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A Case of Hypersomnolence with Subclinical Hypothyroidism Treated with Levothyroxine.

Minkyeong KIM ; Song Hwa CHAE ; Eun Hye OH ; Baik Kyun KIM ; Dae Jin KIM ; Jae Wook CHO

Journal of Sleep Medicine.2015;12(1):23-25. doi:10.13078/jsm.15005

We present a patient who complained of excessive daytime sleepiness (EDS), which started three years ago. She had no other medical, neurological, and psychiatric disorders. Nocturnal polysomnography did not indicate any sleep disorders, which might cause daytime EDS, such as obstructive sleep apnea. The following multiple sleep latency test was not compatible for narcolepsy. Her laboratory findings were remarkable for subclinical hypothyroidism, although free T4 and T3 were within reference rage, she had elevated thyroid stimulating hormone. After four weeks of levothyroxine treatment, her EDS resolved. The hypersomnolence, as a presenting symptom of subclinical hypothyroidism, was optimally treated after thyroid hormone replacement.
Disorders of Excessive Somnolence* ; Humans ; Hypothyroidism* ; Narcolepsy ; Polysomnography ; Rage ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Thyroid Gland ; Thyrotropin ; Thyroxine*

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Idiopathic REM Sleep Behavior Disorder in Young Adults and Quantitative Analysis of Polysomnography.

Han A KIM ; Su Hyun HAN ; Sang Ahm LEE

Journal of Sleep Medicine.2015;12(1):18-22. doi:10.13078/jsm.15004

Rapid eye movement sleep behavior disorder (RBD) is a sleep disorder characterized by loss of muscle atonia during REM sleep associated with dream enactment, which usually start at the age of older than 50. RBD in elders are known to be developing symptoms of neurodegenerative disorders in the course of disease. However, the pathophysiology and prognosis of "early-onset" idiopathic RBD is unclear. Several existing standard value about REM sleep without atonia (RSWA) of RBD patients was established with "late-onset" RBD for those diagnosed at age 50 and greater, RSWA metrics in "early-onset" RBD patients diagnosed prior to age 50 years have not been previously described. Therefore, we report here two patients who were diagnosed as "early-onset" idiopathic RBD, and performed quantitative RSWA scoring. We suggested that "early-onset" idiopathic RBD has different etiologies the various characteristics of RSWA than adults with RBD.
Adult ; Dreams ; Humans ; Neurodegenerative Diseases ; Polysomnography* ; Prognosis ; REM Sleep Behavior Disorder* ; Sleep, REM ; Young Adult*

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Objective Sleep Quality in Subjects with Restless Legs Syndrome versus with Psychophysiological Insomnia: Polysomnography and Cardiopulmonary Coupling Analysis.

Geon Youb NA ; Su Jung CHOI ; Eun Yeon JOO ; Seung Bong HONG

Journal of Sleep Medicine.2015;12(1):13-17. doi:10.13078/jsm.15003

OBJECTIVES: To compare the sleep quality in the view of polysomnography (PSG) and cardiopulmonary coupling (CPC) analysis in subjects with restless legs syndrome (RLS) versus with psychophysiological insomnia (PPI). METHODS: The PSG data of 109 subjects with RLS and 86 with PPI (apnea-hypopnea index <5 /h) were collected. All subjects reported sleep onset and maintenance insomnia. CPC parameters were obtained using CPC analyzer in RemLogic. Sleep spectrogram by CPC analyses categorized sleep as "stable" [high-frequency coupling (HFC), 0.1-0.4 Hz] and "unstable" [low-frequency coupling (LFC), 0.1-0.01 Hz], independent of sleep stages. We compared PSG and CPC parameters between two groups and performed correlation analyses to find the PSG parameters to affect CPC parameters. RESULTS: In PSG parameters, subjects with PPI showed significantly longer sleep latency (14.2+/-20.06 vs. 27.5+/-34.96, p<0.001), and decreased sleep efficiency (SE, 80.5+/-14.96 vs. 76.5+/-14.45, p=0.009) than RLS. CPC parameters were not significantly different between groups. In both groups HFC was positively correlated with total sleep time and SE and was negatively associated with time of wake after sleep onset in both groups. Meanwhile, very LFC showed the opposite results to HFC with the same PSG parameters. CONCLUSIONS: Although subjects with RLS or PPI present sleep onset and maintenance insomnia, objective sleep quality was worse in PPI than RLS. It suggests that CPC as a factor to differentiate sleep quality between the RLS and the PPI has a limited role.
Polysomnography* ; Restless Legs Syndrome* ; Sleep Initiation and Maintenance Disorders* ; Sleep Stages

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Hyposexuality in Men with Obstructive Sleep Apnea Syndrome.

