• Journal of Yeungnam Medical Science
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• 제37권3호
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• pp.194-201
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• 2020

Background: Dietary polyunsaturated fatty acids (PUFA) are thought to modify systemic inflammation. The present study aimed to evaluate the relationship between PUFA intake, lung function, and health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). Methods: In this study, we used the dataset of 6th Korea National Health and Nutrition Examination Survey, in which, a total of 22,948 individuals including 573 participants with a high probability of developing COPD were enrolled. Participants with missing data for the investigated variables were excluded. Linear regression analyses were used to evaluate the association between PUFA intake (omega-3 [N3], omega-6 [N6], and total) with lung function, and HRQoL. HRQoL was determined according to the European Quality of Life-5 Dimensions (EQ-5D). Subgroup analysis of older patients was performed. Age, sex, body mass index, smoking, alcohol, education, residence, total calorie intake, and predicted FEV₁% were adjusted in all analyses. Results: Although lung function was not associated with PUFA intake, EQ-5D index was remarkably associated with N3, N6, and total PUFA intake in a dose-dependent manner. This association was more pronounced in elderly COPD patients. Mean levels of N3, N6, and total PUFA intake were significantly higher in patients having better HRQoL with respect to mobility, self-care, and usual activities. Conclusion: Our results suggest that N3, N6, and total PUFA intake are associated with HRQoL in COPD patients. This association may be attributed to mobility, self-care, and usual activities. Further longitudinal study is required to clarify this relationship.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.116-122
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• 2018

Background: Chronic obstructive pulmonary disease (COPD) is a serious chronic condition with a global impact. Symptoms of COPD include progressive dyspnea, breathlessness, cough, and sputum production, which have a considerable impact on the lives of patients. In addition to the human cost of living with COPD and the resulting death, COPD entails a huge economic burden on the Chinese population, with patients spending up to one-third of the average family income on COPD management in some regions is clinically beneficial to adopt preventable measures via prudent COPD care utilization, monetary costs, and hospitalizations. Methods: Toward this end, this study compared the relative effectiveness of six indices in predicting patient healthcare utilization, cost of care, and patient health outcome. The six assessment systems evaluated included the three multidimensional Body mass index, Obstruction, Dyspnea, Exercise capacity index, Dyspnea, Obstruction, Smoking, Exacerbation (DOSE) index, and COPD Assessment Test index, or the unidimensional measures that best predict the future of patient healthcare utilization, cost of care, and patient health outcome among Chinese COPD patients. Results: Multiple linear regression models were created for each healthcare utilization, cost, and outcome including a single COPD index and the same group of demographic variables for each of the outcomes. Conclusion: We conclude that the DOSE index facilitates the prediction of patient healthcare utilization, disease expenditure, and negative clinical outcomes. Our study indicates that the DOSE index has a potential role beyond clinical predictions.

• Journal of Rhinology
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• 제25권2호
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• pp.80-85
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• 2018

Background and Objectives: Obesity is one of the most important risk factors for obstructive sleep apnea (OSA). There is limited evidence regarding the obesity-related anthropometric characteristics of Korean patients. Materials and Method: Medical records of 984 patients referred to 3 tertiary referral hospitals for habitual snoring or sleep apnea were analyzed. We defined OSA as apnea-hypopnea index (AHI) ${\geq}5$ and analyzed data to determine the anthropometric characteristics of patients with OSA such as neck circumference (NC), waist circumference (WC), hip circumference (HC), and waist to hip ratio (WHR). Results: A total of 952 patients (719 men) were included in the analysis. The main findings were: 1) BMI, WC, NC, HC, and WHR were greater among patients with OSA than among controls (AHI <5); 2) for both sexes, the proportion of patients with an OSA diagnosis increased with age; it increased steeply for women aged >50 years; 3) WC and WHR were most strongly correlated with AHI for men and women, respectively. Conclusion: OSA is associated with anthropometric characteristics, although different patterns were observed between men and women. OSA was more strongly associated with NC or WC among men and with WHR among women.

• Journal of Sleep Medicine
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• 제15권2호
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• pp.48-54
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• 2018

Objectives: The aim of this study was to develop a predicting model for the optimal continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) patient with obesity by using a machine learning. Methods: We retrospectively investigated the medical records of 162 OSA patients who had obesity [body mass index (BMI) ≥ 25] and undertaken successful CPAP titration study. We divided the data to a training set (90%) and a test set (10%), randomly. We made a random forest model and a least absolute shrinkage and selection operator (lasso) regression model to predict the optimal pressure by using the training set, and then applied our models and previous reported equations to the test set. To compare the fitness of each models, we used a correlation coefficient (CC) and a mean absolute error (MAE). Results: The random forest model showed the best performance {CC 0.78 [95% confidence interval (CI) 0.43-0.93], MAE 1.20}. The lasso regression model also showed the improved result [CC 0.78 (95% CI 0.42-0.93), MAE 1.26] compared to the Hoffstein equation [CC 0.68 (95% CI 0.23-0.89), MAE 1.34] and the Choi's equation [CC 0.72 (95% CI 0.30-0.90), MAE 1.40]. Conclusions: Our random forest model and lasso model ($26.213+0.084{\times}BMI+0.004{\times}$apnea-hypopnea index+$0.004{\times}oxygen$ desaturation index-$0.215{\times}mean$ oxygen saturation) showed the improved performance compared to the previous reported equations. The further study for other subgroup or phenotype of OSA is required.

