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Background@#and Purpose Excess or insufficient sleep, irregular sleep-wake patterns, and an extreme early or late chronotypes adversely impact physical and mental health. Changes in sleep characteristics should therefore be tracked, and factors that contribute to poor sleep should be identified. We investigated the changes in sleep patterns among South Korean adults during 2009–2018. @*Methods@#Using data of a representative sample of South Korean adults from the 2009 (n= 2,658, 48.5% males; age=44.5±15.0 years old [mean±standard deviation], age range=19–86 years) and 2018 (n=2,389, 49.1% males; age=47.9±16.3 years, age range=19–92 years) Korean Headache-Sleep Study, we explored changes in sleep timing, sleep duration, chronotype, and social jetlag (SJL). Logistic regression analysis was used to examine the association between average sleep duration and depression. @*Results@#From 2009 to 2018, bedtimes were advanced by 10 and 25 min on workdays and free days, respectively. Meanwhile, wake-up times were advanced by 13 min and delayed by 12 min on workdays and free days, respectively. The average sleep duration significantly decreased from 7.45 h to 7.13 h. The prevalence of short sleep duration (<7 h) increased, whereas that of long sleep duration (≥8 h) decreased. A circadian preference toward eveningness and SJL increased. The prevalence of depression increased from 4.6% to 8.4%, and there were significant reverse J-shaped and U-shaped associations between average sleep duration and depression in 2009 and 2018, respectively. @*Conclusions@#Changes in sleep patterns and the association between sleep duration and depressive mood were determined from a representative sample of the South Korean adult population. Interventions to modify sleep behaviors might improve public health.
ABSTRACT
Objectives@#Clinicians often depend on the results of the the multiple sleep latency test (MSLT) for diagnosing narcolepsy, but the diagnosis can be confusing when there is a co-existence of obstructive sleep apnea (OSA). This study is aimed to address the diagnostic tendency and the strategies of treatment for narcolepsy and other hypersomnia in the grey zone. @*Methods@#We performed a web-based survey of Korean neurologists who were interested in narcolepsy and had experience with sleep studies. @*Results@#The results of this survey present their concerns according to the severity of comorbid OSA in analyzing the results of the MSLT. @*Conclusions@#This study also might help by providing the opinions of experienced Korean neurologists for the assessment and management of excessive daytime sleepiness.
ABSTRACT
We present the case of a 78-year-old female who experienced acute mental deterioration after vomiting. She showed severe hypercapnia without definite lung disease and hypoxic injury on brain image. After the acute period, she still had excessive daytime sleepiness, and the hypercapnia aggravated during the night. Polysomnography revealed severe obstructive sleep apnea, a sleep-related breathing disorder with a high apneahypopnea index of 60.2/h (mainly a hypopnea index of 59.0/h). She was diagnosed with combined obesity hypoventilation syndrome (OHS) and sleep-related breathing disorder, as the cause of daytime hypercapnia and excessive daytime sleepiness. Three months of successful bi-level positive airway pressure (BiPAP) therapy dramatically improved her daytime sleepiness and cognition. This case suggests that patients with OHS can be susceptible to hypoxic brain damage, and emphasizes the importance of the recognition and diagnosis of OHS and appropriate treatment with BiPAP therapy.
ABSTRACT
Obstructive sleep apnea (OSA) is known to be associated with various health concerns, including sleepiness, fatigue, cognitive dysfunction, diminished quality of life, hypertension, cardiovascular diseases, and stroke. OSA-induced sleepiness at the wheel reduces vigilance and driving performance, which significantly increase the risk of motor vehicle accidents. Sleepiness-induced motor vehicle accidents are characterized by high morbidity and mortality. OSA is a well-established significant risk factor for drowsy driving-related motor vehicle accidents, which can be prevented through appropriate treatment. However, currently no clinical guidelines or regulations are available for evaluation or management of the risk of motor vehicle accidents in patients with OSA in Korea. In this review, we discuss the risk of motor vehicle accidents in patients with OSA, the effects of positive airway pressure therapy as a preventive measure to reduce this risk, and the published recommendations for OSA in other countries with regard to fitness to drive. We propose recommendations for screening, evaluation, and treatment of OSA with regard to the risk of motor vehicle accidents, which would serve as useful practical guidelines for sleep specialists in clinical practice. Further research is warranted to establish optimal strategies for effective improvements in OSA-related traffic safety.
