• Sleep Medicine and Psychophysiology
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• v.19 no.2
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• pp.77-83
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• 2012

Objectives: Recent studies have reported a correlation between obstructive sleep apnea syndrome (OSA) and depression. In attempt to verify the suggestion that eveningness is related to depression, we examined the effect of morningness-eveningness on their depressive mood in patinets with OSA. Methods: The examination was based on the medical records and polysomnography reports of 211 OSA patients. Information was gathered from the patients who filled out the H$\ddot{o}$rne and Ostberg questionnaire (HOQ), profile of mood states-Korean version (K-POMS), and Epworth sleepiness scale (ESS). We compared mean values of K-POMS total, subscales of K-POMS, ESS, and OSA severity variables among the 3 morningness-eveningness groups (morningness, eveningness, and neither groups). Partial correlation analysis was performed between variables and ANCOVA was performed among the 3 groups after adjustment with age and weight. Results: There were significant negative correlations between HOQ and the followings : K-POMS total, POMS-T (tension-anxiety), POMS-D (depression-dejection), POMS-A (anger-hostility), POMS-F (fatigue-inertia), POMS-C (confusion-bewilderment), spontaneous arousal index, average O2 saturation. There were significant positive correlations between HOQ and the followings : POMS-V (vigor-activity), apnea-hypopnea index, respiratory arousal index, snore time. There were significant negative correlations between POMS-D and the followings : HOQ, POMS-V, stage 1 sleep (%), AHI, TAI (total arousal index), oxygen desaturation index, respiratory arousal index, neck circumference, average O2 desaturation, snore time (%). There were significant positive correlations between POMS-D and K-POMS total, POMS-T, POMS-A, POMS-F, POMS-C, sleep latency, stage 2 sleep (%), heart rate, spontaneous arousal index. There were significant differences in K-POMS total, POMS-T, POMS-D, POMS-F, POMS-C, spontaneous arousal index among the three HOQ groups in ANCOVA. Conclusion: The depressive correlates of OSA patients might be affected, not by excessive daytime sleepiness or OSA severity indexes, but by eveningness circadian characteristics. It would be important to take into account the morningness-eveningness tendency when we manage the depressive mood of OSA patients.

• Sleep Medicine and Psychophysiology
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• v.20 no.1
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• pp.31-34
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• 2013

Objectives: The aim of this study was to evaluate the differences in patients with positional dependent sleep apnea according to their non-supine apnea-hypopnea index (AHI, ${\geq}5$ vs. <5). Methods: 92 patients with positional sleep apnea were evaluated. The patients were divided into two groups : group I was non-supine AHI having ${\geq}5$ ; group II was non-supine AHI having less than 5. Statistical analysis was performed to find the difference between two groups. Results: In 92 patients, the number of group I patients was 11 (12%) and the number of group II patients was 81 (88%). In the severe AHI group, percentage of group I was dominated (70%) and showing a significant difference compared with the mild and moderate AHI groups (p<.05). In the severe body mass index (BMI) group, percentage of group I was dominated (54.5%) and showing a significant difference compared with of the mild and moderate BMI groups (p<.05). The percentage of group I was significantly higher than group II (p<.05) in the AHI, supine AHI, non-supine AHI and snore time. Conclusions: In patients with positional sleep apnea, severe OSA and high BMI are more common in patients with non-supine AHI${\geq}5$ than non-supine AHI<5.

• Tuberculosis and Respiratory Diseases
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• v.42 no.2
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• pp.206-217
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• 1995

Background: In patients with obstructive sleep apnea syndrome(OSAS), there are several factors increasing upper airway resistance and there is a predisposition to compromised respiratory function during waking and sleep related to constitutional factors including a tendency to obesity. Several recent studies have suggested a possible relationship between sleep apnea(SA) and systemic hypertension. But the possible pathophysiologic link between SA and hypertension is still unclear. In this study, we have examined the relationship among age, body mass index(BMI), pulmonary function parameters and polysomnographic data in patients with OSAS. And also we tried to know the difference among these parameters between hypertensive OSAS and normotensive OSAS patients. Methods: Patients underwent a full night of polysomnography and measured pulmonary function during waking. OSAS was diagnosed if patients had more than 5 apneas per hour(apnea index, AI). A careful history of previously known or present hypertension was obtained from each patient, and patients with systolic blood pressure $\geq$ 160mmHg and/or diastolic blood pressure $\geq$ 95mmHg were classified as hypertensives. Results: The noctural nadir of arterial oxygen saturation($SaO_2$ nadir) was negatively related to AI and respiratory disturbance index(RDI), and the degree of noctural oxygen desaturation(DOD) was positively related to AI and RDI. BMI contributed to AI, RDI, $SaO_2$ nadir and DOD values. And also BMI contributed to $FEV_1,\;FEV_1/FVC$ and DLco values. There was a correlation between airway resistance(Raw) and AI, and there was a inverse correlation between DLco and DOD. But there was no difference among these parameters between hypertensive OSAS and normotensive OSAS patients. Conclusion: The obesity contributed to the compromised respiratory function and the severity of OSAS. AI and RDI were important factors in the severity of hypoxia during sleep. The measurement of pulmonary function parameters including Raw and DLco may be helpful in the prediction and assessment of OSAS patients. But we could not find clear difference between hypertensive and normotensive OSAS patients.

