Explosive sound without external stimuli following electroencephalography kappa rhythm fluctuation: A case report.

BACKGROUND: The pathology underlying exploding head syndrome, a parasomnia causing a loud sound/sense of explosion, is not well understood. Kappa rhythm is a type of electroencephalogram alpha band activity with maximum potential between contralateral temporal electrodes We report a case of preceding kappa activity before exploding head syndrome attacks. CASE REPORT: A 57-year-old woman complained of explosive sounds for 2 months; a loud sound would transpire every day before sleep onset. She was diagnosed with exploding head syndrome. During polysomnography and the multiple sleep latency test, the exploding head syndrome attacks occurred six times. A kappa wave with activity disappearing a few seconds before most exploding head syndrome attacks was observed. The alpha band power in T3-T4 derivation gradually waxed followed by termination around the attacks. CONCLUSION: This case demonstrated that the dynamics of kappa activity precede exploding head syndrome attacks. Finding ways to modulate electroencephalogram oscillation could elucidate their causality and lead to therapeutic intervention.

Large Questionnaire Survey on Sleep Duration and Insomnia Using the TV Hybridcast System by Japan Broadcasting Corporation (NHK).

BACKGROUND: Japanese people are known to have the shortest sleep duration in the world. To date, no study has assessed a large Japanese population for insomnia and sleep duration. METHODS: We performed an Ιnternet-based survey in association with a national television (TV) program. Questionnaire data were collected not only through personal computers, tablets, and smartphones, but also through the Hybridcast system, which combines broadcasts over airwaves with broadband data provided via the Internet using the TV remote controller. The Athens Insomnia Scale (AIS) was used to assess insomnia. RESULTS: A total of 301,241 subjects participated in the survey. Participants slept for an average of 5.96 ± 1.13 h; the average AIS score was 6.82 ± 3.69. A total of 26.1% of male and 27.1% of female participants had both insomnia (AIS ≥ 6) and short sleep duration (<6 h). Responses were recorded through the Hybridcast system for 76.4% of the elderly (age ≥ 65 years) subjects and through personal computers, tablets, or smartphones for 59.9-82.7% of the younger subjects (age ≤ 65 years). CONCLUSIONS: Almost a quarter of the Japanese participants presented short sleep duration and insomnia. Furthermore, the Hybridcast system may be useful for performing large internet-based surveys, especially for elderly individuals.

Usefulness of a Novel Pinwheel-shaped Incision Technique for Skin Tumor Excision.

Use of the fusiform ellipse excision technique is the most common method for direct closure of circular and elliptical defects. To prevent dog-ear formation after suturing, the long-axis length of the fusiform ellipse should be ≥3 times the transverse dimension and the angle formed by the 2 lines at both ends should be <30°. We devised a pinwheel-shaped incision technique for skin tumor excision that could reduce the scar size. We aim to present this technique and report its results and usefulness. We included 50 patients (55 cases; 54% women; mean age, 39.8 years) who underwent surgery using our pinwheel-shaped incision technique between January 2016 and December 2018. The incision line was designed like a pinwheel around the tumor, and the excess skin was trimmed after suturing at the center. The length-to-width ratio was calculated using the width before the operation and the suture length at the end of the operation. The operation site was primarily the face, and the maximum tumor width was 48 mm. The postoperative suture line length was 2.1 ± 0.2 (mean ± SD) times the width of the excision area. There were no complications such as skin necrosis, and no patient required reoperation because of dog-ear formation. Our new pinwheel-shaped incision technique allows shortening of the length-to-width ratio compared with that required in the conventional method and helps avoid dog-ear formation. We successfully used this technique in 55 cases and confirmed its usefulness.

Self-Isolation Due to COVID-19 Is Linked to Small One-Year Changes in Depression, Sleepiness, and Insomnia: Results from a Clinic for Sleep Disorders in Shiga Prefecture, Japan.

We aimed to analyze (a) the changes in depression, sleepiness, insomnia, and sleep habits in relation to the degree of self-isolation and (b) the effects of changes in sleep habits and social interactions on depression, insomnia, and sleepiness during the coronavirus disease 2019 (COVID-19) pandemic. We enrolled 164 patients who visited the sleep outpatient clinic in Shiga University of Medical Science Hospital. We compared the sleep habits, depression (Patient Health Questionnaire-9: PHQ-9), insomnia (Athens Insomnia Scale: AIS), and sleepiness (Epworth Sleepiness Scale: ESS) of patients during the period from April to July 2019 vs. May 2020 (a period of self-isolation due to COVID-19). A Wilcoxon signed-rank test indicated no significant differences in PHQ-9, ESS, and AIS scores between 2019 and 2020 within both the strong self-isolation group and no/little self-isolation group. With respect to sleep habits, earlier bedtime (p = 0.006) and increased sleep duration (p = 0.014) were found in the strong self-isolation group. The former (p = 0.009) was also found in the no/little self-isolation group, but we found significant differences in sleep duration between the no/little self-isolation group and the strong self-isolation group (p = 0.047). Therefore, self-isolation due to COVID-19 had relatively small one-year effects on depression, sleepiness, and insomnia in a clinical population.

Evaluation of Severity Levels of the Athens Insomnia Scale Based on the Criterion of Insomnia Severity Index.

The Athens Insomnia Scale (AIS) can be regarded as a highly useful instrument in both clinical and research settings, except for when assessing the severity level. This study aims to determine the severity criteria for AIS by using the Insomnia Severity Index (ISI). A total of 1666 government employees aged 20 years or older were evaluated using the AIS and ISI, the Patient Health Questionnaire for depressive symptoms, the Epworth Sleepiness Scale for daytime sleepiness, and the Short Form Health Survey of the Medical Outcomes Study for health-related quality of life (QoL). A significant positive correlation (r) was found between the AIS and the ISI (r = 0.80, p < 0.001). As a result of describing receiver-operator curves, the severity criteria of the AIS are capable of categorizing insomnia severity as follows: absence of insomnia (0-5), mild insomnia (6-9), moderate insomnia (10-15), and severe insomnia (16-24). In addition, compared to all scales across groups categorized by AIS or ISI, it was revealed that similar results could be obtained (all p < 0.05). Therefore, the identification of the severity of AIS in this study is important in linking the findings of epidemiological studies with those of clinical studies.