• Title/Summary/Keyword: 다원술

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A Case of Child with Obstructive Sleep Apnea Syndrome Recurred after Adenotonsillectomy (편도 및 아데노이드 절제술 후 재발한 폐쇄성 수면 무호흡 증후군 소아 1례)

  • Kim, Cu-Rie;Kim, Dong-Soon;Seo, Hyun-Joo;Shin, Hong-Beom;Kim, Eui-Joong;Shim, Hyun-Joon;Ahn, Young-Min
    • Sleep Medicine and Psychophysiology
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    • v.15 no.2
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    • pp.94-99
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    • 2008
  • The most common cause of obstructive sleep apnea syndrome (OSAS) in childhood is adenotonsillar hypertrophy. Adenotonsillectomy improves the symptoms quite well in most cases. However, some patients could experience the OSAS again after adenotonsillectomy, who might have several risk factors such as incomplete operation, misdiagnosis, combined anatomical malformation, sinusitis or chronic allergic rhinitis, obesity, initial severe OSAS, and early onset OSAS. We report a case of 11-year-old obese boy who presented with snoring for several years. He was obese with body mass index (BMI) of $26.3kg/m^2$ and also found to have fatty liver by ultrasonogram. Initial polysomnography (PSG) showed that he met the criteria of severe OSAS with the apnea-hypopnea index (AHI) of 70.5. He underwent adenotonsillectomy and symptoms improved immediately. Four months later symptoms were relieved with AHI of 0, but 1 year after the adenotonsillectomy he started to complain snoring again and the subsequent PSG results showed that OSAS has relapsed with AHI of 43. Paranasal sinus X-ray and physical examination showed sinusitis and re-growth of adenoid. Obesity was proved not to be a contributing factor because his BMI decreased to normal range ($23.1kg/m^2$) after diet control and regular exercise. Also, liver transaminase was normalized and fatty liver was disappeared on follow-up abdominal ultrasonogram. After treatment of sinusitis, symptoms were relieved with decreased AHI (8.5). This case suggests that simple adenotonsillectomy might not be the end of OSAS treatment in childhood. Patients who had adenotonsillectomy should be followed by subsequent PSG if symptoms recur. It is also important to be aware of risk factors in the recurrent OSAS for the proper intervention according to the cause.

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Effects of Nasal Continuous Positive Airway Pressure Application on Sympathetic Activation : Power Spectrum Analysis of Electrocardiogram in Obstructive Sleep Apnea Syndrome (폐쇄성 수면무호흡증에서 지속적 상기도 양압술 시행이 교감신경계 활성도에 끼치는 영향 : 심전도 스펙트럼 분석)

  • Youn, Tak;Park, Hae-Jeong;Kim, Eui-Joong;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.7 no.1
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    • pp.43-50
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    • 2000
  • Objectives: Obstructive sleep apnea syndrome(OSAS) is known to be associated with the changes of autonomic nervous system (ANS). Nasal continuous positive airway pressure(nCPAP) treatment was found to correct abnormal ANS changes in OSAS but it remains to be further clarified. We aimed to assess the effects of nCPAP on ANS manifested on electrocardiogram, using spectrum analysis in the subjects with OSAS. Methods: Digital polysomnography was performed in 18 patients with OSAS(mean age $43.7{\pm}16.6$ years ; 17 males, 1 female ; mean respiratory disturbance index (RDI) $48.6{\pm}20.9$) for one baseline and another CPAP nights. From each night, 300 continuous beats of ECGs without artifact were chosen from both stage 2 sleep and REM sleep and they were used for power spectrum analysis. We compared between baseline and CPAP nights the heart rate variability including VLF(very low frequency power), LF (low frequency power), HF(high frequency power), R-R means, R-R variance, and LF/HF ratio, using Wilcoxon signed ranks test. Results: In all patients, nCPAP proved to be effective in relieving apneas and snoring. During nCPAP night compared with baseline night, decreases in VLF(p<0.05), LF(p<0.01), and R-R variance(p<0.05) were found in stage 2 sleep, and decreased LF(p<0.05) was found in REM sleep. No significant differences in each sleep stage were found in other variables between the two nights. Conclusion: Our findings suggest that OSAS increases the activity of sympathetic nervous system and nCPAP application effectively decreases the activity. And nCPAP does not appear to influence the parasympathetic nervous activity in OSAS.

