• The Journal of the Korean dental association
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• v.53 no.4
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• pp.249-258
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• 2015

Snoring and obstructive sleep apnea are the representative sleep disordered breathings, caused by the temporary and repetitive constriction or obstruction of upper airway during sleep. They present with excessively vibratory noise and repetitive cease of respiration. These disorders commonly result in sleep disturbance and the subsequent daytime sleepiness, chronic fatigue. Furthermore, they can cause the serious and extensive complications including increased risk of hypertension, cardiac arrhythmia, cardiovascular disease, cerebrovascular accident, neurocognitive disturbance, traffic and occupational accidents, type II diabetes, childhood growth interruption, awakening headache and finally, relatively increased mortality rate. Because appropriate therapeutic intervention is best way for patients to relieve their symptoms and prevent their possible complications, it is very important for dentists to recognize their own role and responsibility in diagnosis and treatment of these disorders. For this, the present article provides the understanding of the clinical features, possible complications, various treatment modalities, and suitable treatment strategies for snoring and obstructive sleep apnea.

• Sleep Medicine and Psychophysiology
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• v.18 no.2
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• pp.76-81
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• 2011

Objectives: This study aims to analyze the association between the severity of sleep apnea, sleep and mood related scales, and activity during sleep in obstructive sleep apnea syndrome (OSAS) patients. Methods: 176 drug-free male patients confirmed as OSAS (average age=$43{\pm}11$ years) were selected through nocturnal polysomnography (NPSG). OSAS was diagnosed with apnea-hypopnea index (AHI) >5, mean AHI was $39.6{\pm}26.0$. Sleep related scales were Stanford Sleepiness Scale (SSS), Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI) and Morningness-Eveningness Scale (MES). Mood related scales were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI) I, II and Profile of Mood States (POMS). NPSG was performed overnight with both wrist actigraphy (WATG). Parameters produced from WATG were total activity score, mean activity score and fragmentation index. We analyzed the correlation between each scale, AHI scored from NPSG and activity score analyzed from WATG. Results: ESS showed significant positive correlation with PSQI, BDI, BAI and STAI I, II, respectively (p<0.01). SSS showed significant positive correlation with PSQI and BAI (p<0.05, p<0.01). BAI showed significant positive correlation with total activity score, mean activity score and fragmentation index (p<0.05, p<0.01, p<0.05).Total activity score showed significant positive correlation with ESS and BAI, respectively (p<0.05). Fragmentation index showed significant positive correlation with ESS, PSQI and BAI (p<0.05, p<0.01, p<0.05). AHI, indicator of sleep apnea is showed no significant correlation with each sleep and mood related scale. Conclusion: The degree of daytime sleepiness tends to be associated with night sleep satisfaction, depression and anxiety, and the activity during sleep rather than the severity of sleep apnea.

• Sleep Medicine and Psychophysiology
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• v.9 no.1
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• pp.41-47
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• 2002

Objectives: In a number of simulated night shift studies, timed exposure to bright light improves sleep quality and work performance. We evaluated the effect of bright light on adaptation to night shift work with a field study. Methods: Five female nurses working shifts at Korea University Hospital were recruited for participation in this study. We investigated two series of six consecutive shift rotations comprising three day and three night shifts, using wrist Actigraphy, the Stanford Sleepiness Scale, Visual-analogue scales, STIM and tympanic membrane temperature for daytime sleep quality, alertness, subjective feeling, attention performance, and temperature rhythm. The subjects were exposed to bright light (2,500 lux) from 24:00 to 04:00 a.m. on three consecutive night shifts during the second series, whereas they worked under normal lightening (650 lux) conditions during the first series. Results: Actigraphic assessment of daytime sleep showed no significant difference between the first and third night shift in both baseline and light exposure phase. The mean lowest temperature shifted earlier during baseline phase but not during the light exposure phase. Also, the score for subjective feelings of depression, anxiety, physical discomfort and sleepiness was significantly higher in the third night shift than the first during baseline phase but not during the light exposure phase. Attention and attention switching ability was significantly improved in the third night shift compared to the first night during the light exposure phase but there were no significant changes during the baseline phase. Conclusion: This result suggests that there were no significant differences between the two phases in measures of quality of daytime sleep, but subjective feelings, attention and alertness were enhanced during light exposure. Although some placebo effects and learning effects might influence this result, bright light exposure between midnight and 4:00 a.m. may improve adaptation to night shift. In future, further controlled studies with a larger sample size, including melatonin measurement, are needed for real shift workers.

