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.
{"title":"Pathological Gambling Disorder Associated With Modafinil Therapy in a Patient With Type 1 Narcolepsy","authors":"Dong-Hyeon Shin, Hyun-Woo Kim, M. Park, Sang Jun Park, Jae Wook Cho","doi":"10.13078/jsm.230011","DOIUrl":"https://doi.org/10.13078/jsm.230011","url":null,"abstract":"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.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88029258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Strategies for Adaptation to Shift Work","authors":"S. Choi","doi":"10.13078/jsm.230009","DOIUrl":"https://doi.org/10.13078/jsm.230009","url":null,"abstract":"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.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79042838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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。
{"title":"Proportion and Associated Clinical Factors of Paradoxical Insomnia in Patients With Chronic Insomnia: A Retrospective and Observational Study","authors":"J. No, Jiyoung Kim, Gha-Hyun Lee, Jae Wook Cho, Hyun-Woo Kim","doi":"10.13078/jsm.230007","DOIUrl":"https://doi.org/10.13078/jsm.230007","url":null,"abstract":"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.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90457221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 10.5005/jp-journals-10069-0109
Vidushi Rathi, P. Ish, Nitesh Gupta, Mahendran Arul Janakiammal, M. Madan
{"title":"An Uncommon Cause of Hypersomnolence","authors":"Vidushi Rathi, P. Ish, Nitesh Gupta, Mahendran Arul Janakiammal, M. Madan","doi":"10.5005/jp-journals-10069-0109","DOIUrl":"https://doi.org/10.5005/jp-journals-10069-0109","url":null,"abstract":"","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44203990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 10.5005/jp-journals-10069-0107
V. Nangia, Amina Mobashir, S. Shenoy, Navin Dalal, Rohit R Chandran
{"title":"Insomnia: An Under-recognized Mental Health Catastrophe during the COVID-19 Era","authors":"V. Nangia, Amina Mobashir, S. Shenoy, Navin Dalal, Rohit R Chandran","doi":"10.5005/jp-journals-10069-0107","DOIUrl":"https://doi.org/10.5005/jp-journals-10069-0107","url":null,"abstract":"","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44485229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 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
{"title":"Smartphones and Consumer Devices in Management of Obstructive Sleep Apnea","authors":"Kamaldeep Singh, Arpit Jain, Ishita Panchal, Hritik Madan, S. Chaturvedi, Anastas Kostojchin, A. Shahzadi, Muzammil M Khan, S. Piplani","doi":"10.5005/jp-journals-10069-0108","DOIUrl":"https://doi.org/10.5005/jp-journals-10069-0108","url":null,"abstract":"","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47318249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 10.5005/jp-journals-10069-0106
J. Suri, T. Suri
{"title":"A Review of the Current Status of Home Sleep Apnea Testing vis-à-vis In-lab Polysomnography: Is Old Still Gold?","authors":"J. Suri, T. Suri","doi":"10.5005/jp-journals-10069-0106","DOIUrl":"https://doi.org/10.5005/jp-journals-10069-0106","url":null,"abstract":"","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45846261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"The Oxygen Desaturation Index for Severity Assessment of Obstructive Sleep Apnea Associated With Cigarette Smoking","authors":"Sujin Lee, Min Jae Seong, E. Joo","doi":"10.13078/jsm.220024","DOIUrl":"https://doi.org/10.13078/jsm.220024","url":null,"abstract":"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.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78608433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Magnetic Resonance Imaging of the Glymphatic System in the Human Brain","authors":"H. Lee, K. Park","doi":"10.13078/jsm.220025","DOIUrl":"https://doi.org/10.13078/jsm.220025","url":null,"abstract":"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.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78096244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"The Grey Zone in Multiple Sleep Latency Test for Diagnosis of Narcolepsy: A Survey of Korean Neurologist","authors":"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","doi":"10.13078/jsm.220018","DOIUrl":"https://doi.org/10.13078/jsm.220018","url":null,"abstract":"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.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88719542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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