p=0.01, R²=302). CONCLUSION: These findings suggest that NPS in MCI may be a predictor of progression to dementia. NPS may be a useful item including delusion, agitation/aggression, depression, and disinhibition. To study course and nature of NPS may lead to better understanding of Alzheimer's disease.
Aged ; Alzheimer Disease ; Delusions ; Dementia* ; Depression ; Humans ; Logistic Models ; Mild Cognitive Impairment* ; Prevalence ; Risk Factors