Objective: We aimed to examine the effectiveness of personalized light intervention using a blue-enriched light-emitting-diodes device on rest–activity rhythm (RAR) and light exposure rhythm (LER) in patients with mild and moderate Alzheimer’s disease (AD). Methods: AD patients with poor sleep quality and/or insomnia symptoms were assigned into either an experimental group (EG) or control group (CG) in a single-blind design. Personalized light intervention was given at 9–10 h after individual dim light melatonin onset, lasting for 1 h every day for two weeks in the EG (77.36±5.79 years, n=14) and CG (78.10±7.98 years, n=10). Each patient of CG wore blue-attenuating sunglasses during the intervention. Actigraphy recording at home for 5 days was done at baseline (T0), immediate postintervention (T1), and at four weeks after intervention (T2). The variables of RAR and LER were derived using nonparametric analysis. Results: We found a significant time effect on the intradaily variability (IV) of RAR at T2 with respect to T0 (p=0.039), indicating reduced IV of RAR at four weeks after personalized light intervention regardless of blue-enriched light intervention. There was a time effect on the IV of LER at T1 with respect to T0 (p=0.052), indicating a reduced tendency in the IV of LER immediately after intervention. Conclusion Our personalized light intervention, regardless of blue-enriched light source, could be useful in alleviating fragmentation of RAR and LER in AD patients.

Many patients with a traumatic brain injury (TBI) experience a range of sleep problems. Although some studies investigated the pathophysiology of sleep-wake cycle disturbances in TBI patients, it has not been clarified. This paper presents a middle aged female patient who showed sleep deprivation and sleep-wake cycle disturbances for approximately three months after TBI. The improvement in the subjective and objective sleep quality was shown by the sleep diary and actigraphy during this period. Moreover, the dim light melatonin onset (DLMO) had been delayed before returning to the normal range in 3 months. In addition, the patient showed an improvement in the neurocognitive function, including attention, memory and language function, along with a consolidation of the sleep-wake cycle. This case showed that the sleep disturbance following a TBI was probably caused by the disrupted melatonin rhythm based on the abnormality of the DLMO. In addition, the cognitive dysfunction after TBI could be associated with sleep-wake cycle disturbances because its gradual improvement occurred as the sleep disturbance diminished. Further studies on the change in circadian rhythm after a brain injury related to neurocognitive impairment are required.
Actigraphy ; Brain Injuries ; Circadian Rhythm ; Female ; Humans ; Melatonin ; Memory ; Middle Aged ; Reference Values ; Sleep Deprivation

OBJECTIVES: We examined the effects of sleep variables and emotional factors including stress, anxiety and depression on the quality of life in insomnia patients. METHODS: We recruited 153 insomnia patients and 96 normal control (NC) subjects who visited three Public Health Centers in Kangwon-do from 2013 until 2015. The Pittsburgh Sleep Quality Index (PSQI), Korean version of Morningness-Eveningness Questionnaire (MEQ-K), Korean version of Epworth Sleepiness Scale, Ford Insomnia Response to Stress Test (FIRST), Hyperarousal Scale (HAS), Perceived Stress Scale (PSS), Anxiety-Sensitivity Index (ASI), Beck Depression Inventory (BDI), and Short Form-12 Health Survey Questionnaire (SF-12) were administered for each subject. We compared the scores of the above scales between the insomnia and control groups, using analysis of covariance to control for age. Stepwise regression analysis assessed the association of these variables with SF-12 scores. RESULTS: The scores of PSQI, FIRST, HAS, ASI, BDI in insomnia patients were significantly higher than those of NC subjects, but the Mental Component Summary (MCS) scores of SF-12 were lower. Stepwise regression analysis showed the scores of PSS and MEQ-K significantly predicted the MCS scores in NC subjects, and the BDI score predicted scores in insomnia patients. CONCLUSION: In our study, greater subjective stress and evening preference could explain lower mental quality of life in NC subjects. In insomnia patients, greater depression is an additional factor.
Anxiety ; Depression ; Exercise Test ; Gangwon-do ; Health Surveys ; Humans ; Public Health ; Quality of Life* ; Sleep Initiation and Maintenance Disorders* ; Weights and Measures

The light therapy has been known to be effective to non-seasonal affective disorder as well as seasonal affective disorder. Although the mechanism of action of light therapy for depressive disorder has not been verified yet, its clinical application revealed similar effects like antidepressants and relatively smaller side effects. However, it is not common to apply the light therapy for treatment resistant depressive disorder. This case report indicates a robust efficacy of light therapy and its clinical usefulness, illustrating the complete remission in a treatment resistant patient with major depressive disorder after bright light therapy.
Antidepressive Agents ; Depressive Disorder ; Depressive Disorder, Major* ; Humans ; Mood Disorders ; Phototherapy* ; Seasonal Affective Disorder

