The Relationship Between Brain Activation for Taking Others' Perspective and Interoceptive Abilities in Autism Spectrum Disorder: An fMRI Study.

Objectives: In this functional magnetic resonance imaging study, we aimed to investigate the differences in brain activation between individuals with autism spectrum disorder (ASD) and typically developing (TD) individuals during perspective taking. We also examined the association between brain activation and empathic and interoceptive abilities. Methods: During scanning, participants from the ASD (n=17) and TD (n=22) groups were shown pain stimuli and asked to rate the level of the observed pain from both self- and other-perspectives. Empathic abilities, including perspective taking, were measured using an empathic questionnaire, and three dimensions of interoception were assessed: interoceptive accuracy, interoceptive sensibility, and interoceptive trait prediction errors. Results: During self-perspective taking, the ASD group exhibited greater activation in the left precuneus than the TD group. During other-perspective taking, relative hyperactivation extended to areas including the right precuneus, right superior frontal gyrus, left caudate nucleus, and left amygdala. Brain activation levels in the right superior frontal gyrus while taking other-perspective were negatively correlated with interoceptive accuracy, and those in the left caudate were negatively correlated with perspective taking ability in the ASD group. Conclusion: Individuals with ASD show atypical brain activation during perspective taking. Notably, their brain regions associated with stress reactions and escape responses are overactivated when taking other-perspective. This overactivity is related to poor interoceptive accuracy, suggesting that individuals with ASD may experience difficulties with the self-other distinction or atypical embodiment when considering another person's perspective.

Graph Theoretical Analysis of Brain Structural Connectivity in Patients with Alcohol Dependence.

This study aimed to compare brain structural connectivity using graph theory between patients with alcohol dependence and social drinkers. The participants were divided into two groups; the alcohol group (N=23) consisting of patients who had been hospitalized and had abstained from alcohol for at least three months and the control group (N=22) recruited through advertisements and were social drinkers. All participants were evaluated using 3T magnetic resonance imaging. A total of 1000 repeated whole-brain tractographies with random parameters were performed using DSI Studio. Four hundred functionally defined cortical regions of interest (ROIs) were parcellated using FreeSurfer based on the Schaefer Atlas. The ROIs were overlaid on the tractography results to generate 1000 structural connectivity matrices per person, and 1000 matrices were averaged into a single matrix per subject. Graph analysis was performed through igraph R package. Graph measures were compared between the two groups using analysis of covariance, considering the effects of age and smoking pack years. The alcohol group showed lower local efficiency than the control group in the whole-brain (F=5.824, p=0.020), somato-motor (F=5.963, p=0.019), and default mode networks (F=4.422, p=0.042). The alcohol group showed a lower global efficiency (F=5.736, p=0.021) in the control network. The transitivity of the alcohol group in the dorsal attention network was higher than that of the control (F=4.257, p=0.046). Our results imply that structural stability of the whole-brain network is affected in patients with alcohol dependence, which can lead to ineffective information processing in cases of local node failure.

Hippocampal Subfields and White Matter Connectivity in Patients with Subclinical Geriatric Depression.

Despite an abundance of research related to the functional and structural changes of the brain in patients with geriatric depression, knowledge related to early alterations such as decreased white matter connectivity and their association with cognitive decline remains lacking. We aimed to investigate early alterations in hippocampal microstructure and identify their associations with memory function in geriatric patients with subclinical depression. Nineteen participants with subclinical geriatric depression and 19 healthy controls aged ≥65 years exhibiting general cognitive function within the normal range were included in the study and underwent assessments of verbal memory. Hippocampal subfield volumes were determined based on T1-weighted magnetization-prepared rapid gradient echo (T1-MPRAGE) images, while group tractography and connectometry analyses were conducted using diffusion tensor images. Our findings indicated that the volumes of whole bilateral hippocampus, cornus ammonis (CA) 1, molecular layer, left subiculum, CA3, hippocampal tail, right CA4, and granule cell/molecular layers of the dentate gyrus (GC-ML-DG) were significantly smaller in the subclinical depression group than in the control group. In the subclinical depression group, verbal learning was positively correlated with the volumes of the CA1, GC-ML-DG, molecular layer, and whole hippocampus in the right hemisphere. The fractional anisotropy of the bilateral fornix was also significantly lower in the subclinical depression group and exhibited a positive correlation with verbal learning and recall in both groups. Our results suggest that hippocampal microstructure is disrupted and associated with memory in patients with subclinical depression.

