• The korean journal of orthodontics
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• v.40 no.2
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• pp.115-126
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• 2010

This case report describes the treatment of a 66 year old adult patient with a diagnosis of severe obstructive sleep apnea who was intolerant of nasal continuous positive airway pressure (nCPAP) treatment and oral appliance therapy. An alternative treatment of snoring and obstructive sleep apnea (OSA) with 2 orthodontic microimplants anchored to the mandible providing skeletal anchorage for mandibular advancement was implemented. After a 2 week healing period, a custom designed facemask provided extraoral anchorage to which the microimplants were connected to for titratable mandibular advancement. Microimplant Mandibular Advancement (MiMA) therapy resulted in resolution of the symptoms of severe OSA with a reduction of the apnea-hypopnea index (AHI), snoring and OSA symptoms.

• 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.

• 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.

• Sleep Medicine and Psychophysiology
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• v.4 no.2
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• pp.140-146
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• 1997

Sleep-related breathing disorders, especially sleep apnea syndrome are complicated by neuropsychiatric dysfunction such as excessive daytime sleepiness, cognitive dysfunction, and depression. As the determinants of daytime sleepiness, sleep fragmentation is more influential than nocturnal hypoxia. Daytime sleepiness can be improved by continuous positive airway pressure (CPAP) or surgery in up to 95% of the treated subjects. Both sleepiness and nocturnal hypoxia would cause cognitive dysfunction. While impairments in attention and verbal memory are more related with sleepiness and prominent in mild to moderate sleep apnea syndrome (SAS), impairments in general intellectual function and executive function are more related with nocturnal hypoxia and prominent in severe SAS. Several cognitive deficits related with nocturnal hypoxia may be irreversible despite CPAP or surgical treatments. So, early detection and early appropriate treatment of SAS would prevent sleepiness and cognitive deterioration.

• Clinical and Experimental Pediatrics
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• v.45 no.10
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• pp.1204-1212
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• 2002

Purpose : Early surfactant therapy with either gentle ventilation, high-frequency ventilation or aggressive weaning of mechanical ventilation are principles for the treatment of respiratory distress syndrome(RDS). We studied to determine the accessibility of noninvasive nasal continuous positive airway pressure(CPAP) rather than mechanical ventilation by invasive intubation after early surfactant therapy. Methods : The study group consisted of 14 infants who were born and diagnosed with moderate respiratory distress syndrome and received early surfactant therapy with nasal CPAP of PEEP 5-6 cm $H_2O$ within two hours after birth in the Fatima neonatal intensive care unit for two years from January 1999 to August 2001. The control group consisted of 15 infants who were diagnosed with the disease and could be weaned from mechanical ventilator within five days after birth during the same period. Results : The characteristics, the severity of clinical symptoms and laboratory findings in the two groups at birth showed no significant difference. Neither did the interim analysis of laboratory data in two groups. Of 14 infants in the study group who received nasal CPAP after early surfactant therapy, only two infants showed weaning failure with this therapy. In the response cases, duration of CPAP was five days and mean airway pressure was $5.4{\pm}0.5cm$ $H_2O$. Two had the complication of CPAP with abdominal distension. Final complications and outcomes in the two groups showed no signifcant difference(P>0.05). Conclusion : The clinical courses in the two groups showed no significant difference. Therefore, we suggest that early surfactant therapy with noninvasive nasal CPAP is a simple and safe method rather than aggressive weaning after invasive mechanical ventilation in moderate respiratory distress syndrome.

• Journal of Oral Medicine and Pain
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• v.37 no.4
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• pp.213-219
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• 2012

Oral appliances are a primary treatment option for snoring and mild to moderate obstructive sleep apnea (OSA) and are considered as an alternative for patients with severe OSA who have failed continuous positive airway pressure (CPAP) or upper airway surgery. But it is true that OAs have varying degrees of effectiveness depending on different oral appliances and the efficacy of OAs are established in some but not all patients. New oral appliance, which is one of Adjustable Anterior Positioners, was developed by Dept of Oral Medicine, Dental School, Dankook University. This is a report for treating severe OSA patient with a failure of previous uvulopalatopharyngoplasty using a new Adjustable Anterior Positioner, followed by significant success of controlling OSA.

