Weon-Jeong Lim

Effects of 2-Week Nocturnal Oxygen Supplementation and Continuous Positive Airway Pressure Treatment on Psychological Symptoms in Patients With Obstructive Sleep Apnea: A Randomized Placebo-Controlled Study

Abstract Psychological symptom improvement has been observed after continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA). Because CPAP normalizes both sleep disruption and oxyhemoglobin desaturation, the mechanism of psychological symptom improvement is unclear. Using a 3-arm placebo-controlled design, we parsed out the separate effects of treatment on psychological symptoms. OSA patients (N = 38) were monitored 2 nights with polysomnography and then randomized to 2-weeks therapeutic CPAP, placebo CPAP, or O2 supplementation. Pre-and post-treatment, patients completed the Brief Symptom Inventory (BSI): Higher scores indicate greater severity. Repeated measures analysis of covariance reveals a Time × Treatment interaction for BSI Global Severity Index (GSI): significant pre- to post-treatment reductions in GSI with O2 supplementation and therapeutic CPAP, but not placebo CPAP. A Time × Treatment interaction was also found for depression: Depression decreased with O2 supplementation but not with therapeutic CPAP or placebo CPAP. Both therapeutic CPAP and O2 supplementation resulted in decreased psychological symptoms. Results suggest hypoxemia may play a stronger role than sleep disruption vis-à-vis OSA related psychological distress.

Relationship Between Weekend Catch-up Sleep and Poor Performance on Attention Tasks in Korean Adolescents

OBJECTIVE To investigate the relationship between insufficient sleep and poor attention in Korean adolescents, adjusting for potential confounding factors of depressed mood and habitual snoring. DESIGN School-based cross-sectional study. SETTING Eight high schools in 3 cities in the Republic of Korea. PARTICIPANTS A sample of 2638 urban high school students (42.2% male and 57.8% female; mean [SD] age, 17.3 [0.6] years [age range, 14-19 years]) completed questionnaires and computerized attention tasks during the school term. EXPOSURE Weekend catch-up sleep. MAIN OUTCOME MEASURES Self-reported sleep schedules and habits, including sleep duration, bedtime, wake-up time, depressed mood, and habitual snoring. Also measured were numbers of omission and commission errors on computerized attention tasks. RESULTS The mean (SD) sleep duration on weekdays was 5 hours 42 minutes (1 hour 0 minutes) per day and on weekends was 8 hours 24 minutes (1 hour 36 minutes) per day. The mean (SD) weekend catch-up sleep was 2 hours 42 minutes (1 hour 42 minutes) per day. After adjusting for age, sex, depressed mood (Beck Depression Inventory score, ≥10), habitual snoring, and weekday sleep duration, increased weekend catch-up sleep was significantly associated with more omission and commission errors on sustained attention tasks (P < .001 and P = .03, respectively) and on divided attention tasks (P = .01 and P = .04, respectively). CONCLUSIONS Increased weekend catch-up sleep as an indicator of insufficient weekday sleep is associated with poor performance on objective attention tasks. Assessment of catch-up sleep and sleep duration may be useful for physicians to evaluate sleep insufficiency and its adverse effects on attention in adolescents.

Which Measures of Obesity Are Related to Depressive Symptoms and in Whom

The authors asked which obesity measurements were associated with depressive symptoms, whether this relationship differed by gender, and whether controlling for fatigue and response bias affected the relationship. A sample of 129 subjects (66 men, 63 women), with a mean age of 36.9 years and a mean Body Mass Index (BMI) of 26.4 participated in the study. Depressive symptoms, levels of fatigue, response bias, and anthropometrics were assessed. In women, but not men, BMI and percent of ideal body weight were related to depression. However, percent of body fat did not show a relationship with depression after controlling for fatigue and response bias. These findings suggest that womens depressive symptoms are more influenced by body size than body fat composition, whereas mens depressive symptoms seem to be unrelated to obesity.

Weekend catch-up sleep is independently associated with suicide attempts and self-injury in Korean adolescents

The current study aims to determine the associations of insufficient sleep with suicide attempts and self-injury in a large, school-based Korean adolescent sample. A sample of 4553 middle- and high-school students (grades 7-10) was recruited in this study. Finally, 4145 students completed self-report questionnaires including items on sleep duration (weekday/weekend), self-injury, suicide attempts during the past year, the Suicidal Ideation Questionnaire (SIQ), and the Beck Depression Inventory (BDI). A multiple linear regression model showed that higher SIQ scores were associated with longer weekend catch-up sleep duration (p=0.009), higher BDI score (p<0.001), and longer time spent in a private educational institute (p=0.025). The multiple logistic regression analysis revealed that longer weekend catch-up sleep duration (p=0.011), higher BDI score (p<0.001), longer time spent in a private educational institute (p=0.046), and poorer academic record (p=0.029) were associated with suicide attempt and self-injury during the past year. The present results suggest that weekend catch-up sleep duration--which is an indicator of insufficient weekday sleep--might be associated with suicide attempts and self-injury in Korean adolescents.