Application of Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) to Public Workers for Measuring Their Anxiety Response During the COVID-19 Pandemic.

Objective: This study aimed to compare the adaptability of the adapted version of Stress and Anxiety to Viral Epidemics-9 (SAVE-9) for public workers and the SAVE-6 scale and to validate them among public workers who are on the frontline of the coronavirus disease 2019 pandemic. Methods: A total of 300 public workers responded to the anonymous online survey during April 1-12, 2021. Principal component analysis was conducted with varimax rotation to explore the factor structure of this scale. Confirmatory factor analysis was also used to explore construct validity. Spearman correlation analysis of the scale with the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) was performed to explore the convergent validity. The cut-off score in accordance with the mild degree of generalized anxiety symptoms (GAD-7 score of 5) was defined using the receiver operating characteristic (ROC) analysis. Findings: The single-structure model of each scale (the adapted version of SAVE-9 and SAVE-6) was adopted based on the results of the parallel analysis. Because SAVE-6 showed good construct validity, but the adapted version of SAVE-9 did not, we adopted to apply the SAVE-6 scale to assess the anxiety response of public workers in response to the viral epidemic. SAVE-6 showed good internal consistency (Cronbach's alpha = 0.817; McDonald's Omega = 0.818) and good convergent validity with GAD-7 (rho = 0.417, p < 0.001) and PHQ-9 (rho = 0.317, p < 0.001) scale scores. The appropriate cut-off score for SAVE-6 was determined to be ≥ 16. Conclusion: The SAVE-6 scale, as compared to the public workers' version of SAVE-9, is a reliable and valid rating scale to assess the work-related stress and anxiety of public workers due to the viral epidemic.

Disrupted Association Between Empathy and Brain Structure in Attention-Deficit/Hyperactivity Disorder.

OBJECTIVES: To investigate the relationship between brain structure and empathy in early adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS: Nineteen early adolescents with ADHD and 20 healthy controls underwent 3T MRI. All the participants were assessed for different aspects of empathy using measures including the Interpersonal Reactivity Index and Empathy Quotient. Cortical thickness and subcortical structural volume based on T1-weighted scans were analyzed using FreeSurfer. RESULTS: Cognitive empathy (t=-2.52, p=0.016) and perspective taking (t=-2.10, p=0.043) were impaired in the ADHD group compared with the control group. The cluster encompassing the left posterior insular, supramarginal, and transverse temporal cortices [cluster-wise p-value (CWP)=0.001], which are associated with emotional empathy, was significantly smaller in the ADHD group, and the volume of the left nucleus accumbens was greater than that of the control group (F=10.12, p=0.003, effect size=0.22). In the control group, the left superior temporal (CWP=0.002) and lingual cortical (CWP=0.035) thicknesses were positively associated with cognitive empathy, while the right amygdala volume was positively associated with empathic concern (Coef=14.26, t=3.92, p=0.001). However, there was no significant correlation between empathy and brain structure in the ADHD group. CONCLUSION: The ADHD group had a smaller volume of the cortical area associated with emotional empathy than the control group, and there was no brain region showing significant correlation with empathy, unlike in the control group.

Effects of Depression and Resilience of Public Workers on Work-related Stress and Anxiety in Response to the COVID-19 Pandemic.

BACKGROUND: This study explored the clinical variables related to public workers' stress and anxiety regarding the viral epidemic, and the mediating effect of resilience on the relationship between their depression and anxiety in response to coronavirus disease 2019 (COVID-19) pandemic. METHODS: A total of 938 public workers answered anonymous questionnaires in May 2020. The survey included rating scales such as the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), Patients Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Connor-Davidson Resilience Scale 2 items (CD-RISC 2), and subjects also answered whether they were employed in COVID-19 related fields. RESULTS: Married, female, junior, public workers reported a higher level of stress and anxiety in response to the viral epidemic. Furthermore, high levels of stress and anxiety toward the epidemic are defined by high PHQ-9, high GAD-7, and low CD-RISC 2 scores. It could also be seen that resilience mediated the effect of depression in public workers and their stress and anxiety levels toward the epidemic. CONCLUSION: It is important to reduce the psychological burden of public workers and manage their mental health to help them cope with the epidemic wisely and efficiently. Among many mental health factors, psychological resilience represents an essential target for psychological intervention among public workers.

