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Nocturnal Restless Arms and Face Improved by Dopamine Agonist: Is It a Variant of Restless Legs Syndrome?.

Dae seop SHIN ; Seung Cheol LEE ; Soo A KIM ; Hyung Ki KIM ; Kwang Ik YANG

Journal of Sleep Medicine.2017;14(1):43-45. doi:10.13078/jsm.17006

The symptoms of restless legs syndrome (RLS) usually involve legs and can extend to other body parts. However, isolated body parts other than leg have rarely been involved. A 32-year-old woman had abnormal sensations of both forearms and face during night, which caused a difficulty falling in sleep. The symptoms were relieved by shaking and rubbing. She experienced a clear benefit from pramipexole, but a recurrence of restlessness was followed in both arms subsequent to pramipexole withdrawal. Finally, she had been prescribed a dose of 0.375 mg, which was well tolerated for 6 years. We report a case of nocturnal restless arms and face without leg involvement, which was like RLS in terms of clinical criteria except lesion site.
Accidental Falls ; Adult ; Arm* ; Dopamine Agonists* ; Dopamine* ; Female ; Forearm ; Human Body ; Humans ; Leg ; Psychomotor Agitation ; Recurrence ; Restless Legs Syndrome* ; Sensation

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The Relationship between Subjective Sleep, Emotions, Social Support and Excessive Daytime Sleepiness in Female Undergraduate Students.

Jiyoung LEE ; Sooyeon SUH

Journal of Sleep Medicine.2017;14(1):36-42. doi:10.13078/jsm.17005

OBJECTIVES: The current study aimed to explore the relationship between subjective sleep, emotions, social support and excessive daytime sleepiness (EDS), and extract the strongest predictor of EDS in female undergraduate students. METHODS: Our subjects consisted of 168 female undergraduate students (mean age 21.64±1.66). All participants completed Epworth Sleepiness Scale (ESS), Insomnia Severity Index, Hospital Anxiety and Depression Scale, Social Support Scale, and the Munich Chronotype Questionnaire. RESULTS: There were significant associations between insomnia, anxiety, depression with EDS, but not with subjective total sleep time of workdays and freedays. Also, 23.8% (n=40) of subjects endorsed clinical levels of EDS (ESS>10). Insomnia, anxiety, and depression were higher, and social support was lower in the EDS group compared to the normal group. Finally, we explored factors that influenced EDS, resulting in anxiety and social support being the strongest predictors of EDS. Social support was the strongest predictor of EDS compared to other predictors (β=-0.276, p<0.001). CONCLUSIONS: Results suggest that social support may be important to consider in female undergraduate students who experience EDS.
Anxiety ; Depression ; Female* ; Humans ; Sleep Initiation and Maintenance Disorders

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Assessing Sleep-Wake Pattern and Chronotype with the Korean Munich ChronoType for Shift-Workers in Shift Working Nurses.

Su Jung CHOI ; Sooyeon SUH ; Eun Yeon JOO

Journal of Sleep Medicine.2017;14(1):23-35. doi:10.13078/jsm.17004

OBJECTIVES: To investigate sleep-wake patterns and chronotype in rapidly rotating shift nurses (SRN). METHODS: We translated and back-translated the Korean Munich ChronoType for Shift-Workers (K-MCTQ(shift)) with original authors' permission. In this study, 353 full-time, SRN (age 28.7±3.95 years 341 females, mean shift–working duration=5 years 9 months) at one university hospital completed the K-MCTQ(shift) and the Morningness-Eveningness Questionnaire (MEQ). Time in bed, sleep duration, and mid-sleep time (sleep onset time+1/2 sleep duration) were evaluated on work days and free days. Social jet lag was computed for each shift. Chronotype was assessed based on the mid-sleep time on free days corrected for sleep debt accumulated over the workweek (MSF(SC)). RESULTS: Sleep duration on workdays were 5.2 hours (day shift, D), 7.7 hours (evening shift, E), and 5.7 hours (night shift, N), respectively. Alarm clock usage on workdays was the highest in day-shifts (92.4%). The chronotype of 166 SRN who did not use alarm on free days was 6:09 h. Social jet lag was the longest in day-shifts (3.3 hours), and the shortest in evening-shifts (0.3 hour). Mid-sleep after the evening-shift (MSW(E), MSF(E), MSF(E)(SC)) showed significant correlations with MEQ scores. CONCLUSIONS: The Korean MCTQ(shift) provides actual sleep-wake patterns per shift schedule and chronotype in shift workers. We suggest that the sleep-corrected version of mid-sleep on free days after evening shifts (MSF(E)(SC)) is suitable for assessing chronotype in shift workers.
Appointments and Schedules ; Female ; Humans