• Sleep Medicine and Psychophysiology
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• v.5 no.1
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• pp.45-53
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• 1998

Objectives : The change of sleep patterns commonly occurs in association with the pregnancy. This study was to investigate sleep habits during the course of normal pregnancy. Methods : Sleep habits questionnaire was administered to healthy women in their first trimester(TR1) of pregnancy and then the same questionnaire was repeatedly administered during their second(TR2) and third(TR3) trimesters. The following aspects were assessed : patterns of night sleep, daytime status, sleep posture, reasons for sleep alteration, and the experience of any particular parasomnias, as well as sleep problem-related treatment or medication. Data analysis was based on 26 women who maintaind good health throughout their pregnancy and completed the questionnaire three times. Results : In comparisons between each trimester and non-pregnant state, total night sleep time, daytime tiredness, and sleepiness were significantly increased in all trimesters. Sleep latency was significantly decreased in TR1 and TR2, but not in TR3. In addition, refreshed feeling on waking the following day was significantly decreased and the number of awakenings during night sleep was significantly increased in TR3, but not in TR1 and TR2. In comparisons between trimesters, there was a significant increase in sleep latency, daytime sleepiness and the number of awakenings during night sleep and a significant decrease in refreshed feeling on waking the following day in TR3 compared to TR1 and TR2. Over the course of pregnancy, the rate of lateral position during sleep was gradually increased and all the pregnant women took the lateral sleeping posture in TR3. The major reasons for sleep pattern alteration were nausea, vomiting and heartburn in TR1, urinary frequency, fetal movement and ache in hips in TR2, and urinary frequency, fetal movement, cramp in legs and backache in TR3. Conclusion : These findings are expected to be useful for educating pregnant women about sleep hygiene. In future studies, the underlying factors and mechanisms regarding sleep patterns during pregnancy will need to be clarified.

• Korean Journal of Clinical Laboratory Science
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• v.39 no.2
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• pp.141-146
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• 2007

Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a disorder characterized by the repetitive collapse of the pharyngeal airway during sleep, which leads to oxygen desaturation, sleep fragmentation, daytime sleepiness, and increased risk for hypertension and stroke. We investigated the clinical factors related to the severity of OSAHS. Polysomnography was performed in three hundred and ninety five consecutive adult patients with clinical symptoms of obstructive sleep apnea syndrome. All patients completed the sleep questionnaire and the Epworth Sleepiness Scale before polysomnography. Patients were classified into four groups based on the severity of their polysomnographic data: Non-OSA group, characterized by Apnea-Hypopnea Index (AHI) < 5; mild OSA group, by AHI 5-15; moderate OSA group, by AHI 16-30; and severe OSA group, by AHI > 30. Neck circumference was also measured at the cricothyroid level. A total of 395 patients (336 men and 59 women) were studied. In the non-OSA group, there were 55 patients; their mean neck circumference was $39.63{\pm}4.24cm$ and mean BMI was $24.48{\pm}3.53$. In the mild group, there were 101 patients; their mean neck circumference was $41.93{\pm}3.75cm$ and mean BMI was $25.33{\pm}2.94$. In the moderated group, there were 93 patients; their mean neck circumference was $43.27{\pm}3.50cm$ and BMI was $25.90{\pm}2.88$. In the severe group, there were 146 patients; their mean neck circumference was $44.94{\pm}3.93cm$ and mean BMI was $26.81{\pm}3.76$. Men had significantly larger neck circumference than women ($Mean{\pm}SD$, $43.72{\pm}3.83$ vs $39.17{\pm}4.30$, p < 0.001), and higher AHI than women ($29.12{\pm}22.65$ vs $14.63{\pm}14.11$, p < 0.001). Multiple regression analysis revealed that neck circumference was the most significant predictor of AHI. Neck circumference and BMI were positively correlated with the severity of OSAHS. The severity of OSAHS was greater in men than in women.

