• Imaging Science in Dentistry
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• 제46권1호
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• pp.9-16
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• 2016

Purpose: To evaluate the upper airway dimensions of obstructive sleep apnea (OSA) and control subjects using a cone-beam computed tomography (CBCT) unit commonly applied in clinical practice in order to assess airway dimensions in the same fashion as that routinely employed in a clinical setting. Materials and Methods: This was a retrospective analysis utilizing existing CBCT scans to evaluate the dimensions of the upper airway in OSA and control subjects. The CBCT data of sixteen OSA and sixteen control subjects were compared. The average area, average volume, total volume, and total length of the upper airway were computed. Width and anterior-posterior (AP) measurements were obtained on the smallest axial slice. Results: OSA subjects had a significantly smaller average airway area, average airway volume, total airway volume, and mean airway width. OSA subjects had a significantly larger airway length measurement. The mean A-P distance was not significantly different between groups. Conclusion: OSA subjects have a smaller upper airway compared to controls with the exception of airway length. The lack of a significant difference in the mean A-P distance may indicate that patient position during imaging (upright vs. supine) can affect this measurement. Comparison of this study with a future prospective study design will allow for validation of these results.

• Journal of Rhinology
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• 제25권2호
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• pp.69-74
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• 2018

Background and Objectives: Sleep disturbances and excessive daytime sleepiness (EDS) are the major symptoms of obstructive sleep apnea (OSA). This study aimed to investigate clinical implications of insomnia and EDS in patients with OSA using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Materials and Method: We evaluated 131 subjects with suspected OSA who were undergoing polysomnography (PSG) and performing the PSQI and ESS surveys. OSA was diagnosed when the apnea-hypopnea index was five or more. EDS was defined when ESS score was 11 points or higher. Detailed history and questionnaire were used to categorize insomnia. We compared clinical variables and PSG results in subgroups with or without insomnia and EDS. Results: There were no significant differences of PSQI and ESS score between controls and OSA. OSA with insomnia had significantly increased total score (p<0.001) and decreased total sleep time (p=0.001) and sleep efficiency (p=0.001) on the PSQI compared to those without insomnia. OSA with EDS showed significantly increased PSQI score (p=0.022) and decreased total sleep time (p=0.018) on PSG compared to those without EDS. Neither PSQI nor ESS score had a correlation with respiratory variables such as AHI and oxygen saturation. Total sleep time had a significant effect on both insomnia and EDS in patients with OSA. Conclusion: Decreased total sleep time had important effects on subjective symptoms of OSA and comorbid insomnia. Therefore, restoration of decreased sleep time is important in the management of OSA.

• 수면정신생리
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• 제30권1호
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• pp.9-12
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• 2023

Periodic limb movements during sleep (PLMS) are prevalent in various sleep disorders, such as restless legs syndrome (RLS), periodic limb movements disorder, obstructive sleep apnea (OSA), REM sleep behavior disorder (RBD), and narcolepsy. PLMS has been hypothesized to be related to the decline of dopaminergic transmission. In RLS, PLMS is suggested to be related to iron deficiency and symptom severity. PLMD is a rare sleep disorder, and the role of PLMS in PLMD has not been clearly investigated yet. PLMS in OSA, which remain after proper PAP therapy, may need further management. The clinical relevance of PLMS in RBD and narcolepsy have not been investigated thoroughly and need further studies. Whether PLMS are to be considered as a mere symptom of individual sleep disorders or not can be elucidated through studies investigating the efficacy of therapeutic approaches to reduce PLMS in various sleep disorders.