OBJECTIVE: We examined the difference in responses to donepezil between carriers and non-carriers of the A allele at the +4 position of the choline acetyltransferase (ChAT) gene in Koreans. METHODS: Patients who met the criteria for probable Alzheimer's disease (AD) (n=199) were recruited. Among these, 145 completed the 12-week follow-up evaluation and 135 completed the 26-week scheduled course. Differences and changes in the Korean version of the mini-mental state examination (MMSE-KC) score, Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-K[N]) wordlist subtest score (WSS), CERAD-K(N) total score (TS), and the Korean version of geriatric depression scale (GDS-K) score between baseline and 12 weeks or 26 weeks were assessed by the Student's t-test. RESULTS: At 12 weeks, the changes in the MMSE-KC score, CERAD-K(N) WSS, and CERAD-K(N) TS from baseline were not significant between ChAT A allele carriers and non-carriers; however, at 26 weeks, these changes were significantly larger in ChAT A allele carriers than in non-carriers (p=0.02 for MMSE-KC and p=0.03 for CERAD-K(N) WSS respectively). CONCLUSION: Our findings in this study suggested that presence of the A allele at the +4 position of ChAT might positively influence the treatment effect of donepezil in the early stages of AD in Koreans.
Alleles ; Alzheimer Disease* ; Choline O-Acetyltransferase* ; Choline* ; Depression ; Follow-Up Studies ; Genotype* ; Humans ; Polymorphism, Single Nucleotide

OBJECTIVES: The aim of this study was to examine the differences in subjective sleep quality and objective sleep parameters between groups with different severities of limb movements during sleep in elderly persons with sleep complaints. METHODS: We recruited adult subjects with sleep complaints from four areas in Gangwon-do. Nocturnal polysomnography studies were conducted for 159 subjects at Kangwon National University Hospital. A total of 72 subjects older than 60 years were finally selected, and we classified them into three groups according to the limb movement index (LMI) : 29 subjects with LMI below 15, 21 subjects with LMI between 15 and 44, and 22 subjects with LMI above 44. RESULTS: The proportion of existing restless legs syndrome (RLS) symptoms differed between the three groups, but was not statistically significant (p=0.051). No difference in nocturnal sleep parameters was observed between the three groups. In the total group, the limb movement arousal index showed positive correlation with respiratory arousal index (r=0.252, p<0.05). CONCLUSION: In elderly persons with sleep complaints, a greater LMI severity was associated with a tendency of higher comorbidity of RLS. Frequent arousals due to limb movements were not associated with a greater severity of limb movements during sleep severity, but with increased arousals due to respiratory events.
Adult ; Aged* ; Arousal ; Comorbidity ; Extremities* ; Gangwon-do ; Humans ; Polysomnography ; Restless Legs Syndrome

OBJECTIVES: The aim of our study was to compare sleep wake patterns and nocturnal sleep parameters between the morning type (MT) and evening type (ET). METHODS: The Morningness-Eveningness Questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Korean version of the Epworth Sleepiness Scale (KESS) were administered to subjects recruited among visitors to the Chuncheon National Museum from 2010 to 2011. Actigraphy data (Actiwatch-2, Philips-Respironics Co.) were collected from eight MT (Age 38.0+/-3.8, M : F=2 : 6), 12 neither type (NT) (Age 34.2+/-5.1, M : F=2 : 10), and nine ET (Age 30.3+/-6.8, M : F=2 : 7) subjects. RESULTS: Scores for PSQI and KESS did not differ significantly among the MT, NT, and ET groups. No differences in time in bed, total sleep time, sleep efficiency, wake after sleep onset, sleep latency, and fragmentation index were observed among the three groups. In the ET group, the mean wake time on free days was significantly later, and the mean sleep duration on free days was significantly longer, compared with those of the MT group (p<0.01). CONCLUSION: No differences in sleep quality, daytime sleepiness, and nocturnal sleep parameters were observed among the MT, NT, and ET groups. Compared to MT subjects, ET subjects showed later wake time and longer sleep duration on free days.
Actigraphy ; Museums ; Surveys and Questionnaires