• Sleep Medicine and Psychophysiology
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• v.29 no.2
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• pp.35-39
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• 2022

REM sleep behavior disorder is parasomnia characterized by unpleasant dreams and dream-enactment behaviors associated with excessive electromyography activity in REM sleep. This may appear idiopathic or secondary to other neurological or medical conditions. REM sleep behavior disorder, which appears to be idiopathic, most often implies the possibility of later neurodegenerative diseases due to synucleinopathy, so accurate diagnosis is important in predicting prognosis. For the diagnosis of REM sleep behavioral disorder, REM sleep without atonia, which appears in the polysomnography, is essential. Obstructive sleep apnea, trauma-related sleep disorders, and vigorous periodic leg movements during sleep are known as diseases that show dream enactment behavior in elderly patients. Considering that it may be accompanied by other sleep disorders that can mimic REM sleep behavioral disorders, it is important to differentiate sleep

• Sleep Medicine and Psychophysiology
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• v.11 no.1
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• pp.5-9
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• 2004

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent cessation of breathing due to complete or partial upper airway occlusion during sleep. The incompetent tone of palatal, pharngeal, and glossal muscles which fail to maintain airway patency during sleep causes narrowing of the airway dimension and increased resistance of breathing. The identification of the sites of upper airway obstruction in patients with OSA is important in understanding the pathogenesis and deciding the treatment modality of snoring and/or OSA. Various upper airway imaging modalities have been used to assess upper airway size and precise localization of the sites of upper airway obstruction during sleep. Dynamic imaging modalities enabled assessment of dimensional changes in the upper airway during respiration and sleep. This article focused on reviews of various upper airway imaging modalities, especially dynamic upper airway imaging studies providing important information on the pathogenesis of OSA.

• Sleep Medicine and Psychophysiology
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• v.9 no.2
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• pp.106-114
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• 2002

Objectives: Daytime sleepiness is a common symptom and is associated with sleep behavior, sleep deprivation, and night shift, etc. It is also one of the most important symptoms of sleep disorders like obstructive sleep apnea (OSA). According to our survey on Korean literature, a few studies have dealt with daytime sleepiness, and we have not been able to locate any study comparing normal subjects with polysomnography-proven sleep disorder patients regarding daytime sleepiness. We aimed at comparing daytime sleepiness among normal healthy daytime workers, medical students being expected to have daytime sleepiness due to chronic sleep deprivation, and patients having sleep disorders diagnosed with polysomnography. We also studied the association between subjective daytime sleepiness and objective polysomnographic findings in patients with sleep disorders. Methods: One hundred three hospital workers, 137 medical students, and patients with sleep disorders were studied. Sleep disorders included OSA, periodic limb movements in sleep (PLMS), insomnia, and narcolepsy. The degree of subjective sleepiness in each group was measured by the Korean version of Epworth sleepiness scale and compared. The relationship between polysomnographic findings reflecting severity of sleep disorder in each patient group and subjective sleepiness was analyzed. As for patients with narcolepsy, the relationship between the mean sleep latency and subjective sleepiness was studied. Results: There was a significant difference of ESS score (F=68.190, dF=5.752, p<0.001) among daytime workers, medical students, and sleep disorder patients. In OSA patient group, the degree of the sleepiness had no significant correlation either with mean O2 satuaration (p=0.062) or with RDI (p=0.807). In PLMS patient group, there was no correlation between periodic limb movement index (PLMI) and subjective sleepiness (p=0.761). In narcolepsy patient group, the subjective sleepiness had no correlation with mean sleep latency measured with MSLT (p=0.055). Conclusion: We found a significant difference of subjective sleepiness among daytime workers, medical students, and patients with sleep disorders. However, no consistent correlation was found between severity of subjective sleepiness and objective polysomnographic findings reflecting severity of each sleep disorder. This research confirms that the evaluation of subjective sleepiness is important clinically, but it cannot substitute the objective measures such as nocturnal polysomnography and MSLT.