The Schoolteachers' Version of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale for Assessing Stress and Anxiety During the COVID-19 Pandemic.

This study aimed to validate the schoolteachers' version of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) scale. This scale assessed the work-related stress and anxiety response of schoolteachers to the COVID-19 pandemic. A total of 400 schoolteachers participated in an online survey between March 4 and 15, 2021. The survey questionnaire included the schoolteachers' version of the SAVE-9, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorders-7 (GAD-7) scales. A scree test and parallel analysis suggested a single-factor structure model for the schoolteachers' version of the SAVE-9 scale (real-data eigenvalue = 68.89, 95th percentile of the random eigenvalues = 27.56). The SAVE-9 scale showed good internal consistency (Cronbach's alpha = 0.853) and good convergent validity with GAD-7 (rho = 0.545, p < 0.001) and PHQ-9 (rho = 0.434, p < 0.001) scale scores. This, schoolteachers' version of the SAVE-9 scale is a reliable and valid rating scale that can be applied to teachers in a pandemic situation.

White matter integrity in alcohol-dependent patients with long-term abstinence.

ABSTRACT: Based on association studies on amounts of alcohol consumed and cortical and subcortical structural shrinkage, we investigated the effect of chronic alcohol consumption on white matter pathways using probabilistic tractography.Twenty-three alcohol-dependent men (with an average sobriety of 13.1 months) from a mental health hospital and 22 age-matched male healthy social drinkers underwent 3T magnetic resonance imaging. Eighteen major white matter pathways were reconstructed using the TRActs Constrained by UnderLying Anatomy tool (provided by the FreeSurfer). The hippocampal volumes were estimated using an automated procedure. The lifetime drinking history interview, Alcohol Use Disorder Identification Test, Brief Michigan Alcoholism Screening Test, and pack-years of smoking were also evaluated.Analysis of covariance controlling for age, cigarette smoking, total motion index indicated that there was no definite difference of diffusion parameters between the 2 groups after multiple comparison correction. As hippocampal volume decreased, the fractional anisotropy of the right cingulum-angular bundle decreased. Additionally, the axial diffusivity of right cingulum-angular bundle was positively correlated with the alcohol abstinence period.The results imply resilience of white matter in patients with alcohol dependence. Additional longitudinal studies with multimodal methods and neuropsychological tests may improve our findings of the changes in white matter pathways in patients with alcohol dependence.

Association between dementia and systemic rheumatic disease: A nationwide population-based study.

OBJECTIVES: Systemic rheumatic disease is characterized by autoimmunity and systemic inflammation and affects multiple organs. Few studies have investigated whether autoimmune diseases increase the risk of dementia. Herein, we evaluate the relationship between systemic rheumatic disease and dementia through a population-based study using the Korean National Health Insurance Service (NHIS) claims database. METHODS: We conducted a nationwide population-based study using the Korean NHIS database, consisting of individuals who submitted medical claims from 2002-2013. Dementia was defined as having an acetylcholinesterase inhibitors (AChEIs) prescription along with symptoms satisfying the Alzhemier's disease (AD) International Classification of Diseases (ICD)-10 codes (F00 or G30), or vascular dementia (VaD; ICD-10 or F01) criteria. Control subjects were matched to the dementia patients by age and sex. The study group was limited to those diagnosed with rheumatic disease at least 6 months prior to diagnosis of dementia. Rheumatic disease was defined by the following ICD-10 codes: Rheumatoid arthritis (RA: M05), Sjögren's syndrome (SS: M35), systemic lupus erythematosus (SLE: M32), and Behcet's disease (BD: M35.2). RESULTS: Of the 6,028 dementia patients, 261 (4.3%) had RA, 108 (1.6%) had SS, 12 (0.2%) had SLE, and 6 (0.1%) had BD. SLE history was significantly higher in dementia patients (0.2%) than in controls (0.1%) and was associated with dementia (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.19-5.15). In subgroup analysis, SLE significantly increased dementia risk, regardless of dementia type (AD: OR, 2.29; 95% CI, 1.06-4.91; VaD: OR, 4.54; 95% CI, 1.36-15.14). However, these associations were not sustained in the mild CCI or elderly group. CONCLUSION: SLE was independently associated with a higher risk of dementia, including AD and VaD when compared to the control group, even after adjustment. SLE patients (<65 years old) are a high-risk group for early vascular dementia and require screening for early detection and active prevention.