Jun Kyu MUN ; Eun Yeon JOO

Journal of Sleep Medicine.2015;12(1):7-12. doi:10.13078/jsm.15002

OBJECTIVES: Hyposexuality is defined as diminished sexual drive or libido. There has been little research into the sexuality in patients with obstructive sleep apnea (OSA). We investigated the prevalence and relating factors for hyposexuality in OSA men. METHODS: Consecutive 182 male (mean age 48.3 y) were enrolled who were newly diagnosed with OSA through polysomnography. All completed Symptom checklist-90-Revised (SCL-90-R), Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Subjects were divided into non-hyposexuality (score 0) and hyposexuality (score > or =1) groups according to the question "Loss of sexual interest or pleasure" in SCL-90-R. RESULTS: 110 of 182 subjects (60.4%) answered hyposexuality (score > or =1). Significant correlations were found between hyposexuality and following factors; age (rho=0.248), BDI (rho=0.450), BAI (rho=0.410), ESS (rho=0.221), and percentage of non-REM stage 3 (N3%) (rho=-0.184). Apnea-hypopnea index was significantly correlated with nocturia (rho=0.320), ESS (r=0.230), N1% (r=0.596), N2% (r=-0.540), N3% (r=-0.195), and lowest oxygen saturation (r=-0.641). Comparing two groups, hyposexuality group showed significantly lowered total sleep time (380.2 min vs. 359.1 min), and sleep efficiency (83% vs. 76%). The severity of hyposexuality was correlated with BDI (rho=0.330), BAI (rho=0.253), and N3% (rho=-0.215) in subjects with hyposexuality. After controlling for age, polysomnographic parameters were not correlated with hyposexuality. CONCLUSIONS: About half of untreated OSA male subjects reported diminished libido. Age, daytime sleepiness, mood disorders, and decreased sleep quality were associated with hyposexuality. Of these, aging process was the most important factor for hyposexuality.
Aging ; Anxiety ; Depression ; Humans ; Libido ; Male ; Mood Disorders ; Nocturia ; Oxygen ; Polysomnography ; Prevalence ; Sexuality ; Sleep Apnea, Obstructive*

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Cognition in Restless Legs Syndrome.

Ki Young JUNG

Journal of Sleep Medicine.2015;12(1):1-6. doi:10.13078/jsm.15001

Cognition is the mental abilities related to knowledge which includes attention, memory, language, judgment, and decision making. Cognitive function can be affected by several factors including attention, emotion, and sleep. In restless legs syndrome (RLS), cognitive dysfunction may ensue due to sleep disturbance, emotional disorders, and attention deficit which are common in RLS. However, it remains unclear whether cognitive performance is decreased in patients with RLS. To date, there are ten published articles which studied cognition in RLS. Five studies reported cognitive dysfunction of RLS, particularly decreased performance in the attention, frontal executive function, and mental flexibility function. Three reported no significant differences in cognitive performance between RLS patients and control subjects. Two studies reported even better performance in patients with RLS compared with control subjects. Dopamine agonist may improve cognitive performance in RLS. However, it remains unclear whether this is direct effect on RLS symptoms or indirect effect including improved sleep duration, daytime sleepiness and depression, or both. Event-related potential studies demonstrated reduced P300 amplitude either oddball task or Sternberg working memory task. Larger sample and studies using functional neuroimaging study are needed to confirm whether cognition is impaired or not in RLS.
Affective Symptoms ; Cognition* ; Decision Making ; Depression ; Dopamine Agonists ; Evoked Potentials ; Executive Function ; Functional Neuroimaging ; Humans ; Judgment ; Memory ; Memory, Short-Term ; Pliability ; Restless Legs Syndrome*

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Treatment Failure of Continuous Positive Airway Pressure with a Full Face Mask, Reversed with a Nasal Mask.

Jee Hyun KIM ; Jae Wook CHO

Journal of Sleep Medicine.2016;13(2):67-69. doi:10.13078/jsm.16012

Although a nasal mask is a standard interface for continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA), severe mouth breathing during sleep often leads to the use of a full face mask which covers the nose and mouth. Herein, we present a case of a patient with uncontrolled severe OSA with CPAP and a full face mask, who subsequently shows dramatic improvement of OSA with a nasal mask and lower CPAP pressure.
Continuous Positive Airway Pressure* ; Humans ; Masks* ; Mouth ; Mouth Breathing ; Nose ; Sleep Apnea, Obstructive ; Treatment Failure*

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Effect of Low and High-Dose GABA from Unpolished Rice-Germ on Timing and Quality of Sleep: A Randomized Double-Blind Placebo-Controlled Trial.

Yu Yong SHIN ; Jung Ick BYUN ; Sung Eun CHUNG ; Min Ji SEONG ; Han Ah CHO ; Hyun Keuk CHA ; Won Chul SHIN

