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Pathological Gambling Disorder Associated With Modafinil Therapy in a Patient With Type 1 Narcolepsy 病理性赌博障碍与莫达非尼治疗在1型发作性睡患者中的相关性
Pub Date : 2023-04-30 DOI: 10.13078/jsm.230011
Dong-Hyeon Shin, Hyun-Woo Kim, M. Park, Sang Jun Park, Jae Wook Cho
We report the case of a 22-year-old man with type 1 narcolepsy who experienced pathological gambling after modafinil therapy. The patient was administered with modafinil, which improved excessive daytime sleepiness (EDS). However, he experienced heart palpitations and nervousness, eventually developing gambling addiction. After six months of modafinil therapy, he engaged in various online gambling activities, leading to significant financial loss and stress. Consequently, modafinil was replaced with pitolisant, which is a potent and selective antagonist/inverse agonist of histamine H3 receptor. One month after modafinil discontinuation, EDS symptoms were well controlled with pitolisant and gambling urge was resolved. Modafinil is prescribed as a first-line therapy for treating EDS symptoms in patients with narcolepsy. However, it may cause psychiatric side effects via the dopaminergic system. Alternatively, pitolisant could be used to avoid modafinil’s psychiatric side effects in patients with narcolepsy.
我们报告的情况下,22岁的男子1型嗜睡症谁经历病理性赌博后莫达非尼治疗。患者给予莫达非尼,改善白天过度嗜睡(EDS)。然而,他经历了心悸和紧张,最终染上了赌博瘾。经过六个月的莫达非尼治疗后,他参与了各种在线赌博活动,导致了重大的经济损失和压力。因此,莫达非尼被吡托利坦取代,这是一种有效的选择性组胺H3受体拮抗剂/逆激动剂。停用莫达非尼1个月后,EDS症状得到很好的控制,赌博冲动得到缓解。莫达非尼是治疗发作性睡症患者EDS症状的一线药物。然而,它可能通过多巴胺能系统引起精神方面的副作用。另外,pitolisant可用于避免莫达非尼对嗜睡症患者的精神副作用。
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引用次数: 0
Strategies for Adaptation to Shift Work 适应轮班工作的策略
Pub Date : 2023-04-30 DOI: 10.13078/jsm.230009
S. Choi
More than 20% of the industrialized workforce includes shift workers. The misalignment between their work schedules and circadian clock-driven sleep-wake cycles can result in excessive sleepiness during work and disturbed sleep after work. Shift work is associated with various negative health consequences, and workers are at risk for shift work disorder. In this review, we focus on strategies to facilitate shift work adaptation, including medication, light therapy, scheduled sleep and naps, flexible shift schedules, sleep hygiene, and family and social support to promote sleep, wakefulness, and adaptation to the circadian clock. An integrated approach that combines multiple management strategies in contrast to a single approach, can enable more effective shift work adaptation.
超过20%的工业化劳动力包括轮班工人。他们的工作时间表和生物钟驱动的睡眠-觉醒周期之间的不一致可能导致工作期间过度困倦,下班后睡眠受到干扰。轮班工作与各种负面健康后果有关,工人面临轮班工作障碍的风险。在这篇综述中,我们重点介绍了促进轮班工作适应的策略,包括药物治疗、光疗、安排睡眠和小睡、灵活的轮班安排、睡眠卫生、家庭和社会支持,以促进睡眠、觉醒和对生物钟的适应。与单一方法相比,结合多种管理策略的综合方法可以更有效地适应轮班工作。
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引用次数: 0
Proportion and Associated Clinical Factors of Paradoxical Insomnia in Patients With Chronic Insomnia: A Retrospective and Observational Study 慢性失眠症患者矛盾性失眠的比例及相关临床因素:一项回顾性观察性研究
Pub Date : 2023-04-30 DOI: 10.13078/jsm.230007
J. No, Jiyoung Kim, Gha-Hyun Lee, Jae Wook Cho, Hyun-Woo Kim
Objectives: Paradoxical insomnia, a type of sleep disorder, is characterized by misperception and underestimation of an individual’s sleep time. In this study, we investigated the percentage and clinical factors associated with paradoxical insomnia in patients with chronic insomnia, who underwent polysomnography.Methods: The study included 148 patients with chronic insomnia. The study population was categorized into paradoxical and non-paradoxical insomnia groups. The following criteria were used to define paradoxical insomnia: 1) total sleep time >390 min and sleep efficiency ≥85.0%, and 2) significant discrepancy of >1 hour between subjective and objective sleep measurements. We analyzed demographic data, polysomnographic parameters, and perceived sleep time in all patients.Results: Among 148 patients with chronic insomnia, 33 (22.6%) had paradoxical insomnia. We observed significant intergroup differences in age, sex, and the Insomnia Severity Index (ISI). Sleep architecture patterns were relatively better in the paradoxical than in the non-paradoxical insomnia group. Logistic regression analysis was performed to determine clinical factors associated with paradoxical insomnia. Female sex (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.19–7.37), age (OR 0.97, 95% CI 0.94–0.99), and ISI (OR 1.18, 95% CI 1.05–1.31) were significantly associated with paradoxical insomnia.Conclusions: Approximately 20.0% of patients with chronic insomnia were classified into the paradoxical insomnia group, and female sex, age, and ISI were identified as clinical factors associated with this type of sleep disorder.