Korean Clinical Practice Guideline for the Diagnosis and Treatment of Insomnia in Adults.

OBJECTIVE: We aim to present a clinical guideline for the diagnosis and treatment of insomnia in adults by reviewing and integrating existing clinical guidelines. The purpose of this guideline is to assist clinicians who perform evidence-based insomnia treatment. METHODS: We selected literature that may be appropriate for use in guideline development from evidence-based practice guidelines that have been issued by an academic or governmental institution within the last five years. The core question of this guideline was made in sentence form including Patient/Problem, Intervention, Comparison, Outcome (PICO) elements. After searching PubMed, EMBASE, and medical guideline issuing agencies, three guidelines were judged to be the most appropriately reviewed, up-to-date, and from trusted sources. RESULTS: The Appraisal of Guidelines for Research and Evaluation (AGREE) II tool was used to evaluate the quality of the three clinical guidelines. The final outcome of the guideline development process is a total of 15 recommendations that report the strength of the recommendation, the quality of evidence, a summary of content, and considerations in applying the recommendation. CONCLUSION: It is vital for clinical guidelines for insomnia to be developed and continually updated in order to provide more accurate evidence-based treatments to patients.

Cognitive and Emotional Empathy in Young Adolescents: an fMRI Study.

OBJECTIVES: We investigated the differences in cognitive and emotional empathic ability between adolescents and adults, and the differences of the brain activation during cognitive and emotional empathy tasks. METHODS: Adolescents (aged 13-15 years, n=14) and adults (aged 19-29 years, n=17) completed a range of empathic ability questionnaires and were scanned functional magnetic resonance imaging (fMRI) during both cognitive and emotional empathy task. Differences in empathic ability and brain activation between the groups were analyzed. RESULTS: Both cognitive and emotional empathic ability were significantly lower in the adolescent compared to the adult group. Comparing the adolescent to the adult group showed that brain activation was significantly greater in the right transverse temporal gyrus (BA 41), right insula (BA 13), right superior parietal lobule (BA 7), right precentral gyrus (BA 4), and right thalamus whilst performing emotional empathy tasks. No brain regions showed significantly greater activation in the adolescent compared to the adult group while performing cognitive empathy task. In the adolescent group, scores of the Fantasy Subscale in the Interpersonal Reactivity Index, which reflects cognitive empathic ability, negatively correlated with activity of right superior parietal lobule during emotional empathic situations (r=-0.739, p=0.006). CONCLUSION: These results strongly suggest that adolescents possess lower cognitive and emotional empathic abilities than adults do and require compensatory hyperactivation of the brain regions associated with emotional empathy or embodiment in emotional empathic situation. Compensatory hyperactivation in the emotional empathy-related brain areas among adolescents are likely associated with their lower cognitive empathic ability.

Prevalence of and factors associated with anxiety and depression in Korean patients with newly diagnosed advanced gastrointestinal cancer.

