• Clinical and Experimental Pediatrics
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• v.61 no.12
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• pp.392-396
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• 2018

Purpose: Adenotonsillar hypertrophy (ATH) that causes upper airway obstruction might lead to chronic hypoxemic pulmonary vasoconstriction and right ventricular (RV) dysfunction. We aimed to evaluate whether adenotonsillectomy (T&A) in children suffering from obstructive sleep apnea (OSA) due to severe ATH could improve RV function. Methods: Thirty-seven children (boy:girl=21:16; mean age, $9.52{\pm}2.20years$), who underwent T&A forsleep apnea due to ATH, were included. We analyzedthe mean pulmonary artery pressure (mPAP), the presence and the maximal velocity of tricuspid regurgitation (TR), the tricuspid annular plane systolic excursion (TAPSE), and the right ventricular myocardial performance index (RVMPI) with tissue Doppler echocardiography (TDE) by transthoracic echocardiography pre- and post-T&A. The follow-up period was $1.78{\pm}0.27years$. Results: Only the RVMPI using TDE improved after T&A ($42.18{\pm}2.03$ vs. $40{\pm}1.86$, P=0.001). The absolute value of TAPSE increased ($21.45{\pm}0.90mm$ vs. $22.30{\pm}1.10mm$, P=0.001) but there was no change in the z score of TAPSE pre- and post-T&A ($1.19{\pm}0.34$ vs. $1.24{\pm}0.30$, P=0.194). The mPAP was within normal range in children with ATH, and there was no significant difference between pre- and post-T&A ($19.6{\pm}3.40$ vs. $18.7{\pm}2.68$, P=0.052). There was no difference in the presence and the maximal velocity of TR (P=0.058). Conclusion: RVMPI using TDE could be an early parameter of RV function in children with OSA due to ATH.

• Journal of Oral Medicine and Pain
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• v.47 no.3
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• pp.135-143
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• 2022

Purpose: This study aimed to evaluate polysomnographic and cephalometric characteristics of patients with OSA according to obesity level based on the World Health Organization (WHO) Asian-Pacific BMI criteria. Methods: One hundred and thirty-one consecutive patients with obstructive sleep apnea (OSA) were evaluated using standard level 1 polysomnography and cephalometric analyses. The subjects were categorized into normal, overweight and obese groups according to the WHO Asian-Pacific BMI criteria. Respiratory indices and cephalometric parameters were compared among groups. Results: The 131 patients consisted of 111 males and 20 females, with a mean age of 44.1±12.4 years. The mean value of BMI was 25.3±3.4 kg/m² for all subjects, 20.6±2.2 kg/m² for normal (n=27), 24.0±0.5 kg/m² for overweight (n=33) and 27.6±2.2 kg/m² for obese (n=71). The obese group had a significantly higher apnea-hypopnea index (AHI) and respiratory arousal index and lower oxygen saturation level than the normal group (p<0.05). Total AHI, mean oxygen saturation level and respiratory arousal index were significantly correlated with BMI (p<0.001). A longer soft palate and anterior position of the hyoid bone were significantly correlated with BMI level (p ≤0.05). Conclusions: Obese patients have a higher risk of compromised craniofacial skeletal features and soft tissue structures, and severe OSA than non-obese patients.

• Journal of Sleep Medicine
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• v.15 no.2
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• pp.55-61
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• 2018

Objectives: Despite the accumulating evidence of the effectiveness of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) syndrome, adherence to PAP therapy is not high. Several factors reportedly affect PAP adherence; however, it remains unclear whether patients' symptoms were detrimental to adherence rate. This study is aimed at investigating the relationship between insomnia symptoms and adherence. Methods: Retrospective analyses were performed in 359 patients with OSA (mean age $58.4{\pm}13.2$ years; females, n=80). Logistic regression analyses were performed between PAP adherence with clinical factors and questionnaires, such as Epworth Sleepiness Scale, Insomnia Severity Index, and Beck Depression Inventory (BDI). Results: PAP adherence was defined as the use of PAP for ${\geq}4h$ per night on 70% of nights during 30 consecutive days. The median follow-up time was 55 days (interquartile range, 30-119 days), and 54.3% showed poor adherence. Non-adherent patients showed more severe sleep onset insomnia, higher BDI, and higher nadir oxygen saturation ($SaO_2$). Patients with good adherence had higher apnea-hypopnea index, oxygen desaturation index, and respiratory arousal to total arousal ratio. Sleep onset insomnia [odds ratio (OR)=1.792, p=0.012], BDI (OR = 1.055, p=0.026), and nadir $SaO_2$ (OR=1.043, p=0.040) were independently associated with PAP non-adherence. Conclusions: Not the severity of insomnia but sleep onset insomnia was associated with PAP adherence, as well as depressive mood. It suggests that different interventions for reducing insomnia and depressive mood are needed to increase PAP adherence in patients with OSA.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.1
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• pp.7-14
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• 2001

