• Sleep Medicine and Psychophysiology
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• v.14 no.1
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• pp.13-19
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• 2007

Sleep disordered breathing is highly prevalent in the elderly and affects older men and women similarly. Nocturia, cardiovascular diseases, cognitive impairment, traffic accidents and repeated falls are common manifestations of sleep apnea in the elderly and sleep study may be indicated in these patients. When a sleep study is planned, reliable markers of respiratory efforts and a tibial EMG should be included because central sleep apneas and periodic leg movements are common in the elderly patients. Although cardiovascular morbidity and mortality seem to be lower in the elderly than in middle-aged adults, these may not be as low as commonly believed. Excessive daytime sleepiness, cognitive dysfunction and nocturia can be improved by effective treatment with continuous positive airway pressure and a therapeutic trial should be recommended to all symptomatic patients. It is still unclear whether sleep apnea in older adults is a specific entity or the same disease as in younger adults. Further clinical research is warranted.

• The Journal of the Korean dental association
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• v.57 no.5
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• pp.288-295
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• 2019

Sleep-disordered breathing (SDB) is defined as a disturbed breathing during sleep caused by repetitive upper airway collapse. Complete collapse causes a cessation of breathing, known as obstructive sleep apnea (OSA) and snoring can arise from partial collapse. Undiagnosed and untreated OSA means recurrent intermittent hypoxemia and leads to a variety of cardiovascular disorders, disturbed neurocognition, and excessive daytime sleepiness. Various behavioral modalities have been suggested for treating snoring and sleep apnea including changing the sleep position, avoiding alcohol, and weight loss. Until now continuous positive airway pressure (CPAP) therapy is one of effective treatment for patients with OSA, but its discomfort causes less tolerance and compliance. Therefore, clinical effectiveness and convenience for oral appliance have emerged and the role of dentists has become more important in the management of OSA.

• The Journal of the Korean dental association
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• v.57 no.5
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• pp.279-287
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• 2019

Obstructive sleep apnea syndrome (OSAS) is characterized by obstructive events of the upper airway (UAW) during sleep, which can be associated with clinical signs and symptoms such as snoring, excessive daytime sleepiness, impaired memory, and fatigue. It is associated with many problems like psychosocial problems, physiologic alterations in the cardiovascular and respiratory systems as a result of hypoxia and repeated awakenings during sleep. Conservative treatments such as weight loss, sleep positioning, improvement of sleep hygiene, CPAP and MAD can be performed for the obstructive sleep apnea. However, their effect for the OSA is limited and differs by patient's individual properties. Accordingly, surgical reconstructions of the upper airway must be carried out for the treatment of OSA.

• Sleep Medicine and Psychophysiology
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• v.18 no.1
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• pp.40-44
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• 2011

Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/$m^2$. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 ${\mu}IU$/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 $^*0602$ type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatmen, and the cataplexy not supported by HLA DQB1 $^*0602$ should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.

• Sleep Medicine and Psychophysiology
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• v.3 no.1
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• pp.47-55
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• 1996