• Journal of Oral Medicine and Pain
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• 제47권3호
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• pp.135-143
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• 2022

Purpose: This study aimed to evaluate polysomnographic and cephalometric characteristics of patients with OSA according to obesity level based on the World Health Organization (WHO) Asian-Pacific BMI criteria. Methods: One hundred and thirty-one consecutive patients with obstructive sleep apnea (OSA) were evaluated using standard level 1 polysomnography and cephalometric analyses. The subjects were categorized into normal, overweight and obese groups according to the WHO Asian-Pacific BMI criteria. Respiratory indices and cephalometric parameters were compared among groups. Results: The 131 patients consisted of 111 males and 20 females, with a mean age of 44.1±12.4 years. The mean value of BMI was 25.3±3.4 kg/m² for all subjects, 20.6±2.2 kg/m² for normal (n=27), 24.0±0.5 kg/m² for overweight (n=33) and 27.6±2.2 kg/m² for obese (n=71). The obese group had a significantly higher apnea-hypopnea index (AHI) and respiratory arousal index and lower oxygen saturation level than the normal group (p<0.05). Total AHI, mean oxygen saturation level and respiratory arousal index were significantly correlated with BMI (p<0.001). A longer soft palate and anterior position of the hyoid bone were significantly correlated with BMI level (p ≤0.05). Conclusions: Obese patients have a higher risk of compromised craniofacial skeletal features and soft tissue structures, and severe OSA than non-obese patients.

• Tuberculosis and Respiratory Diseases
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• 제47권2호
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• pp.218-230
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• 1999

연구배경: 두개안면 및 상기도의 해부학적 이상은 폐쇄성 수면 무호흡 발생과 밀접한 관련이 있는 것으로 알려져 있다. 저자들은 한국인 폐쇄성 수면 무호흡 증후군 환자가 지니고 있는 두개안면 및 상기도의 해부학적 특성을 평가하고, 폐쇄성 수면 무호흡의 발생을 예측함에 있어서 두개골계측분석의 임상적 유용성을 조사하고자 하였다. 방법: 폐쇄성 수면 무호흡 증후군 환자 39명(OSAS), 단순코골이 39명(simple snorers) 및 정상인 20명(control)을 대상으로 Riley 등의 방법을 이용한 두개골계측분석의 각 계측치와 수면다원검사의 각 지표와의 상호 관련성을 분석하였다. 결과: Pm-UPW길이와 V-LPW길이는 OSAS 및 simple snorers 에서 control에 비해 각각 유의하게 짧았으며 (p<0.01), PAS 깊이는 simple snorers가 control에 비해 짧았다 (p<0.05). ANS-Gn길이는 OSAS가 control에 비해 유의하게 길었고 (p<0.01), PNS-P길이는 OSAS 및 simple snorers가 control에 비해 각각 유의하게 길었다(p<0.01). MP-H길이는 OSAS가 control 및 simple snorers 에 비해 각각 유의하게 길었고 (p<0.01), simple snorers는 control에 비해 길었다(p<0.05). NL/Pm-P각도는 OSAS가 control 에 비해 작았다(p<0.05). MP-H길이는 OSAS에서 무호흡-저호흡지수와 유의한 상관관계가 있었으며 (r=0.561, p<0.01), OSAS와 simple snorers를 합한 대상에서도 MP-H 길이와 무호흡-저호흡지수는 유의한 상관관계가 있었다(r=0.511, p<0.01. PNS-P길이는 OSAS와 simple snorers를 합한 대상에서 무호흡-저호흡지수와 관련성이 있었다(r=0.286, p<0.05). 전체 대상에서 남자의 비만도가 PNS-P길이(r=0.355, p<0.01) 및 MP-H길이(r=0.460, p<0.01)와 유의한 상관관계가 있었다. 결론: 두개골계측분석은 폐쇄성 수면 무호흡 증후군의 원인이 될 수 있는 두개안면 및 상기도약 해부학적 특성을 평가할 수 있는 유용한 검사이다. 여러 가지 두개골계 측치중에서 설골의 위치를 나타내는 MP-H길이는 수면중에 발생 가능한 상기도의 협착 혹은 폐쇄 정도를 예측하는 자료로서 임상적 유용성이 높을 것으로 생각된다.

• 수면정신생리
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• 제23권2호
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• pp.93-96
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• 2016

Obstructive sleep apnea syndrome (OSAS) has negative effects on health, including increased mortality, risk of cardiovascular disease, and neurocognitive difficulties. OSAS is common in obese patients and obesity is an important risk factor of OSAS. A 41-year-old female OSAS patient with severe obesity (body mass index [BMI] ${\geq}35$) who failed dietary weight loss underwent bariatric surgery. After surgery, there were improvements in BMI (from 36.9 to $31.7kg/m^2$) and polysomnographic data, including the apnea-hypopnea index (from 25.1 to 11.2 events/hr) and minimum SaO2 (from 69 to 82%). This case demonstrates that bariatric surgery may be an effective therapeutic option to reduce sleep-disordered breathing in severely obese patients with moderate OSAS. Bariatric surgery as a treatment option for OSAS should be considered in OSAS patients with severe obesity who failed dietary weight loss.

