ABSTRACT
Background@#Alopecia areata (AA) is common non-scarring hair loss disease. Sleep distrubance has been regarded as a triggering or aggravating factor for AA. However, objective evaluation of sleep disturbance and its clinical effect on AA has not been clearly demonstrated. @*Objective@#This study investigated objective sleep evaluation tool for AA patients and their clinical correlation. @*Methods@#Patients presenting with new-onset AA or recurrences of pre-existing AA were included, and those who reported sleep disturbance in the preliminary survey were designated as the sleep disturbance group (SD group). Sleep quality was investigated for them using three self-administered questionnaires: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleep Scale (ESS). Demographic information and clinical features of AA were analyzed according to sleep quality. @*Results@#A total of 400 participants were enrolled, and 53 were categorized into the SD group. The incidence of stressful events was significantly higher in the SD group (54.7%) than in the non-SD group (25.1%) (p<0.001). Based on the PSQI, 77.3% of participants were objective poor sleepers (score of 5 or more), and they showed a significantly higher incidence of stressful events compared to good sleepers (p=0.019). The proportion of poor sleepers was significantly lower in patients with mild AA (S1) than in those with moderate to severe AA (S2~S5) (p=0.045). @*Conclusion@#This study demonstrated a positive correlation among stress, SD, and AA. The degree of SD was objectively represented by the PSQI score, showing different scores according to AA severity.
ABSTRACT
Obstructive sleep apnea (OSA), a common condition observed in clinical practice, is a significant public health concern; however, several patients with OSA remain underdiagnosed and untreated. OSA is not merely anatomically driven but is a heterogeneous disorder attributable to complex pathophysiology. Therefore, anatomically driven therapy such as continuous positive airway pressure (CPAP), dental device use, or upper airway surgery offers limited benefit because these approaches do not consider the various clinical and other pathophysiological contributors to OSA. Poor long-term adherence is a limitation of CPAP, the most effective modality recommended as first-line therapy in patients with OSA. Recent advances in our understanding of the pathophysiology and heterogeneity of OSA have led to the identification of three OSA phenotypes based on pathophysiological traits, polysomnographic traits, and clinical/symptombased characteristics. In this review, we summarize recent progress and research trends in the phenotypic approach to OSA.
ABSTRACT
Purpose@#Setting standards is critical in health professions. However, appropriate standard setting methods do not always apply to the set cut score in performance assessment. The aim of this study was to compare the cut score when the standard setting is changed from the norm-referenced method to the borderline group method (BGM) and borderline regression method (BRM) in an objective structured clinical examination (OSCE) in medical school. @*Methods@#This was an explorative study to model the implementation of the BGM and BRM. A total of 107 fourth-year medical students attended the OSCE at 7 stations for encountering standardized patients (SPs) and at 1 station for performing skills on a manikin on July 15th, 2021. Thirty-two physician examiners evaluated the performance by completing a checklist and global rating scales. @*Results@#The cut score of the norm-referenced method was lower than that of the BGM (P<0.01) and BRM (P<0.02). There was no significant difference in the cut score between the BGM and BRM (P=0.40). The station with the highest standard deviation and the highest proportion of the borderline group showed the largest cut score difference in standard setting methods. @*Conclusion@#Prefixed cut scores by the norm-referenced method without considering station contents or examinee performance can vary due to station difficulty and content, affecting the appropriateness of standard setting decisions. If there is an adequate consensus on the criteria for the borderline group, standard setting with the BRM could be applied as a practical and defensible method to determine the cut score for OSCE.
ABSTRACT
Purpose@#Setting standards is critical in health professions. However, appropriate standard setting methods do not always apply to the set cut score in performance assessment. The aim of this study was to compare the cut score when the standard setting is changed from the norm-referenced method to the borderline group method (BGM) and borderline regression method (BRM) in an objective structured clinical examination (OSCE) in medical school. @*Methods@#This was an explorative study to model the implementation of the BGM and BRM. A total of 107 fourth-year medical students attended the OSCE at 7 stations for encountering standardized patients (SPs) and at 1 station for performing skills on a manikin on July 15th, 2021. Thirty-two physician examiners evaluated the performance by completing a checklist and global rating scales. @*Results@#The cut score of the norm-referenced method was lower than that of the BGM (P<0.01) and BRM (P<0.02). There was no significant difference in the cut score between the BGM and BRM (P=0.40). The station with the highest standard deviation and the highest proportion of the borderline group showed the largest cut score difference in standard setting methods. @*Conclusion@#Prefixed cut scores by the norm-referenced method without considering station contents or examinee performance can vary due to station difficulty and content, affecting the appropriateness of standard setting decisions. If there is an adequate consensus on the criteria for the borderline group, standard setting with the BRM could be applied as a practical and defensible method to determine the cut score for OSCE.
