Polysomnographic Sleep and Attentional Deficits in Traumatized North Korean Refugees

Abstract

Jooyoung Lee,1 Sehyun Jeon,2 Somin Kim,1 Yumin Seo,1 Jinme Park,3 Yu Jin Lee,4 Seog Ju Kim1 1Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea; 2Department of Psychiatry, Korea University Anam Hospital, Seoul, Republic of Korea; 3Department of Psychology, University of Konstanz, Konstanz, Germany; 4Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of KoreaCorrespondence: Seog Ju KimDepartment of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Ilwon-ro, Kangnam-gu, #06351, Seoul, 135-710, KoreaTel [phone]Fax [phone]Email [email protected]: Attentional deficits and sleep problems are common in refugees who have experienced trauma. In the present study, we used polysomnography (PSG) to investigate the relationship between attentional deficits and objective measures of sleep structure in traumatized North Korean refugees.Methods: We recruited 32 North Korean refugees (mean age = 33.78 ± 14.33 years) and 39 South Korean participants (mean age = 35.03 ± 11.08 years). Sustained attention and divided attention were assessed using the Computerized Attention Test. We conducted an overnight PSG to objectively assess sleep structure. The participants also completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Impact of Event Scale-Revised (IES-R), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI).Results: The North Korean refugees showed more commission errors (CEs, p < 0.05) and a larger standard deviation (SD) of the reaction time (RT) (p < 0.05) in the sustained attention task compared to the South Korean participants. Furthermore, the North Korean refugees showed a shorter period of wake after sleep onset (WASO, p < 0.01), less time spent in N1 (p < 0.05), and more time spent in N2 (p < 0.05). The larger SD of RT in the sustained attention task in the North Korean refugees was positively correlated with WASO (r = 0.62, p < 0.01) and N1 stage (r = 0.47, p < 0.05) after controlling for age, sex, BDI, BAI, and IES-R.Conclusion: The North Korean refugees showed poorer performance on the sustained attention task. Nocturnal PSG revealed shorter WASO and time spent in N1 in this population, which are independently associated with the preservation of attentional capacity. These data suggest that traumatized refugees may compensate for attentional deficits induced by their traumatic experiences via increased sleep continuity.Keywords: attention, sleep, trauma, North Korean refugees

Keywords

• attention
• sleep
• trauma
• north korean refugees