• 대한불안의학회지
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• 제4권2호
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• pp.157-159
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• 2008

저자들은 심한 수면 무호흡증을 가진 성인 남자에서,CPAP 치료 후 조증 및 경조증 삽화가 유발된 증례를 보고하였다. 본 증례는 정신과적 병력 및 가족력이 없던 환자에게서 CPAP 치료 후 조증 삽화와 경조증 삽화가 연속해서 유발된 첫 번째 보고이다. 환자는 CPAP 치료 시작 직후부터 약 한달 동안 기분 고양감과 목적지향 활동의 증가를 보이다가 2~3일만에 정신병적 증상이 동반된 조증 삽화를 보였다. 또한 퇴원 후 투약을 지속하면서 다시 CPAP치료를 한 직후 경조증 삽화로 추정되는 일련의 기분 및행동 변화가 나타났다. 따라서 이 환자의 조증 삽화와 경조증 삽화로 추정되는 기분 변화는 CPAP 치료로 유발되었을 가능성이 있다고 판단되었다. 폐쇄성 무호흡증이 심하여 CPAP 치료가 처방되는 경우에 임상의들은 정신과적 질환의 기왕력이나 위험 인자가 없는 환자에서도 조증상태가 발생할 수 있는 가능성에 대해 유의하여야 하고, 주기적으로 객관적인 척도를 사용하여 기분 변화 정도를 점검할 필요가 있다. 특히 CPAP 사용 후 특별한 이유 없이 행동 변화나 기분 고양의 정도가 심해질 때는 조증 가능성을 의심해 보아야 할 것으로 사료된다.

• Journal of Oral Medicine and Pain
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• 제41권3호
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• pp.126-132
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• 2016

Purpose: The aims of this study were to analyze the association between inflammatory cytokine and obstructive sleep apnea (OSA), and to evaluate treatment outcome and changes of plasma inflammatory cytokine levels after oral appliance therapy. Methods: Twenty-seven subjects who visited Department of Oral Medicine in Seoul National University Dental Hospital were performed nocturnal polysomnography and analyzed plasma C-reactive protein (CRP), interleukin (IL)-$1{\beta}$, IL-6, IL-10, and tumor necrosis factor (TNF)-${\alpha}$ levels. Each subject was evaluated with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). The subjects were classified into 12 OSA patients (apnea-hypopnea index [AHI] >5) and 15 control (AHI ${\leq}5$) groups. The OSA group was treated with mandibular advancement device (MAD) for 3 months and re-evaluated nocturnal polysomnography and plasma inflammatory cytokine levels. Results: Plasma TNF-${\alpha}$, IL-10, and IL-6 levels were significantly higher in OSA patients compared to controls. Total AHI showed significant positive correlations with plasma IL-6 and TNF-${\alpha}$ levels. Percentage time of $SpO_2$ <90 and lowest $SpO_2$ were significantly correlated with plasma TNF-${\alpha}$ level. ESS showed significant positive correlation with plasma IL-10 level. Total AHI, percentage time of $SpO_2$ <90, lowest $SpO_2$, and mean $SpO_2$ were significantly improved after the MAD therapy. Plasma TNF-${\alpha}$ level was significantly decreased after MAD therapy. Conclusions: We suggest that MAD therapy is an effective treatment modality for patients with OSA and can decrease plasma cytokine level.

• 대한치과의사협회지
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• 제48권3호
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• pp.190-195
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• 2010

Oral appliance therapy is a simple, reversible way for improving snoring and/or obstructive sleep apnea. It may be indicated for the patients who are unable to tolerate continuous positive airway pressure (CPAP) or who have potential risks for surgical intervention. Oral appliance therapy increases airway space by the providing stable anterior positioning of the mandible, pulling out tongue, lifting up soft palate, or changing the muscle activity of the genioglossus. Currently, more than 80 different types of oral appliances have been introduced for snoring and/or obstructive sleep apnea. They are classified by their characteristics such as mode of action, adjustability and material used. This article provides a detailed clinical protocol and treatment procedure for oral appliance therapy.

