Ho-Jun Seo

Objective Narcolepsy often begins in adolescence, yet diagnosis is frequently delayed. This study aimed to identify factors associated with delayed diagnosis of narcolepsy, defined as more than 1 year between symptom onset and diagnosis, focusing on age at onset, clinical symptoms, and family history.Methods We recruited 235 patients with clinically diagnosed narcolepsy from St.Vincent’s Hospital in South Korea. Participants completed an online survey assessing age at symptom onset, diagnostic timing, clinical features, and family history of sleep disorders. Patients were classified into a non-delay group (diagnosis within 1 year, n=53) and a delay group (diagnosis after 1 year, n=182). Group differences were analyzed using independent t-tests and chi-square tests.Results The mean diagnostic delay was 0.49±0.50 years in the non-delay group and 10.96±8.37 years in the delay group. The delay group had a significantly younger age at symptom onset than the non-delay group (15.13±4.88 vs. 17.89±7.91 years, p=0.002). Diagnosis in the delay group typically occurred only after marked functional impairment due to excessive daytime sleepiness. Cataplexy showed a nonsignificant trend toward earlier diagnosis, while other narcolepsy symptoms and family history were not associated with diagnostic timing.Conclusion Earlier age at onset is the strongest risk factor for delayed diagnosis of narcolepsy. Neither symptom profile nor family history reliably facilitates early recognition. Proactive screening and improved awareness among clinicians and families are needed to reduce diagnostic delay and its psychosocial burden.

Young-Chan Kim, Sang-Woo Hahn, Jin Pyo Hong, Kyoung-Uk Lee, Se Joo Kim, Sang-Hyuk Lee, Jong-Chul Yang, Seung Jae Lee, Seon-Cheol Park, Min-Sook Gim, Jeong-Ho Chae, Ho Jun Seo. Clin Psychopharmacol Neurosci -0001;0:. https://doi.org/10.9758/cpn.26.1412

Objective Cardiovascular health (CVH), assessed through Life’s Essential 8 (LE8), has been widely studied in relation to physical health outcomes. However, its association with mental health, including psychological distress, suicidal behavior, and mental health service utilization, remains underexplored. This study examined whether better CVH is associated with reduced risk of mental health problems and greater engagement with mental health services.Methods We conducted a cross-sectional analysis using data from 4,106 Korean adults aged ≥19 years from the 2021 Korea National Health and Nutrition Examination Survey. CVH was measured using LE8 and categorized into low (0–49), moderate (50–79), and high (80–100) groups. Mental health outcomes included perceived stress, depressive mood, suicidal ideation, suicide planning, suicide attempts, and mental health service utilization.Results Higher LE8 scores were significantly associated with lower stress (p=0.041) and reduced odds of suicidal ideation (p=0.001). Compared to the low CVH group, adjusted odds ratios (ORs) for stress perception were 0.748 (95% confidence interval [CI]: 0.587–0.953) in the moderate group and 0.685 (95% CI: 0.491–0.956) in the high group. For suicidal ideation, the ORs were 0.517 (95% CI: 0.329–0.813) and 0.199 (95% CI: 0.078–0.507), respectively. LE8 health behaviors, not health factors, were significantly associated with stress perception and suicidal ideation.Conclusion Better CVH is associated with lower psychological distress and suicidal behavior, with health behaviors in LE8 showing stronger associations with mental health outcomes than health factors. Further longitudinal studies are needed to confirm causality and underlying mechanisms.

