• Journal of Clinical Otolaryngology Head and Neck Surgery
• /
• v.29 no.2
• /
• pp.190-197
• /
• 2018

Background and Objectives : Positional OSAS is characterized by an apnea-hypopnea index (AHI) score >5, which, while sleeping in the supine position, is double that in non-supine position. This study was performed to compare the clinical characteristics of positional OSAS and non-positional OSAS patients, and the effects of the modified jaw thrust maneuver during drug-induced sleep endoscopy (DISE) between positional OSAS and non-positional OSAS patients. Materials and Methods : 68 positional OSAS patients and 19 non-positional OSAS patients were included. They all underwent full-night polysomnography and DISE. The modified jaw thrust maneuver was introduced during DISE. Airway structural changes induced by the modified jaw thrust maneuver were evaluated and documented. Results : There were no statistically significant differences in Friedman stage or tonsil grade, body mass index, Epworth sleepiness scale (ESS) score, blood pressure, AHI, or obstructive pattern between the positional and non-positional OSAS patients. However, mean arterial oxygen saturation (SaO2), lowest SaO2, and total arousal index values were more severe in the non-positional OSAS patients. After introduction of the modified jaw thrust maneuver, retrolingual level obstruction showed a tendency toward a higher rate of airway opening in positional OSAS patients than in non-positional OSAS patients. Conclusions : The effects of a mandibular advancement device (MAD) can be estimated by carrying out a modified jaw thrust maneuver during DISE. The tendency toward a higher rate of airway opening in positional OSAS patients than non-positional OSAS patients in retrolingual level obstruction after jaw thrust maneuver introduced during DISE may be clinically important for MAD.

• Journal of Sleep Medicine
• /
• v.15 no.2
• /
• pp.55-61
• /
• 2018

Objectives: Despite the accumulating evidence of the effectiveness of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) syndrome, adherence to PAP therapy is not high. Several factors reportedly affect PAP adherence; however, it remains unclear whether patients' symptoms were detrimental to adherence rate. This study is aimed at investigating the relationship between insomnia symptoms and adherence. Methods: Retrospective analyses were performed in 359 patients with OSA (mean age $58.4{\pm}13.2$ years; females, n=80). Logistic regression analyses were performed between PAP adherence with clinical factors and questionnaires, such as Epworth Sleepiness Scale, Insomnia Severity Index, and Beck Depression Inventory (BDI). Results: PAP adherence was defined as the use of PAP for ${\geq}4h$ per night on 70% of nights during 30 consecutive days. The median follow-up time was 55 days (interquartile range, 30-119 days), and 54.3% showed poor adherence. Non-adherent patients showed more severe sleep onset insomnia, higher BDI, and higher nadir oxygen saturation ($SaO_2$). Patients with good adherence had higher apnea-hypopnea index, oxygen desaturation index, and respiratory arousal to total arousal ratio. Sleep onset insomnia [odds ratio (OR)=1.792, p=0.012], BDI (OR = 1.055, p=0.026), and nadir $SaO_2$ (OR=1.043, p=0.040) were independently associated with PAP non-adherence. Conclusions: Not the severity of insomnia but sleep onset insomnia was associated with PAP adherence, as well as depressive mood. It suggests that different interventions for reducing insomnia and depressive mood are needed to increase PAP adherence in patients with OSA.

• Sleep Medicine and Psychophysiology
• /
• v.28 no.1
• /
• pp.18-26
• /
• 2021

Sleep is essential to brain function and mental health. Insomnia and obstructive sleep apnea (OSA) are the two most common sleep disorders, and are major public health concerns. Proton magnetic resonance spectroscopy (¹H-MRS) is a non-invasive method of quantifying neurometabolite concentrations. Therefore, ¹H-MRS studies on individuals with sleep disorders may enhance our understanding of the pathophysiology of these disorders. In this article, we reviewed ¹H-MRS studies in insomnia and OSA that reported changes in neurometabolite concentrations. Previous studies have consistently reported insomnia-related reductions in γ-aminobutyric acid (GABA) levels in the frontal and occipital regions, which suggest that changes in GABA are important to the etiology of insomnia. These results may support the hyperarousal theory that insomnia is associated with increased cognitive and physiological arousal. In addition, the severity of insomnia was associated with low glutamate and glutamine levels. Previous studies of OSA have consistently reported reduced N-acetylaspartate (NAA) levels in the frontal, parieto-occipital, and temporal regions. In addition, OSA was associated with increased myo-inositol levels. These results may provide evidence that intermittent hypoxia induced by OSA may result in neuronal damage in the brain, which can be related to neurocognitive dysfunction in patients with OSA. The current review summarizes findings related to neurochemical changes in insomnia and OSA. Future well-designed studies using ¹H-MRS have the potential to enhance our understanding of the pathophysiology of sleep disorders including insomnia and OSA.

