• 대한임상검사과학회지
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• 제43권4호
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• pp.188-193
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• 2011

Obstructive sleep apnea (OSA) is the most common type of sleep apnea and is caused by obstruction of the upper airway. Since it is closely related to sleep parameter and body indices, the study was focused on the relationship with them. The results of polysomnography (PSG) in obstructive sleep apnea was done at ENT department of Ewha women university Mokdong hospital from March to September 2010 with 52 subjects (male 35, female 17). The leads were placed to measure electroencephalogram (EEG), electrooculogram (EOG), mandibular and anterior tibialis electromyogram (EMG), airflow in nasal and oral cavity, chest and abdominal breathing pattern, snoring sound and arterial oxygen saturation ($SpO_2$) level. From sleep parameter and body indices of adult obstructive sleep apnea compared to normal adult revealed that age (p<0.01) and snoring sound (p<0.05) were increased, stage 1 sleep (p<0.01) was increased, the deeper stages (3&4) of sleep (p<0.05) were reduced. Respiratory disturbance index (RDI) (p<0.01), mean $SpO_2$ (p<0.05) and lowest $SpO_2$ (p<0.01) were also decreased. The correlation analysis from sleep parameter and body indices of OSA showed the positive correlation with age (r=0.463, p<0.001), snoring sound (r=0.278, p<0.05), stage 1 sleep (r=0.391, p<0.01) and RDI (r=0.409, p<0.01), but showed the negative correlation with the deeper stages (3&4) of sleep (r=-0.307, p<0.05), mean $SpO_2$=(r=-0.274, p<0.05) and lowest $SpO_2$ (r=-0.392, p<0.01). This study proves that obstructive sleep apnea and indices have closed related.

• Clinical and Experimental Pediatrics
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• 제55권6호
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• pp.212-214
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• 2012

Rubinstein-Taybi syndrome (RTS) is characterized by peculiar facies, mental retardation, broad thumbs, and great toes. Approximately one-third of the affected individuals have a variety of congenital heart diseases. They can also have upper airway obstruction during sleep, due to hypotonia and the anatomy of the oropharynx and airway, which make these patients susceptible to obstructive sleep apnea (OSA). In our case, pulmonary hypertension was caused, successively, by congenital heart defects (a large patent ductus arteriosus and arch hypoplasia) and obstructive sleep apnea during early infancy. The congenital heart defects were surgically corrected, but persistent pulmonary hypertension was identified 2 months after the operation. This pulmonary hypertension was due to OSA, and it was relieved by nasal continuous positive airway pressure. This case is the first report of pulmonary hypertension from OSA in a young infant with RTS.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권5호
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• pp.277-283
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• 2022

Objectives: The main purpose of the present study was to investigate the associations between the risk of obstructive sleep apnea (OSA) and chronic orofacial pain in a nationally representative sample of the Korean population. Materials and Methods: Data from the 8th wave Korean national health and nutrition examination survey, which was conducted from 2019 to 2020 were analyzed. This study included 5,780 Koreans (2,503 males, 3,277 females) over 40 years of age. The presence of subjective chronic facial pain lasting more than 3 months was evaluated based on a self-reported questionnaire. The risk of OSA was determined using the STOP-BANG questionnaire. Data related to anthropometric and sociodemographic factors; diagnostic history of hypertension, depression, and OSA; level of health-related quality of life and stress awareness; health-related behaviors, including smoking and alcohol drinking; and sleep duration were collected. The participants were classified into two groups according to the presence of chronic facial pain. Results: The level of health-related quality of life and stress awareness showed significant differences between the two groups. The sleep duration on weekends also presented significant differences. No significant differences were observed in the presence of snoring and observed apnea, while participants with chronic facial pain showed significantly higher levels of tiredness between the groups. The risk of OSA evaluated by STOP-BANG questionnaire showed significant differences between groups; however, the risk of OSA seemed to be higher in participants without chronic facial pain. Conclusion: The participants with chronic facial pain demonstrated decreased sleep duration, lower health-related quality of life, and increased stress and tiredness. Even though, the role of OSA in the development of chronic facial pain was inconclusive from the study, it is possible that ethnicity play a role in relationship between OSA and chronic facial pain.