ABSTRACT
Narcolepsy is a chronic sleep disorder characterized by irresistible sleep attacks, hypersomnolence, cataplexy (sudden loss of muscle tone provoked by emotion), and sleep paralysis. Individuals with narcolepsy are at a high risk of experiencing sleepiness while driving leading to road traffic accidents. To prevent such accidents, some countries have regulations for commercial and noncommercial drivers with narcolepsy. Evaluating sleepiness is essential. Therefore, several subjective reports and objective tests were used to predict the possibility of car crashes or near-misses. Brain stimulants are effective in treating narcolepsy and can reduce daytime sleepiness in these patients. However, no guideline has been established for the driving safety of patients with narcolepsy in Korea. The Korean Sleep Research Society has prepared this proposal for preventing motor vehicle accidents caused by drowsy driving in patients with narcolepsy.
ABSTRACT
Pulmonary embolism (PE) is a potentially fatal disease if the diagnosis or treatment is delayed. Currently, multidetector computed tomography (MDCT) is considered the standard imaging method for diagnosing PE. Dual-energy CT (DECT) has the advantages of MDCT and can provide functional information for patients with PE. The aim of this review is to present the potential clinical applications of DECT in PE, focusing on the diagnosis and risk stratification of PE.
ABSTRACT
Driving is a complicated process that demands coordination between a range of neurocognitive functions, including attention, visuo-perception, and appropriate judgment, as well as sensory and motor responses. Therefore, several factors may reduce the driving performance of an individual, such as sleepiness, distraction, overspeeding, alcohol consumption, and sedative drugs, all of which increase the hazard of motor vehicle accidents. Among them, drowsy driving is a major cause of traffic accidents, leading to more serious injuries as compared to other causes of major traffic accidents. Although sleep disorders have been highly associated among drowsy drivers, they are often untreated and unrecognized as a disease. In particular, obstructive sleep apnea and narcolepsy are some sleep disorders that are highly related to traffic accidents. Insomnia, which can cause inadequate sleep duration and promote sedative effects from sleeping pills, may also cause traffic accidents. These conditions are especially applicable to commercial bus or truck drivers, nocturnal workers, and shift workers, who are highly vulnerable to drowsy driving. Therefore, assertive screening and management of sleep disorders are necessary in general private drivers and relevant occupational drivers.
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The relationship between cluster headache (CH) and sleep has been demonstrated. A 60-year-old man who suffered from refractory CH that occurred exclusively at night, complained of sleep fragmentation. Polysomnography revealed severe obstructive apnea with deep desaturation and sleep fragmentation every 2 hours due to cyclic pain. Three months of successful continuous positive airway therapy dramatically improved both headache intensity and frequency, as well as sleep apnea. This case suggests the significance of comorbid OSA when managing patients with CH or primary headaches with nocturnal tendencies.