Purpose : The lateral cephalometric Korean norms of the skeletal and pharyngeal dimension were analyzed for the diagnosis of obstructive sleep apnea syndrome(OSAS). Materials and Methods : The lateral cephalometric radiographies were taken in male(n=53) and female(n=50), who had a normal profile, class I occlusion, normal ANB $(0{\sim}4^{\circ})$ and normal Wits $Appraisal(-4{\sim}0mm)$. The X-rays were traced by two oral and maxillofacial surgeons twice. The significant differences between male-female and examiners were tested. Results : The angle of mandibular line to Nasion-Sella line was $31.12^{\circ}/33.79^{\circ}$ (in male/in female, p=0.0018). The lower Gonion angle was $73.74^{\circ}/73.74^{\circ}(p=0.9978)$. The length of the soft palate was 36.93mm/34.35mm(p=0.0002). The pharyngeal airway space was 13.42mm/11.55mm at mandibular plane level(PAS(ML))(p=0.0025). The hyoid was placed inferiorly to mandibular plane 10.18mm/7.72mm(p=0.0051). The results from this study are to be used for the diagnosis of OSAS.

• Journal of the Institute of Electronics and Information Engineers
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• v.51 no.4
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• pp.201-209
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• 2014

Obstructive sleep apnea syndrome(OSAS) is a respiratory disease caused by partial or complete obstruction of the upper airway during sleep. In this paper, we proposed the optical flow method to analyze the upper airway dynamic changes during respiration for children with OSAS and control subjects. We compared the absolute value of difference between inspiration and expiration for airway area analysis method and optical flow method for 5 children with OSAS and 6 control subjects. From the statistical analysis, airway area analysis method and optical flow method are statistically significant at the 0.1 (p value is 0.0977) and 0.01 (p value is 0.0011) significance level respectively. From this simulations, the optical flow method could provide more accurate information to diagnose the OSAS patients than the traditional airway area analysis method.

• Sleep Medicine and Psychophysiology
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• v.23 no.1
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• pp.16-24
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• 2016

Background and Objectives: Obstructive sleep apnea (OSA) is often undiagnosed but is an important risk factor affecting the health of an individual. The level of awareness of the illness among patients with OSA is low and is not correlated with severity of the illness. This study was conducted to compare awareness of OSA symptoms and illness between patients with OSA and simple snorers. Materials and Methods: Two hundred eighty-two patients who were suspected of having OSA participated in this study. All subjects underwent overnight polysomnography. Those with an apnea-hypopnea index (AHI) ${\geq}5$ were classified as the OSA group, while those with an AHI < 5 were classified as the simple snoring group. A sleep questionnaire, which included items on awareness of the illness, OSA, and sleep symptoms, was administered to all subjects and their bed-partners. Results: Simple snorers were much more aware of their symptoms such as snoring, irregular breathing, and apnea than were patients with OSA. Bed-partners of simple snorers were also more aware of the participants' sleep symptoms than were partners of patients with OSA. However, the duration of OSA symptoms was longer in the OSA group. In the correlation analysis, the level of awareness of OSA symptoms was negatively correlated with AHI, age, body mass index, and Epworth Sleepiness Scale score. Among the sleep questionnaire and polysomnography results, only Pittsburgh Sleep Quality Index was positively correlated with level of awareness of OSA symptoms. The minority of the respondents had heard about the treatment methods of continuous positive airway pressure and oral appliance and preferred them as treatment options. Conclusion: This study suggests that simple snorers are more aware of their symptoms than are patients with OSA. A higher severity of OSA, represented by a higher AHI, is correlated with lower awareness of one's OSA symptoms.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.501-508
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• 1993

Background: Sleep apnea syndrome is a common disorder which is estimated to affect about 1~4% of adult male population. And if untreated, sleep apnea can cause significant sequelae, such as hypertension, nocturnal cardiac arrhythmia, daytime hypersomnolence, and cognitive impairment. Various kinds of treatment for obstructive sleep apnea (OSA) have been developed. Among them nasal CPAP, first introduced by Sullivan et al in 1981, has received widespread interest and acclaim as a treatment of OSA, and is currently recommended as first-line treatment for OSA. We evaluated the effect of nasal CPAP in OSA and the side effects of nasal CPAP hindering patients from using nasal CPAP. Methods: We performed sleep studies in 20 OSA patients at 2 consecutive nights; baseline night at first day and CPAP night at second day. We compared apnea index, lowest oxygen concentration during apnea, maximal apnea time, and total apnea duration per total sleep time before and after CPAP. We also evaluated the side effects of CPAP with inquiry to the patients. Results: 1) Apnea index was significantly decreased after CPAP in 17 out of 20 OSA patients (85%) and increased in 3 patients (15%). 2) Average apnea index was significantly decreased after CPAP ($34.1{\pm}18.9/h{\rightarrow}15.4{\pm}10.3/h$, p<0.01). 3) Total apnea duration per total sleep time was also significantly decreased after CPAP ($28.5{\pm}16.0%{\rightarrow}11.9{\pm}9.3%$, p<0.05). 4) The lowest oxygen satuation and maximal apnea time were not significantly changed after CPAP. 5) The most frequent side effect of nasal CPAP was mask discomfort (80%), and the next was drying of nasal passages (65%). Conclusion: Nasal CPAP is an effective treatment for OSA. Futher studies should be concentrated on long term follow up of nasal CPAP for its therapeutic effects and the study of methods to enhance patients' compliance.

