• Journal of Oral Medicine and Pain
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• 제34권4호
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• pp.371-377
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• 2009

본 연구의 목적은 자세성 수면무호흡증 환자군과 비자세성 수면무호흡증 환자군의 수면다원검사 결과를 비교 분석하여 그 원인 요소를 알아보는데 있다. 서울대학교치과병원에 코골이 및 수면무호흡증을 주소로 내원한 환자들 중 수면다원검사 결과 수면무호흡증으로 진단된 (무호흡-저호흡 지수 5이상) 환자 47명을 Cartwright 등의 분류에 따라 37명의 자세성 수면무호흡증 환자 (앙와위에서의 수면무호흡-저호흡 지수가 측와위에서의 수면무호흡-저호흡 지수의 2배 이상)와 10명의 비자세성 수면무호흡증 환자 (앙와위에서의 수면무호흡-저호흡 지수가 측와위에서의 수면무호흡-저호흡 지수의 2배 미만)로 분류하여 각 군간의 수면다원검사 지수들을 비교 분석 하였다. 연구 결과, 나이, 성별, 체질량지수, 주간졸리움 지수, 전체 수면무호흡-저호흡 지수, 전체 각성 지수, 코골이 시간에서 두 군간의 유의한 차이를 보이지 않았다. 그러나 비자세성 수면무호흡증 환자군에서 자세성 수면무호흡증 환자군보다 높은 REM 수면에서의 수면무호흡-저호흡 지수 및 각성지수와 낮은 REM 수면 평균혈중산소포화도를 나타내었다. 결론적으로 본 연구의 결과는 비자세성 수면무호흡환자가 자세성 수면무호흡증 환자보다 구인두 기도에서의 더 높은 협착도를 갖고 있을 가능성을 제시하여 준다.

• 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.

• Journal of Oral Medicine and Pain
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• 제42권1호
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• pp.1-7
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• 2017

Purpose: The aims of this study were to evaluate the clinical characteristics and polysomnographic results of patients visited the Seoul National University Dental Hospital (SNUDH) and to suggest guidelines for the management of sleep disordered-breathing patients in a dental clinic. Methods: Five hundred sixty-two patients who visited the Snoring and Sleep Apnea Clinic of SNUDH were evaluated for clinical characteristics including associated comorbidities, age, gender, body mass index (BMI), neck circumference, and daytime sleepiness and among them 217 patients were performed nocturnal polysomnography for evaluating respiratory disturbance index, apnea-hypopnea index (AHI), oxygen saturation levels, and sleep stages. The associations among clinical characteristics, sleep parameters, and positional and rapid eye movement (REM) dependencies of the patients were analyzed. Results: The most common co-morbidities of the patients were cardiovascular (30.2%), endocrine (10.8%), and respiratory diseases (7.9%). Age (${\beta}=0.394$), total AHI (${\beta}=0.223$), and lowest $O_2$ saturation levels (${\beta}=0.205$) were significantly associated with the number of co-morbidities in patients with obstructive sleep apnea (OSA). Mean $O_2$ saturation was not significantly associated with number of co-morbidities. Non-positional OSA patients had higher BMI, longer neck circumferences, more severe AHI values, and lower mean and lowest $O_2$ saturation levels compared to positional OSA patients. Not-REM-related patients were older and had more severe AHI values compared to REM-related patients. Not-REM-related patients have longer duration of stage I sleep and shorter stage II, III, and REM sleep than REM-related patients. There were no significant differences in each sleep stage between positional and non-positional patients. Neck circumference, positional dependency, REM dependency, and percentage of supine position were significantly associated with severity of OSA. Conclusions: Age, total AHI, and lowest $O_2$ saturation level were significantly associated with the number of co-morbidities in patients with OSA. Neck circumference, positional dependency, REM dependency, and percentage of supine position were significantly associated with severity of OSA.