BACKGROUND/AIMS: The purpose of the present study was to assess the prevalence of and factors associated with anxiety and depression in Korean patients with advanced gastrointestinal cancer. METHODS: One hundred and twenty consecutive patients with newly diagnosed, advanced gastrointestinal cancer who were scheduled to receive palliative chemotherapy between July 2012 and June 2014 were enrolled in this observational prospective study. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9). RESULTS: Thirty-seven patients (30.8%) had anxiety or depression with clinical significance according to HADS or PHQ-9. Multivariate analysis identified lower performance status (odds ratio [OR], 4.19; 95% confidence interval [CI], 1.22 to 14.35; p = 0.023), gastric cancer (OR, 5.39; 95% CI, 0.37 to 78.23; p = 0.018), and knowledge of advanced cancer (OR, 15.07; 95% CI, 1.80 to 125.90; p = 0.012) as significantly associated with anxiety or depression. Twenty-one patients with anxiety or depression visited the psycho-oncologic clinic. In these patients, PHQ-9 score (p = 0.008), global health status (p = 0.023), fatigue (p = 0.047), and appetite loss (p = 0.006) improved from baseline to 3 months after study enrollment. CONCLUSIONS: Approximately 30% of Korean patients with advanced gastrointestinal cancer had anxiety or depression. The prevalence of anxiety or depression was higher in patients with poor performance status, gastric cancer, or knowledge of advanced cancer. Psychiatric interventions may be effective in reducing depression and improving quality of life in cancer patients with anxiety or depression.

Autism and Beauty: Neural Correlates of Aesthetic Experiences in Autism Spectrum Disorder.

OBJECTIVES: The purpose of this study was to investigate whether the neural activity of autism spectrum disorder (ASD) patients is different from that of normal individuals when performing aesthetic judgments. METHODS: We recruited typical ASD patients without savant skills (ASD group, n=17) and healthy controls (HC group, n=19) for an functional magnetic resonance imaging study. All subjects were scanned while performing aesthetic judgment tasks on two kinds of artwork (magnificent landscape images and fractal images). Differences in brain activation between the two groups were assessed by contrasting neural activity during the tasks. RESULTS: The aesthetic judgment score for all images was significantly lower in the ASD group than in the HC group. During the aesthetic judgment tasks, the ASD group showed less activation than the HC group in the anterior region of the superior frontal gyrus, and more activation in the temporoparietal area and insula, regardless of the type of images being judged. In addition, during the aesthetic judgment task for the fractal images, the ASD group exhibited greater neural activity in the amygdala and the posterior region of the middle/inferior temporal gyrus (Brodmann area 37) than the HC group. CONCLUSION: The results of this study suggest that the brain activation patterns associated with aesthetic experiences in ASD patients may differ from those of normal individuals.

Prevalence and clinical characteristics of insomnia and its subtypes in the Korean elderly.

BACKGROUND: Insomnia is known to be associated with psychiatric disorders, other sleep disorders and medical conditions, but the prevalence of insomnia diagnosis has never been estimated according to its subtypes. We studied the prevalence and clinical characteristics of insomnia diagnosis and its subtypes in the Korean elderly population. METHODS: Among 1423 sampled elderly individuals aged 60 years or older, 881 subjects participated in this study. The Athens Insomnia Scale was applied to detect insomnia symptoms, and insomnia diagnosis was finally evaluated using the international classification of sleep disorders, 2nd edition. To define insomnia subtypes, the DSM-IV-based interview, detailed history on sleep disorders and semi-structured interview for medical conditions were performed. Subsyndromal depression was defined when depressive symptoms did not meet the criteria for depressive disorders. RESULTS: The prevalence of insomnia disorder was 32.8% in all subjects, with the prevalence being significantly higher in women than in men (37.9% vs. 25.2%; p<0.001). The prevalence of insomnia subtypes was as follows; psychophysiological insomnia (PI), 20.5%; insomnia due to mental disorder 7.2%; insomnia due to general medical conditions 2.9%; insomnia in other sleep disorders 2.2%, and insomnia due to substance use 0.2%. Among subjects with PI, subsyndromal depression was diagnosed in 53.7%. CONCLUSIONS: Nearly one third of Korean elderly individuals suffer from insomnia and insomnia patients showed diverse comorbid conditions, especially depressive symptoms. By establishing insomnia subtypes, we can plan to treat comorbid conditions as well as insomnia itself.

Volume of hippocampal subfields in patients with alcohol dependence.