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A Twenty-Minute Nap Boosts the Planning Domain of Executive Function in Sleep Deprived Late Adolescents.

Kyungmo KANG ; Juheon CHOI ; Hee jin HWANG ; Dae Lim KOO ; Jong Seung KIM ; Bumjo OH

Journal of Sleep Medicine.2017;14(1):18-22. doi:10.13078/jsm.17003

OBJECTIVES: The positive effects of nap on cognitive function and memory have been researched intensively among children and adults. However, the relationship between afternoon nap and executive function among sleep deprived late adolescents has not been studied as much. METHODS: Ten sleep deprived, otherwise healthy Korean high school students were recruited, and asked to fill out Pittsburgh Sleep Quality Index questionnaire. They were put to nap for 5 min on three days during the first week, then for 10, 20, and 30 min in the same protocol during the consecutive weeks. After a 1-h class, both the students themselves and their corresponding teachers evaluated the participation level of the participants. They were then divided into two groups, and were instructed to play iPad game ‘Free Flow’. One group took a nap while the other group was prohibited from taking a nap. Both groups were instructed to play the game again. This was repeated once every afternoon for three days. RESULTS: The experiment showed that 20-min nap was superior in subjective evaluations to the other nap duration, and the mean game score differences before and after were significantly higher in the nap taking group after the 20-min nap when analyzed using non-parametric statistical method (p-value 0.04). CONCLUSIONS: Therefore, 20-min nap is likely to boost planning domain of executive function on sleep deprived late adolescents.
Adolescent* ; Adult ; Child ; Cognition ; Executive Function* ; Humans ; Memory ; Methods ; Sleep Deprivation

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Effects of Electrical Automatic Massage of Whole Body at Bedtime on Sleep and Fatigue.

Su Jung CHOI ; Su Hwa YUN ; Eun Yeon JOO

Journal of Sleep Medicine.2017;14(1):10-17. doi:10.13078/jsm.17002

OBJECTIVES: To investigate the effect of electrical automatic massage (EAM) at bedtime on sleep quality and fatigue. METHODS: We recruited consecutively 35 adults (23 male, 48.7±8.07 y) who complained of poor sleep (Pittsburgh Sleep Quality Index≥5) and fatigue (Chalder Fatigue Scale≥4). This is a cross over study including two consecutive sleep studies with or without EAM. The EAM session includes preset ‘sleep mode’, which last 30 minutes covering whole body. Participants were seated in the commercially available massage chair (REX-L®) under the calm and dim light condition immediately before polysomnography. Participants reported perceived sleep latency, sleep duration, and fatigue using visual analogue scale following morning. RESULTS: Polysomnography parameters and subjective reports were compared between sleep with EAM and sleep without EAM. Paired comparison on average revealed sleep structure improvement N1 (13.6→10.9%) and N2 sleep (59.3→57.2%) decreased, and N3 sleep increased (3.0→6.4%), as well as sleep latency (10.3→5.6 min). Improvement in arousal index (17.1→13.0/h) and apnea-hypopnea index (9.1→7.0/h) were also seen following sleep after EAM. Sleep efficiency and total sleep time were not changed by EAM. Participants subjective reports also indicated better sleep on EAM; more lengthened sleep (306→330 minutes) and more relieved fatigue significantly after EAM. CONCLUSIONS: This study demonstrated that muscle relaxation through EAM at bedtime may improve the sleep and alleviate fatigue. It suggests that EAM may be one of alternatives to promote sleep quality. Further studies in a clinical setting are warranted to support this finding.
Adult ; Arousal ; Fatigue* ; Humans ; Male ; Massage* ; Matched-Pair Analysis ; Muscle Relaxation ; Polysomnography ; Relaxation

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Overview of Treatment for Obstructive Sleep Apnea in Adults.

