Su-Hyun Han

The utility of a Korean version of the REM sleep behavior disorder screening questionnaire in patients with obstructive sleep apnea.

PURPOSE To explore the utility of a Korean version of the rapid eye movement sleep behavior disorder screening questionnaire (RBDSQ-K) to discriminate patients with idiopathic REM sleep behavior disorder (iRBD) from patients with obstructive sleep apnea (OSA) and healthy subjects. METHODS Participants with iRBD (n=47) and OSA (n=213) were diagnosed by polysomnography. In healthy subjects (n=58), RBD was excluded by medical history without polysomnography. Receiver operating characteristic curve analysis was used to identify the optimal cutoff value of the RBDSQ-K for iRBD. RESULTS RBDSQ-K score was higher in iRBD subjects than in OSA subjects and healthy subjects (both p<0.001). The optimal cutoff was 6.5 to distinguish iRBD subjects from OSA subjects and 4.5 to distinguish iRBD subjects from healthy subjects. The corresponding sensitivity and specificity was high for detecting iRBD from OSA and healthy subjects. The percentages of individuals with RBDSQ-K scores ≥5 and ≥7 were higher in OSA subjects with daytime sleepiness (36.1% and 13.8%, respectively) than in OSA subjects without daytime sleepiness (12.0% and 3.1%, respectively). Apnea-hypopnea index had no influence on RBDSQ-K score. Cronbachs alpha for the RBDSQ-K was 0.768, indicating a high degree of internal consistency. CONCLUSIONS The RBDSQ-K had acceptable sensitivity and specificity for screening persons with probable RBD from healthy subjects and OSA subjects when the cutoff score was 4.5 and 6.5 points, respectively. However, attention must be paid to the possibility of false positives when using this scale, especially in OSA subjects with daytime sleepiness.

Anxiety and its relationship to quality of life independent of depression in patients with obstructive sleep apnea

OBJECTIVES The relationship between anxiety and obstructive sleep apnea (OSA) has not been well studied. We evaluated the factors associated with anxiety and whether anxiety is related to quality of life (QoL) independently of depression in OSA patients. METHODS Data were collected from adults with newly diagnosed, untreated OSA. The State-Trait Anxiety Inventory-State Scale (STAI-S), the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS), and the Short Form 36 Health survey (SF-36) were used. Anxiety and depression were defined as high levels of anxiety symptoms (STAI-S score≥40) and depressive symptoms (BDI≥10), respectively. Associations between anxiety and OSA were analyzed using multiple linear regression analysis. RESULTS Of 655 OSA subjects included, the prevalence of anxiety and depression was 48.4% and 46.4%, respectively. The scores of STAI-S had strong correlations with BDI (r=0.676, p<0.001). Female sex (p<0.05), excessive daytime sleepiness (ESS≥10) (p<0.05), and a lower educational level (p<0.05) were identified as independent factors for predicting the presence of anxiety in OSA patients. The severity of OSA measured by the apnea-hypopnea index or respiratory distress index was not related to comorbid anxiety. In linear regression analysis, both anxiety (ß=-10.196, p<0.001) and depression (ß=-16.317, p<0.001) were independently associated with lower SF-36 scores in OSA patients. CONCLUSIONS The presence of anxiety can be predicted by female sex, daytime sleepiness, and a lower educational level. Both anxiety and depression were independently associated with a lower QoL in OSA patients.

Contribution of the family environment to depression in Korean adults with epilepsy

PURPOSE Depression is common in adults with epilepsy and an important factor that affects quality of life in these individuals. However, there are few studies on the interactions between epilepsy and family factors in adults and we here investigate this association. METHODS This cross-sectional, multicenter study collected data on 391 adults with epilepsy and their caregivers recruited from 27 hospitals throughout Korea. The Beck Depression Inventory (BDI), Stigma Scale, and Caregiver Burden Inventory (CBI) were used to evaluate the study population. Multivariate analysis was conducted using hierarchical linear regression. The Sobel test and structural equation modeling were used to examine interrelationships among the potential factors. RESULTS The mean patient BDI score was 16.3 (SD=11.1). Depressive symptoms (BDI≥10) were in 68.3% and 57.0% in patients and their caregivers, respectively. Hierarchical linear regression analysis only identified caregiver BDI (β=0.219; p<0.001) as an independent factor related to patient BDI. The mediational model suggested that caregiver BDI mediated the effects of other family factors on patient BDI: caregivers educational level (p=0.002), caregivers CBI score (p<0.001), caregivers Stigma Scale score (p<0.001), and family APGAR score (p<0.001). In addition, structural equation modeling showed that the relation between caregiver and patient BDI was unidirectional. CONCLUSION Caregiver depression is the most important contributor to depression in adults with epilepsy. The other family factors such as caregivers perception of burden and the level of family function are indirectly correlated with patient depression via the mediating effects of caregiver depression.

Sleep hygiene and its association with mood and quality of life in people with epilepsy.

