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- 저자 : 김하욤 (검색결과 4 건)
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A Case of Circadian Rhythm Sleep-Wake Disorder in Partial Blindness
김하욤,박진환,김정빈 대한수면연구학회 2018 Journal of sleep medicine Vol.15 No.1
Although it is well known that sleep disturbances can be developed in complete blindness, normally entrained circadian rhythm was observed in the majority of patients with partial blindness. Here, we describe a case with circadian rhythm sleep-wake disorder in partial loss of light perception. A 58-year-old man presented with difficulty in sleep initiation and excessive daytime sleepiness after retinal surgery. The electroretinography revealed partial impairment of light perception in the right side and preserved light perception in the left side. He was diagnosed as circadian rhythm sleep-wake disorder due to impaired light perception. While taking 2 mg of melatonin regularly at 9 every night, his sleep cycle and difficulty in sleep initiation were gradually improved and became fully normalized after 2 weeks. Circadian rhythm sleep-wake disorder could be developed even in partial blindness. Melatonin supplements could effectively improve the circadian rhythm sleep-wake disorder in partial blindness, like as in complete blindness.
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Heart-Rate-Based Machine-Learning Algorithms for Screening Orthostatic Hypotension
김정빈,김하욤,성주혜,백설희,김병조 대한신경과학회 2020 Journal of Clinical Neurology Vol.16 No.3
Background and Purpose Many elderly patients are unable to actively stand up by themselves and have contraindications to performing the head-up tilt test (HUTT). We aimed to develop screening algorithms for diagnosing orthostatic hypotension (OH) before performing the HUTT. Methods This study recruited 663 patients with orthostatic intolerance (78 with and 585 without OH, as confirmed by the HUTT) and compared their clinical characteristics. Univariate and multivariate analyses were performed to investigate potential predictors of an OH diagnosis. Machine-learning algorithms were applied to determine whether the accuracy of OH prediction could be used for screening OH without performing the HUTT. Results Differences between expiration and inspiration (E-I differences), expiration:inspiration ratios (E:I ratios), and Valsalva ratios were smaller in patients with OH than in those without OH. The univariate analysis showed that increased age and baseline systolic blood pressure (BP) as well as decreased E-I difference, E:I ratio, and Valsalva ratio were correlated with OH. In the multivariate analysis, increased baseline systolic BP and decreased Valsalva ratio were found to be independent predictors of OH. Using those variables as input features, the classification accuracies of the support vector machine, k-nearest neighbors, and random forest methods were 84.4%, 84.4%, and 90.6%, respectively. Conclusions We have identified clinical parameters that are strongly associated with OH. Machine- learning analysis using those parameters was highly accurate in differentiating OH from non-OH patients. These parameters could be useful screening factors for OH in patients who are unable to perform the HUTT.
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Patterns of Orthostatic Blood Pressure Changes in Patients with Orthostatic Hypotension
석흥열,김유환,김하욤,김병조 대한신경과학회 2018 Journal of Clinical Neurology Vol.14 No.3
Background and Purpose The objective of this study was to determine the patterns of blood pressure (BP) changes during the head-up tilt (HUT) test, particularly in terms of its clinical significance for patients with orthostatic hypotension (OH). Methods OH was divided into four categories based on systolic BP changes occurring within the first 10 minutes of the HUT test: sustained orthostatic hypotension (SOH), progressive orthostatic hypotension (POH), orthostatic hypotension with partial recovery (OHPR), and transient orthostatic hypotension (TOH). Results In total, 151 patients were analyzed: 65 with SOH, 38 with POH, 21 with OHPR, and 27 with TOH. POH patients exhibited the greatest reduction in systolic BP after HUT and were also the most likely to develop symptoms requiring early termination of the HUT test (42.1%, p<0.001). Additionally, SOH patients exhibited smaller heart-rate variation with deep breathing values (p=0.003) and Valsalva ratios (p=0.022) compared to POH patients. The sweat volume was greatest in OHPR patients. Conclusions Clinical characteristics, including the findings of autonomic function tests, differed between the OH patient groups. This might reflect differences in the underlying pathophysiologic mechanisms. Determining the patterns of BP changes during the HUT test may facilitate the development of effective management strategies in patients with OH.
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