Jun Sang SUNWOO ; Kwang Ik YANG

Journal of Sleep Medicine.2017;14(1):1-9. doi:10.13078/jsm.17001

Obstructive sleep apnea (OSA) is a common disorder characterized by obstructive apneas, hypopneas, and respiratory effort related arousals during sleep. Treatment of OSA is important because untreated patients have potential adverse clinical outcomes, such as excessive daytime sleepiness, metabolic dysfunction, cardiovascular disease, and mortality. Therefore, OSA should be considered as a chronic disease that requires long-term and multidisciplinary care. Positive airway pressure (PAP) therapy is the mainstay of treatment for OSA in adults. Alternative therapies include oral appliance, behavioral modification, and upper airway surgery. The treatment of OSA in adults is reviewed here with focus on PAP therapy.
Adult* ; Apnea ; Arousal ; Cardiovascular Diseases ; Chronic Disease ; Complementary Therapies ; Humans ; Mortality ; Sleep Apnea, Obstructive*

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Abnormal Nocturnal Sensation of Hands in the Patient with Hyperthyroidism.

Doh Eui KIM ; Dae Seop SHIN ; Seung Cheol LEE ; Hyung Kook PARK ; Kwang Ik YANG

Journal of Sleep Medicine.2016;13(1):31-33. doi:10.13078/jsm.16006

The symptoms of restless legs syndrome usually involve legs, but can extend to other body parts. However, isolated body parts other than the leg are rarely involved. A 36-year-old woman presented for evaluation with a tingling and burning sensation in the both hands for one year. These abnormal sensations appeared in the evening and night, resulting in difficulty in falling asleep. The symptoms were relieved by shaking and bending of hands and wrists. Pramipexole was increased to 0.375 mg, and 75 mg of pregabalin was added, but her abnormal nocturnal sensation was not improved. Overt hyperthyroidism was revealed by thyroid function test: free thyroxin 2.99 ng/dL and thyroid-stimulating hormone 0.009 µIU/mL. One month later, her symptom showed much improvement after taking methimazole 5 mg twice a day. We report a case of abnormal nocturnal sensation of hands in the patient with hyperthyroidism who responded with methimazole.
Accidental Falls ; Adult ; Burns ; Female ; Hand* ; Human Body ; Humans ; Hyperthyroidism* ; Leg ; Methimazole ; Pregabalin ; Restless Legs Syndrome ; Sensation* ; Thyroid Function Tests ; Thyrotropin ; Thyroxine ; Wrist

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Cheol Won JANG ; Zoon Yup KIM ; Ki Hwan JI

Journal of Sleep Medicine.2016;13(1):28-30. doi:10.13078/jsm.16005

Sleep-related laryngospasm is a rare cause of sleep-related breathing disturbance which produce stridor or interruption of airflow associated with a distinct polysomnography arousal pattern. We report a case of a sixty-five-year-old woman who was referred for awakenings with abrupt respiratory distress and fear of suffocation. A polysomnography showed a total or near-total cessation of airflow, followed by choking and stridor for several minutes with a rapid increase in heart rate. Temporary hoarseness was seen. The esophageal pH monitoring indicated acid reflux, which confirmed gastroesophageal reflux disease. The protonpump inhibitor eliminated the sleep-related laryngospasm.
Airway Obstruction ; Arousal ; Asphyxia ; Esophageal pH Monitoring ; Female ; Gastroesophageal Reflux* ; Heart Rate ; Hoarseness ; Humans ; Laryngismus* ; Polysomnography ; Respiration ; Respiratory Sounds

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The Effect of Night Eating Syndrome Tendency on Mood, Sleep, and Alcohol Use in Female Undergraduate Students.