• Sleep Medicine and Psychophysiology
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• v.11 no.2
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• pp.84-88
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• 2004

Objectives: Obstructive sleep apnea (OSA) syndrome is diagnosed through history, physical examination, imaging studies and polysomnography. Clinical examination of this condition may point to hypertrophic tonsils and crowded oropharynx. The objective of this study is to investigate the usefulness of modified Mallampati grade (MMG) and tonsil grade (TG) in predicting the severity of obstructive sleep apnea. Methods: MMG and TG were divided into 4 and 5 groups, respectively, according to their severity. Medical records were collected from 94 patients who had received polysomnography and otorhinolaryngologic examination for snoring and sleep apnea at Keimyung University Dongsan Medical Center from March 2002 through April 2004. Patients were divided into two groups according to the apnea-hypopnea index (AHI)：control (n=24), and patients with sleep apnea (n=70). Results: Patients with higher MMG and TG had higher AHI, and MMG and TG proved to have a statistically significant correlation with AHI (p<0.05) Conclusion: MMG and TG were reliable predictors of OSA and helpful parameters in deciding treatment method.

• Sleep Medicine and Psychophysiology
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• v.24 no.2
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• pp.106-117
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• 2017

Objectives: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is characterized by repetitive collapse or partial collapse of the upper airway during sleep in spite of ongoing effort to breathe. It is believed that OSA is usually worsened in REM sleep, because muscle tone is suppressed during REM sleep. However, many cases showed a higher apnea-hypopnea index (AHI) during NREM sleep than during REM sleep. We aimed here to determine the characteristics of REM sleep-dependent OSA (REM-OSA) and NREM sleep-dependent OSA (NREM-OSA). Methods: Five hundred sixty polysomnographically confirmed adult OSA subjects were studied retrospectively. All patients were classified into 3 groups based on the ratio between REM-AHI and NREM-AHI. REM-OSA was defined as REM-AHI/NREM-AHI > 2, NREM-OSA as NREM-AHI/REM-AHI > 2, and the rest as sleep stage-independent OSA (IND-OSA). In addition to polysomnography, questionnaires related to subjective sleep quality, daytime sleepiness, and emotion were completed. Chi-square test, ANOVA, and ANCOVA were performed. Results: There was no age difference among subgroups. The REM-OSA group was comprised of large proportions of mild OSA and female OSA patients. These patients experienced poor sleep and more negative emotions than other two groups. The AHI and oxygen desaturation index (ODI) were lowest in REM-OSA. Sleep efficiency and N3 percentage of REM-OSA were higher than in NREM-OSA. The percentage of patients who slept in a supine position was higher in REM-OSA than other subgroups. IND-OSA showed higher BMI and larger neck circumference and abdominal circumference than REM-OSA. The patients with IND-OSA experienced more sleepiness than the other groups. AHI and ODI were highest in IND-OSA. NREM-OSA presented the shortest total sleep time and the lowest sleep efficiency. NREM-OSA showed shorter sleep latency and REM latency and higher percentage of N1 than those of REM-OSA and the highest proportion of those who slept in a lateral position than other subgroups. NREM-OSA revealed the highest composite score on the Horne and ${\ddot{O}}stberg$ questionnaire. With increased AHI severity, the numbers of apnea and hypopnea events during REM sleep decreased, and the numbers of apnea and hypopnea events during NREM sleep increased. The results of ANCOVA after controlling age, sex, BMI, NC, AC, and AHI showed the lowest sleep efficiency, the highest AHI in the supine position, and the highest percentage of waking after sleep onset in NREM-OSA. Conclusion: REM-OSA was associated with the mild form of OSA, female sex, and negative emotions. IND-OSA was associated with the severe form of OSA. NREM-OSA was most closely related to position and showed the lowest sleep efficiency. Sleep stage-dependent characteristics could provide better understanding of OSA.

• Journal of Oral Medicine and Pain
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• v.42 no.1
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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.