• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권2호
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• pp.149-165
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• 1999

The pathomechanism of obstructive sleep apnea(OSA) is not clearly elucidated. The possible mechanisms are pathologic reduction of pharyngeal muscular tonus during sleep, abnormal anatomical stenosis of nasopharyx or a combination of the above two mechanisms. It is very important to find the cause(anatomical location or pathologic dynamic change) of OSA in order to treat it. Cephalometric analysis in patients with obstructive sleep apnea is a good method for evaluating anatomical morphologic change but it cannot give any information about the dynamic changes occurring during sleep. On the contrary, nasopharyngeal endoscopy offer 3 dimensional image and information about the dynamic changes. Accordingly, these two diagnostic tools can be utilize in the diagnosis and treatment planning of OSA Cephalometric analysis of craniofacial skeletal and soft tissue morphology in 53 patients with OSA and 43 controls was performed and cephalometric analysis and nasopharygeal endoscopy were performed in 9 patients with OSA in order to come up with individualized therapy plans. Following results were obtained ; Patients with OSA showed 1. body weight gain 2. clockwise mandibular rotation 3. increased anterior lower facial height 4. inferiorly positioned hyoid bone 5. increased length of soft palate 6. decreased sagittal dimension of nasopharyx 7. increased vertical length of inferior collapsable nasopharyx 8. increased length of tongue Through cephalometric analysis and nasopharygeal endoscopy(mutually cooperative in diagnosis), 9. one can find the possible origin of OSA and make a adequate individualized therapy plan and predict accurate prognosis. Cephalometric analysis and nasopharygeal endoscopy are highly recommended as a diagnostic aid in OSA patients

• 수면정신생리
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• 제15권2호
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• pp.77-81
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• 2008

배 경：수면은 크게 비렘수면(non-REM sleep)과 렘수면(REM sleep)으로 나눌 수 있으며 렘수면 중에는 근력의 소실로 상기도 확장 근육의 긴장도가 저하되고 상기도 저항은 증가하여 무호흡증이 발생하거나 악화될 수 있다. 폐쇄성 수면무호흡증 자체에 대해서는 이미 많은 부분이 알려져 왔으나 렘수면에만 특이적으로 나타나는 렘수면 의존성 폐쇄성 수면무호흡증(REM-dependent OSA)은 그 중요성이 간과되어 왔다. 본 연구에서는 REM-dependent OSA 환자들의 임상 특성과 수면 변인을 살펴보고자 하였다. 방 법：2004년 3월부터 2007년 2월까지 시립은평병원 수면검사실을 방문하여 경도나 중등도의 폐쇄성 수면무호흡증으로 진단받은(5$53.7{\pm}16.7$, 남성：42명)를 대상으로 하였다. REM-dependent OSA(AHIREM/AHINREM${\ge}$2) 환자군과 No REM-dependent OSA(AHIREM/AHINREM<2) 환자군의 임상적 특성과 수면 관련변인을 비교하였다. 통계분석은 Statistica 6.0 프로그램을 사용하였으며, 유의수준은 p<0.05로 하였다. 결 과：대상군 56명 중 21명(37.5%)가 REM-dependent OSA으로 진단되었다. 두 군사이의 연령, 성별, BMI (Body Mass Index)는 유의한 차이를 보이지 않았다. 성별, 연령, BMI, PLMI를 통제한 후, 수면 관련 변인 중 REMdependent OSA 환자군에서 AHI(Apnea Hypopnea Index), ODI(Oxygen Desaturation Index)가 유의하게 낮았다($12.1{\pm}6.4$ vs. $35.9{\pm}24.7$, p=0.010; $6.0{\pm}5.3$ vs. $24.0{\pm}20.4$, p=0.006, respectively, ANCOVA). REMdependent OSA 환자군에서유의하게 높은 2단계 수면이 관찰되었다($58.5{\pm}10.3$ vs. $51.2{\pm}13.2$, p=0.031, ANCOVA). REM-dependent OSA군으로 대상군을 한정하였을 때, 성별, 연령, BMI, PLMI를 통제한 후, 렘수면중 AHI는 전체 수면중 AHI, 비렘수면중 AHI, ODI와 유의미한 양의 상관관계를 보였다(r=0.720, p=0.001；r=750, p=0.001；r=0.749, p=0.001, partial correlation, respectively). 결 론 ：본 연구에서는 폐쇄성 수면무호흡증 환자 중 37.5%를 REM-dependent OSA 환자로 진단할 수 있었다. REM-dependent OSA 환자는 더 경한 정도의 수면 무호흡증을 보이는 경향이 있었으며, 2단계 수면 분율의 증가 같은 수면구조의 변화와 연관되어 있었다. 또한, 렘수면중의 무호흡은 산소포화도 저하와 연관되어 있었다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권5호
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• pp.259-266
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• 2022

