• 수면정신생리
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• 제14권1호
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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.

• 대한치과의사협회지
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• 제57권5호
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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.

• 대한치과의사협회지
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• 제57권5호
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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.

• 수면정신생리
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• 제18권1호
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• pp.40-44
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• 2011

기면병은 과도한 주간 졸림, 탈력발작, 수면 분절화, 입면환각의 특징을 가진 수면 질환이다. 기면병의 증상은 내과적, 신경과적 질환으로부터 생길 수도 있다. 17세의 고등학생 남자 환자가 3개월 전부터 발생한 참을 수 없는 과도한 주간 졸림으로 본원 수면클리닉을 통해 입원하였다. 내원 이후 측정된 체질량지수는 30.4 kg/$m^2$였고 맥박은 분당 70~90회, 혈압은 150/100~120/70 mmHg로 관찰되었다. 갑상선기능 검사에서 T3 391.2 ng/dL(60~181), free T4 4.38 ng/dL(0.89~1.76), TSH(thyroid stimulating hormone) <0.01 ${\mu}IU$/mL(0.35~5.5)로 갑상선 중독증이 시사되었다. 수면다원검사가 실시되었고, 수면 자세의 변환은 시간당 81 회로 매우 많은 편이었다. 입면 잠복기는 33.5분, 수면 효율은 47.9%, 입면에서 렘수면 입면시간은 153.6분으로 지연되었고 렘수면은 27.1%로 증가하였다. 주기성 사지 운동지수는 13.4/h로 나타났다. 수면잠복기반복검사에서 평균 입면잠복시간은 24초, SOREMP(sleep onset REM period)은 3회에서 관찰되었다. actogram상 수면-각성의 경계가 불분명하였고, HLA typing에서 DQB1 $^*0602$는 음성이었다. 환자의 갑상선중독증은 대해 3개월간 methimazole 30 mg, propranolol 40 mg이 투약되며 갑상선 기능이 호전되었다. 탈력발작은 venlafaxine 75 mg으로 조절되었고, 야간 수면 유지와 주기적 사지운동증을 치료 하기 위해 clonaze-pam 0.5 mg이 사용되었고 주관적인 야간 수면의 질은 향상되었다. 과도한 주간 졸림에 대해서는 3개월간 modafinil 200~400 mg이 투여되었고 부분적이긴 하지만 다소의 호전을 보이고 있다. 본 증례는 기면병으로 최종 진단된 환자에 있어 병력과 검사상 발견된 갑상선 중독증, 그리고 수면 효율 감소 등이 과도한 주간 졸림을 평가하는데 혼란 변수로 작용한 경우라 하겠다. 다만, 주간 과다 졸림이 modafinil에 부분적인 효과를 보이는 것, HLA DQB1 $^*0602$ 음성의 결과를 보인 환자에게 나타났던 탈력발작에 대해서도 더 설명이 필요할 것으로 보인다. 향후 CSF hypocretin level을 추가로 측정하고 수면 문제의 추이를 관찰하면서 추가적인 PSG와 MSLT가 필요할 것으로 사료된다.

• 수면정신생리
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• 제3권1호
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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.

• 수면정신생리
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• 제12권2호
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• pp.133-138
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• 2005

목 적：본 연구에서는 성남 용인 소재 고등학생 대상으로 기면병의 특징적인 증상인 주간졸림증, 탈력발작, 수면마비, 입면시 환각의 비율을 조사하고 성별차이에 대한 연관성을 알아보고자 하였다. 방 법：성남 용인 지역의 35개 대상 고등학교 중 26개 학교가 연구에 협조하여 20,407명 대상으로 하였다. 전체 학생들에게 한국어로 번안한 Ullanlinna 기면병 척도를 측정하였고, 14점 이상인 학생들에게 기면병의 증상에 대해서 전화 인터뷰를 시행하였다. 기면병 증상의 비율과, 성별에 따른 심한 정도의 차이, 수면마비와 입면시 환각의 상관관계에 대해서 비교, 분석하였다. 결 과：Ullanlinna 기면병 설문지에 응답한 학생은 20,407명 중 20,343명이었으며 이 가운데 14점 이상 학생은 4,535명(22.2%)였다. Ullanlinna 기면병 설문지에 응답한 20,343명의 남녀 사이에 기면병 척도 평균점수는 유의한 차이가 있었고, 탈력발작과 주간졸림증의 평균점수도 남녀간의 차이가 있었다. Ullanlinna 기면병 설문지에서 14점 이상인 학생 4,535명 가운데 전화 인터뷰에 응답한 학생은 3,234명이었으며 수면발작, 주간 졸림증, 유사 탈력발작, 수면마비, 입면시 환각이 남자보다 여자에서 높은 비율을 보였다. 하지만 심한 수면발작과 유사 탈력발작의 빈도에 있어서는 남녀간의 차이가 없었다. 수면마비와 입면시 환각은 흔히 동반되는 증상이었으며 두 변수 사이에 상관관계가 관찰되었다. 수면마비가 일어나는 시기는 잠자기 전, 잠자는 동안, 잠에서 깨어난 후 중에 잠자는 동안에서 가장 많이 일어난다고 보고하였다. 결 론：기면병의 특징적인 증상인 주간졸림증, 탈력발작, 수면마비, 입면시 환각에서 남자보다 여자에서 높은 비율을 나타냈다. 이러한 성별 차이는 여학생이 남학생보다 신체 증상에 좀 더 민감하다는 것과 연관하여 설명할 수 있을 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권2호
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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.

• 수면정신생리
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• 제23권2호
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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.

• 대한임상검사과학회지
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• 제39권3호
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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.

• 대한전기학회논문지:시스템및제어부문D
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• 제55권5호
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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.