• Sleep Medicine and Psychophysiology
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• v.12 no.1
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• pp.64-67
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• 2005

Obstructive sleep apnea syndrome(OSAS) is a common disease in the field of otorhinolaryngology and is characterized by repeated upper airway occlusions occurring during sleep. OSAS can occur due to various etiologies of the nasal, oral, pharyngeal and laryngeal airway in adults. Nasal obstruction can be caused by septal deviation, nasal polyps, concha bullosa, choanal atresia, neoplasms, foreign body, postoperative/post-traumatic synechiae, various rhinitis and so on. There are various kinds of surgical treatment of OSAS including nasal surgery, LAUP, UPPP, surgery of tongue base, tracheostomy and so on, but the effect of nasal surgery on snoring and OSAS is controversial. The authors report the case of a patient who had experienced nasal obstruction, moderate snoring and OSAS and who improved after septoplasty and turbinoplasty.

• Tuberculosis and Respiratory Diseases
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• v.53 no.5
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• pp.561-568
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• 2002

Severe obesity can produce a marked impairment of respiratory function. The obesity hypoventilation or Pickwickian syndrome comprises of extreme obesity, alveolar hypoventilation, somnolence, plethora, pulmonary hypertension and right heart failure. It is sometimes associated with obstructive sleep apnea but can be distinguished from obstructive sleep apnea by the presence of awake $CO_2$ retention. Alt hough uncommon, it is important to recognize this syndrome because due to its potential life threatening nature and because can be reversed by appropriate treatment. Here, we report 3 cases of obesity hypoventilation syndrome.

• Journal of Dental Rehabilitation and Applied Science
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• v.29 no.4
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• pp.391-398
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• 2013

Botulinum toxin has been used for treating strabismus, blepharospasm, cerebral palsy, cervical dystonia, hyperhydrosis, facial wrinkle and chronic migraine under US Food and Drug administration approval. Also it has been tried spasticity-induced pain, post-herpetic neuralgia, myofascial pain and aphthous ulcer as off-label use. In this study, we reviewed recent studies that suggested effects of botulinum toxin on snoring and sleep apnea.

• Sleep Medicine and Psychophysiology
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• v.2 no.2
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• pp.156-164
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• 1995

Objectives : Patients with obstructive sleep apnea syndrome(OSAS) often complain of nocturnal enuresis. There are a few reports that OSAS patients have altered renal function, and there are some evidences that the increased release of atrial natriuretic peptide(ANP) may be involved in the pathogenesis of nocturnal urinary symptoms of OSAS patients. In this study, we measured plasma ANP concentrations during waking and sleep in OSAS patients and normal controls to investigate whether there were differences of ANP concentrations between OSAS patients and normal subjects. Methods : 27 patients with OSAS and 10 normal subjects were studied. All subjects underwent a full-night polysomnographic study. Venous blood samples were separately drawn during waking and sleep. Plasma ANP concentrations were measured using radioimmunoassay. Results : In OSAS patients, ANP concentrations during sleep($122.9\;{\pm}\;29.9pg/ml$) were significantly higher than ANP concentrations during waking($60.2\;{\pm}\;5.8pg/ml$)(p < 0.05). However, in normal subjects, there was no significant difference between ANP concentrations during waking($59.2\;{\pm}\;5.7pg/ml$) and sleep($69.6\;{\pm}\;3.0pg/ml$)(p > 0.05). There was no significant difference of ANP concentrations during waking between OSAS patients($60.2\;{\pm}\;5.8pg/ml$) and normal controls($59.2\;{\pm}\;5.7pg/ml$)(p > 0.05), and also there was no significant difference during sleep between OSAS patients($122.9\;{\pm}\;29.9pg/ml$) and normal subjects($69.6\;{\pm}\;3.0pg/ml$)(p > 0.05). Plasma ANP concentrations during sleep showed significant positive correlations with apnea index(r = 0.3846, p < 0.05) and respiratory disturbance index(r = 0.3939, p < 0.05) in OSAS patients. Conclusion : These data suggest that, in OSAS patients, plasma ANP concentrations during sleep are significantly higher than plasma ANP concentrations during waking, and there is a positive correlation between the plasma ANP concentration during sleep and the severity of sleep apnea.

• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.836-845
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• 1999

Background : Obesity is present in the majority of adult patients with obstructive sleep apnea(OSA) and is considered to be a major risk factor for its development. A reduction in body weight has been associated with substantial improvement in the severity of apnea. However, a variety of treatment strategies for obesity have yielded limited sucess. This study was done to determine resting energy expenditure(REE) in patients with obstructive sleep apnea and the correlation between the severity of sleep apnea and REE, and to investigate whether leptin influences REE and correlated with the severity of sleep apnea in 39 patients with OSA and 45 controls matched for obesity. Method : Overnight polysomnography was performed on all subjects using standard techniques. Measurements of REE were made using a Sensormedic Vmax 229 and a canopy system. Serum leptin concentration was measured by human leptin RIA kit of LINCO Research INC. Results : REE was greater in patients with OSA compared with controls, but there was no difference between the two groups on REE%. And also there was no significant correlation between anthropometric data, polysomnographic data and REE%. Serum leptin was linearly related to body mass index(BMI), apnea index, apnea hypopnea index and lowest arterial oxygen saturation($SaO_2$) but not related to REE%. Conclusion : This study suggests the followings. Firstly patients patients with sleep apnea have a pattern of obesity characterized by energy homeostasis at an elevated body weight set-point. In order to achieve a lower body weight in these patients, it may be necessary to increase energy expenditure by increasing physical activity. Secondly leptin level was not correlated with REE, suggesting that leptin may predominantly regulate body fat by altering eating behavior rather than calorigenesis. Lastly leptin level was significantly correlated with the severity of sleep apnea. These elevated level of leptin in patients of sleep apnea may be related to the obesity, however it needs further studies to determine the relationship between the severity of sleep apnea and serum leptin.

• Sleep Medicine and Psychophysiology
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• v.12 no.1
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• pp.32-38
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• 2005

Objectives: Obstructive sleep apnea syndrome (OSAS) has drawn increasing attention as medical community has become to be aware of its co-morbidities and complications, especially cardiovascular complications and excessive daytime sleepiness with accident proneness. As of now, polysomnography is the standard tool to diagnose sleep apnea and estimate the treatment validity. However, its being rather expensive and inconvenient, alternate diagnostic tools have been proposed including wrist actigraphy. So far, actigraphies have been adopted usefully to field-survey sleep apnea prevalence. In this study, we attempted in a sleep laboratory setting to assess the supplemental value of actigraphy in diagnosing OSAS. Methods: This study was done at the Division of Sleep Studies, the Seoul National University Hospital. Thirty-seven clinically suspected cases of OSAS underwent the one-night polysomnography, simultaneously wearing an actigraphy on non-dominant wrist. We analyzed the data of 27 polysomnographically-proven OSAS patients (male：female 20： 7；age $47.6{\pm}12.9$ years old；age range 23 to 72 years) with no other sleep disorders. We calculated RDI (respiratory disturbance index) from the polysomnography data and FI (fragmentation index) from the actigraphy data. Pearson correlation was calculated in order to compare FI with RDI and to evaluate the supplemental diagnostic value of the actigraphy. Results: Mean total sleep time on polysomnography was $401.4{\pm}57.8\;min$ (range of 274.0 to 514.1 min). Mean RDI was $21.7{\pm}20.4/hour$. Mean FI was $21.9{\pm}13.0/hour$. RDI and FI showed significant correlation (r=0.55, p<0.01). Conclusions: Wrist actigraphy in OSAS patients generates a comparable outcome to polysomnography, in measuring the nocturnal sleep fragmentation. The actigraphy could be used supplementally in inpatients, outpatients, and field survey subjects, if polysomnography is unavailable or impossible. In follow-ups related with nasal CPAP (continuous positive airway pressure), upper airway surgery, and oral appliance in OSAS patients, the actigraphy might play a more dominant role in the future.

• Sleep Medicine and Psychophysiology
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• v.25 no.2
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• pp.45-50
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• 2018

Smoking is one of the most harmful causes of disease. Many previous researches have shown that cigarette smoking leads to cardiovascular, respiratory, oncologic, and cerebrovascular diseases. In addition to such adverse effects, the literature indicates that cigarette smoking can worsen sleep quality and induce sleep disorders. This review focuses on the relationship between smoking/nicotine and sleep and sleep disorders of insomnia, obstructive sleep apnea, and restless legs syndrome. Because smoking is a behavioral pattern that can be changed, it is important to quit smoking to improve overall health and sleep.