Jeonghwa LEE ; Sooyeon SUH

Journal of Sleep Medicine.2016;13(1):21-27. doi:10.13078/jsm.16004

OBJECTIVES: The current study aimed to investigate individuals with night eating syndrome tendency in 115 female undergraduate sample based on night eating syndrome criteria, and analyze its association between mood, sleep, and alcohol use. METHODS: Subjects were divided into high and low tendency group of night eating syndrome based on the night eating questionnaire. All participants completed the Hospital Anxiety and Depression Scale, Insomnia Severity Index, Munich Chronotype Questionnaire, and Alcohol-Use Disorders Identification Test. Data was collected at two time points which were 3 months apart. All analyses were conducted using repeated measure ANOVA. RESULTS: Results indicated a significant difference between night eating syndrome tendency groups for anxiety and depression [F(1,113)=12.35, p=0.001 and F(1,113)=9.59, p=0.002, respectively]. Depression also had a significant time effect [F(1,113)=11.15, p=0.001]. Additionally, the high night eating syndrome tendency group had higher levels of insomnia severity [F(1,113)=24.34, p<0.001], eveningness [F(1,113)=15.09, p<0.001], and alcohol use [F(1,113)=6.73, p=0.011], and lower sleep efficiency [F(1,113)=6.30, p=0.014] compared to the low night eating syndrome tendency group. CONCLUSIONS: The high night eating syndrome tendency group had higher negative mood, sleep disturbance, and alcohol use compared to the low night eating syndrome tendency group. In summary, intervention for night eating syndrome may be important to consider in undergraduate students.
Alcohol Drinking ; Anxiety ; Circadian Rhythm ; Depression ; Eating* ; Feeding and Eating Disorders ; Female* ; Humans ; Sleep Initiation and Maintenance Disorders

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The Utility of the McGill Overnight Oximetry Score for the Moderate to Severe Obstructive Sleep Apnea Syndrome in Korean Children.

Seung Soo KIM ; Kwang Ik YANG

Journal of Sleep Medicine.2016;13(1):15-20. doi:10.13078/jsm.16003

OBJECTIVES: We conducted this study to evaluate the utility of the McGill oximetry score (MOS) to rule out moderate to severe obstructive sleep apnea syndrome (OSAS) in Korean children. METHODS: We performed a cross-sectional study by using medical and polysomnography (PSG) records from our sleep disorder center. We assessed 58 PSG records conducted from September 2011 to December 2015. MOS was calculated from the overnight oximetry tests performed as part of PSG. We also investigated age, gender, height z-score, weight z-score, body mass index z-score, obesity, underweight, and pediatric daytime sleepiness scale. RESULTS: MOS revealed inconclusive (score 1) in 50 (68.2%), and abnormal (2-4) in 8 (13.8%) of PSG results. And moderate to severe OSAS were diagnosed in 20 (34.5%) records according to the apnea-hyponea index (≥5). In a multivariate logistic regression analysis, age [adjust odds ratio (OR) 0.8; p-value=0.013] and abnormal MOS (adjust OR 39.5; p-value=0.007) showed statistical significance between normal/mild OSAS group and moderate/severe OSAS group. MOS had a positive predictive value of 88%, a negative predictive value of 74%, a sensitivity of 35% and a specificity of 97% for detecting moderate/severe OSAS. CONCLUSIONS: In our small group study, MOS cannot exclude moderate to severe OSAS. Further prospective studies are needed.
Body Mass Index ; Child* ; Cross-Sectional Studies ; Humans ; Logistic Models ; Obesity ; Odds Ratio ; Oximetry* ; Polysomnography ; Prospective Studies ; Sensitivity and Specificity ; Sleep Apnea, Obstructive* ; Sleep Wake Disorders ; Thinness

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