The relationship between obstructive sleep apnea (OSA) and diverse types of pain conditions have been proposed. However, no consensus on the relationship between OSA and painful temporomandibular disorders (TMDs) has been established. Therefore, this systematic review has been conducted to review the existing literatures and provide comprehensive synthesis of such literatures about OSA and painful TMDs using the evidence-based methodology. A literature search was conducted using two electronic databases, Scopus, and PubMed. Risk of bias was assessed using the risk-of-bias assessment tool for non-randomized study version 2.0. A total of 158 articles were screened from the initial search and eventually, 5 articles were included in this systematic review. One study adopted both the longitudinal prospective cohort and case-control designs and other 4 articles adopted the cross-sectional design. Two studies employed polysomnography (PSG) for the diagnosis of OSA and mentioned the results from the PSG. All cross-sectional studies demonstrated higher OSA prevalence among patients with TMD, and one cohort study suggested OSA as a risk factor for TMD. OSA appears to have potential influences on the development of TMD; however, the role of TMD in the development of OSA remains to be unknown owing to the lack of high-quality evidences.

• 대한임상검사과학회지
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• 제43권2호
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• pp.82-88
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• 2011

Mandibular advancement devices (MAD) are therapeutic options for obstructive sleep apnea (OSA). The aim of study was to investigate treatment outcomes of before and after insertion of MAD in OSA patients. We retrospectively selected a total of 13 patients who were diagnosed with OSA syndrome. All sleep-related parameters including apnea-hypopnea index (AHI), oxygen desaturation index (ODI), wake after sleep onset (WASO), total arousal were measured by before and after MAD. The use of MAD proves to be efficient in reducing snoring, apnea-hypopne index ($17.2{\pm}14.6$ vs $20.9{\pm}14.6$), WASO ($27.4{\pm}28.8$ vs $47.9{\pm}43.6$), oxygen desaturation index ($9.0{\pm}11.6$ vs $16.4{\pm}11.7$), stage N3 ($54.8{\pm}45.2$ vs $36.6{\pm}22.0$), REM sleep times ($73.3{\pm}19.4$ vs $66.0{\pm}31.0$) and increases sleep efficiency ($92.6{\pm}6.6$ vs $87.2{\pm}11.2$). The decreases in apnea index based on a reduction in the overall and supine AHI values after MAD therapy were significantly greater for the positional OSA than nonpositional OSA patients. The use of MAD proves to be efficient in snoring, WASO, sleep efficiency, reduced AHI and associated with good compliance of patients.

• Journal of Oral Medicine and Pain
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• 제41권1호
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• pp.7-15
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• 2016

Purpose: Mandibular advancement device (MAD) is widely recognized as an important treatment option for obstructive sleep apnea (OSA) and is readily accepted than any other treatment options owing to its simplicity and ambulatory nature. At this time, there are a multitude of MAD designs and their efficacies may be influenced by adjustment and retention mechanism. The MAD with the anterior connector (anteriorly adjustable mandibular advancement device, AAMAD) was newly developed in the Department of Oral Medicine, Dankook University Dental Hospital (Cheonan, Korea) and was prescribed for the OSA patients including snoring patients. Thus, this study was aimed to objectively investigate the effectiveness of the AAMAD on the OSA patients using the self-applied portable device (ApneaLink), and evaluate the treatment outcomes among patients with various severity of OSA level. Methods: Results of the treatment of fourteen patients (13 male, 1 female) with the AAMAD were retrospectively analyzed. Each patient underwent home sleep test before treatment and were divided into two groups, i.e., those with mild (apnea-hypopnea index [AHI] ${\geq}5$ and <15) to moderate OSA (AHI ${\geq}15$ and <30) and severe OSA (AHI ${\geq}30$). After treatment, home sleep test was conducted again and treatment outcomes were compared between mild to moderate and severe OSA patients. Results: Of all patients, 78.6% showed more than 50% AHI reduction. We found a significant reduction (85.3%) of AHI in the severe OSA patients. Patients with mild to moderate OSA showed the reduced AHI (56.1%). Conclusions: We concluded that AAMAD is an effective oral appliance for the majority of OSA patients.