• Sleep Medicine and Psychophysiology
• /
• v.27 no.2
• /
• pp.77-81
• /
• 2020

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder in which narrowing and obstruction of the upper airway lead to frequent arousal and decreased arterial oxygenation during sleep. OSA is more common in children with genetic disorders like achondroplasia compared to children without genetic disorders. Achondroplasia is genetic disorder characterized by hypoplasia of the facial bone and skull base with foramen magnum stenosis, resulting in exceedingly high frequency of OSA. The authors present a case of a patient with achondroplasia diagnosed with severe OSA through polysomnography after adenectomy showed little therapeutic effect and who was treated with continuous positive airway pressure.

• Clinical and Experimental Pediatrics
• /
• v.51 no.4
• /
• pp.372-376
• /
• 2008

Purpose : To identify clinical characteristics of severe respiratory syncytial virus (RSV) in neonatal period and early infancy and provide information in clinical practice. Methods : Twelve neonates and young infants (<6 months) who were infected by respiratory syncytial virus and required mechanical ventilation between March 2005 and July 2007 were enrolled. Diagnosis of RSV infection was made based on the positive results by rapid antigen immunoassay or polymerase chain reaction. Results : There were four premature infants, of whom three were near-term. Birth weight of subject patients was $2.8{\pm}0.6kg$, gestational age was $37{\pm}2weeks$ and the age at the time of admission was $35{\pm}15days$. Nine of them showed apnea and in five patients, apnea itself was an indication for mechanical ventilation. In seven of the apneic patients, apnea was the first manifestation of RSV infection. In three of these seven apneic patients, apnea preceded definite respiratory distress signs or typical stethoscopic findings by 1-3 days. Mean duration of mechanical ventilation was $3{\pm}2days$, and mean duration of stay in intensive care unit was $6{\pm}2days$. Conclusion : RSV is a major cause of severe respiratory tract infection in term or near-term infant younger than 2 months. For apnea could be the first manifestation of the RSV infection, high level of suspicion is required in practice of neonates or young infants who show any upper respiratory infection symptoms during RSV season.

• Tuberculosis and Respiratory Diseases
• /
• v.47 no.2
• /
• pp.218-230
• /
• 1999

Background: Craniofacial anatomic abnormalities related to structural narrowing of the upper airway have been reported in patients with obstructive sleep apnea syndrome. In this study, we evaluated the craniofacial anatomic characteristics of Korean patients with obstructive sleep apnea syndrome, and the role of cephalometric analysis in the prediction of abnormal breathing during sleep. Methods: Thirty-nine patients with obstructive sleep apnea syndrome(OSAS), 39 simple snorers(simple snorers) and 20 controls(control) had cephalometric analysis using the technique of Riley et al, and underwent standardized polysomnographic recordings. Different variables, including sex, body mass index, cephalometric and polysomnographic data, were statistically analyzed. Results: Pm-UPW and V-LPW distances were significantly shorter in OSAS when compared with simple snorers or control. PAS in simple snorers was shorter than in control. ANS-Gn distance in OSAS was significantly longer than in control. PNS-P distance in OSAS or simple snorers was significantly longer than in control. MP-H distance in OSAS was significantly longer than in simple snorers or control and MP-H distance in simple snorers was also longer than in control. NL/Pm-P angle in OSAS was lesser than in control. MP-H distance in OSAS or in the combined groups of OSAS and simple snorers was significantly correlated with apneahypopnea index(AHI). PNS-P distance in the combined groups of OSAS and simple snorers was correlated with AHI. In male of all subjects, body mass index was significantly correlated with PNS-P or MP-H distance. Conclusion: Cephalometric analysis can be useful tool in determining the craniofacial anatomic abnormalities in patients with obstructive sleep apnea syndrome. Cephalometric parameters, especially MP-H distance, can be useful for predicting frequency of narrowing or obstruction of upper airway during sleep.

• Tuberculosis and Respiratory Diseases
• /
• v.43 no.5
• /
• pp.755-762
• /
• 1996