目的:矛盾性失眠是一种睡眠障碍,其特征是对个体睡眠时间的误解和低估。在这项研究中,我们调查了慢性失眠症患者接受多导睡眠图检查时与矛盾性失眠相关的百分比和临床因素。方法:对148例慢性失眠症患者进行研究。研究人群被分为矛盾型和非矛盾型失眠症组。悖论性失眠的定义标准为:1)总睡眠时间>390 min,睡眠效率≥85.0%;2)主观睡眠测量值与客观睡眠测量值差异大于1小时。我们分析了所有患者的人口统计数据、多导睡眠图参数和感知睡眠时间。结果:148例慢性失眠症患者中,33例(22.6%)为矛盾性失眠症。我们观察到年龄、性别和失眠严重程度指数(ISI)的显著组间差异。矛盾型失眠组的睡眠结构模式相对好于非矛盾型失眠组。采用Logistic回归分析确定与矛盾性失眠相关的临床因素。女性性别(比值比[OR] 2.96, 95%可信区间[CI] 1.19-7.37)、年龄(OR 0.97, 95% CI 0.94-0.99)和ISI (OR 1.18, 95% CI 1.05-1.31)与矛盾性失眠显著相关。结论:大约20.0%的慢性失眠症患者被归类为矛盾型失眠症组,女性性别、年龄和ISI被确定为与这类睡眠障碍相关的临床因素。
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引用次数: 0
An Uncommon Cause of Hypersomnolence 嗜睡的罕见原因
Pub Date : 2023-04-29 DOI: 10.5005/jp-journals-10069-0109
Vidushi Rathi, P. Ish, Nitesh Gupta, Mahendran Arul Janakiammal, M. Madan
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引用次数: 0
Insomnia: An Under-recognized Mental Health Catastrophe during the COVID-19 Era 失眠:新冠肺炎时代一场被低估的心理健康灾难
Pub Date : 2023-04-29 DOI: 10.5005/jp-journals-10069-0107
V. Nangia, Amina Mobashir, S. Shenoy, Navin Dalal, Rohit R Chandran
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引用次数: 0
Smartphones and Consumer Devices in Management of Obstructive Sleep Apnea 智能手机和消费类设备治疗阻塞性睡眠呼吸暂停
Pub Date : 2023-04-29 DOI: 10.5005/jp-journals-10069-0108
Kamaldeep Singh, Arpit Jain, Ishita Panchal, Hritik Madan, S. Chaturvedi, Anastas Kostojchin, A. Shahzadi, Muzammil M Khan, S. Piplani
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引用次数: 0
A Review of the Current Status of Home Sleep Apnea Testing vis-à-vis In-lab Polysomnography: Is Old Still Gold? 家庭睡眠呼吸暂停测试现状综述-à-vis实验室多导睡眠描记术:老还是金吗?
Pub Date : 2023-04-29 DOI: 10.5005/jp-journals-10069-0106
J. Suri, T. Suri
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引用次数: 0
The Oxygen Desaturation Index for Severity Assessment of Obstructive Sleep Apnea Associated With Cigarette Smoking 评价吸烟相关阻塞性睡眠呼吸暂停严重程度的氧去饱和指数
Pub Date : 2022-12-28 DOI: 10.13078/jsm.220024
Sujin Lee, Min Jae Seong, E. Joo
Objectives: Nicotine stimulates release of neurotransmitters that regulate the sleep-wake cycle and thereby leads to insomnia. Smoking is associated with upper airway distress; however, its role in severe sleep-related breathing disorders remains controversial. In this study, we investigated the effects of smoking on obstructive sleep apnea (OSA).Methods: We investigated 1,163 patients diagnosed with OSA who underwent polysomnography between March 2020 and July 2022. We recorded details including smoking status (current, former, and non-smoker), demographics, questionnaire-related data, and polysomnography findings and performed univariate analysis to compare these variables between smokers and non-smokers. We also analyzed the correlation between smoking status and OSA severity. The risk of smoking on the severity of OSA was determined using logistic regression analysis.Results: Current and former smokers included 461 male (49.1%) and 10 female (4.4%) (p=0.001). Smokers had a high apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) (p<0.001), high arousal index (p=0.001), and severe daytime sleepiness (indicated by the Epworth Sleepiness Scale, p<0.001). We observed no correlation between the AHI and the number of cigarettes smoked per day and the duration of smoking. Logistic regression analysis after adjustment for age, sex, body mass index, and alcohol consumption showed that smoking was a risk factor for ODI (ODI >15, odds ratio 1.33, p=0.04), and AHI was independent of smoking.Conclusions: Controversy regarding the severity of OSA with smoking has currently not been definitively determined. However, our results provide new evidence to support the association between smoking and the ODI, which few studies have investigated to date.