• Tuberculosis and Respiratory Diseases
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• v.67 no.3
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• pp.183-190
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• 2009

Background: Repeated arousals during sleep have been known to be associated with excessive daytime sleepiness and cardiovascular complications. We investigated the relationship between arousal indices and clinical parameters. Methods: We retrospectively reviewed medical records of 41 patients who performed polysomnography for a diagnosis of obstructive sleep apnea syndrome. We defined total arousal index (TAI) as the number of arousals per hour and respiratory arousal index (RAI) as the number of arousals associated with apnea or hypopnea per hour. Results: There were significant positive correlations between arousal indices and apnea-hypopnea index (AHI) (RAI vs. AHI, r=0.958, p<0.001; TAI vs. AHI, r=0.840, p<0.001). RAI and mean oxygen saturation showed a significant negative correlation with each other (r=-0.460, p=0.002). TAI revealed a significant positive correlation with mean systolic blood pressure (MSBP) and mean diastolic blood pressure (MDBP) (TAI vs. MSBP, r=0.389, p=0.014; TAI vs. MDBP, r=0.373, p=0.019). There was no significant correlation between arousal indices and parameters of sleepiness. RAI had a significant positive correlation with body mass index (BMI) and neck circumference (NC) (RAI vs. BMI, r=0.371, p=0.017; RAI vs. NC, r=0.444, p=0.004). When partial correlation analysis was performed to adjust for other variables, there was significant correlation between RAI and AHI (r=0.935, p<0.001). Conclusion: This study shows that respiratory arousal index could be a useful index reflecting of severity of obstructive sleep apnea syndrome. Arousal during sleep would be concerned in the development of cardiovascular complication of obstructive sleep apnea. And some anthropometric factors would contribute to the development of arousals during sleep. Further studies are needed to clarify any cause-effect relationship.

• Sleep Medicine and Psychophysiology
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• v.26 no.1
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• pp.16-22
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• 2019

Objectives: The objective of this study was to investigate the correlation between insufficient sleep and visuospatial memory in adolescents using a computerized neurocognitive function test. Methods: A total of 103 high school students (26 males and 77 females; mean age $17.11{\pm}8.50years$) without a serious psychiatric problem was recruited. All subjects were requested to complete a self-report questionnaire about weekday total sleep time and weekend total sleep time. The epworth sleepiness scale (ESS) and the beck depression inventory (BDI) were administered to measure daytime sleepiness and symptoms of depression. Seven subsets of the Cambridge Neuropsychological test automated battery were examined to assess visuospatial memory. Results: After controlling for age, sex, ESS, and BDI, longer weekend total sleep time was correlated with poor performance on delayed matching to sample (r = -0.312, p = 0.002) and immediate recall on pattern recognition memory (r = -0.225, p = 0.025). Increased weekend catch-up sleep time was correlated with poor performance of delayed matching to sample (r = -0.236, p = 0.018), immediate recall on pattern recognition memory (r = -0.220, p = 0.029), and delayed recall on pattern recognition memory (r = -0.211, p = 0.036) after controlling for age, sex, ESS, and BDI. Conclusion: This study showed that increased weekend catch-up sleep time reflecting insufficient weekday sleep were associated with poor performance in delayed recall tasks of visual memory. This finding suggests that insufficient sleep during adolescence might produce a decline of visuospatial memory.