The relationship between psychotic-like experiences and attention deficits in adolescents

OBJECTIVE The present study focused on the relationship between psychotic-like experiences (PLEs) and attention deficits in adolescents. METHODS A total of 2325 students, ages 14-19 years, across eight high schools in the Republic of Korea were recruited. Students performed the computerized Comprehensive Attention Test (CAT), which measures sustained and divided attention, and completed the Eppendorf Schizophrenia Inventory (ESI) and Beck Depression Inventory (BDI). One hundred sixty-six participants were excluded from the present study due to incomplete answers on the ESI; thus, data from 2159 students were included in the final analysis. RESULTS Higher ESI scores predicted more omission and commission errors in divided-attention tasks after controlling for age, sex, and depressed mood (p = 0.024; p = 0.001, respectively). Attention and speech impairments on the ESI were the most frequent predictors of an increased number of errors in the attention tasks. All four ESI domains predicted the number of commission errors in divided-attention tasks (p < 0.001, p = 0.040, p = 0.046, and p = 0.013, respectively). In the high-risk group for psychosis (ESI ≥ 29), higher scores on the ideas of reference subscale were significantly associated with a higher number of both omission and commission errors in divided-attention tasks (p = 0.006, p = 0.017, respectively). CONCLUSIONS PLEs during adolescents were associated with impaired attention on the divided-attention task, which demands increased attentional effort. Attention deficits in adolescents prone to psychosis may be related to thought-content disturbances rather than to cognitive and perceptual symptoms.

A Study on Correlation between Anxiety Symptoms and Suicidal Ideation.

Objective In South Korea, the number of deaths from suicide has increased in the last two decades, and suicide has become both a social and political problem. In this study, after controlling the variables influencing suicidal ideation, it was expected that it would be determined if anxiety symptoms are independently related to suicidal ideation. Methods Data were obtained from 327 psychiatric outpatients accomplished a self-reported questionnaire that included sociodemographic characteristics and clinical variables as well as self-rating scales for measuring the severity of ones anxiety, depression, and suicidal ideation. Logistic-regression analyses were used to determine the correlation between anxiety symptoms and significant suicidal ideation, adjusting for covariates. Results The patients with significant suicidal ideation were shown to be less educated, unemployed, never married, divorced, or separated by death, or living alone, and were shown to have a lower income, a drinking habit, a higher number of past suicide attempts, and more family members who committed suicide, than the patients without significant suicidal ideation. After adjusting the covariates influencing significant suicidal ideation, anxiety symptoms were associated with significant suicidal ideation. However, after adjusting for depressive symptoms, only the trait anxiety was associated with significant suicidal ideation. Conclusion These findings suggest that anxiety symptoms are an independent risk factor for suicidal ideation. Clinicians may thus use anxiety symptoms for the screening examination when evaluating suicidal ideation and risk, and will have to actively evaluate and treat the anxiety symptoms of patients with suicidal tendencies.

The Associations of Coping Mechanism with Arterial Stiffness in Hwa-Byung Patients

Objective The goal of this study is to assess the relationship between stress coping mechanisms and the risk of atherosclerosis in patients with Hwa-Byung. Methods The Korean version of the Ways of Coping Checklist (WOCC) was administered to 50 patients with Hwa-Byung (49.1±10.1 years, 6 males). Brachial-ankle pulse wave velocity (baPWV) and serum cholesterol level were assessed in all participants. Results After controlling for age, sex, diagnosis of hypertension, Body Mass Index (BMI), and serum cholesterol level, the score of seeking social support in coping strategies was negatively correlated with right and left baPWV (r=-0.356, p=0.016; r=-0.373, p=0.012, respectively). In addition, the score of active coping mechanism was negatively correlated with both sides of baPWV (r=-0.383, p=0.009; r=-0.389, p=0.008, respectively). Conclusion The seeking social support and active coping mechanism were inversely related to the severity of arterial stiffness in Hwa-Byung patients. Therefore, our result may suggest a possibility that coping strategies in Hwa-Byung patients are associated with the risk of atherosclerosis.

Psychological and genetic risk factors associated with suicidal behavior in Korean patients with mood disorders

INTRODUCTION To prevent suicide, a nationwide important issue in Korea, understanding its etiology is essential. This study aimed to delineate the risk factors for suicidal behavior in mood disorder patients in Korea. METHODS 216 patients with mood disorders were recruited. We measured suicidal ideation (SI) and suicide attempt (SA) history and the association of six gene polymorphisms with SB: COMT (rs4680), HTR1A (rs6295), TPH1 (rs1800532), BDNF (rs6265), SLC1A3 (rs2269272), and SLC1A2 (rs4755404). RESULTS Patients in the high-SI and SA groups reported more severe depressive, hopelessness, and anxiety symptoms and lower resilience and used less social support-seeking coping than those in the non-significant SI and non-SA groups. Multivariate logistic analysis revealed that depressive disorder, depressive symptoms, poor social support, and less social support-seeking coping were significant independent predictors of suicidal ideation. After adjustment for covariates, age, alcohol consumption, and the rs4680 AA genotype in the COMT gene were associated with suicide attempt. LIMITATIONS The modest sample size and a relatively few candidate genes are limitations of the study. In addition, there is no normal control group and the retrospective evaluation of SA limits the interpretation of the causal relationship with factors affecting SA. CONCLUSIONS Suicidal behavior in Korean patients with mood disorders may be associated with younger age, alcohol consumption, depressive symptoms, poor social support, less social support-seeking coping, and the COMT rs4680 Met/Met genotype.