Background and Objective Depression and attentional difficulties are prevalent in narcolepsy. Although depression has been noted in first-degree relatives, the impact of sleep disturbances on these self-reported symptoms remains unclear. We investigated depressive symptoms and attention-deficit/hyperactivity disorder (ADHD)-related traits in patients and their relatives, while controlling for sleep quality and sleepiness.Methods A cross-sectional study included 613 participants: narcolepsy patients (n=253), first-degree relatives (n=156), and healthy controls (n=204). We measured symptoms using the Beck Depression Inventory-II (BDI-II), Adult ADHD Self-Report Scale (ASRS), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). We analyzed group differences using ANCOVA, adjusting for age, sex, body mass index, PSQI, and ESS.Results Patients exhibited significantly high unadjusted scores for depression (mean, 27.51) and attentional symptoms (mean, 11.47). After controlling for covariates, group status remained significantly associated with BDI-II total scores (F=25.03, p<0.001), with both patients and relatives reporting higher levels of depression than controls. Notably, affective-cognitive items on the BDI-II remained elevated. However, the group effect on the ASRS was no longer significant after adjustment (F=1.45, p=0.236).Conclusions Depressive symptoms were consistently elevated in both patients and first-degree relatives, even after accounting for sleep quality and daytime sleepiness, indicating a potential shared familial vulnerability. In contrast, ADHD-like symptoms appeared to be largely influenced by sleep quality and excessive daytime sleepiness, indicating they may be state-dependent.

Suhyung Kim, Young-chan Kim, Yoo Hyun Um, Tae-Won Kim, Ho-Jun Seo, Seung-Chul Hong, Sung-Hoon Yoon, Jong-Hyun Jeong. Clin Psychopharmacol Neurosci -0001;0:. https://doi.org/10.9758/cpn.25.1378

Objective The visual system plays a crucial role in regulating sleep by providing cues that synchronize the circadian rhythm. Consequently, ophthalmic diseases—particularly diabetic retinopathy (DMR), age-related macular degeneration (AMD), epiretinal membrane (EM), and glaucoma—may influence sleep duration through circadian disruption and disease-related psychological stress. However, large-scale studies examining the relationship between these conditions and sleep duration remain limited. This study investigated these associations in a nationwide, population-based sample.Methods This cross-sectional study analyzed data from the 2019 and 2020 the Korea National Health and Nutrition Examination Survey. Ophthalmic diseases were diagnosed through fundoscopy, and sleep duration on weekdays and weekends was self-reported. The study included 8,395 participants aged 40 years or older who underwent fundoscopy. Statistical models were adjusted for demographic and clinical covariates, including age, sex, body mass index, and comorbidities.Results Patients with DMR and EM had significantly reduced sleep duration, with reductions of 0.3 hours to 0.5 hours on weekdays and weekends compared to individuals without these conditions. No significant differences in sleep duration were observed for AMD or glaucoma. After covariate adjustment, the associations between shorter sleep duration and DMR or EM remained significant.Conclusion This nationwide population-based study using fundus photography revealed that DMR and EM are significantly associated with reduced sleep duration, while AMD and glaucoma are not. These findings suggest a differential sleep impact by disease type and support the need for targeted evaluation and management of sleep in patients with ophthalmic diseases. Further research is warranted to clarify underlying mechanisms and guide public health strategies.

Young-Chan Kim, Kyungdo Han, Suhyung Kim, Yoo Hyun Um, Tae-Won Kim, Ho Jun Seo, Seung-Chul Hong, Jong-Hyun Jeong. Clin Psychopharmacol Neurosci 2025;23:476-87. https://doi.org/10.9758/cpn.25.1310