Alcohol-induced hippocampal atrophy has been well documented in many studies and is known to affect various subfields. Given the functional heterogeneity of these subfields, we investigated the precise effects of alcohol-induced damage in these areas. Twenty-six male patients with alcohol dependence (alcohol group) and twenty-six age-matched male healthy social drinkers were recruited from a mental health hospital and the community respectively, with the aim of comparing the hippocampal subfields between groups. Each participant underwent a 3T MRI scan. Hippocampal subfield volumes were estimated using an automated procedure and drinking history recorded using Lifetime Drinking History, Alcohol Use Disorder Identification Test, and the Brief Michigan Alcoholism Screening Test. The alcohol group showed a lower total hippocampus volume, specifically in the left presubiculum, fimbria, and bilateral subiculum. Regression analysis assessing the influence of age and group showed that group was a more significant factor than age in most subfields. Our findings suggest that alcohol dependence alters hippocampal subfield volumes. Further longitudinal studies on the interaction of structural and neurocognitive changes would improve our understanding of brain structural changes resulting from long-term alcohol consumption.

Surface-Based Parameters of Brain Imaging in Male Patients with Alcohol Use Disorder.

OBJECTIVE: The structural alteration of brain shown in patients with alcohol use disorder (AUD) can originate from both alcohol effects and genetic or developmental processes. We compared surface-based parameters of patients with AUD with healthy controls to prove the applicability of surface-based morphometry with head size correction and to determine the areas that were sensitive to brain alteration related to AUD. METHODS: Twenty-six abstinent male patients with AUD (alcohol group, mean abstinence=13.2 months) and twenty-eight age-matched healthy participants (control group) were recruited from an inpatient mental hospital and community. All participants underwent a 3T MRI scan. Surface-based parameters were determined by using FreeSurfer. RESULTS: Every surface-based parameter of the alcohol group was lower than the corresponding control group parameter. There were large group differences in the whole brain, grey and white matter volume, and the differences were more prominent after head size correction. Significant group differences were shown in cortical thicknesses in entire brain regions, especially in parietal, temporal and frontal areas. There were no significant group differences in surface areas, but group difference trends in surface areas of the frontal and parietal cortices were shown after head size correction. CONCLUSION: Most of the surface-based parameters in alcohol group were altered because of incomplete recovery from chronic alcohol exposure and possibly genetic or developmental factors underlying the risk of AUD. Surface-based morphometry with controlling for head size is useful in comparing the volumetric parameters and the surface area to a lesser extent in alcohol-related brain alteration.

Characteristics of methods of suicide attempts in Korea: Korea National Suicide Survey (KNSS).

BACKGROUND: Because the method used for a suicide attempt is an important determinant of outcome, these methods should be explored. The present study was a nationwide investigation of suicide attempts and the characteristics of suicidal behavior. AIMS: To compare the suicide methods used in attempted suicides with those used in completed suicides and to examine the factors associated with each phenomenon. METHODS: The present study reviewed the medical charts of subjects who had attempted suicide and subsequently visited the emergency rooms of 17 medical centers from May 1, 2013 to November 7, 2013. All subjects completed a full psychiatric interview conducted by trained psychiatric residents. Suicide-attempt methods were divided into the following six categories: drug poisoning, pesticide poisoning, gassing, cutting, hanging, and others. The associations among demographic variables, related psychiatric variables, and suicide-attempt methods were analyzed using a multinomial regression analysis. RESULTS: Of the 1359 suicide attempts or instrumental suicide-related behaviors with/without injuries and the 14,160 completed suicides, drug poisoning and cutting were the most common suicidal behaviors with/without injuries, but they were the least frequent method of completed suicides. In contrast, hanging and jumping from a height were less common among failed suicide attempts but resulted in a higher percentage of fatalities. Being male, age, and area of residence were associated with pesticide poisoning, whereas previous suicide attempts were associated with cutting, pesticide poisoning, and gassing. CONCLUSION: A previous suicide attempt is a risk factor for suicide; thus, assessing the characteristics of suicide attempts or instrumental suicide-related behaviors with/without injuries is necessary to prevent these attempts. The present findings showed that the methods of suicide used by individuals who only attempted suicide differed from those used by individuals who completed. Of the suicide methods, pesticide poisoning was related to age, residential area (urban), and a history of previous suicide attempts.

The prevalence of and risk factors for sleep-disordered breathing in an elderly Korean population.