目的:尼古丁刺激调节睡眠-觉醒周期的神经递质的释放,从而导致失眠。吸烟与上呼吸道窘迫有关;然而,它在严重睡眠相关呼吸障碍中的作用仍然存在争议。在这项研究中,我们调查了吸烟对阻塞性睡眠呼吸暂停(OSA)的影响。方法:我们调查了1163名诊断为OSA的患者,他们在2020年3月至2022年7月期间接受了多导睡眠图检查。我们记录了详细信息,包括吸烟状况(现在、以前和不吸烟)、人口统计、问卷相关数据和多导睡眠图结果,并进行单变量分析,比较吸烟者和非吸烟者之间的这些变量。我们还分析了吸烟状况与OSA严重程度的相关性。采用logistic回归分析确定吸烟对OSA严重程度的影响。结果:目前和曾经吸烟的男性461人(49.1%),女性10人(4.4%)(p=0.001)。吸烟者呼吸暂停低通气指数(AHI)和氧去饱和指数(ODI)较高(p15,优势比1.33,p=0.04), AHI与吸烟无关。结论:关于阻塞性睡眠呼吸暂停与吸烟的严重程度的争议目前尚未明确确定。然而,我们的研究结果为支持吸烟和ODI之间的联系提供了新的证据,迄今为止很少有研究对此进行调查。
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引用次数: 0
Magnetic Resonance Imaging of the Glymphatic System in the Human Brain 人脑淋巴系统的磁共振成像
Pub Date : 2022-12-28 DOI: 10.13078/jsm.220025
H. Lee, K. Park
Our conventional understanding of fluid transport across the brain has significantly changed over the last decade after introduction of the concept of the glymphatic system and discovery of meningeal lymphatics. The glymphatic system is not a true anatomical structure but merely a functional system for cerebrospinal fluid (CSF) and interstitial fluid exchange, whereby the CSF enters the brain through the periarterial space. This movement is driven by a few potential driver mechanisms. The CSF thereafter travels to the interstitium facilitated by aquaporin 4 channels in the astrocytic end feet and subsequently through the interstitium via diffusion and convection/advection and finally exits through the perivenous space. In this review, we describe magnetic resonance imaging (MRI) techniques that have been used or may potentially be useful to analyze the glymphatic system, together with a brief summary and discussion of limitations. MRI, a widely used clinical modality, may potentially provide deeper understanding of the pathophysiology of various diseases based on the concept of the glymphatic system.
在引入淋巴系统的概念和发现脑膜淋巴管后,我们对脑内液体运输的传统理解在过去十年中发生了重大变化。淋巴系统不是一个真正的解剖结构,而仅仅是脑脊液和间质液交换的功能系统,脑脊液通过动脉周围间隙进入大脑。这种运动是由几个潜在的驱动机制驱动的。脑脊液随后通过星形细胞端足的水通道蛋白4通道进入间质,随后通过扩散和对流/平流穿过间质,最后通过静脉周围间隙退出。在这篇综述中,我们描述了磁共振成像(MRI)技术已经使用或可能是有用的分析淋巴系统,并简要总结和局限性的讨论。MRI是一种广泛应用于临床的方法,它可能基于淋巴系统的概念,为各种疾病的病理生理学提供更深入的了解。
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引用次数: 0
The Grey Zone in Multiple Sleep Latency Test for Diagnosis of Narcolepsy: A Survey of Korean Neurologist 多次睡眠潜伏期试验诊断发作性睡的灰色地带:韩国神经科医生的调查
Pub Date : 2022-12-28 DOI: 10.13078/jsm.220018
H. Im, Y. Hong, Jae Wook Cho, J. Sunwoo, Daeyoung Kim, D. Koo, S. Yim, Hyeyun Kim, Kyung Min Kim, Y. Jung, Kwang Ik Yang
Objectives: Clinicians often depend on the results of the the multiple sleep latency test (MSLT) for diagnosing narcolepsy, but the diagnosis can be confusing when there is a co-existence of obstructive sleep apnea (OSA). This study is aimed to address the diagnostic tendency and the strategies of treatment for narcolepsy and other hypersomnia in the grey zone.Methods: We performed a web-based survey of Korean neurologists who were interested in narcolepsy and had experience with sleep studies.Results: The results of this survey present their concerns according to the severity of comorbid OSA in analyzing the results of the MSLT.Conclusions: This study also might help by providing the opinions of experienced Korean neurologists for the assessment and management of excessive daytime sleepiness.
目的:临床医生通常依靠多次睡眠潜伏期试验(MSLT)的结果来诊断发作性睡病,但当同时存在阻塞性睡眠呼吸暂停(OSA)时,诊断可能会令人困惑。本研究旨在探讨灰色地带嗜睡症和其他嗜睡症的诊断倾向和治疗策略。方法:我们对对发作性睡病感兴趣并有睡眠研究经验的韩国神经科医生进行了一项基于网络的调查。结果:本调查结果在分析MSLT结果时,根据共病性OSA的严重程度提出了他们的关注。结论:本研究可提供韩国资深神经科医师对日间过度嗜睡之评估与处理之意见。
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引用次数: 0
期刊
Indian journal of sleep medicine
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