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Introduction Sleep patterns have been linked to various heath disease. Evaluating population-level trend of sleep could provide a comprehensive population health-forecasting model that has the potential to inform targeted interventions. Therefore, we aimed to examine the cross-sectional differences in sleep characteristics among Korean adults during a 9-year period of 2009-2018. Methods The data in this study were derived from two nationwide survey regarding sleep and headache in the representative sample of Korean adult population, namely the Korean Sleep Headache Study phase I (2009) and II (2018). The survey was conducted through door-to-door visit and face-to-face interview by using structured questionnaires. Total of 2,836 participants from Phase I (47.9±16.4 years old; female, 50.2%) and 2,501 participants (47.9±16.4 years old; female, 50.3%) from Phase II gave informed consents and completed the survey. For this study, we excluded those who worked as shift workers and missing data. From the MCTQ, we collected participants’ sleep schedule during workdays and free days over the past four weeks. Average sleep duration was a weighted mean of sleep duration on workdays and free days. Poor sleep quality was defined as PSQI >5. Excessive daytime sleepiness and Depression are performed with ESS and PHQ-9, respectively. Results During the 9 years, average sleep duration decreased by 21 minutes, especially more reduction on free days (workday: 7:17±1:58 vs. 7:06±1:06, p Conclusion Decreased sleep duration seems to be on the rise in the general adult population, which lead to a poor health status. Interventions to promote adequate sleep is urgently needed. Support (if any)

Introduction Increasing research suggests that subjective cognitive decline (SCD) in the absence of objective cognitive dysfunction may be a forerunner of non-normative cognitive decline and eventual progression to dementia. We investigated the association between chronotype and subjective cognitive functioning in the representative sample of the adult population. Methods We included subjects who participated in a nationwide cross-sectional survey of sleep and headache in 2018 in the Republic of Korea. A total of 2136 subjects (age 19-92, mean 48.3 ± 16.5 years old, 1062 male) was included in the analysis. To assess subjective cognitive functioning, we adopted the Mail-In Cognitive Function Screening Instrument (MCFSI). The MCSFSI is a brief, self-administered potential outcome measure developed by the Alzheimer’s Disease Cooperative Study (ADCS) to detect early changes in cognitive and functional abilities in individuals without clinical impairment. MCFSI scores ≥5 were considered abnormal for this study. As an indicator of chronotype, we adopted the “midpoint of sleep on free days corrected for sleep extension on free days (MSFsc).” MSFsc was calculated as follows: MSFsc = midpoint of sleep on free days − 0.5 × (sleep duration on free days − [5 × sleep duration on workdays + 2 × sleep duration on free days]/7). Participants whose MSFsc occurred before 04:00 AM, between 04:00 and 04:59 AM, and after 05:00 AM were classified as early, intermediate, and late chronotype, respectively. The associations between chronotype and subjective cognitive functioning were analyzed with logistic regression models adjusted for potential confounders. Results Subjective cognitive functioning was abnormal in 381 subjects (17.8%). A late chronotype was significantly associated with abnormal subjective cognitive functioning compared with an early chronotype independent of age, sex, average sleep duration, alcohol, smoking, regular exercise, anxiety, depression, body mass index (BMI), education years, and income status (OR 1.619, 95% CI 1.03 - 2.55, p=0.038). Abnormal subjective cognitive functioning was significantly associated with older age, female sex, lower education, higher BMI, anxiety, and depression. Conclusion This survey cohort results provide evidence at the population level that late chronotype is associated with abnormal subjective cognitive functioning. Support (if any)

Study objectives To determine if weekend catch-up sleep (CUS) impacts body mass index (BMI) in the general population. Methods A stratified random sample (2156 subjects; age 19-82 years old, 43.0 ± 14.5; 1183 male) from the general population was evaluated, in 2010, using face-to-face interviews about sociodemographic characteristics, height, weight, habitual sleep duration, and time-in-bed at night on weekdays and weekend, sleep-related profiles, mood and anxiety scales, and comorbid-medical conditions. Weekend CUS was identified when nocturnal sleep extension occurred over the weekend, and this was quantified. Average sleep duration, BMI, and chronotype were determined. The association of BMI with the presence and the amount of weekend CUS was analyzed, independent of average sleep duration, chronotype, and sociodemographic factors. Results BMI and average sleep duration was 23.0 ± 3.0 kg/m2 and 7.3 ± 1.2 hours, respectively. The weekend CUS group consisted of 932 subjects (43.2%) who slept longer on weekend than weekdays by 1.8 ± 1.1 hours. Weekend CUS subjects had a significantly lower BMI (22.8 ± 0.19 kg/m2) than the non-CUS (23.1 ± 0.19 kg/m2) group, after adjustment for age, sex, average sleep duration, chronotype, other sociodemographic factors, and anxiety/mood status (p = .01) The relationship between weekend CUS and BMI was dose-dependent (p = 0.02): Every additional hour of weekend CUS was associated with a decrease of 0.12 kg/m2 in BMI (95% confidence interval, -0.23 to -0.02). Conclusions Weekend sleep extension may have biological protective effects in preventing sleep-restriction induced or related obesity. The results suggest a simple population-level strategy to minimize effects of sleep loss.