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Usefulness of the Chin Press Maneuver in Assessing the Severity of Obstructive Sleep Apnea Syndrome (폐쇄성 수면무호흡증후군의 진단에 있어 턱 압박술의 유용성)

  • Kim, Moo-Jin
    • Sleep Medicine and Psychophysiology
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    • v.8 no.1
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    • pp.22-29
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    • 2001
  • Objectives: Obstructive sleep apnea syndrome (OSA) is a moderately prevalent disorder. Even though much progress has been made in the diagnosis of this disorder, the cost-effectiveness of nocturnal polysomnography is undertermined and physicians and patients are still hesitant to undergo this procedure. The authors wanted to see the validity of chin press/tongue curl maneuver in estimating the severity of OSA which is easy to measure and was originally proposed by Simmons etc. by looking at the correlations between this score and the conventional respiratory disturbance indices. Methods: Forty-three sleep-related breathing disorder patients (28 OSA patients and 15 upper airway resistance syndrome (UARS) patients) who underwent investigation for posssible OSA were studied. Two conventional indices of OSA (apnea/hypopnea index (AHI) and oxygen saturation dip rate (SaO2 dips)), four other sleep variables (lowest SaO2, % of time with SaO2<90% (%SaO2 <90), % of sleep stage 1, mean length of SaO2 dips) and the score of Epworth sleepiness scale (ESS) were compared with the chin press score (CPS) which was newly revised by the author and ranges from 0 to 6. Results: The age of subjects was $45.95{\pm}12.47$ (range 14-76) and their average BMI was $25.98{\pm}3.61$ (range 19.65-37.64). There were no significant differences in age, sex and BMI except repiratory disturbance indices and ESS (p<0.05) between OSA and UARS group. Grouped median CPS of the all subjects was 4.14 (range 1-6). There was a remarkable relationship between CPS and diagnosis category (Likelihood Ratio $X^2$ test; $X^2$=17.41, df=5, p=0.004) and measures of association (Somers' $d=0.65{\pm}0.12$, t=4.83, p=0.000) indicated that CPS increased when the diagnosis changed from UARS to OSA. Spearman's rank correlations between CPS and SaO2 dips (R=0.83), between CPS and AHI (R=0.77) were good (p<0.001). Other variables except mean length of SaO2 dips showed good correlations with CPS as well (p<0.05). Regression analysis indicated that when CPS is 3 there is a provability of 0.35 to have AHI of less than 5. Conclusion: Chin press scores that can be measured easily is well correlation with the conventional sleep apnea indices. They may therefore provide a useful guide in diagnosing obstructive sleep apnea synrome.

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구개수구개인두성형술 이후의 음성변화

  • 손영익;김선일;윤영선;이은경
    • Proceedings of the KSLP Conference
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    • 1997.11a
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    • pp.259-259
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    • 1997
  • 폐쇄성 수면무호흡의 치료를 목적으로 한 구개수구개인두성형술 이후의 음성변화 유무를 파악하여, 성악가 등의 전문적인 음성사용자에게 상기한 수술을 결정함에 있어서 가능한 guideline을 제시하여 보고자 하였다. 수면다원검사상 폐쇄성 수면무호흡증으로 진단된 성인남자 20명을 대상으로 수술전후의 음성변화에 대한 설문조사를 하였고, 수술전, 수술후 1개월에 각각 /아/, /이/, /우/ 모음의 제1, 2, 3 음향대를 비교하였으며, 표준 비음비율이 각기 다른 세가지 문장을 이용하여 수술전후의 비음비율의 변화를 측정하였다. 환자 자신은 수술전후의 음성이나 음색의 변화를 느낄 수 없었고, 비음비율의 변화나 모음의 음형대에 대부분은 변화가 없었지만, /우/ 음의 제3음형대 특성에 변화가 있음을 관찰하였고, 구인두가 중요한 역할을 담당할 수 있는 특정언어의 일부 발음이나 vibrato, singer's formant등의 변화유무에 대한 연구가 없는 점을 감안한다면, 성악가를 비롯한 전문적 음성사용자에?서는 구개수 구개인두성형수술을 결정함에 있어 신중을 기하여야 할 것으로 사료되었다.