• Sleep Medicine and Psychophysiology
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• v.11 no.1
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• pp.17-21
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• 2004

Nasal congestion is one of the most common symptoms of medical complaints. Snoring is caused by vibration of the uvula and the soft palate. Nasal obstruction may contribute not only to snoring and obstructive sleep apnea (OSA) but also impair application of continuous nasal positive airway pressure (CPAP), which is the most widely employed treatment for OSA. Total or near-total nasal obstruction leads to mouth breathing and has been shown to cause increased airway resistance. However, the exact role of the nasal airway in the pathogenesis of OSA is not clear and there is no consensus about the role of nasal obstruction in snoring and sleep apnea. Some reports have failed to demonstrate any correlation between snoring and nasal obstruction. On the other hand, opposing reports suggest that nasal disease may cause sleep disorders and that snoring can be improved after nasoseptal surgery. Reduced cross-sectional area causes increased nasal resistance and predisposes the patient to inspiratory collapse of the oropharynx, hypopharynx, or both. Discrete abnormalities of the nasal airway, such as septal deformities, nasal polyps, and choanal atresia and with certain mucosal conditions such as sinusitis, allergic rhinitis and inferior turbinate hypertrophy can cause snoring or OSA. Thus, these sources of nasal obstruction should be corrected medically or surgically for the effective management of OSA and adjunctive for CPAP.

• Sleep Medicine and Psychophysiology
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• v.24 no.1
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• pp.19-23
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• 2017

Obstructive sleep apnea is a common disorder in which respiratory flow decreases or disappears despite respiratory effort due to occlusion of the upper respiratory tract during sleep. Oxidative stress and systemic inflammatory reaction induced by the obstruction cause complications such as hypertension, coronary artery disease, and diabetes and increase cancer incidence. Furthermore, in patients with interstitial lung disease, obstructive sleep apnea has a very high prevalence and is thought to have a close pathophysiological and clinical correlation. In other words, obstructive sleep apnea could be the cause or a complication of interstitial lung disease ; when these two afflictions coexist, the prognosis of the patient is worse. In patients with interstitial lung disease with obstructive sleep apnea, CPAP treatment significantly improved sleep and quality of life, as well as improved morbidity and mortality in a recent study. Therefore, early diagnosis and treatment of obstructive sleep apnea in patients with interstitial lung disease are very important, and additional studies designed to include patients with idiopathic pulmonary fibrosis as well as patients with advanced interstitial lung disease should be performed.

• Sleep Medicine and Psychophysiology
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• v.12 no.2
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• pp.98-104
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• 2005

Approximately 1% to 3% of all children have obstructive sleep apnea syndrome (OSAS). OSAS in children can lead to a variety of symptoms and sequalae; impairment of development and quality of life, behavioral and personality disturbance, learning problem, cor pulmonale and hypertension. Diagnosis and treatment of OASA for children are different from those for adults in many respects. Adenotonsillar hypertrophy is major cause of childhood OSAS. Overnight polysomnography in a sleep laboratory is the gold standard for diagnosing childhood OSAS. However, because full polysomnography in children may be difficult to obtain, expensive, and inconvenient, other methods to diagnose OSAS have been investigated. Adenotonsillectomy is the most common surgical treatment of childhood OSAS. But if residual symptoms remained after adenotonsillectomy, it should be considered to additional treatment such as weight control, sleep positional change, and continuous positive airway pressure (CPAP).

• The Journal of the Korean dental association
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• v.57 no.5
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• pp.270-278
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• 2019

Oral appliances therapy is becoming increasingly recognized as a successful treatment for snoring and obstructive sleep apnea(OSA). Compared with continuous positive airway pressure(CPAP), the gold standard therapy for OSA, oral appliance therapy are less efficacious for severe OSA but are more acceptable and tolerable for patients, which in turn, may lead to a comparable level of therapeutic effectiveness. Nevertheless, the various side effects of oral appliance therapy, such as, increased salivation or dryness, pain or discomfort in the teeth or gums, occlusal discomfort in the morning, temporomandibular disorders, dental and occlusal changes may cause discontinuation of treatment or changes in treatment plan. Therefore, oral appliance therapy should be provided by a qualified dentist who can evaluate oral tissues, occlusion, and temporomandibular joints, and prevent and manage the possible side effects.