• 대한임상검사과학회지
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• 제44권2호
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• pp.52-58
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• 2012

Patients with obstructive sleep apnea (OSA) often have more aggravated symptoms in the supine position. We tried to investigate the clinical characteristics and the predictive factors for positional OSA. Polysomnographic data were reviewed for OSA patients (apnea hypopnea index, $AHI{\geq}5$) from April, 2008 to April, 2011 at the Asan Medical Center. Clinical data, comorbid medical condition data and questionnaires (SF-36, MFI-20, ESS, BDI, STAI) were assessed. All patients were classified into two groups: positional patients (PP) group and non-positional patients (NPP) group. PP was defined as a patient who had the AHI in the supine position was at least twice as high as that in the lateral position. The body position of patients was confirmed by sleep position sensor and video monitor. All patients had at least 30 minutes of positional and 30 minutes of non-positional sleep. We compared clinical, medical, polysomnographic data, and questionnaire results between two (PP and NPP) groups and investigated predictive factors for the PP group using binary logistic regression analysis. In total, 371 patients were investigated. 265 (71.4%) was categorized as PP group and 106 (28.5%) as NPP group. The mean age ($mean{\pm}SD$) was higher in the PP group ($52.4{\pm}9.8$) than in the NPP group ($49.5{\pm}11.9$) (p<0.05). Comparison of sleep parameters between the PP and the NPP group showed that the PP group had significantly lower BMI (PP: $26.1{\pm}3.2kg/m^2$; NPP: $27.8{\pm}4.3kg/m^2$, p<0.001), neck circumference (PP: $39.7{\pm}2.8cm$; NPP: $41.5{\pm}3.7cm$, p<0.001) and hypertension rate (PP: n=89/265 (33.5%); NPP: n=48/106 (45.2%), p=0.0240). In the PP group, the percentage of deep sleep (PP: $8.7{\pm}8.1%$; NPP: $5.6{\pm}7.0%$, P=0.001) and rapid eye movement (REM) (PP: $17.5{\pm}6.1%$; NPP: $14.0{\pm}6.9%$, p<0.001) were significantly higher whereas the percentage of light sleep (stage N1) was significantly lower than the NPP group (PP: $30.4{\pm}12.3$; NPP: $44.5{\pm}20.8%$, p<0.001). During the sleep, the AHI in the supine position (PP: $48.6{\pm}19.5$; NPP: $60.5{\pm}22.6$, p<0.001) and in the non-supine position (PP: $9.4{\pm}8.9$; NPP: $48.4{\pm}24.8$, p=<0.001) were significantly lower and the minimal arterial oxygen saturation in non-REM sleep was significantly higher in the PP group (PP: $80.3{\pm}7.6$; NPP: $75.1{\pm}9.9$, p=<0.001). There were no significant differences in all questionnaires including quality of life. The results of the binary logistic regression analysis showed that age, the amount of REM sleep(%) and AHI were significant predictive factors for positional OSA. The significant predictive factors for positional OSA were older age, higher percentage of REM and lower AHI. The questionnaire results were not significantly different between the two groups.

• 대한치과교정학회지
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• 제25권6호
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• pp.655-664
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• 1995

Sixty male patients with polysomnographically documented OSA were included in this study. A pair of cephalograms were obtained in the upright and supine positions. In the supine position, the ANB angle, lower facial height and the cross-sectional area of soft palate increased and there was a decrease in the vertical airway length and oropharynx cross-sectional area. Positional changes did not affect the cross-sectional area of tongue, but the cross-sectional area of the oropharynx decreased in the supine position. The obese group had higher AI and RDI. Maxillary unit length, C3-H, the cross-sectional areas of tongue, soft palate and oropharynx were significantly greater in the group Obese than in non-obese group. No correlation was noted between the mandibular unit length and OSA severity, The group of small mandibular unit length showed shorter lower facial height and maxillary unit length, and smaller cross-sectional area of tongue than the long mandibular unit length group. Hyold bone positioned more inferiorly and cross-sectional area of nasopharynx decreased as the OSA severity increased.

• Tuberculosis and Respiratory Diseases
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• 제48권6호
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• pp.956-963
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• 2000