Purpose Narcolepsy diagnosis relies on polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT), though concerns remain regarding their diagnostic accuracy and reliability. Nocturnal sleep-onset rapid eye movement periods (SOREMPs) are a known feature of narcolepsy. This study investigated the clinical significance of nocturnal SOREMP in narcolepsy diagnosis and its association with test–retest reliability. Methods We retrospectively reviewed 109 patients who underwent at least two MSLTs. Patients were categorized into nocturnal SOREMP (n = 40) and non-nocturnal SOREMP (n = 69) groups based on PSG findings. Only MSLT-identified SOREMPs were used for diagnosis. Group comparisons and follow-up changes were analyzed using t-tests, chi-square tests, or Wilcoxon signed-rank tests. Results The nocturnal SOREMP group had more SOREMPs (3.50 vs. 2.23), shorter mean sleep latency (1.99 vs. 4.77), and higher initial narcolepsy diagnosis rates (92.5% vs. 63.8%). Diagnostic stability was significantly higher in the nocturnal group (90.0% vs. 50.7%). Among narcolepsy type 2 (NT2) patients, those with nocturnal SOREMP showed complete diagnostic retention (100%), whereas only 27.3% of those without nocturnal SOREMP did. In a subgroup analysis, patients who had a nocturnal SOREMP on at least one of the two PSGs exhibited significantly higher diagnostic stability (93.9%) than those without nocturnal SOREMP on either test (50.0%). Similarly, NT2 retention was 100% in the former versus 16.7% in the latter. Conclusions Nocturnal SOREMP may serve as a specific marker for narcolepsy, suggesting potential utility in supporting diagnostic consistency. Its presence appears to be associated with improved diagnostic reliability, particularly in NT2.

Objective Obstructive sleep apnea (OSA) is a breathing disorder characterized by recurrent airway obstruction during sleep. Previous western studies have investigated the link between medical disorders and the pathophysiology of OSA. The prevalence and comorbidity rates of OSA; however, vary across different countries and racial groups. This study aimed to delve into medical comorbidities in patients with OSA using a large nationwide healthcare database in Korea.Methods This nationwide study used the Korean National Health Insurance claims database (2010–2019). The effect of OSA on the incidence of medical disorders was estimated using the Cox proportional hazard ratio (HR) model. The results were reported as crude and adjusted HRs with 95% confidence intervals (CI). Subgroup analysis was conducted by sex and age.Results In total, 103,785 patients with OSA and 207,570 patients without OSA were included. OSA group had significantly higher HRs for ischemic heart disease and stroke even after adjusting for hypertension, dyslipidemia, and diabetes. The OSA group also showed an increased risk of metabolic syndrome-related diseases, chronic kidney disease, and gastroesophageal reflux disease. Female patients with OSA exhibited notably higher rates of comorbid liver cirrhosis, chronic obstructive pulmonary disease, and asthma. The cardiovascular burden of patients increased in accordance with the patients’ age.Conclusion Korean patients with OSA have a significantly increased risk of cardio-cerebrovascular diseases, which aligns with the previous studies conducted in the western countries. This result holds particular significance as it represents the first nationwide, population-based study conducted in Asia.

Background and Objective The complex relationship between obstructive sleep apnea (OSA) and neurodegenerative diseases is increasingly being recognized. This study aims to elucidate the association between OSA and α-synucleinopathies, with a focus on Parkinson’s disease (PD), Parkinson’s disease dementia (PDD), and dementia with Lewy bodies (DLB), highlighting the impact of demographic variables.Methods Employing a retrospective cohort approach, we analyzed 103785 patients diagnosed with OSA and their matched controls. The data were sourced from South Koreas National Health Insurance claims database spanning 2010 to 2019. Our investigation centered on the incidence of PD, PDD, and DLB among patients with OSA, utilizing chi-square tests, t-tests, and multivariable logistic regression to compute adjusted odds ratios (AOR). Additionally, we conducted a subgroup analysis focusing on variations by sex and age.Results The findings indicate that individuals suffering from OSA had a significantly elevated risk for PD (AOR = 2.166, 95% confidence interval [CI]: 1.840–2.549, p < 0.0001) and DLB (AOR = 4.001, 95% CI: 1.501–10.660, p = 0.0056). Subgroup analyses further highlighted that the association between PD, DLB, and OSA was markedly stronger in men and escalated in those above 60 years of age.Conclusions Our analysis establishes a substantial link between OSA and an increased likelihood of developing PD and DLB, emphasizing the vital role demographic factors play. These findings suggest the need for intensified surveillance and customized management strategies for OSA, particularly among individuals at heightened risk for neurodegenerative disorders. Additionally, this research lays the foundation for further studies into the progression and therapeutic interventions for these conditions.