Journal of Sleep Medicine.2016;13(2):60-66. doi:10.13078/jsm.16011

OBJECTIVES: Gamma-aminobutyric acid (GABA) has potential benefits in counteracting the sleep disruption and potential therapeutic effects on blood pressure, stress, cancer, and inflammatory diseases. Recently, High-dose GABA can be extracted from fermented rice germ using lactic acid bacteria. This study aimed to evaluate the effects of GABA natural extracts from fermented rice-germ on sleep latency, subjective sleep quality and insomnia symptoms. METHODS: This was a prospective randomized double-blind placebo-controlled trial performed at Kyung-Hee University hospital at Gangdong from June 2013 to October 2013. Adult (age≥30) patients who was diagnosed of insomnia according to DSM-IV criteria was enrolled. They were randomized into three groups: high dose treatment group 300 mg; low-dose treatment group, 100 mg; and placebo group. Questionnaires including Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), WHO-5 Well-Being Index were performed, and 1-week actigraphy was recorded before and 1 week after the treatment. RESULTS: Total of 114 patients were randomized into 3 groups: high-dose treatment (n=37), low-dose treatment (n=38), and placebo treatment group (n=39). At 1 week after the treatment, PSQI total score and C2 (sleep latency) score significantly decreased in low-dose and high-dose treatment group than the placebo groups [Repeated measures analysis of variance (ANOVA), p=0.017, 0.004 respectively]. ISI score also decreased in the two groups in dose-dependent manner (Repeated measures ANOVA, p=0.037). There were five (4.4%) patients who reported medication adverse events. CONCLUSIONS: This study suggests that treatment of low and high-dose GABA from unpolished rice-germ decreases sleep latency and improve insomnia severity without severe adverse events.
Actigraphy ; Adult ; Bacteria ; Blood Pressure ; Diagnostic and Statistical Manual of Mental Disorders ; gamma-Aminobutyric Acid* ; Humans ; Lactic Acid ; Prospective Studies ; Sleep Initiation and Maintenance Disorders ; Therapeutic Uses

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Comparison of Dream Themes, Emotions and Sleep Parameters between Nightmares and Bad Dreams in Nightmare Sufferers.

Ruda LEE ; Sooyeon SUH

Journal of Sleep Medicine.2016;13(2):53-59. doi:10.13078/jsm.16010

OBJECTIVES: The current study aimed to explore the difference of dream themes, emotional intensity, and sleep parameters between nightmares and bad dreams in nightmare sufferers. METHODS: Twenty-four nightmare sufferers who endorsed clinical levels of nightmares (Disturbing Dream and Nightmare Severity Index Scores ≥10) recorded daily information about their dream themes using a modified version of the Typical Dreams Questionnaire, emotional intensity about their nightmares and bad dreams, and sleep for two weeks on a mobile device. RESULTS: Evil presence (35%) was reported with higher frequency in nightmares, whereas interpersonal conflicts (31%) were predominantly reported in bad dreams. Nightmares were rated substantially more emotionally intense than bad dreams. Especially, fear (Z=-2.118, p=0.034) was rated as being significantly higher in nightmares than bad dreams. There were differences on time in bed, wake after sleep onset, sleep efficiency on the days with nightmares or bad dreams compared to other days; however, there were no differences in sleep parameters between nightmares and bad dreams. CONCLUSIONS: The results suggest that nightmares may be qualitatively and quantitatively different from bad dreams in nightmare sufferers.
Dreams*

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Comparison of Health Related Quality of Life between Type I and Type II Narcolepsy Patients.

Jae Wook CHO ; Dae Jin KIM ; Kyoung Ha NOH ; Junhee HAN ; Dae Soo JUNG

Journal of Sleep Medicine.2016;13(2):46-52. doi:10.13078/jsm.16009

OBJECTIVES: Narcolepsy with cataplexy is a rare chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations. The aims of the present study were comparing the health-related quality of life (HR-QOL) of patients with type I and type II narcolepy patients, and determining the factors that influence the HR-QOL in narcolepsy patients. METHODS: All patients performed night polysomnography (PSG) and multiple sleep latency test (MSLT). HR-QOL and the severity of subjective symptoms were evaluated using various questionnaires, including the Korean versions of the Medical Outcome Study Short Form-36, the Pittsburg Sleep Quality Index-Korean version, the Korean version Epworth Sleepiness Scale, and the Korean version Beck Depression Inventory-2. RESULTS: We enrolled 21 type I narcolepsy patients and 27 type II patients. Type I patients had short rapid eye movement (REM) latency on night PSG and more sleep onset REM periods on MSLT. The total score of HR-QOL was worse in patients with type I narcolepsy than in the type II narcolepsy patients. There was association between the severities of excessive daytime sleepiness, depression and the degree of worsening of QOL. CSF hypocretin level had no correlation with the scores of HR-QOL. CONCLUSIONS: These findings demonstrate that type I narcolepsy patients are sleepier, depressive, and have more burden on the HR-QOL. And the impairment in QOL of narcolepsy patients is related to the degree of excessive daytime and depressive mood.
Cataplexy ; Depression ; Hallucinations ; Humans ; Narcolepsy* ; Outcome Assessment (Health Care) ; Polysomnography ; Quality of Life* ; Sleep Paralysis ; Sleep Wake Disorders ; Sleep, REM

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Subjective Sleep Disturbances of Factory Workers in Relation to Shift Work Schedule and Chronotype.

Pamela SONG ; Su Jung CHOI ; Eun Yeon JOO

Journal of Sleep Medicine.2016;13(2):40-45. doi:10.13078/jsm.16008

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

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