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Measuring and Predicting Success of Uvulopalatopharyngoplasty in Obstructive Sleep Apnea Patients (폐쇄성 수면무호흡증 환자에서 구개수구개인두 성형술의 결과평가 및 예측 변수에 관한 고찰)

  • Park, Young-Hak;Park, So-Young
    • Sleep Medicine and Psychophysiology
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    • v.3 no.1
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    • pp.31-37
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    • 1996
  • Uvulopalatopharyngoplasty(UPPP) is an operation that is frequently performed for the patient of obstructive sleep apnea(OSA). A major problem has been to select those patients who will have a good response to UPPP. We compared preoperative and postoperative polysomnography(PSG) in 20 patients to evaluate the success rate of the operation. Each subject underwent a cephalometric roentgenogram, and fiberoptic nasopharyngoscopy with Mueller maneuver was applied in roentgenogram and fiberoptic nasopharyngoscopy with Mueller maneuver was applied in preop evaluation of patients with OSA. No PSG parameter could accurately predict the changes in sleep after UPPP. There were no significant differences between the responders and the nonresponders concerning the cephalometric analysis, the type of obstruction by Mueller maneuver, and body mass index(BMI). The conclusions of this study are thus that UPPP is an effective treatment for the OSAS with a high success rate, but that there is no single useful parameter predicting the success of the operation.

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One-year Graft Patency after Coronary Artery Bypass Surgery (관상동맥우회술 후 1년 개존성에 관한 연구)

  • Kim, Gi-Bong;Kim, Hyeon-Jo;Seong, Gi-Ik
    • Journal of Chest Surgery
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    • v.30 no.12
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    • pp.1190-1196
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    • 1997
  • Between July 1994 and August 1995, 78 patients underwent coronary artery bypass graft at Seoul National University Hospital. Coronary angiogram was performed one year after coronary artery bypass graft in 49 patients(62.8%) for evaluation of the graft patency and analysis of the risk factors for graft occlusion. The patency rates of both the internal mammary artery and the radial artery grafts were 100% , although three internal mammary artery grafts(5.0%) were narrowed(string sign). And that of the saphenous vein grafts were 85.2%. Multivariate analysis for the preoperative, operative, and postoperative factors was done between the widely patent and the narrowed internal mammary artery graft groups, and between the patent and the occluded saphenous vein graft groups by the general linear models procedure. Patient's age($\geq$60 years), postoperative intraaortic balloon pump insertion, bleeding, and acute renal failure were found to be the significant risk factors for internal mammary artery graft narrowing, and coronary artery size(< 1.5 mm) was the significant risk factor for the saphenous vein graft occlusion (p<0.05) . This study confirms that the arterial graft is superior to the vein graft at one-year patency rate, and suggests the risk factors for graft occlusion during the first postoperative year. Knowledge of this study may provide a basis for estimating the risk factors for graft occlusion, and thereby modifying surgical strategy and postoperative surveillance.

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The Evolving Sound Art (Part 2): A Deliberation about Advancement of Contemporary Genre-Disruptive Art Practices (진화하는 사운드 아트 (2부): 탈경계적 현대예술의 발전에 대한 궁리(窮理))

  • Lee, Irene Eunyoung
    • The Journal of the Convergence on Culture Technology
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    • v.6 no.2
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    • pp.169-176
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    • 2020
  • As the sound art field is keep growing and expanding, we shall contemplate from the sociology of the arts and cognitive science point of views to wisely accept and properly appreciate various artistic works and practices. It is because the value evaluation of new arts shall substantially involve analysis and inspections with considerations of today's complex environments, the creative productions, and the consumptions; because, such critiques are necessity for the advancement of new arts. This paper briefly introduces reasoning of including sociological analysis and criticism in evaluating sound arts beyond dichotomy of the fine arts and music fields. It also looks into changes and conditions of cultural arts grants and allowances of the interdisciplinary art genre in South Korea as it has been almost alone a playground for its domestic creative practices of the sound art. This paper is written in a hope to suggest some possible directions for future developments of these contemporary borderless and/or experimental arts.