• 수면정신생리
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• 제5권2호
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• pp.210-215
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• 1998

OSA(Obstructive Sleep Apnea) is a condition with repeated obstruction of the upper airway while sleeping. This obstruction of the upper airway may result if sleep-induced physiologic change in muscle activity is superimposed on various structural defects of the upper airway. Macroglossia, micrognathia, retrognathia, and decreased airway lumen have all been implicated in OSA. There are a variety of surgical and nonsurgical treatment modalities currently available for OSA. Recently the uvulopalatopharyngoplasty has achieved widespread use, but success rates vary and long-term effects are still unknown. Current nonsurgical treatment methods can be cumbersome and uncomfortable with variable responses. For this case. we diagnosed as OSA by using polysomnographic analysis and cephalometric analysis, and delivered intraoral removable appliance which is more conservative, reversible and easy to use for patient. And we got results that Apnea Index(AI) decreased from 14.4 to 3.1, Total Respiratory Disturbance Index(Total RDI) decreased from 18.1 to 7.0 and removal of chronic headache in daytime.

• 대한치과의사협회지
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• 제57권5호
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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.

• Imaging Science in Dentistry
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• 제53권4호
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• pp.283-289
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• 2023

The apnea-hypopnea index is widely regarded as a measure of the severity of obstructive sleep apnea (OSA), a condition characterized by recurrent episodes of apnea or hypopnea during sleep that induce airway collapse. OSA is a catastrophic problem due to the wide range of health issues it can cause, including cardiovascular disease and memory loss. This review was conducted to clarify the roles of various imaging modalities, particularly cone-beam computed tomography (CBCT), in the diagnosis of and preoperative planning for OSA. Unfortunately, 2-dimensional imaging techniques yield insufficient data for a comprehensive diagnosis, given the complex anatomy of the airway. Three-dimensional (3D) imaging is favored as it more accurately represents the patient's airway structure. Although computed tomography and magnetic resonance imaging can depict the actual 3D airway architecture, their use is limited by factors such as high radiation dose and noise associated with the scans. This review indicates that CBCT is a low-radiation imaging technique that can be used to incidentally identify patients with OSA, thereby facilitating early referral and ultimately enhancing the accuracy of surgical outcome predictions.

• 수면정신생리
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• 제11권1호
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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.

• Journal of Oral Medicine and Pain
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• 제48권3호
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• pp.96-105
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• 2023

Purpose: Mandibular advancement devices (MAD) are known to be insufficiently effective in all patients with obstructive sleep apnea (OSA). This study aimed to compare the treatment outcomes of MAD therapy according to OSA severity and to investigate the risk factors for the lack of response to MAD therapy. Methods: A total of 29 patients diagnosed with OSA received an adjustable two-piece MAD treatment. Sleep parameters measured with the home sleep apnea test device, including apnea-hypopnea index (AHI) and oxygen saturation (SpO₂), and daytime sleepiness using the Epworth Sleepiness Scale (ESS) were retrospectively assessed both before and after the MAD treatment. Results: The patients were classified into three groups according to AHI severity: mild (n=16, AHI<15), moderate (n=6, 15≤AHI<30), and severe OSA (n=7, AHI≥30). MAD therapy significantly improved the sleep parameters (p<0.001 for AHI and p=0.004 for minimum SpO₂) and daytime sleepiness (p<0.001 for ESS). Furthermore, successful outcomes (reduction in AHI>50% and AHI<10 events/h) were achieved in 83.3% and 71.4% of moderate and severe OSA cases, respectively. Of 13 patients with moderate and severe OSA, 10 were classified as responders and 3 as non-responders. The non-responders had significantly lower baseline value of SpO₂ (p=0.049 for average SpO₂ and p=0.007 for minimum SpO₂) and higher baseline AHI (p=0.049) than the responders. Conclusions: The results of the present study suggest that MAD is effective in the majority of patients with OSA of varying severities. The success of MAD therapy does not seem to depend solely on AHI severity. In addition to AHI, minimum SpO₂ may be a prognostic measure of the efficacy of MAD treatment in clinical dental practice.