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Background@#Real-world data analysis is useful for identifying treatment patterns.Understanding drug prescription patterns of type 2 diabetes mellitus may facilitate diabetes management. We aimed to analyze treatment patterns of type 2 diabetes mellitus using Observational Medical Outcomes Partnership Common Data Model based on electronic health records. @*Methods@#This retrospective, observational study employed electronic health records of patients who visited Jeonbuk National University Hospital in Korea during January 2000– December 2019. Data were transformed into the Observational Medical Outcomes Partnership Common Data Model and analyzed using R version 4.0.3 and ATLAS ver. 2.7.6. Prescription frequency for each anti-diabetic drug, combination therapy pattern, and prescription pattern according to age, renal function, and glycated hemoglobin were analyzed. @*Results@#The number of adults treated for type 2 diabetes mellitus increased from 1,867 (2.0%) in 2000 to 9,972 (5.9%) in 2019. In the early 2000s, sulfonylurea was most commonly prescribed (73%), and in the recent years, metformin has been most commonly prescribed (64%). Prescription rates for DPP4 and SGLT2 inhibitors have increased gradually over the past few years. Monotherapy prescription rates decreased, whereas triple and quadruple combination prescription rates increased steadily. Different drug prescription patterns according to age, renal function, and glycated hemoglobin were observed. The proportion of patients with HbA1c ≤ 7% increased from 31.1% in 2000 to 45.6% in 2019, but that of patients visiting the emergency room for severe hypoglycemia did not change over time. @*Conclusion@#Medication utilization patterns have changed significantly over the past 20 years with an increase in the use of newer drugs and a shift to combination therapies. In addition, various prescription patterns were demonstrated according to the patient characteristics in actual practice. Although glycemic control has improved, the proportion within the target is still low, underscoring the need to improve diabetes management.
ABSTRACT
Pulmonary embolism (PE) is a potentially fatal disease if the diagnosis or treatment is delayed. Currently, multidetector computed tomography (MDCT) is considered the standard imaging method for diagnosing PE. Dual-energy CT (DECT) has the advantages of MDCT and can provide functional information for patients with PE. The aim of this review is to present the potential clinical applications of DECT in PE, focusing on the diagnosis and risk stratification of PE.
ABSTRACT
Driving is a complicated process that demands coordination between a range of neurocognitive functions, including attention, visuo-perception, and appropriate judgment, as well as sensory and motor responses. Therefore, several factors may reduce the driving performance of an individual, such as sleepiness, distraction, overspeeding, alcohol consumption, and sedative drugs, all of which increase the hazard of motor vehicle accidents. Among them, drowsy driving is a major cause of traffic accidents, leading to more serious injuries as compared to other causes of major traffic accidents. Although sleep disorders have been highly associated among drowsy drivers, they are often untreated and unrecognized as a disease. In particular, obstructive sleep apnea and narcolepsy are some sleep disorders that are highly related to traffic accidents. Insomnia, which can cause inadequate sleep duration and promote sedative effects from sleeping pills, may also cause traffic accidents. These conditions are especially applicable to commercial bus or truck drivers, nocturnal workers, and shift workers, who are highly vulnerable to drowsy driving. Therefore, assertive screening and management of sleep disorders are necessary in general private drivers and relevant occupational drivers.
ABSTRACT
The relationship between cluster headache (CH) and sleep has been demonstrated. A 60-year-old man who suffered from refractory CH that occurred exclusively at night, complained of sleep fragmentation. Polysomnography revealed severe obstructive apnea with deep desaturation and sleep fragmentation every 2 hours due to cyclic pain. Three months of successful continuous positive airway therapy dramatically improved both headache intensity and frequency, as well as sleep apnea. This case suggests the significance of comorbid OSA when managing patients with CH or primary headaches with nocturnal tendencies.