Study objectives Research points to impaired cognitive performance in sleep clinic patients with obstructive sleep apnea (OSA). However, inconsistent findings from various epidemiologic studies make this relationship less generalizable. The current study investigated the association between OSA and functional outcome measures, such as cognition, daytime sleepiness, and quality of life, in a Korean general population sample. Methods A total of 1492 participants from the Korean Genome and Epidemiology Study (KoGES) were included in the analyses. The presence of OSA measured by overnight polysomnography (PSG) was defined by apnea-hypopnea index (AHI) >5. Cognitive performance was determined with scores from a comprehensive neuropsychological battery. Excessive daytime sleepiness and quality of life were additionally measured through subjective reports. Results After adjusting for various demographic and medical characteristics, OSA was independently associated with lower performance in the Digit Symbol Test (52.73 ± 17.08 vs. 58.72 ± 18.03, OSA vs. not, p = .02). Hypoxia measures were not related to cognitive performance. OSA was associated with higher odds of displaying excessive daytime sleepiness (odds ratio = 1.72, 95% CI: 1.05-2.80), but there was no significant relationship between OSA and quality of life. Conclusions Cognition was unexpectedly unaffected overall. However, OSA was associated with impairment in a multidomain test that taps skills generally associated with frontal lobe function. The results suggest that research on protective and adaptive brain mechanisms to OSA stress can provide unique insights into the brain-sleep interface. As the study runs longitudinally, it will enable future studies on the impact of OSA on cognitive decline.

STUDY OBJECTIVE Obstructive sleep apnea (OSA) contributes to the development of systemic hypertension, and hypertension strongly predicts the development of white matter change (WMC). Thus, it is plausible that OSA mediates WMC. The goal of the current study is to determine whether a contextual relationship exists between OSA and cerebral WMC. DESIGN Cross-sectional analyses conducted in a population-based study. SETTING Korean community-based sample from the Korean Genome and Epidemiology Study (KoGES) who attended examinations in 2011 at a medical center. PARTICIPANTS There were 503 individuals (mean ± SD, age 59.63 ± 7.48 y) who were free of previously diagnosed cardiovascular and neurologic diseases. MEASUREMENTS AND RESULTS Participants underwent 1-night polysomnography and were classified as no OSA (obstructive apnea-hypopnea index [AHI] < 5, n = 289), mild OSA (AHI 5-15, n = 161), and moderate to severe OSA (AHI ≥ 15, n = 53). WMC was identified with brain magnetic resonance imaging (MRI) and was found in 199 individuals (39.56%). Multivariate logistic regression analyses adjusted for covariates revealed that moderate to severe OSA was significantly associated with the presence of WMC (odds ratio [OR] 2.08, 95%, confidence interval [CI] 1.05-4.13) compared with no OSA. Additional adjustment of hypertension to the model did not alter the significance of the association (OR 2.03, 95% CI 1.02-4.05). CONCLUSIONS Moderate to severe OSA is an independent risk factor for WMC in middle-aged and older individuals. Thus, early recognition and treatment of OSA could reduce the risk of stroke and vascular dementia.

Study Objectives: To investigate the prevalence of restless legs syn- drome (RLS) in Korea. Design: A large population-based telephone interview method using the Korean version of the Johns Hopkins telephone diagnostic interview for the RLS. Setting: A computer aided telephone interview method Participants: A total of 5,000 subjects (2,470 men and 2,530 women) were interviewed in depth. A representative sample aged 20 to 69 years was constituted according to a stratified, multistage random sampling method. Interventions: N/A Measurements and Results: Of the respondents, 373 respondents (7.5%) of the population (pop) met the criteria for the definite or prob - able RLS groups: 194 (3.9% of pop) respondents fulfilled the criteria for definite RLS and 179 (3.6% of pop) respondents fulfilled the criteria for probable RLS. The prevalence of RLS was generally higher for women than men (4.4% vs. 3.3% for definite, 8.7% vs. 6.2% for definite plus probable). About 90% of RLS individuals were experiencing symptoms at the time of the interview and this was similar for both RLS groups. Seventy-four respondents (1.48%) reported symptoms were moder- ately or severely distressing and were therefore classified as RLS "suf - ferers." Of those with a diagnosis of RLS sufferer, 24.3% reported being treated for their symptoms, compared to 12.4% of RLS not designated a "sufferer." Conclusion: RLS is common and underdiagnosed in Korea with nearly 1% of the population reporting disturbed sleep related to their RLS. These results are comparable to other countries.

OBJECTIVE: A chemo-sensitizing effect of levetiracetam (LEV) has been suggested because LEV inhibits O-6-methylguanine-DNA methyltransferase (MGMT). However, the survival benefit of LEV has not been clinically documented. This study was performed to assess the survival benefit of LEV as a chemo-sensitizer of temozolomide for glioblastoma patients compared to other anti-epileptic drugs (AEDs). METHODS: A total of 46 consecutive patients with primary supratentorial glioblastoma who were treated with concomitant chemoradiotherapy and adjuvant temozolomide therapy with LEV were prospectively enrolled. Forty-four consecutive patients with the same condition who had not taken LEV during identical chemoradiotherapy were selected as the control group. Gender, age, extent of lesion, the Karnofsky performance scale (KPS) score, extent of removal, and methylation status of the MGMT promoter were not significantly different between the LEV group and the control group. RESULTS: The median progression-free and overall survival (PFS and OS, respectively) of the LEV group (10.8 months [95% CI, 8.3-13.3] and 25.7 months [95% CI, 21.0-30.4], respectively) were significantly longer than those of the control group (6.6 months [95% CI, 5.2-8.0] and 16.8 [95% CI, 12.2-21.4], respectively) (p = 0.017 and 0.035, respectively). Significant prognostic factors for OS of all 90 patients were the preoperative KPS score (p = 0.027; HR = 0.360), methylation status of the MGMT promoter (p = 0.002; HR = 0.203), and LEV (p = 0.004; HR = 0.244) in multivariate analysis. CONCLUSIONS: LEV may provide a survival benefit in glioblastoma patients who receive temozolomide-based chemotherapy compared with other AEDs. A prospective randomized study may be indicated.