Background : Continuous positive airway pressure(CPAP) is doubtlessly using as a medical treatment of choice for patients with obstructive sleep apnea (OSA) syndrome. CPAP is effective in OSA patients as a physical "pneumatic pressure splint" mechanism. We have done this study for two purposes, first to seek for the factors to determine the optimal CPAP titer, second to predict the minimal CPAP titer using the determined factors. Methods: We studied a 72 OSA patients who were treated with CPAP. All of them were studied by using a two nights polysomnographic rests in hospital. We compared the patients requiring CPAP over $10cmH_2O$ with those who required CPAP under 5cm $H_2O$ to determine the factors affecting the minimal CPAP titer. Results : The high CPAP group is characterized by a significantly higher body mass index(BMI), apnea index(AI) and apnea and hyponea index(AHI) and significantly lower lowest $SaO_2$. Regression analysis using the optimal four variables resulted in the following prediction equation for CPAP titer. CPAPtiter=8.382 + 0.064 ${\times}$ BMI + 0.077 ${\times}$ AI - 0.004 ${\times}$ AHI - 0.077 ${\times}$ lowest $SaO_2$ When this regression equation was applied to the 72 patients, the mean CPAP titer as predicted by the above equation was $7.80{\pm}2.96$ mmHg. Compared this value with actually determined CPAPtiter, $7.93{\pm}4.00$mmHg, there was no significant difference between the two values. Conclusion: Obesity, apnea severity and lowest Sa02 were strongly correlated with CPAP titer. Linear regression equation for CPAP titer using these indices predicted very closely the actually measured values in the sleep laboratory.

• Sleep Medicine and Psychophysiology
• /
• v.8 no.1
• /
• pp.22-29
• /
• 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.

• Sleep Medicine and Psychophysiology
• /
• v.13 no.2
• /
• pp.45-51
• /
• 2006

Obstructive sleep apnea (OSA) syndrome disrupts normal sleep. However, there were few studies to evaluate the asymmetric distribution, the one of the important factors of normal sleep in OSA subjects. We hypothesized that asymmetry would be broken in OSA patients. 49 male subjects with the complaint of heavy snoring were studied with polysomnography. We divided them into two groups based on the apnea-hypopnea index (AHI) fifteen: 13 simple snoring group (SSN, average AHI $5.9{\pm}4.4$) and 32 OSA group (average AHI $47.3{\pm}23.9$). We compared split sleep variables between the first half and the second half of sleep within each group with paired t-test for the evaluation of asymmetry. Changes of sleep architecture of OSA were higher stage 1 sleep% (S1), total arousal index (TAI), AHI, and mean heart rate (HR) and lower stage 2 sleep% (S2), REM sleep%, and mean arterial O2 saturation (SaO2) than SSN subjects. SWS and wake time after sleep onset (WASO) were not different between two groups. In split-night analysis, OSA subjects showed higher S2, slow wave sleep% (SWS), spontaneous arousal index (SAI), and mean HR in the first half, and higher REM sleep% and mean SaO2 in the second half. Those were same pattern as in SSN subjects. Mean apnea duration and longest apnea duration were higher in the second half only in the OSA. No differences of AHI, ODI, WASO, and S1 were found between the first and the second half of sleep in both groups. TAI was higher in the first half only in the SSN. SWS and WASO seemed to be influenced sensitively by simple snoring as well as OSA. Unlike our hypothesis, asymmetric distributions of major sleep architecture variables were preserved in OSA group. Losing asymmetry of TAI might be related to pathophysiology of OSA. We need more studies that include large number of subjects in the future.

• Sleep Medicine and Psychophysiology
• /
• v.12 no.1
• /
• pp.39-44
• /
• 2005

Objectives: Much attention has been paid to sleep apnea syndrome (SAS) in the elderly because of its high prevalence. It is expected that SAS in the elderly has both similarities and differences compared to SAS in the young or middle-aged populations. The aim of this study was to elucidate the characteristics and consequences of SAS in the elderly. Methods: In this study we included 210 young or middle-aged adults between 23 and 59 years (20 women and 190 men) and 65 older adults between 60 and 83 years of age (16 women and 49 men). Respiratory disturbance indices (RDIs) of the study subjects were more than 5 in an overnight polysomnography. They completed the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Informations about body mass index (BMI), neck, waist, and hip measurements, and blood pressure were obtained. Results: No difference was observed between older adults with SAS (older SAS) and adults aged under 60 with SAS (SAS aged under 60) in RDI, apnea index, % time of oxygen saturation less than 90%, and PSQI. Obstructive apnea index and oxygen desaturation index (ODI) were lower in older SAS. Compared to SAS aged under 60, lowest oxygen saturation and central apnea index were higher in older SAS, but they were statistically not significant. BMI and neck circumference were significantly lower in older SAS compared to SAS aged under 60. Diastolic blood pressure was lower in older SAS compared to SAS aged under 60 with no difference in systolic blood pressure. Older SAS showed lower scores in ESS than SAS aged under 60. Significant correlation was observed between RDI and BMI in SAS aged under 60, but not in the case of older SAS. The relationships between RDI and neck circumference, systolic and diastolic pressure, and ESS were similar. Conclusions: The elderly with SAS were not over-weight and there was no relationship between body weight and the severity of SAS. Also, the behavioral and cardiovascular effects of SAS were not marked in the elderly, which might be partly explained by decreased ODI and relatively higher lowest oxygen saturation in older SAS. The normal aging process, aside from increased body weight, might contribute to the development of SAS in the elderly with modest complications.