ABSTRACT
Objectives@#Split-night polysomnography (PSG) can be used for the diagnosis and treatment of obstructive sleep apnea (OSA). Recently, the American Academy of Sleep Medicine has broadened the indication of split-night PSG from severe to moderate OSA in a time window of 2 hours. However, majority pieces of evidence have been derived from the male predominant study population. The objective of this study was to investigate the diagnostic accuracy of split-night PSG in Korean women. @*Methods@#This study included 122 adult women with OSA. Apnea-hypopnea index (AHI) from the first 120 minutes of clock time (T120-AHI) and full-night AHI (FN-AHI) were compared using the concordance correlation coefficient (CCC) method and Bland-Altman plot. Receiver operating characteristic (ROC) curves and the area under the ROC curves were plotted with various cut-off points of AHI. @*Results@#The T120-AHI correlated with FN-AHI (CCC=0.77). The area under the ROC curve for T120-AHI with FN-AHI ≥15 was 0.865, with a sensitivity of 78.6% and specificity of 82.7%. @*Conclusions@#T120-AHI showed a significant correlation with the FN-AHI value in Korean female patients with OSA.
ABSTRACT
Objectives@#To investigate whether a history of body injury is associated with obstructive sleep apnea (OSA) in patients with rapid eye movement (REM) sleep behavior disorder (RBD). @*Methods@#We enrolled 56 consecutive patients with RBD, a history of dream-enacting behaviors, and polysomnographic evidence of REM sleep without atonia. Participants were asked whether they had any history of body injuries such as self-injury or bed-partner injury during sleep. The demographic characteristics and polysomnographic parameters of the groups with a history of injury (n=34, 60.7%) and without (n=22, 39.3%) were compared. The association between the history of injury and OSA was assessed. @*Results@#OSA [apnea-hypopnea index (AHI) ≥5/h) was associated with a history of body injury [odds ratio (OR)=6.25, 95% confidence interval (CI)=1.64–23.84]. Additionally, the logistic regression analysis showed that insomnia severity index (OR=0.87, 95% CI=0.80–0.98) and AHI (OR=1.10, 95% CI=1.02–1.18) were associated with history of body injury. @*Conclusions@#Therefore, we can conclude that history of body injury is related to obstructive sleep apnea in patients with RBD.
ABSTRACT
Patients often present with combinations of psychological disorders that manifest with neurological symptoms and/or signs that are not attributable to identifiable structural or functional etiology associated with the nervous system. We present the case of an elderly woman with functional weakness, which was documented using polysomnography with extended surface electromyography. Our findings show that polysomnography with extended surface electromyography may be a useful diagnostic tool for functional weakness in conversion disorder.
ABSTRACT
Objectives@#Split-night polysomnography (PSG) can be used for the diagnosis and treatment of obstructive sleep apnea (OSA). Recently, the American Academy of Sleep Medicine has broadened the indication of split-night PSG from severe to moderate OSA in a time window of 2 hours. However, majority pieces of evidence have been derived from the male predominant study population. The objective of this study was to investigate the diagnostic accuracy of split-night PSG in Korean women. @*Methods@#This study included 122 adult women with OSA. Apnea-hypopnea index (AHI) from the first 120 minutes of clock time (T120-AHI) and full-night AHI (FN-AHI) were compared using the concordance correlation coefficient (CCC) method and Bland-Altman plot. Receiver operating characteristic (ROC) curves and the area under the ROC curves were plotted with various cut-off points of AHI. @*Results@#The T120-AHI correlated with FN-AHI (CCC=0.77). The area under the ROC curve for T120-AHI with FN-AHI ≥15 was 0.865, with a sensitivity of 78.6% and specificity of 82.7%. @*Conclusions@#T120-AHI showed a significant correlation with the FN-AHI value in Korean female patients with OSA.