• Sleep Medicine and Psychophysiology
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• v.4 no.2
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• pp.147-155
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• 1997

To assess the reliability of chronobiological models of sleep/wake regulation, it is necerssary that the models predict the data which has been studied in sleep research, and they should be generalized across all ages. To date, many adult human data on such models have accumulated, yet it is evident that a comprehensive theory of the biorhythmic aspects of sleep/wake states has not established. Circadian rhythms such as the time going to bed, sleep onset, slow wave sleep pressure, periodicity of REM sleep, daytime performance, and early evening alertness are resumed everyday. Even in adult humans, sleep is inherently polyphasic. In both the disentrained and entrained states, naps when allowed tend to recur in a temporally lawful manner. The monophasic sleep pattern of most industrial societies therefore appears to be purely of social origin. The endogenous biorhythmic nature of circasemidian sleep tendency is supported by the ubiquity of the phenomenon across all ages. The NREM/REM sleep cycle within sleep with its inherent physiological, endocrine, and neurochemical fluctuations represents the best-documented ultradian sleep rhythms. Also, a daytime ultradian variation in sleepiness with a periodicity similar to nocturnal NREM/REM cycle(BRAC hypothesis) is suggested. This review article provides a brief synoptic review of the evidences for circadian, circasemidian, and ultradian sleep/wake rhythms, and then the authour will suggest the issues which expedite fuller modeling of sleep/wake system, to be further discussed.

• Korean Journal of Adult Nursing
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• v.15 no.2
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• pp.296-304
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• 2003

Purpose: This study is to study sleep disorder, sleep pattern, and depression in adult women, and to offer basic data for a program of the improvement of women's health and nursing intervention. Method: A structured questionnaire was carried out from September 1, 2001 to October 30, 2001 on the subject of 441 females, who are above 18 years old and lived in Seoul. This research tool measured insomnia with APA's insomnia scale(1994), sleep pattern and sleep disorder factors scale(Shin et al(1999)'s), and depression with Radloff's CES-D scale (1977). The data were analyzed with a SPSS program for descriptive statistics, ${\chi}^2-test$, and t-test. Result: The result were as follows; 1) 35.1% of all participants have insomnia. 2) Sleep disorder group appeared shorter($50.98{\pm}29.41min$.) than normal group($73.03{\pm}38.7min$.) in daytime sleepiness(p=0.001). 3) Factors of sleep disorder were stress(76.6%), worry(55.6%), without reason(39.6%), and noise outside(37.4%). 4) In relation between sleep disorder and depression, group with sleep disorder($20.20{\pm}11.06$) marked higher depression score than normal group($14.25{\pm}8.81$)(p<0.0001). Conclusion: Based upon these finding, sleep disorder in adult women was influenced by psychological factors, group with sleep disorder showed a higher depression score than normal group, and which indicated correlation with sleep disorder and depression. This study shows that nursing intervention on women's sleep disorder and depression is needed and further research be done to verify the results.

• Sleep Medicine and Psychophysiology
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• v.11 no.2
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• pp.106-109
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• 2004

Adenotonsillar hypertrophy is the leading cause of childhood obstructive sleep apnea. Obstructive sleep apnea syndrome in childhood, however, can occur from various causes such as obesity or craniofacial abnormalities. Childhood obstructive sleep apnea syndrome can be accompanied by enuresis, parasomnias and behavior problems. For patients with the symptoms of snoring and apnea, obstructive sleep apnea should be suspected and diagnosed properly. In addition, the evaluation of complications and proper treatment are indispensable. When the cause of childhood obstructive sleep apnea is adenotonsillar hypertrophy, symptoms can be improved by surgical methods. If the cause is other than adenotonsillar hypertrophy, such as obesity, it should be treated with other therapeutic modalities, like nasal continuous positive airway pressure (nCPAP), weight reduction and modification of life style. This paper reports a case of nCPAP used to manage severe sleep apnea when it was not resolved after adenoidectomy and tonsillectomy. Differential diagnosis of narcolepsy in a case with excessive daytime sleepiness and reflections on accompanying enuresis and parasomnia were also described.