• 대한의용생체공학회:의공학회지
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• 제35권3호
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• pp.55-61
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• 2014

In sleep monitoring system, polysomnography (PSG) is the gold-standard but previous studies revealed that attaching numerous amount of sensors disturb sleep during the test which is the fundamental disadvantage of PSG. We suggest an unconstrained rapid-eye-movement (REM) sleep monitoring method measured with polyvinylidene (PVDF) film-based sensor for the normal and the obstructive sleep apnea (OSA) patients. Nine normal subjects and seventeen OSA patients have participated in the study. During REM sleep, rate and variability of respiration are known to be greater than in other sleep stages. Based on this phenomena, respiratory signals of participants were unconstrainedly measured using the PVDF-based sensor with the PSG and REM sleep were extracted from the average rate and variability of respiration. In epoch-by-epoch REM sleep detection, proposed method classified REM sleep with an average sensitivity of 72.3%, specificity of 92.5%, accuracy of 88.9%, and kappa statistic of 0.60 compared to the results of PSG. Student's t-test showed no significant difference between the results of normal and OSA group. This method is potentially applicable to REM sleep detection in homing environment or ambulatory monitoring.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권5호
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• pp.295-304
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• 2012

Objectives: Lateral cephalometry, computed tomography (CT) and full-night polysomnography were used to examine the correlation of obstructive sleep apnea (OSA) severity. Materials and Methods: A total of 29 patients (5 females, 24 males) diagnosed with OSA were evaluated by lateral cephalometry, CT and full-night polysomnography. Lateral cephalometry was performed in the closed and open mouth states. The radiographic and polysomnography measurements of the patients with OSA were evaluated statistically to determine the association with OSA severity. Results: A significant relationship was observed between the increased respiratory disturbance index and closing lateral cephalometry. With mouth opening, the airway space narrowed and the OSA worsened. Lateral cephalometry revealed OSA patients to have an inferiorly positioned hyoid bone, longer-than-normal soft palate and narrowing airway space. As OSA was severe, the airway shape was ovoid in the CT horizontal view. Conclusion: Polysomnography and the radiographic parameter can be used for diagnosing OSA.

• 대한치과교정학회지
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• 제48권3호
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• pp.133-142
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• 2018

Objective: The purpose of this study was to evaluate differences in three-dimensional (3D) morphology of the hard palate between Korean adults with and without mild-to-moderate obstructive sleep apnea (OSA) using cone-beam computed tomographic (CBCT) data. Methods: The protocol for the two-dimensional (2D) and 3D mathematical modeling was established by analyzing CBCT images of 30 adults with OSA and 30 matched controls without OSA, using MIMICS software. The linear and angular measurements were also determined using this software. The measurements were repeated for 30 palates, by the same operator, to assess reliability. Results: The palates of OSA patients were higher in the posterior part and narrower in the anterior-superior part than those of the control group (p < 0.05). The nasal cavities of patients with OSA were narrower (p < 0.05) than those of controls. The increasing angle of the first molar palatal root is a compensation of the upper dental arch to improve occlusion. However, for most palatal measurements, there were no significant differences between the OSA and control groups (p > 0.05). The results of 2D and 3D mathematical models were consistent for linear and angular measurements, indicating that 2D and 3D mathematical modeling of the palate is a reliable methodology. Conclusions: OSA is a multifactorial disease; the palates of adults with mild-to-moderate OSA do not have specific morphological features distinct from those of healthy controls.

• 수면정신생리
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• 제3권1호
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• pp.31-37
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• 1996

Uvulopalatopharyngoplasty(UPPP) is an operation that is frequently performed for the patient of obstructive sleep apnea(OSA). A major problem has been to select those patients who will have a good response to UPPP. We compared preoperative and postoperative polysomnography(PSG) in 20 patients to evaluate the success rate of the operation. Each subject underwent a cephalometric roentgenogram, and fiberoptic nasopharyngoscopy with Mueller maneuver was applied in roentgenogram and fiberoptic nasopharyngoscopy with Mueller maneuver was applied in preop evaluation of patients with OSA. No PSG parameter could accurately predict the changes in sleep after UPPP. There were no significant differences between the responders and the nonresponders concerning the cephalometric analysis, the type of obstruction by Mueller maneuver, and body mass index(BMI). The conclusions of this study are thus that UPPP is an effective treatment for the OSAS with a high success rate, but that there is no single useful parameter predicting the success of the operation.