• 수면정신생리
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• 제28권1호
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• pp.18-26
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• 2021

Sleep is essential to brain function and mental health. Insomnia and obstructive sleep apnea (OSA) are the two most common sleep disorders, and are major public health concerns. Proton magnetic resonance spectroscopy (¹H-MRS) is a non-invasive method of quantifying neurometabolite concentrations. Therefore, ¹H-MRS studies on individuals with sleep disorders may enhance our understanding of the pathophysiology of these disorders. In this article, we reviewed ¹H-MRS studies in insomnia and OSA that reported changes in neurometabolite concentrations. Previous studies have consistently reported insomnia-related reductions in γ-aminobutyric acid (GABA) levels in the frontal and occipital regions, which suggest that changes in GABA are important to the etiology of insomnia. These results may support the hyperarousal theory that insomnia is associated with increased cognitive and physiological arousal. In addition, the severity of insomnia was associated with low glutamate and glutamine levels. Previous studies of OSA have consistently reported reduced N-acetylaspartate (NAA) levels in the frontal, parieto-occipital, and temporal regions. In addition, OSA was associated with increased myo-inositol levels. These results may provide evidence that intermittent hypoxia induced by OSA may result in neuronal damage in the brain, which can be related to neurocognitive dysfunction in patients with OSA. The current review summarizes findings related to neurochemical changes in insomnia and OSA. Future well-designed studies using ¹H-MRS have the potential to enhance our understanding of the pathophysiology of sleep disorders including insomnia and OSA.

• 수면정신생리
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• 제19권1호
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• pp.22-26
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• 2012

목 적 : 체위성 수면무호흡은 폐쇄성수면무호흡증으로 진단된 환자에서 앙와위 수면시 apnea-hypopnea index(AHI)가 비앙와위 수면시 AHI에 비해 2배 이상인 경우로 정의하며, 일반적으로 전체 폐쇄성수면무호흡 환자의 56%로 알려져 있다. 본 연구는 수면 클리닉을 방문하여 폐쇄성수면무호흡을 진단 받은 환자 중 체위성 수면무호흡의 발생빈도를 알아보고, 체위 의존성에 따른 수면무호흡의 임상 소견 및 수면다원검사를 비교 분석하였다. 방 법 : 코골이 및 목격되는 무호흡으로 내원하여 AHI가 5 이상이면서 앙와위 및 비앙와위 수면 시간이 15분 이상이고, 앙와위 시 AHI가 비앙와위시 AHI에 비하여 2배 이상인 경우를 체위성 수면무호흡으로, 그렇지 않은 경우를 비체위성 수면무호흡으로 분류하였다. 체위 의존성 여부에 따라 인구학적 특성과 수면다원검사에서 나타난 수면 변인 및 호흡 변인을 분석하였다. 결 과 : 폐쇄성수면무호흡으로 진단된 101명 중에서 체위성 수면무호흡 환자는 76명(75.2%), 비체위성 수면무호흡 환자는 25명(24.8%)이었다. 폐쇄성수면무호흡의 중증도별로 체위성 수면무호흡의 유무에 따라 발생빈도가 통계적으로 유의하게 차이가 있었으며, 특히 비체위성 수면무호흡 환자군에서는 중증 환자의 비율이 높았다. 비체위성 수면무호흡환자군이 체위성 환자군에 비하여 체중, 허리둘레, 엉덩이 둘레, 허리-엉덩이 둘레비, 체질량 지수 및 목둘레가 유의하게 더 높았다. 수면다원검사상에서는 체위성 수면무호흡군에서 비교적 수면구조가 잘 유지되었으며 주관적인 졸림도 덜하였다. 비체위성 수면무호흡군에서 체위성 수면무호흡군에 비해 평균산소포화도 및 최저산소포화도가 유의하게 낮았으며 AHI는 통계적으로 유의하게 더 높았다. 결 론 : 폐쇄성수면무호흡 환자중 체위성 수면무호흡 환자의 비율은 75% 정도였으며, 비체위성 수면무호흡 환자에 비해 체위성 수면무호흡 환자는 비만도가 덜 하고 경증 및 중등도의 폐쇄성수면무호흡의 양상을 보이는 것으로 관찰되었다.