• Sleep Medicine and Psychophysiology
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• v.5 no.1
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• pp.103-110
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• 1998

Objectives : High co-morbidity of periodic limb movements during sleep(PLMS) and obstructive sleep apnea syndrome(OSAS) is well known and their incidences tend to increase in the elderly. Previous studies have inconsistently rep0l1ed increase or no change of periodic limb movement index(PLMI) by nasal continuous positive airway pressure(CPAP) in OSAS without analyzing possible variables affecting PLMI. We attempted to examine PLMI change evoked during CPAP titration and also factors affecting it in OSAS. Methods : Twenty-nine OSAS patients(M:F=26:3, mean age: $51.6{\pm}10.6\;yrs$) without other sleep disorders except for PLMS were selected, based on the nocturnal (baseline) polysomnograhy. Another night of noctumal polysomnography was performed for CPAP pressure titration. We compared between those two nights PLMI, mean and lowest $SaO_2$, and sleep variables. We also calculated PLMI differences between baseline and CPAP nights, named as delta PLMI (value of CPAP night PLMI minus value of baseline night PLMI). Correlations were calculated between delta PLMI and factors such as age, body mass index, applied CPAP pressure, baseline night values of respiratory disturbance index, mean and lowest $SaO_2$, and sleep parameter differences between baseline and CPAP nights. Results : Decrease of RDI(p<.01) and increase in mean and lowest $SaO_2$ (p<.05, p<.01) were observed during CPAP night. No sleep parameters showed significant change except for the decrease of total stage 1 sleep%(p<.01) during CPAP night. Ten out of 29 patients showed PLMI increase, while the other 19 patients showed either no change(n=14) or even PLMI decrease(n=5) during CPAP night. The 10 patients showing PLMI increase during CPAP night showed a significant positive correlation between delta PLMI and baseline night RDI(p<.05), which meant that PLMI increase was found to be more prominent in higher RDI patients than in lower RDI ones. There were no significant correlations between delta PLMI and other factors in the other 19 patients. Conclusions : We suggest that during the baseline night PLMS would have been underscored and/or masked due to the overlapping of PLMS and apneas/hypopneas or the arousals induced by apneas/hypopneas. Despite its still unknown mechanism, the CPAP application may unmask PLMS and increase PLMI in a subgroup of OSAS patients. It needs to be evaluated further whether the chronic CPAP use sustains the above finding.

• Journal of the Korea Convergence Society
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• v.9 no.1
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• pp.387-392
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• 2018

The aim of this study was to determine the statistical significance of heart rate variability(HRV) between sleep stages, Apnea-hypopnea index(AHI) and age in patients with obstructive sleep apnea(OSA). This study evaluated the main parameters of HRV over time domain and frequency domain in 40 patients with sleep apnea. The non-REM(sleep stage) was statistically validated by comparing the AHI degree of the three groups(mild, moderate, severe) of sleep apnea patients. The NN50(p=0.043), pNN50(p=0.044), VLF peak(p=0.022), LF/HF(p=0.028) were statistically significant in the R-R interval of patients with sleep apnea from the control group (p<0.05). The LF / HF (p = 0.045) and HF power (p = 0.0395) parameters between the non-RAM sleep (sleep 2 phase) and REM sleep in patients with sleep apnea were statistically significant in the control group(p<0.05). We may be able to provide a basis for understanding the correlation among AHI, sleep stage and age and heart rate variability in patients with obstructive sleep apnea.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.600-612
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• 1996

Background : Recent studies deported that untreated patients with obstructive sleep apnea syndrome had high long-term mortality rates, and cardiovascular complications of these patients clad a major effect on mortality. Several data indicates that obstructive sheep apnea syndrome contributes to the development of diurnal systemic hypertension. But the pathophysiological mechanism of the development of systemic hypertension in these patients is still uncertain. This study was performed to evaluate the possible role of sympathetic nervous system activity for the development of systemic hypertension in patients with obstructive sleep apnea syndrome. Method : 35 patients with obstructive sleep apnea syndrome(OSAS) and 13 Control subjects(control) were included in this study. 21 patients of OSAS were normotensives(OSAS-NBP), and 14 patients of OSAS were hypertensives(OSAS-HBP). Full night polysomnography was undertaken to all subjects. We measured plasma norepinephrine(NE) and epinephrine(EP) concentrations during waking and sleep, using high performance liquid chromatography, in all patients and control subjects. Results : In OSAS, OSAS-NBP and control, plasma NE and EP concentrations during sleep were lowed than during waking(p<0.01). But, in OSAS-HBP, these was no difference between during waking and sleep. Plasma NE concentrations during sleep of OSAS, OSAS-NBP and OSAS-HBP were higher than Control(p<0.05). In OSAS-HBP, daytime systolic blood pressure correlated with plasma NE concentration during sleep(r=0.7415, p<0.01), arid correlated inversely with mean arterial oxygen saturation(r=-0.6465, p<0.05) or arterial oxygen saturation nadir(r=-0.6) 14, p<0.05) during sleep. Conclusion : The sympathetic activity during sleep of obstructive sleep apnea syndrome patients was higher than control subjects. In obstructive sleep apnea syndrome patients with systemic hypertension, there was no diurnal variation of sympathetic activity, and there was correlation between daytime systolic blood pressure and sympathetic activity during sleep. These data suggests that chronic hyperactivity of sympathetic nervous system may contribute to the development of diurnal systemic hypertension in patients with obstructive sleep apnea syndrome.

• 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.