폐쇄성 수면 무호흡증에 대한 포괄적 치료 - 수면 클리닉에서 치과의 역할

COMPREHENSIVE TREATMENT OF OBSTRUCTIVE SLEEP APNEA - THE ROLE OF DEPARTMENT OF DENTISTRY IN SLEEP CLINIC

  • 권대근 (경북대학교 치과대학 구강악안면외과학교실) ;
  • 조용원 (계명대학교 의과대학 신경과학교실) ;
  • 안병훈 (계명대학교 의과대학 이비인후과학교실) ;
  • 황상희 (계명대학교 의과대학 치과학교실) ;
  • 남기영 (계명대학교 의과대학 치과학교실)
  • Kwon, Tae-Geon (Dept. of Oral & Maxillofacial Surgery, College of Dentistry, Kyungpook National University) ;
  • Cho, Yong-Won (Dept. of Neurology, Keimyung University) ;
  • Ahn, Byung-Hoon (Dept. of Otolaryngology, Keimyung University) ;
  • Hwang, Sang-Hee (Dept. of Dentistry, College of Medicine, Keimyung University) ;
  • Nam, Ki-Young (Dept. of Dentistry, College of Medicine, Keimyung University)
  • 발행 : 2004.04.30

초록

The etiology of the obstructive sleep apnea includes the various factors such as anatomical abnormality in upper airway, craniofacial structure, obesity and personal habit. To establish reasonable treatment plan, multi-department approach is should be emphasized because the treatment modality is depend on the result of analysis for degree & site of obstruction and various behavioral factors. In Sleep Clinic in Keimyung University Medical Center, the standard of care for sleep apnea patient was established according to the Standard of practice committee of Americal Sleep Disorders Association. After one year experience of comprehensive approach for sleep apnea we could achieve following recommendation for the treatment. 1) The multi-department examination and diagnosis could prevent unnessesary treatment because the treatment plan could be established under comprehensive discussion. 2) Determination of the site of obstruction is important for treatment planning. However, no single determinant could be found. We expect multi-department approach can reduce the mistake in detection of obstruction. 3) Further evaluation of treatmet outcome should be succeeded to establish Korean standard of care for sleep apnea treatment.

키워드

참고문헌

  1. Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes. American Thoracic Society. J Respir Crit Care Med. 1994;150:1738-45
  2. Standard of practice committee of Americal Sleep Disorders Association: Practice parameters for the indications for polysomnography and related procedures. Sleep 1997;20:406-22
  3. Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S: Oral appliances for the treatment of snoring and obstructive sleep apnea: a review
  4. Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research, The report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:668-689
  5. He J, Kryger MH, Zorick FJ, Conway W, Roth T: Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988;94:9-14
  6. Rama AN, Tekwani SH, Kushida CA: Sites of Obstruction in Obstructive Sleep Apnea . Chestt 2002;122:1139-1147 https://doi.org/10.1378/chest.122.4.1139
  7. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213 https://doi.org/10.1016/0165-1781(89)90047-4
  8. Hoddes E, Zarcone V, Smythe H, Phillips R, Dement WC: Stanford sleep scale. Quantification of sleepiness: a new approach. Psychophysiology. 1973;10:431-436
  9. Johns MW: A new method for measuring daytime sleepiness : the Epworth Sleepiness Scale. Sleep 1991;14:540-545
  10. Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, Caldarelli D: Clinical predictors of obstructive sleep apnea. Laryngoscope 1999;109:1901-7 https://doi.org/10.1097/00005537-199912000-00002
  11. 권대근, 조용원, 안병훈, 서영성: 폐쇄성 수면 무호흡증에 있어 두부 규격 방사선 계측학적 기여 인자. 대한구강악안면외과학회지 2003;29:338-345
  12. Browman CP, Sampson MG, Yolles SF, Gujavarty KS, Weiler SJ, Walsleben JA et al: Obstructive apnea and body weight. Chest 1984;85:435-438 https://doi.org/10.1378/chest.85.3.435
  13. Littner M, Hirshkowitz M, Davila D, Anderson WM, Kushida CA, Woodson BT, Johnson SF, Merrill SW: Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. An American Academy of Sleep Medicine report. Sleep 2002;25:143-7
  14. Thorpy M, Chesson A, Derderian S, Kader G, Millman R, et al: Practice parameters for the treatment of obstructive sleep apnea in adults: the efficacy of surgical modifications of the upper airway. Report of the American Sleep Disorders Association. Sleep 1996;19:152-5
  15. 박광호, Waite PD: 폐쇄성수면무호흡환자의 상하악전방이동술 전후의 두부계측방사선사진에서 산출한 기도직경, 상기도 공간의 기류저항과 호흡방해지수 변화와의 연관성. 대한 구강악안면외과학회지 2001;27:157-161
  16. Thorpy M, Chesson A, Derderian S, Kader G, Millman R, et al: Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. American Sleep Disorders Association. Sleep 1995;18:511-3
  17. Sher AE, Schechtman KB, Piccirillo JF: The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996 ;19:156-77
  18. Fujita S, Conway W, Zorick F, Roth T: Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 1981;89:923-34
  19. Millman RP, Carlisle CC, Rosenberg C, Kahn D, McRae R, Kramer NR: Simple predictors of uvulopalatopharyngoplasty outcome in the treatment of obstructive sleep apnea. Chest 2000;118:1025-30 https://doi.org/10.1378/chest.118.4.1025
  20. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 1993 ;108:117-25
  21. Baik UB, Suzuki M, Ikeda M, Sugawara J, Mitani M: Relationship between cephalometric characteristics and obstructive sites in obstructive sleep apnea syndrome. Angle Orthod 2002;72:124-134
  22. deBerry-Borowiecki B, Kukwa A, Blanks RH: Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea. Laryngoscope 1988;98:226-34
  23. Partinen M, Guilleminault C, Quera-Salva MA, Jamieson A: Obstructive sleep apnea and cephalometric roentgenograms: the role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest 1988;93:1199-1205 https://doi.org/10.1378/chest.93.6.1199