연구배경 : 폐쇄성 수면 무호흡증 환자 중 수평와위보다 측와위에서 호흡장애의 정도가 호전되는 체위성 폐쇄성 수면 무호흡증 환자의 신체계측인자와 수면단계 및 수면구조의 특성, 그리고 동맥혈산소포화도의 차이를 수면다원검사를 통하여 확인하고자 하였다. 대상 및 방법 : 1996년부터 1998년까지 수면장애로 영남대학병원에서 수면다원검사를 실시하여 폐쇄성 수면 무호흡증으로 진단된 환자 중 20세 이상으로 체질량지수(BMI) 20 이상, 호흡장애지수(RDI) 10 이상, 수평와위와 측와위로 각각 30분 이상 수면을 취했던 환자 50명을 대상으로 하였다. Cartwright 등의 기준에 따라 체위성, 비체위성 수면 무호흡증으로 구분하였다. 수면 다원 검사와 동맥혈 산소포도를 측정하였고 자동 체위감지 장치와 전문검사자의 관찰로 환자의 체위를 확인하였다. 결과 : 체위성 폐쇄성 수면 무호흡증 환자는 전체 폐쇄성 수면 무호흡증 환자의 30%를 차지하였다. 이들의 신체 계측의 특징은 비체위성 무호흡증 환자와 비교할 때 몸무게는 낮은 경향이 있었고(p>0.05), 체질량지수는 낮았다(p<0.05). 체위성 폐쇄성 수면 무호흡증 환자는 수면효율이 높고(p<0.05), 총 수면시간과 깊은 수면을 나타내는 3, 4 단계의 수면지속 시간은 길었으며(p<0.05), 무호흡지수는 유의하게 낮았다(p<0.05). 또한 수면 중 평균저산소포화도 및 평균산소 포화도, 그리고 최저산소포화도는 각각 87.7%, 92.7%, 78.3%로 비체위성 무호흡증 환자보다 유의하게 높았고(p<0.05), 동맥혈 산소 불포화도 지수는 체위성 무호흡증 환자가 훨씬 낮았다(p<0.05). 결과 : 폐쇄성 수면 무호흡증 환자는 체위에 따라 수면 중 발생하는 호흡장애정도나 무호흡 빈도의 차이가 크고, 체질량지수는 이러한 체위에 따른 호흡양상의 변화에 중요한 역할을 한다. 따라서 일부 폐쇄성 수면 무호흡증 환자의 호흡장애를 개선시키기 위하여 체위치료법과 비만도 조절이 중요하며, 수면다원검사를 시행할때 체위변동 관찰과 체위변동에 따른 수면구조의 변화에 대한 평가가 반드시 필요할 것으로 생각한다.

• Journal of Oral Medicine and Pain
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• 제41권4호
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• pp.180-187
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• 2016

Purpose: The aims of this study were to evaluate the differences of clinical and polysomnographic features between rapid eye movement (REM)-related obstructive sleep apnea (OSA) and not-REM-related OSA, and to suggest the pathogenesis according to the REM dependency of OSA. Methods: One hundred ninety consecutive patients diagnosed with OSA were evaluated clinical features and performed full night polysomnography. The patients were divided into REM-related (REM apnea-hypopnea index [AHI] at least two times higher than their non-REM AHI) and not-REM-related (a REM AHI less than two times higher than their non-REM AHI) OSA groups and evaluated the differences in age, body mass index (BMI), neck circumference, Ep-worth Sleepiness Scale score, and parameters of polysomnography. Results: REM-related patients were younger and showed higher sleep efficacy, low percentage of light sleep stage (stage 1 sleep), and low rate of positional OSA. Age was significantly associated with REM dependency of OSA and REM AHI were significant correlated with BMI, neck circumference, percentage of sleep in supine position, and percentage time of snoring. Conclusions: Our results showed that REM-related OSA patients showed less severe polysomnographic parameters than not-REM-related patients. However, significant risk factors were differed depending on the REM dependency and OSA severity, and the clinical features correlated with REM AHI and non-REM AHI were also showed differently. We suggest that the occurrence of OSA according to the REM dependency can be based on different mechanisms.

• 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.

• 수면정신생리
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• 제4권2호
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• pp.164-171
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• 1997