• Tuberculosis and Respiratory Diseases
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• 제69권4호
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• pp.243-249
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• 2010

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and mortality worldwide. The aim of this study was to evaluate the risk factors associated with recurrent hospital admissions for exacerbation of COPD in Korea. Methods: A retrospective study of 77 consecutive patients hospitalized for exacerbation of COPD at Pusan National University Hospital during the time period January 2005 to May 2008 was performed. The information was collected from the hospitalization period: clinical information, spirometric measures, and laboratory variables. In addition, socioeconomic characteristics, co-morbidity, anxiety, and depression were reviewed. Frequent readmission was defined as 2 or more hospitalizations in the year following discharge. Results: During the 1-year period after discharge, 42 patients (54.6%) reported one hospital admission and 35 patients (45.4%) reported 2 or more hospital readmissions. Among the 35 frequent readmission patients, 4 had more than 10 readmissions. Univariate analysis showed that a body mass index (BMI) <$18.5kg/m^2$, duration >36 months, forced expiratory volume in 1 second ($FEV_1$) <50% predicted, arterial $CO_2$ partial pressure ($PaCO_2$) >40 mm Hg, and arterial oxygen saturation ($SaO_2$) <95% at discharge were associated significantly with frequent readmissions. The multivariate analysis revealed that BMI <$18.5kg/m^2$, $PaCO_2$ >40 mm Hg at discharge were independently associated with frequent readmissions for exacerbation of COPD. Conclusion: Frequent readmissions for exacerbation of COPD were associated with low BMI and hypercapnia at discharge.

• 생물정신의학
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• 제20권2호
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• pp.54-60
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• 2013

Objectives The purpose of this study is to find the influential clinical and physical characteristics which affect apnea-hypopnea index (AHI) in suspected obstructive sleep apnea (OSA) patients. Methods We evaluated the comprehensive factors including sleep related symptoms, clinical scales, medical history, substance use, and anthropometric data of the 119 participants who complained of the symptoms of OSA. All the participants underwent attended-full night laboratory polysomnography. The correlation and multiple regression analysis were conducted to find the influential and predictive factors of AHI. Results A multiple linear regression model 1 showed that higher AHI was associated with higher body mass index (BMI)(p < 0.001) and higher frequency of observed apnea (p = 0.002). In multiple linear regression model 2, AHI was associated with higher BMI (p < 0.001) and loudness of snoring (p = 0.018). Conclusions The present preliminary results suggest that BMI and observed apnea are most influential factors that affect AHI in suspected OSA patients. In the future study we will design the prediction formula for the OSA and AHI, which is useful in the clinical medical field.

• 수면정신생리
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• 제13권2호
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• pp.52-58
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• 2006

목 적：본 연구에서는 폐쇄성 수면 무호흡 환자에서 지속적 상기도 양압술의 순응도와 부작용에 대해서 조사하고, 지속적 상기도 양압술 치료 전후의 주간졸림증, 수면질 평가, 우울증, 체질량지수 변화를 알아보고자 하였다. 방 법：호흡장애 지수가 5 이상이면서 양압술 치료를 시행한 106명의 폐쇄성 수면 무호흡 환자들을 대상으로 하였고, 연구대상에게 간단한 신체검사, 피츠버그 수면질척도, 엡워스 졸림증 척도, 벡 우울증 척도 등을 포함한 설문지 평가와 수면다원검사를 반복 시행하였다. 양압술 치료의 순응도와 부작용을 평가하기 위해서 전화면담과, 우편설문을 시행하여 비교, 분석하였다. 결 과：41.5%가 양압술 치료에 순응하고 있었으며, 38.7%는 양압술 치료에 비순응 하였다. 양압술 치료에 순응하는 집단은 비순응 집단에 비해, 피츠버그 수면질 척도 점수와 폐쇄성 무호흡지수가 더 높았다. 비순응 집단에서 1개월 이내에 양압술 치료를 중단한 환자는 51.2%였다. 양압술 치료 비순응 집단에서는 양압기 착용의 번거로움을 호소한 비율이 85.7%로 높았으며, 양압술 치료에 순응하는 집단에서는 비인두 증상의 부작용을 많이 호소하였다. 양압술 치료 후 엡워스 졸림증 척도 점수, 피츠버그 수면질 척도 점수, 체질량지수는 호전되었으나 벡 우울증 척도 점수는 차이가 없었다. 결 론：양압술 치료는 주간졸림증과 체질량지수를 감소시키고, 수면질을 향상시킨 것으로 나타났다. 초기 1개월 이내에 양압기 사용을 중단한 비율이 가장 높으므로 순응도를 높이기 위해서는 초기에 교육과 지지가 필요하다고 생각된다.