ABSTRACT
Background@#Real-world data analysis is useful for identifying treatment patterns.Understanding drug prescription patterns of type 2 diabetes mellitus may facilitate diabetes management. We aimed to analyze treatment patterns of type 2 diabetes mellitus using Observational Medical Outcomes Partnership Common Data Model based on electronic health records. @*Methods@#This retrospective, observational study employed electronic health records of patients who visited Jeonbuk National University Hospital in Korea during January 2000– December 2019. Data were transformed into the Observational Medical Outcomes Partnership Common Data Model and analyzed using R version 4.0.3 and ATLAS ver. 2.7.6. Prescription frequency for each anti-diabetic drug, combination therapy pattern, and prescription pattern according to age, renal function, and glycated hemoglobin were analyzed. @*Results@#The number of adults treated for type 2 diabetes mellitus increased from 1,867 (2.0%) in 2000 to 9,972 (5.9%) in 2019. In the early 2000s, sulfonylurea was most commonly prescribed (73%), and in the recent years, metformin has been most commonly prescribed (64%). Prescription rates for DPP4 and SGLT2 inhibitors have increased gradually over the past few years. Monotherapy prescription rates decreased, whereas triple and quadruple combination prescription rates increased steadily. Different drug prescription patterns according to age, renal function, and glycated hemoglobin were observed. The proportion of patients with HbA1c ≤ 7% increased from 31.1% in 2000 to 45.6% in 2019, but that of patients visiting the emergency room for severe hypoglycemia did not change over time. @*Conclusion@#Medication utilization patterns have changed significantly over the past 20 years with an increase in the use of newer drugs and a shift to combination therapies. In addition, various prescription patterns were demonstrated according to the patient characteristics in actual practice. Although glycemic control has improved, the proportion within the target is still low, underscoring the need to improve diabetes management.
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This document is the third part of the guidelines for the interpretation and post-processing of cardiac magnetic resonance (CMR) studies. These consensus recommendations have been developed by a Consensus Committee of the Korean Society of Cardiovascular Imaging (KOSCI) to standardize the requirements for image interpretation and post-processing of CMR. This third part of the recommendations describes tissue characterization modules, including perfusion, late gadolinium enhancement, and T1- and T2 mapping. Additionally, this document provides guidance for visual and quantitative assessment, consisting of “What-to-See,” “How-To,” and common pitfalls for the analysis of each module. The Consensus Committee hopes that this document will contribute to the standardization of image interpretation and post-processing of CMR studies.
ABSTRACT
Objective@#The present study aimed to investigate whether quantitative dual-energy computed tomography (DECT) parametersoffer an incremental risk stratification benefit over the CT ventricular diameter ratio in patients with acute pulmonary embolism(PE) by using propensity score analysis. @*Materials and Methods@#This study was conducted on 480 patients with acute PE who underwent CT pulmonary angiography(CTPA) or DECT pulmonary angiography (DE CT-PA). This propensity-matched study population included 240 patients with acutePE each in the CTPA and DECT groups. Altogether, 260 (54.1%) patients were men, and the mean age was 64.9 years (64.9 ±13.5 years). The primary endpoint was all-cause death within 30 days. The Cox proportional hazards regression model was usedto identify associations between CT parameters and outcomes and to identify potential predictors. Concordance (C) statisticswere used to compare the prognoses between the two groups. @*Results@#In both CTPA and DECT groups, right to left ventricle diameter ratio ≥ 1 was associated with an increased risk of allcausedeath within 30 days (hazard ratio: 3.707, p< 0.001 and 5.573, p< 0.001, respectively). However, C-statisticsshowed no statistically significant difference between the CTPA and DECT groups for predicting death within 30 days(C-statistics: 0.759 vs. 0.819, p= 0.117). @*Conclusion@#Quantitative measurement of lung perfusion defect volume by DECT had no added benefit over CT ventriculardiameter ratio for predicting all-cause death within 30 days.
ABSTRACT
Spontaneous bleeding due to vascular involvement of neurofibromatosis type 1 is rare but potentially fatal. Herein, we report a case of a lethal spontaneous hemomediastinum in a patient with neurofibromatosis type 1. The bleeding was caused by rupture of an aberrant bronchial artery arising from the ipsilateral subclavian artery, which was successfully treated using transarterial embolization with coils and N-butyl-2-cyanoacrylate.