ABSTRACT
Objectives@#To investigate whether a history of body injury is associated with obstructive sleep apnea (OSA) in patients with rapid eye movement (REM) sleep behavior disorder (RBD). @*Methods@#We enrolled 56 consecutive patients with RBD, a history of dream-enacting behaviors, and polysomnographic evidence of REM sleep without atonia. Participants were asked whether they had any history of body injuries such as self-injury or bed-partner injury during sleep. The demographic characteristics and polysomnographic parameters of the groups with a history of injury (n=34, 60.7%) and without (n=22, 39.3%) were compared. The association between the history of injury and OSA was assessed. @*Results@#OSA [apnea-hypopnea index (AHI) ≥5/h) was associated with a history of body injury [odds ratio (OR)=6.25, 95% confidence interval (CI)=1.64–23.84]. Additionally, the logistic regression analysis showed that insomnia severity index (OR=0.87, 95% CI=0.80–0.98) and AHI (OR=1.10, 95% CI=1.02–1.18) were associated with history of body injury. @*Conclusions@#Therefore, we can conclude that history of body injury is related to obstructive sleep apnea in patients with RBD.
ABSTRACT
Patients often present with combinations of psychological disorders that manifest with neurological symptoms and/or signs that are not attributable to identifiable structural or functional etiology associated with the nervous system. We present the case of an elderly woman with functional weakness, which was documented using polysomnography with extended surface electromyography. Our findings show that polysomnography with extended surface electromyography may be a useful diagnostic tool for functional weakness in conversion disorder.
ABSTRACT
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are prevalent and commonly co-occur as overlap syndrome. Patients with an overlap syndrome have a worse prognosis than those with COPD or OSA alone. Here we report a middle-aged man with overlap syndrome who had multiple comorbidities, managed with continuous positive airway pressure and oxygen therapy.
Subject(s)
Humans , Comorbidity , Continuous Positive Airway Pressure , Oxygen , Prognosis , Pulmonary Disease, Chronic Obstructive , Sleep Apnea Syndromes , Sleep Apnea, ObstructiveABSTRACT
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.
Subject(s)
Female , Humans , Airway Obstruction , Arousal , Asphyxia , Esophageal pH Monitoring , Gastroesophageal Reflux , Heart Rate , Hoarseness , Laryngismus , Polysomnography , Respiration , Respiratory SoundsABSTRACT
Antiepileptic drugs (AEDs) have been known to induce cutaneous adverse drug reaction (cADR), ranging from a mild maculopapular eruption (MPE) to potentially life-threatening cADRs such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Despite studies examining mechanisms associated with human leukocyte antigen (HLA), the association between lamotrigine (LTG)-induced cADR and HLA alleles still has room to investigate. We investigated HLA-A,-B, and -C alleles in LTG-induced cADR. The medical records of four patients with LTG-induced cADR were retrospectively reviewed. All patients were treated with LTG for epilepsy. All recovered from cADR after stopping LTG treatment and receiving intensive care. HLA-A, -B, and -C genotyping was performed in all four patients using a PCR-sequence-based typing (SBT) method. Two patients had SJS, and the other two had MPE due to LTG. The range of latency to cADR after the initial LTG dose was 19–42 days. Two patients experienced cross-reactivity with other aromatic or new AEDs. Expression of the HLA-A*24:02/B*51:01 haplotype was detected in three (75%) patients with LTG-induced cADR. The other patient carried homozygous HLA-B*58:01 alleles. The results suggest that Korean individuals with the HLA-A*24:02/B*51:01 haplotype may be susceptible to LTG-induced cADR. Further investigations are necessary to confirm these findings.
Subject(s)
Humans , Alleles , Anticonvulsants , Critical Care , Drug-Related Side Effects and Adverse Reactions , Epilepsy , Haplotypes , HLA-A Antigens , Leukocytes , Medical Records , Methods , Retrospective Studies , Stevens-Johnson SyndromeABSTRACT
A condition of underestimation of sleep is classified as paradoxical insomnia or sleep state misperception. However, overestimation of sleep, so called positive sleep state misperception has not been clearly described. Here we report a middle-aged woman with positive sleep state misperception who presented excessive sleepiness mimicking hypersomnia.
Subject(s)
Female , Humans , Disorders of Excessive Somnolence , Sleep Disorders, Intrinsic , Sleep Initiation and Maintenance DisordersABSTRACT
No abstract available.
Subject(s)
Continuous Positive Airway Pressure , Sleep Apnea Syndromes , Sleep Apnea, ObstructiveABSTRACT
Atopic myelitis (AM) is a relatively mild form of myelitis associated with allergic diathesis, and present with predominant sensory manifestations. Lhermitte's sign has been considered as a relatively non-specific clinical sign suggesting demyelinating lesion in cervical cord. Here we report a patient with recurrent AM who presented with isolated Lhermitte's sign, both in first and second attacks. This report suggests that either the diagnosis or recurrence of AM can be frequently underdiagnosed because of its predominant sensory manifestations.
Subject(s)
Humans , Diagnosis , Disease Susceptibility , Myelitis , RecurrenceABSTRACT
No abstract available.