Narcolepsy is characterized by sleep attack with excessive daytime sleepiness(EDS), cataplexy, sleep paralysis, and hypnagogic hallucination. Paradoxically, narcoleptics tend to complain of frequent arousals and shallow sleep during the night time despite their excessive sleepiness. However, nocturnal sleep fragmentation in narcoleptics is relatively ignored in treatment strategies, compared with sleep attack/EDS and cataplexy. In our paper, we attempted to investigate further on the poor nocturnal sleep in narcoleptics and to discuss possible treatment interventions. Out of consecutively seen patients at Seoul National University Sleep Disorders Clinic and Division of Sleep Studies, we recruited 57 patients, clinically assessed as having sleep attack and/or EDS. Nocturnal polysomnography and multiple sleep latency test(MSLT) were done in each of the subjects. We selected 19 subjects finally diagnosed as narcolepsy(mean age $26.0{\pm}18.3$ years, 16 men and 3 women) for this study, depending on the nocturnal polysomnographic and MSLT findings as well as clinical history and symptomatology. Any subject co-morbid with other hypersomnic sleep disorders such as sleep apnea or periodic limb movements during sleep was excluded. Sleep staging was done using Rechtschaffen and Kales criteria. Sleep parameters were calculated using PSDENT program(Stanford Sleep Clinic, version 1.2) and were compared with the age-matched normal values provided in the program. In narcoleptics, compared with the normal controls, total wake time was found to be significantly increased with significantly decreased sleep efficiency(p<.01, p<.05, respectively), despite no difference of sleep period time and total sleep time between the two groups. Stage 2 sleep%(p<.05), slow wave sleep%(p<.05), and REM sleep%(p<.01) were found to be significantly decreased in narcoleptics compared with normal controls, accompanied by the significant increase of stage 1 sleep%(p<.01). Age showed negative correlation with slow wave sleep%(p<.05). The findings in the present study indicate significant fragmentation of nocturnal sleep in narcoleptics. Reduction of REM sleep% and the total number of REM sleep periods suggests the disturbance of nocturnal REM sleep distribution in narcoleptics. No significant correlations between nocturnal polysomnographic and MSLT variables in narcoleptics suggest that nocturnal sleep disturbance in narcoleptics may be dealt with, in itself, in diagnosing and managing narcolepsy. With the objective demonstration of qualitative and quantitative characteristics of nocturnal and daytime sleep in narcoleptics, we suggest that more attention be paid to the nocturnal sleep fragmentation in narcoleptics and that appropriate treatment interventions such as active drug therapy and/or circadian rhythm-oriented sleep hygiene education be applied as needed.

• Sleep Medicine and Psychophysiology
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• v.12 no.2
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• pp.133-138
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• 2005

Objectives: Narcolepsy is characterized by excessive sleepiness, cataplexy, sleep paralysis and hypnagogic hallucination. As there have been few researches on narcolepsy symptomatology in adolescents, we examined gender differences and prevalence of narcolepsy tetrad among students attending high school. Methods: Total 20,407 subjects, ages 14-19 years filled out Ullanlinna Narcolepsy Scale (UNS). Subjects whose UNS scores were equal to or more than 14 were interviewed by telephone using semi-structured questionnaire. Variables included questions to evaluate tetrad of narcolepsy. Results: UNS scores were higher in female than male ($11.1{\pm}5.2$ vs. $9.6{\pm}4.5$, p<0.001). Subjects scoring the UNS equal to or more than 14 were 4,535 (22.2% of all the participants), more frequently observed in female than in male (p<0.001). Excessive daytime sleepiness, cataplexy-like symptoms, sleep paralysis and hypnagogic hallucination in subjects of UNS ${\geq}14$ were significantly higher in female subjects than male ones. However, no significant gender difference was observed in the frequencies of severe sleep attack and cataplexy-like symptoms. Sleep paralysis was most frequently reported during sleep. There was significant correlation between sleep paralysis and hypnagogic hallucination (r=0.235, p<0.01). Conclusions: Our findings were that female adolescents complained more frequently narcolepsy symptoms than male subjects. Female adolescents might be more sensitive than male ones to physical complaints such as sleepiness or muscle weakness.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.2
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• pp.162-166
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• 2001

Obstructive sleep apnea syndrome(OSAS) is a complex sleep disorder characterized by intermittent apnea secondary to sleep-induced obstruction of the upper airway. It occurs because of an airway obstruction anywhere between the trachea and the oronasal apparatus. The hallmark of OSAS is snoring, which is caused by vibration of the tissues of the pharynx as the airway narrows. The consequences of OSAS have focused on excessive daytime sleepiness resulting from sleep fragmentation and the cardiovascular derangements producing hypertension and arrhythmias. The primary method of controlling OSAS has been surgery. The current surgical procedures used for OSAS are tracheostomy, tonsillectomy, nasal septoplasty, uvulopalatopharyngoplasty, anterior mandibular osteotomy with hyoid myotomy and suspension, and maxillary, mandibular and hyoid advancement. We report a case of OSAS that was improved by genial advancement with infrahyoid myotomy and suspension. The patient was objectively documented by polysomnography, cephalometric analysis, and physical examination before the surgical procedure. The patient underwent genial advancement with infrahyoid myotomy and suspension. Patient had a good response from surgery.