• Sleep Medicine and Psychophysiology
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• v.19 no.2
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• pp.68-76
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• 2012

Objectives: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. Methods: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=$41.50{\pm}13.16$ yrs, AHI <5, n=20), Group 2 : mild OSAS (mean age=$43.67{\pm}12.11$ yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age $44.93{\pm}12.38$ yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age=$45.87{\pm}12.44$ yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. Results: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were $991.1{\pm}27.1$ and $875.8{\pm}22.0$ ms (p=0.016), standard deviation of NN interval (SDNN) was $85.4{\pm}6.6$ and $112.8{\pm}5.4$ ms (p=0.022), SDNN index was $57.5{\pm}5.2$ and $87.6{\pm}4.2$ (p<0.001), total power was $11,893.5{\pm}1,359.9$ and $18,097.0{\pm}1,107.2ms^2$(p=0.008), very low frequency (VLF) was $7,534.8{\pm}1,120.1$ and $11,883.8{\pm}912.0ms^2$ (p=0.035), low frequency (LF) was $2,724.2{\pm}327.8$ and $4,351.6{\pm}266.9ms^2$(p=0.003). Conclusions: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.

• Sleep Medicine and Psychophysiology
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• v.13 no.2
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• pp.45-51
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• 2006

Obstructive sleep apnea (OSA) syndrome disrupts normal sleep. However, there were few studies to evaluate the asymmetric distribution, the one of the important factors of normal sleep in OSA subjects. We hypothesized that asymmetry would be broken in OSA patients. 49 male subjects with the complaint of heavy snoring were studied with polysomnography. We divided them into two groups based on the apnea-hypopnea index (AHI) fifteen: 13 simple snoring group (SSN, average AHI $5.9{\pm}4.4$) and 32 OSA group (average AHI $47.3{\pm}23.9$). We compared split sleep variables between the first half and the second half of sleep within each group with paired t-test for the evaluation of asymmetry. Changes of sleep architecture of OSA were higher stage 1 sleep% (S1), total arousal index (TAI), AHI, and mean heart rate (HR) and lower stage 2 sleep% (S2), REM sleep%, and mean arterial O2 saturation (SaO2) than SSN subjects. SWS and wake time after sleep onset (WASO) were not different between two groups. In split-night analysis, OSA subjects showed higher S2, slow wave sleep% (SWS), spontaneous arousal index (SAI), and mean HR in the first half, and higher REM sleep% and mean SaO2 in the second half. Those were same pattern as in SSN subjects. Mean apnea duration and longest apnea duration were higher in the second half only in the OSA. No differences of AHI, ODI, WASO, and S1 were found between the first and the second half of sleep in both groups. TAI was higher in the first half only in the SSN. SWS and WASO seemed to be influenced sensitively by simple snoring as well as OSA. Unlike our hypothesis, asymmetric distributions of major sleep architecture variables were preserved in OSA group. Losing asymmetry of TAI might be related to pathophysiology of OSA. We need more studies that include large number of subjects in the future.

• Sleep Medicine and Psychophysiology
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• v.14 no.2
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• pp.86-91
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• 2007

Background: Actigraphy is a reliable and valid method for assessing sleep in normal, healthy populations, but it may be less reliable and valid for detecting disturbed sleep in patients. In this study, we attempted to assess the utility of actigraphy in the estimation of sleep quality in patients with obstructive sleep apnea syndrome (OSAS), a major sleep disorder. Method: We analyzed the data of patients who underwent polysomnography (PSG) and actigraphy simultaneously for one night at the Center for Sleep and Chronobiology, Seoul National University Hospital from November 2004 to March 2006. Eighty-nine subjects with OSAS alone and 21 subjects with OSAS and periodic limb movement disorder (PLMD) were included for final data analyses between groups. Polysomnographic and actigraphic data were also compared. Results: In subjects with mild OSAS (RDI<15), modretae ($15{\leq}RDI$<30), and OSAS with PLMD, PSG and actigraphy did not show significant difference in total sleep time and sleep efficiency. However in severe ($30{\leq}RDI$) OSAS subjects, PSG and actigraphy showed significant difference in total sleep time and sleep efficiency. In all patients, no correlations were found between sleep parameters from PSG and from those using actigraphy. Conclusions: We suggest that in severe OSAS patients, PSG is the diagnostic tool. In mild and moderate cases, actigraphy might be used as a screening tool.