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Diagnostic Confusion of Nocturnal Paroxysmal Motor Activity.

Journal of Sleep Medicine.2016;13(2):77-80. doi:10.13078/jsm.16015

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

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Periodic Limb Movements During Sleep Associated with Human T-Lymphotropic Virus Type I-Associated Myelopathy.

Jung Hwan OH ; Jun Soon KIM ; Sa Yoon KANG ; Jung Joon SUNG

Journal of Sleep Medicine.2016;13(2):74-76. doi:10.13078/jsm.16014

Periodic limb movements during sleep (PLMS) are frequently observed in the general population, although such movements may be associated with a variety of medical and neurological disorders. Human T-lymphotropic virus type I-associated myelopathy (HAM) is a rare progressive disease in which abnormalities are rarely observed on spinal images. We present the case of a 55-year-old woman with PLMS who was later diag-nosed with HAM. The current case indicates that HAM can be considered a possible cause of PLMS.
Extremities* ; Female ; Human T-lymphotropic virus 1 ; Humans* ; Middle Aged ; Nervous System Diseases ; Nocturnal Myoclonus Syndrome ; Spinal Cord Diseases*

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Two Cases of Sleep-Related Painful Erection.

Kyoo Ho CHO ; Hye Ihn KIM ; Kyoung HEO ; Yang Je CHO

Journal of Sleep Medicine.2016;13(2):70-73. doi:10.13078/jsm.16013

Sleep-related painful erection (SRPE) is characterized by deep penile pain accompanied with erection occurring rapid eye movement (REM) movement period. Two (47-year-old and 40-year-old, respectively) male visited with the complaint of painful penile erection occurring during sleep. They had no problems with erection during daytime sexual activities except for mild premature ejaculation in one patient. Urologic inspections revealed no focal abnormalities. Polysomnography with simultaneous penile erection monitoring showed several episodes of awakening with painful erection which are time-locked to onset of REM sleep periods. According to the diagnostic criteria in international classification of sleep disorders, each patient was diagnosed to have chronic, severe SRPE. Despite of a low prevalence of SRPE, this condition should be considered in a patient who presents with nocturnal penile. A polysomnography accompanied with penile erection recording may help confirm diagnosis.
Adult ; Classification ; Diagnosis ; Humans ; Male ; Penile Erection ; Polysomnography ; Premature Ejaculation ; Prevalence ; REM Sleep Parasomnias* ; Sexual Behavior ; Sleep Wake Disorders ; Sleep, REM

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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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Hypersomnia Secondary to Pituitary Tumor.

Ki Hwan JI

Journal of Sleep Medicine.2015;12(2):71-71. doi:10.13078/jsm.15014

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

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Sleepwalking Triggered by Hypoglycemia.

Sun Jung HAN ; Jee Hyun KIM

Journal of Sleep Medicine.2015;12(2):67-70. doi:10.13078/jsm.15013

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*

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