ABSTRACT
Acute viral infection or vaccination generates highly functional memory CD8 T cells following the Ag resolution. In contrast, persistent antigenic stimulation in chronic viral infection and cancer leads to a state of T-cell dysfunction termed T-cell exhaustion. We and other have recently identified a novel subset of exhausted CD8 T cells that act as stem cells for maintaining virus-specific CD8 T cells in a mouse model of chronic lymphocytic choriomeningitis virus infection. This stem cell-like CD8 T-cell subset has been also observed in both mouse and human tumor models. Most importantly, in both chronic viral infection and tumor models, the proliferative burst of Ag-specific CD8 T cells driven by PD-1-directed immunotherapy comes exclusively from this stem cell-like CD8 T-cell subset. Therefore, a better understanding of the mechanisms how CD8 T-cell subsets are regulated during chronic viral infection and cancer is required to improve the current immunotherapies that restore the function of exhausted CD8 T cells. In this review, we discuss the differentiation of virus-specific CD8 T cells during chronic viral infection, the characteristics and function of CD8 T-cell subsets, and the therapeutic intervention of PD-1-directed immunotherapy in cancer.
Subject(s)
Animals , Humans , Mice , Immunotherapy , Lymphocytic choriomeningitis virus , Memory , Stem Cells , T-Lymphocyte Subsets , T-Lymphocytes , VaccinationABSTRACT
40 years or new hires with less than 1 year of service.
Subject(s)
Humans , Brain , Cardiovascular Diseases , Cohort Studies , Firefighters , Follow-Up Studies , Health Surveys , Hospitals, University , Killer Cells, Natural , Korea , Magnetic Resonance Imaging , Mental Disorders , Mental Health , Neuropsychological Tests , Polycyclic Aromatic Hydrocarbons , Prospective Studies , Republic of Korea , Risk FactorsABSTRACT
Acute viral infection or vaccination generates highly functional memory CD8 T cells following the Ag resolution. In contrast, persistent antigenic stimulation in chronic viral infection and cancer leads to a state of T-cell dysfunction termed T-cell exhaustion. We and other have recently identified a novel subset of exhausted CD8 T cells that act as stem cells for maintaining virus-specific CD8 T cells in a mouse model of chronic lymphocytic choriomeningitis virus infection. This stem cell-like CD8 T-cell subset has been also observed in both mouse and human tumor models. Most importantly, in both chronic viral infection and tumor models, the proliferative burst of Ag-specific CD8 T cells driven by PD-1-directed immunotherapy comes exclusively from this stem cell-like CD8 T-cell subset. Therefore, a better understanding of the mechanisms how CD8 T-cell subsets are regulated during chronic viral infection and cancer is required to improve the current immunotherapies that restore the function of exhausted CD8 T cells. In this review, we discuss the differentiation of virus-specific CD8 T cells during chronic viral infection, the characteristics and function of CD8 T-cell subsets, and the therapeutic intervention of PD-1-directed immunotherapy in cancer.
ABSTRACT
Acute viral infection or vaccination generates highly functional memory CD8 T cells following the Ag resolution. In contrast, persistent antigenic stimulation in chronic viral infection and cancer leads to a state of T-cell dysfunction termed T-cell exhaustion. We and other have recently identified a novel subset of exhausted CD8 T cells that act as stem cells for maintaining virus-specific CD8 T cells in a mouse model of chronic lymphocytic choriomeningitis virus infection. This stem cell-like CD8 T-cell subset has been also observed in both mouse and human tumor models. Most importantly, in both chronic viral infection and tumor models, the proliferative burst of Ag-specific CD8 T cells driven by PD-1-directed immunotherapy comes exclusively from this stem cell-like CD8 T-cell subset. Therefore, a better understanding of the mechanisms how CD8 T-cell subsets are regulated during chronic viral infection and cancer is required to improve the current immunotherapies that restore the function of exhausted CD8 T cells. In this review, we discuss the differentiation of virus-specific CD8 T cells during chronic viral infection, the characteristics and function of CD8 T-cell subsets, and the therapeutic intervention of PD-1-directed immunotherapy in cancer.