• Sleep Medicine and Psychophysiology
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• v.23 no.2
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• pp.97-99
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• 2016

Positive airway pressure (PAP) is currently recommended as a primary treatment for obstructive sleep apnea syndrome (OSAS) and positively affects various subjective and objective parameters related to OSAS, such as the apnea-hypopnea index, excessive daytime sleepiness, and blood pressure. However, PAP also exhibits various adverse effects, including skin breakdown, pressure intolerance, claustrophobia, unintentional mask removal, mouth leaks, and dryness. Especially, unintentional mask removal due to nasal obstruction may result in poor PAP compliance. A 47-year-old male patient with severe OSAS who had low PAP compliance due to nasal obstruction underwent nasal surgery. After the surgery, nasal obstruction was corrected and the patient experienced improved PAP compliance (from 30.4% to 86.7%). This case demonstrates that nasal surgery may be useful for improving PAP compliance in OSAS patients with nasal obstruction.

• Korean Journal of Clinical Laboratory Science
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• v.39 no.3
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• pp.264-270
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• 2007

Obstructive sleep apnea syndrome (OSAS) is defined by sleep apnea with decreased oxygen saturation, excessive snoring with daytime sleepiness, and frequent awakening during the night time sleep. The present study was performed to investigate how apnea-hypopnea, that possibly causes breathing disturbance during sleep, can affect sleep pattern in patients with OSAS. We included 115 patients (92 men, 23 women) who underwent a polysomnography from January 2006 to May 2007. As the frequency of sleep apnea-hypopnea increases, the proportion of non-rapid eye movement (REM) sleep (p<0.001), and stage I sleep (p<0.001) increased, while that of stage II sleep (p<0.001), stage III and IV sleep (p<0.01), and REM sleep (p<0.05) decreased. Furthermore, sleep apnea-hypopnea was closely correlated with REM sleep (r=0.314, p<0.001), stage I sleep (r=0.719, p<0.001), stage II sleep (p=-0.342, p<0.05), stage III and IV sleep (r=-0.414, p<0.001), and REM sleep (r=-0.342, p<0.05). Stage I sleep could account for the 51% of the variance of apnea-hyponea. Our study shows sleep apnea-hypopnea affects sleep pattern in pattern with OSAS significantly, and the change of stage I sleep is the most important factor in estimating the disturbance of sleep pattern.

• The Transactions of the Korean Institute of Electrical Engineers D
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• v.55 no.5
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• pp.240-247
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• 2006

Frequent arousals during sleep degrade the quality of sleep and result in sleep fragmentation. Visual inspection of physiological signals to detect the arousal events is cumbersome and time-consuming work. The purpose of this study is to develop an automatic algorithm to detect the arousal events. The proposed method is based on time-frequency analysis and the support vector machine classifier using single channel electroencephalogram (EEG). To extract features, first we computed 6 indices to find out the informations of a subject's sleep states. Next powers of each of 4 frequency bands were computed using spectrogram of arousal region. And finally we computed variations of power of EEG frequency to detect arousals. The performance has been assessed using polysomnographic (PSG) recordings of twenty patients with sleep apnea, snoring and excessive daytime sleepiness (EDS). We could obtain sensitivity of 79.65%, specificity of 89.52% for the data sets. We have shown that proposed method was effective for detecting the arousal events.