OBJECTIVES We determined whether sleep hygiene is directly related to mood and quality of life (QoL) in people with epilepsy and, if not, documented the indirect effects of sleep hygiene through sleep quality. METHODS Data were collected from 150 adults with epilepsy. The Sleep Hygiene Index (SHI), Quality of Life in Epilepsy-10 (QOLIE-10), Hospital Anxiety and Depression Scale (HADS), Sleep Problems Index-2 (SPI-2) of the Medical Outcomes Study-Sleep Scale, and Epworth Sleepiness Scale (ESS) were used. To determine the direct and indirect associations between SHI, mood, and QoL, multiple linear regression analyses and the Sobel test were performed. RESULTS Inadequate sleep hygiene behaviors were answered affirmatively by ≥15% of the participants represented by 6 out of 13 items of the SHI. A younger age was independently related to higher SHI scores (p=0.013). The higher SHI scores were directly related to lower QoL independent of sleep quality, anxiety, and depressive symptoms (p<0.05) but not independently related to anxiety and depressive symptoms. The Sobel test confirmed that the SHI scores were associated with anxiety and depressive symptoms through sleep quality (p<0.001). CONCLUSIONS Inadequate sleep hygiene is independently related to low QoL but indirectly related to anxiety and depressive symptoms through sleep quality. Patients of a younger age are at risk of poorer sleep hygiene.

Sleep hygiene and its association with daytime sleepiness, depressive symptoms, and quality of life in patients with mild obstructive sleep apnea.

PURPOSE To investigate the direct and indirect associations of sleep hygiene with daytime sleepiness, depressive symptoms, and quality of life (QoL), in newly diagnosed, untreated patients with mild obstructive sleep apnea (OSA). METHODS Data were collected from adults with mild OSA. The Sleep Hygiene Index (SHI), Sleep Problems Index-1 (SPI-1) of the Medical Outcomes Study-Sleep Scale, Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Medical Outcomes Study Short-Form Health survey (SF-36) were used to evaluate patients. To determine the indirect and direct associations between SHI and disease outcomes, the Sobel test and multiple linear regression analyses were used, respectively. When we evaluated the direct associations, we excluded 3 items of the original SHI which were more reflective of general health rather than sleep-specific habits and environments. RESULTS In total, 260 patients with mild OSA participated in this study. The average age, AHI, and SHI scores were 49.1 years (SD 12.5), 9.3/h (SD 2.9), and 24.7 (SD 6.0), respectively. Here, ≥ 10% of participants indicated poor sleep hygiene behaviors on 7 of 13 items. Young age and men were associated with higher SHI scores (both p<0.01). The 13-item SHI scores were indirectly related to ESS, BDI, and SF-36 scores via SPI-1 (all p<0.05). The 10-item SHI scores were related to ESS (p=0.049) and SF-36 (p=0.001), but not to BDI, independently of SPI-1 or other confounding factors in mild OSA patients. Age, sex, AHI, and body mass index were not related to ESS, BDI, or total SF-36 scores. CONCLUSIONS Sleep hygiene is indirectly related to daytime sleepiness, depressive symptoms, QoL via sleep quality and also related to daytime sleepiness and QoL independent of sleep quality in mild OSA patients.

Family factors contributing to emotional and behavioral problems in Korean adolescents with epilepsy.

PURPOSE We aimed to determine whether different aspects of family functioning are associated with emotional and behavioral problems in adolescents with epilepsy and, if not, to document any indirect associations mediated by other family factors. METHODS This was a cross-sectional, multicenter study. A total of 297 adolescents with epilepsy and their parents participated. Adolescent psychopathology was measured using the Youth Self-Report. Family factors were classified into proximal (parent-child interaction), distal (parent characteristics), and contextual factors (family characteristics) in accordance to their level of proximity to the adolescents everyday life. Regression analyses were used to analyze the unique and combined predictive power of family factors in relation to psychopathology. RESULTS In total, 44 (14.8%) and 51 (17.2%) adolescents with epilepsy scored above the borderline cutoff (T-score ≥ 60) of internalizing and externalizing problems, respectively. Proximal and distal factors were independently associated with both internalizing and externalizing problems. High levels of parental depressive mood and parental overcontrol were the strongest factors contributing to internalizing and externalizing problems, respectively. Contextual factors were indirectly associated with both internalizing and externalizing problems through more proximal factors. CONCLUSIONS Both proximal and distal family factors affect psychopathology in Korean adolescents with epilepsy. Parental feelings of depression and parental overcontrol are the strongest factors contributing to internalizing and externalizing problems, respectively.

A Case of Phenytoin-induced Rhabdomyolysis in Status Epilepticus.

Phenytoin is a commonly used antiepileptic drug, especially when treating status epilepticus. Here, we present a patient who suffered from status epilepticus and developed rhabdomyolysis after being treated with phenytoin. As multiple seizures itself can induce rhabdomyolysis, it is difficult to recognize that phenytoin can be the cause of rhabdomyolysis in status epilepticus patients. Even though phenytoin is a rare cause of rhabdomyolysis, we should discern that phenytoin can be a causative drug to bring about rhabdomyolysis.