• 수면정신생리
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• 제24권2호
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• pp.106-117
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• 2017

목 적 : 폐쇄성 수면무호흡증(obstructive sleep apnea)은 수면 시 호흡을 하려고 하는 노력에도 불구하고 기도의 부분적/완전 폐색이 반복되는 수면 관련 호흡 질환이다. 일반적으로 렘수면에서 근긴장도의 저하가 나타나게 되므로 렘수면에서 수면무호흡증의 악화가 예상되지만 많은 경우에 있어 비렘수면에서의 무호흡/저호흡 지수(apnea-hypopnea index, AHI)가 렘수면에서의 AHI보다 높은 경우가 관찰되었다. 그러나 그런 현상의 분명한 이유는 밝혀져 있지 않았기에 렘/비렘수면 의존성 수면무호흡증에 대한 특징을 종합적으로 알아보고자 하였다. 방 법 : 560명의 성인 수면무호흡증 환자를 대상으로 후향적 연구를 진행하였다. 모든 환자는 렘 수면시의 AHI (REM-AHI), 비렘수면시의 AHI (NREM-AHI)의 비율에 따라 세군으로 분류하였다. 렘수면 의존성 수면무호흡증(REM sleep dependent OSA, REM-OSA)는 REM-AHI/NREMAHI > 2, 비렘수면 의존성 수면무호흡증(NREM sleep dependent OSA, NREM-OSA)는 NREM-AHI/REM-AHI > 2, 수면 단계 비의존성 수면무호흡증(Sleep stage independent OSA, IND-OSA)로 분류하였다. 수면다원검사 이외에도 주관적인 수면의 질, 낮시간 졸림, 정서와 연관된 설문지를 함께 시행하였다. 카이제곱 검정, 일원배치분산분석, 공분산분석을 시행하였다. 결 과 : 세 군 사이에서 연령의 차이는 보이지 않았다. REM-OSA는 대체로 경도의 수면무호흡증 환자가 많았고 여성의 비율이 가장 높았다. 또한 주관적인 수면의 질이 가장 저하되어 있다고 느꼈으며 기분 상태 평가 척도인 K-POMS의 점수는 가장 높았다. IND-OSA는 BMI, 목둘레(neck circumference, NC), 복부 둘레(abdominal circumfefence)가 REM-OSA에 비해 높았고 주간 졸림의 호소는 세군 중 가장 컸고, 무호흡 관련 변인의 값이 가장 높아 중증도가 심한 군이었다. 공변량을 통제하고 시행한 공분산 분석의 결과에서 NREM-OSA는 앙와위에서의 AHI가 가장 높았고 수면 중 측와위의 비율이 가장 컸다. 또한 수면 효율이 가장 떨어졌고 렘수면 잠복기가 가장 길었으며 입면 후 각성 시간의 비율이 가장 컸다. 결 론 : REM-OSA는 여성이 많고 부정적인 정서를 가장 많이 호소하는 군으로, 경도의 수면무호흡증을 가장 많이 포함하였고 IND-OSA는 중증의 수면무호흡증을 반영하였다. NREM-OSA는 자세 변화와 가장 밀접한 관련은 지니고 있었으며 수면 효율이 가장 떨어졌다. 세 군의 수면무호흡증이 일련의 중중도 차이만이 아닌 또 다른 특성을 반영하는 것으로 보이고 이를 통해 폐쇄성 수면무호흡증의 이해를 넓힐 수 있을 것이다.