A Case of Continuous Positive Airway Pressure Therapy in a Patient with Central Sleep Apnea and Heart Failure (중추성 수면 무호흡이 동반된 심부전 환자에서 지속적 상기도 양압술 적용 1례)

  • An, Jee Young;Kim, Shin Bum;Kang, Hyeon Hui
    • Sleep Medicine and Psychophysiology
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    • v.24 no.2
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    • pp.118-123
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    • 2017
  • Central sleep apnea (CSA) is a highly prevalent comorbidity in patients with heart failure and may present in 25 to 40 percent of heart failure patients. Continuous positive airway pressure (CPAP) is the primary therapeutic option and effective in treatment of obstructive sleep apnea (OSA). In heart failure patients with CSA, several trials of CPAP showed a number of positive effects in heart failure treatment. A 58-year-old male visited the hospital because of dyspnea and he was diagnosed as heart failure with ischemic heart disease. He underwent coronary angiography and received percutaneous coronary intervention due to stenosis at the middle of left anterior descending coronary artery. However, dyspnea was not completely improved after treatment with percutaneous coronary intervention. The patient also experienced snoring and sleep apnea which worsened with symptom of dyspnea in the recent year. We suspected CSA and the patient underwent polysomnography to confirm whether sleep apnea was present. During the polysomnography, CSA with Cheyne-Stokes respiration (CSR) was observed and apnea-hypopnea index was 45.9/hr. The patient was treated with CPAP. After CPAP treatment, hypoxemia and CSA were resolved and dyspnea was improved with reducing NYHA class. We report a case successfully treated with clinical improvement by presuming CSA in a patient with heart failure.

Development of Screening Test for Prediction of Sleep Apnea Syndrome (수면무호흡증 예측을 위한 선별검사 개발)

  • Lee, Sung-Hoon;Lee, Hee-Sang;Lee, Jeung-Gweon;Kim, Kyung-Soo
    • Sleep Medicine and Psychophysiology
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    • v.2 no.1
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    • pp.73-81
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    • 1995
  • Objective : Patients with sleep apnea should be diagnosed with polysomnography(PSG). However, it is not easy to recommend PSG for all patients suspected with sleep apnea in practice. Therefore, we tried to develop the screening test for referral of PSG. Method : 140 patients with snoring and sleep apnea syndrome were studied by the PSG. Sleep apnea questionnaire. Zung's scale for depression. Stanford Sleepiness Scale(SSS), insomnia scale and neuropsychological test were administered. Also, blood pressure, height, weight and neck circumference were measured and some histories were taken. Correlations between respiratory disturbance index(RDI) and various parameters mentioned above and discriminant coefficients of the parameters to RDI were computed. And, we investigated sensitivities of screening tests for selection of the patients with RDI above 20. Results : Using six parameters(neck circumference, systolic blood pressure before sleep, degree of alcohol drinking, frequency of breath-holding during sleep, degree of dry mouth during sleep, sleep apnea score), the patients with RDI above 20 could be discriminated in 92.8% sensitivity. In case of more than two among six parameters(neck circumference of above 40cm, systolic blood pressure of above 125mmHg, frequent alcohol drinking, frequent breath-holding during sleep, frequent dry mouth during sleep, sleep apnea score of above 35), same patients could be discriminated in 87.6% sensitivity. And, in case of more than one among four parameters(neck circumference of above 40cm. systolic blood pressure of above 125mmHg, frequent alcohol drinking, body weight of above 80kg), discrimination sensitivity was 83.5%. Conclusions : Patients with RDI above 20 could be discriminated by above parameters with high sensitivity. Therefore, the screening test using above parameters can be applied in selection of the patients with sleep apnea for PSG in practice.

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