BACKGROUND: There are just a few epidemiological studies on sleep-disordered breathing (SDB) in the elderly, and the results are inconsistent. STUDY OBJECTIVES: We sought to investigate the prevalence of and risk factors for SDB in a representative elderly population with the use of attended nocturnal polysomnography (NPSG). METHODS: Among 6,959 individuals aged ≥ 60 years living in Yongin City, Korea, 696 subjects were selected using random sampling. All the subjects were invited to visit a hospital for NPSG, and SDB was defined as an apnea-hypopnea index ≥ 15. RESULTS: Of the 696 participants investigated, 348 participants completed the sleep study and clinical evaluation. SDB was observed in 127 of the 348 participants, and the prevalence of SDB was 36.5% (52.6% in males and 26.3% in females). A body mass index ≥ 25 was associated with SDB in both male and female subjects, particularly in males, whereas snoring was independently associated with SDB in female participants only. In male participants, SDB was a significant risk factor for hypertension (p = 0.025). CONCLUSIONS: SDB was found to be common among elderly Koreans, and it was more prevalent and severe in male than in female subjects. Health consequences of SDB in the elderly need to be further explored.

Relationships between sleep disturbances and gastroesophageal reflux disease in Asian sleep clinic referrals.

OBJECTIVE: Studies on the association between gastroesophageal reflux disease (GERD) and sleep apnea syndrome (SAS) have reported conflicting results, and attention has not been paid to the relationship between GERD and other sleep disorders. The aim of the study was to evaluate the relationship between GERD and various aspects of sleep disturbances. METHODS: A total of 564 subjects who were referred to a sleep laboratory were enrolled in the study. They underwent nocturnal polysomnography (NPSG), and they were asked to complete a GERD questionnaire. The questionnaire consisted of 14 items, and included questions on seven reflux symptoms, namely, heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, coughing and epigastric soreness. Subjects reporting heartburn or acid regurgitation at least once a week were classified as having GERD. RESULTS: Among 564 participants, 51 subjects (9.0%) were diagnosed as having GERD. GERD patients had higher scores in Beck depression inventory (p<.01), Epworth sleepiness scale (p=.03), Pittsburg sleep quality index (p<.01), more spontaneous arousals in NPSG, and more alcohol consumption than non-GERD patients. There was no association between presence of GERD, SAS-related variables, and body mass index (BMI). GERD was significantly associated with poor sleep quality (adjusted OR, 3.5; 95% CI, 1.3-9.3) and depressed mood (adjusted OR, 2.8; 95% CI, 1.5-5.3). CONCLUSION: Poor subjective sleep and depressive symptoms are associated with the presence of GERD with no association between SAS, BMI and GERD. In managing patients with GERD, psychiatric and sleep symptoms need to be evaluated and appropriately treated.

Enhanced cardiorespiratory coupling in patients with obstructive sleep apnea following continuous positive airway pressure treatment.

BACKGROUND: Weak cardiorespiratory coupling (CRC) has been suggested in patients with obstructive sleep apnea (OSA), but the effects of continuous positive airway pressure (CPAP) on CRC remain unclear. We investigated the effects of CPAP treatment on CRC in patients with severe OSA to examine possible reversibility of altered CRC. METHODS: High-resolution electrocardiograms (ECGs) and respiratory signals were simultaneously recorded for 13 never-treated OSA patients at baseline and after CPAP treatment. The analyses were performed on a 15-min daytime recording of ECG and respiration. Heart rate variability (HRV) indices were extracted from ECGs. After computing the sample entropy (SampEn) to quantify the regularity of both heart rate (SampEn(RR)) and respiration rhythm (SampEn(resp)), cross-sample entropy (cross-SampEn) was calculated to measure the interaction between the two signals. Cross-SampEn denotes asynchrony between heart rate and respiration, and thus negatively correlates with CRC. RESULTS: Lower SampEn(RR) and higher cross-SampEn as well as a shift toward sympathetic dominance were found in OSA patients compared with age- and gender-matched controls. CPAP treatment was associated with improved sympathovagal balance, increased SampEn(RR), and enhanced CRC, corresponding to a decrease in the cross-SampEn value from 0.71±0.08 to 0.49±0.06 (P<.001). The effect sizes for the CPAP-induced changes in sympathovagal balance, SampEn(RR), and cross-SampEn were medium to large (0.54-0.90). CONCLUSIONS: The findings of our study indicate reduced CRC in untreated OSA patients and suggest that CPAP treatment may reverse this abnormality.