OBJECTIVE: It has been suggested that oxidative stress and inflammation are associated with the pathophysiology of sleep disorders in end-stage renal disease (ESRD) patients. We examined the relationship of the sleep variables reflecting sleep breathing disorder and limb movements during sleep with the clinical variables reflecting the metabolic abnormalities in ESRD patients receiving hemodialysis. METHODS: Nocturnal polysomnography was conducted in 30 ESRD patients (21 men, 9 women), who were receiving hemodialysis. Blood was sampled before hemodialysis for each patient in order to measure uric acid (UA), C-reactive protein (CRP), and interleukin-6 (IL-6). RESULTS: UA was correlated positively with the total sleep time (TST)(r=0.407) and negatively with the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI)(r=-0.377, -405). CONCLUSION: CRP was positively correlated with the limb movement index (LMI)(r=0.401). Our study showed that increased UA was related to decreased respiratory disturbance during sleep in ESRD patients receiving hemodialysis.
C-Reactive Protein ; Extremities ; Humans ; Inflammation ; Interleukin-6 ; Kidney Failure, Chronic ; Male ; Oxidative Stress ; Oxygen ; Polysomnography ; Renal Dialysis ; Respiration ; Sleep Wake Disorders ; Uric Acid

OBJECTIVES: We compared the parameters of the sleep-wake rhythm in mild cognitive impairment (MCI) patients to those of normal elderly subjects, to illustrate how the characteristics of circadian rhythm relate to a specific neurocognitive function. METHODS: We selected 12 MCI patients and 12 age- and sex-matched normal control (NC) subjects and administered the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K) Neuropsychological battery and Stroop Color-Word Test (SCWT) to each subject. We measured each subject's sleep-wake rhythm by applying actigraphy for 96 hours. The sleep-wake rhythm was examined by cosinor analysis. RESULTS: There was no significant difference in the amplitude or acrophase of the sleep-wake rhythms between the NC and MCI groups. In the combined group, amplitude was positively correlated with Constructional Praxis scores (r=0.434, p<0.05), and acrophases tended to be positively correlated with Word List Memory scores (r=0.370, p=0.07). CONCLUSION: There was no difference between MCI patients' sleep-wake rhythm's amplitude and acrophase and those of NC subjects. Furthermore, decreased amplitude was associated with impaired visuospatial function in the combined group. It will be necessary to confirm this result in an expanded MCI group in a future study.
Actigraphy ; Aged ; Alzheimer Disease ; Circadian Rhythm ; Humans ; Memory ; Mild Cognitive Impairment ; Polymethacrylic Acids

The purpose of this study was to establish an association between glycemic index (GI), glycemic load (GL), dietary carbohydrates and diabetes with the context of the current population dietary practice in Korea. The subjects of 3,389 adults (male 1,430, female 1,959) were divided into normal (serum fasting glucose < 100 mg/dL), impaired glucose tolerance (100 126 mg/dL) by serum fasting glucose. Anthropometric and hematologic factors, and nutrient intakes, dietary glycemic index (DGI), dietary glycemic load (DGL) were assessed. Multiple logistic regression model was used to determine the odds ratios (ORs) and 95% confidence intervals for relationship of DGI, DGL, carbohydrates intakes, and diabetes. DGI and DGL were not significantly correlated with impaired glucose tolerance and diabetes. However, the risk of impaired glucose tolerance and diabetes showed a tendency to increase as increase of DGI after multivariate adjustment (age, education, income, region area, diabetes family history, smoking, drinking, exercise, energy intake) in male. The risk of impaired glucose tolerance and diabetes showed a tendency to increase in the DGI 71.1-74.8 after multivariate adjustment in female. DGL was inversely related to impaired glucose tolerance and diabetes in male. In female, however, DGL was positively related to impaired glucose tolerance and diabetes. In particular, the risk of diabetes increased positively in level of DGL 260.5, and remained after multivariate adjustment (Q5 vs Q1:2.38, 0.87-6.48). When percent energy intakes from carbohydrates were more than 70%, the risk of impaired glucose tolerance and diabetes increased in both male and female. In particular, when percent energy intakes from carbohydrates were more than 69.9%, the risk of diabetes increased positively in male (Q4 vs Q1:2.34, 1.16-4.17). In conclusion, above 70% energy intakes from carbohydrates appeared to be a risk factor of diabetes. It seemed that the meal with high GI and GL value must be avoided it. And also, the macronutrients of the meal must be properly balanced. In particular, it may be said that it is a preventive way for treatment of the diabetes to avoid eating carbohydrates of much quantity.
Adult ; Carbohydrates ; Dietary Carbohydrates ; Drinking ; Eating ; Fasting ; Female ; Glucose ; Glycemic Index ; Humans ; Korea ; Logistic Models ; Male ; Meals ; Nutrition Surveys ; Odds Ratio ; Risk Factors ; Smoke ; Smoking