Introduction : Periodic limb movement disorder (PLMD) is shown to common in patients with OSA and may become evident or worsened when treated with nasal continuous positive airway pressure (CPAP). Whether this is due to im proved sleep continuity. adverse nocturnal body positioning, uncovered by CPAP, or due to the CPAP stimulus is still debat-ed. We hypothesized that the increase in PLM activity following CPAP is associated with more supine-sleeping tendencies when being treated with CPAP. In the present work, we compared differences in the PLMD index (PLMI) and sleeping position of patients with sleep disordered breathing before and after CPAP treatment. Method : We studied 16 patients (mean age 46 yr, 9M, 7F) with OSA (11 patients) or UARS (5 patients) who either had PLMD on initial polysomnogram (baseline PSG) or on nasal CPAP trial (CPAP PSG). All periodic leg movements were scored on anterior tibialis EMG during sleep according to standard criteria (net duration; 0.5-5.0 seconds, intervals; 4-90 seconds. 4 consecutive movements). Paired t-tests compared PLMD index (PLMI), PLMD-related arousal index (PLMD-ArI), respiratory disturbance index (RDI), and supine sleeping position spent with baseline PSG and CPAP PSG. Results : Ten patients (63%) on baseline PSG and fifteen patients (94%) on CPAP PSG had documented PLMD ($PLMI{\ge}5$) respectively with significant increase on CPAP PSG(p<0.05). Ten patients showed the emergence (6/10 patients) or substantial worsening (4/10 patients) of PLMD during CPAP trial. Mean CPAP pressure was $7.6{\pm}1.8\;cmH_2O$. PLMI tended to increase from baseline PSG to CPAP PSG, and significantly increase when excluding 2 outlier (baseline PSG, $19.0{\pm}25.8/hr$ vs CPAP PSG, $29.9{\pm}12.5/hr$, p<0.1). PLMD-ArI showed no significant change, but a significant decrease was detected when excluding 2 outlier (p<0.1). There was no significant sleeping positional difference (supine vs non-supine) on baseline PSG, but significantly more supine position (supine vs non-supine, p<0.05) on CPAP PSG. There was no significant difference in PLMI during supine-sleeping and nonsupine-sleeping position on both of baseline PSG and CPAP PSG. There was also no significant difference in PLMI during supine-sleeping position between baseline PSG and CPAP PSG. With nasal CPAP, there was a highly significant reduction in the RDI (baseline PSG, $14.1{\pm}21.3/hr$ vs CPAP PSG, $2.7{\pm}3.9/hr$, p<0.05). Conclusion : This preliminary data confirms previous findings that CPAP is a very effective treatment for OSA, and that PLMD is developed or worsened with treatment by CPAP. This data also indicates that supine-sleeping position is more common when being treated with CPAP. However, there was no clear evidence that supine position is the causal factor of increased PLMD with CPAP. It is, however, suggested that the relative movement limitation induced by CPAP treatment could be a contributory factor of PLMD.

• 수면정신생리
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• 제20권1호
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• pp.31-34
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• 2013

목 적: 본 연구는 비앙와시 무호흡-저호흡 지수가 정상화되지 않은 광의의 체위성 수면 무호흡 환자군과 정상화되는 협의의 체위성 수면 무호흡 환자군의 임상적 차이를 알아보고자 하였다. 방 법: 2011년 5월부터 2012년 7월까지 간이 수면검사에서 체위성 수면무호흡으로 진단된 92명을 대상으로 하였고 이들을 2개의 군으로 나누었다. I군은 비앙와위 수면에서 무호흡-저호흡지수가 5 이상인 광의의 체위성 환자군, II군은 비앙와위 수면에서 무호흡-저호흡지수가 5 미만인 협의의 체위성 환자군이었다. 두 군간의 간이 수면검사 결과를 통계적으로 비교 분석하였다. 결 과: 92명의 환자 중에서 I군은 11명(12%)이었고 II군은 81명(88%)이었다. 심한 무호흡-저호흡지수 집단 내에서 I군이 70%를 차지하고 있었고, 경도, 중등도 무호흡-저호흡지수 집단 내에서 I군이 차지하는 비율과 비교하였을 때, 통계적으로 유의한 차이를 보였다. 심한 체질량지수 집단 내에서 I군이 54.5%를 차지하였고, 경도, 중등도 체질량지수 집단 내에서의 I 군이 차지하는 비율과 비교하였을 때, 통계적으로 유의한 차이를 보였다. 무호흡-저호흡지수, 앙와시 무호흡-저호흡지수, 비앙와시 무호흡-저호흡지수, 코골이 시간 비율에서 I군이 II군에 비해 통계적으로 유의하게 높았다(p=0.001). 결 론: 체위성 수면 무호흡 환자에서 심한 무호흡-저호흡지수와 심한 체질량지수는 비앙와시 무호흡-저호흡지수가 5 미만인 환자보다 5 이상인 환자에서 더 흔하다.