• 대한의용생체공학회:의공학회지
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• 제35권4호
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• pp.95-98
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• 2014

The baroreflex is one kind of homeostatic mechanisms to regulate acute blood pressure (BP) changes by controlling heartbeat interval (HBI). To quantify the effect of baroreflex, we suggested a new approach of analyzing Granger causality between systolic BP (SBP) and HBI. The index defined as baroreflex effectiveness (BRE) was generated by the hypothesis that more effectual baroreflex would be related to more effective Granger causal influence of SBP on HBI. Six obstructive sleep apnea (OSA) patients (apnea-hypopnea index, AHI ${\geq}5$ events/hr) and six normal subjects participated in the study. Their SBP and HBI during nocturnal sleep were obtained from a non-invasive continuous BP measurement device. While the BRE ($mean{\pm}SD$) of normal subjects was $47.0{\pm}4.0%$, OSA patients exhibited the BRE of $34.0{\pm}3.8%$. The impaired baroreflex function of OSA patients can be explained by the physiological mechanism associated with recurrent hypoxic episodes during sleep. Thus, the significantly lower BRE in OSA patients verified the availability of Granger causality analysis to evaluate baroreflex during sleep. Furthermore, the range of BRE obtained from normal subjects was not overlapped with that obtained from OSA patients. It suggests the potential of BRE as a new helpful tool for diagnosing OSA.

• 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.

• 수면정신생리
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• 제3권2호
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• pp.65-76
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• 1996

Natural sleep pattern and its physiology in childhood are much different from those in adulthood. Several aspects of clinical evaluation for sleepiness in childhood are more difficult than in adulthood. These difficulties are due to several factors. First, excessive sleepiness in childhood do not always develop functional impairments. Second, objective test such as MSLT may not be reliable since it is hard to be certain that the child understand instructions. Third, sleepiness in children is often obscured by irritability. paradoxical hyperactivity, or behavioral disturbances. Anseguently, careful clinical evaluation is needed for the sleepy children. Usual causes of sleepiness in children are the disorders that induce insufficient sleep such as sleep apnea syndrome, schedule disorder, underlying medical and psychiatric disorder, and so forth. After excluding such factors, we can diagnose the hypersomnic disorders such as narcolepsy, Kleine-Levin syndrome, and idiopathic central nervous system hypersomnia. Among the variety of those causes of sleepiness, I reviewed the clinical difference of narcolepsy and obstructive sleep apnea syndrome in childhood compared with in adulthood. Recognition of the childhood narcolepsy is difficult because even severely sleepy children often do not develop pathognomic cataplexy and associated REM phenomena until much later. Since childhood narcolepsy give srise to many psychological, academical problem. Practicers should be concerned about these aspects. Childhood obstructive sleep apnea syndrome is different from adult obstructive sleep apnea syndrome too. Several aspects such as pathophysiology. clinical feature, diagnostic criteria, complication, management, and prognosis differ from those in the adult syndrome. An important feature of childhood obstructive sleep apnea syndrome is the variety of severe complications such as behavioral disorders, cognitive impairment, cardiovascular symptoms, developmental delay, and ever death. Fortunately, surgical interventions like adenotosillectomy or UPPP are more effective for Childhood OSA than adult form. CPAP is a "safe, effective, and well-tolerated" treatment modality too. So if early detection and proper management of childhood OSA were done, the severe complication would be prevented or ever cured.

• 대한치과교정학회지
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• 제27권6호
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• pp.865-870
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• 1997

폐쇄성 수면무호흡(이하 OSA)환자의 일반적 특징의 하나로 다소 비대한 Submental부위를 든다. 따라서 근간에는 경부 주위의 측정을 임상적 진단의 한 보조방법으로 채택하는 경우도 있다. 본 연구는 80명의 환자로 부터 직접위와 앙와위의 두 자세에서 각각 두 장의 측모두부방서선사진을 채득하여 OSA환자의 안면과 혀의 크기를 일반인의 그것과 비교 하였다. 채득된 실험자료는 각각 증상의 심한 정도에 따라 무증상군, 경미군 중증군 그리고 중중근으로 나누었다. 크기 측정의 방법으로는 각각의 두 계측점간의 거리를 측정하여 모든 계측치의 합으로 해부학적 크기를 대신하였다. 결과로서, 안면의 크기가 혀의 크기보다 체중과 더 높은 상관관계를 보였으나, 증상의 심한 정도와는 혀의 크기가 더 중요한 측정치 임을 알수 있었다. 혀의 크기가 증상의 정도에 비례함에 있어서 $1\%$의 유의차를 보였다.