• Journal of Oral Medicine and Pain
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• v.35 no.3
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• pp.193-202
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• 2010

The purpose of this study was to determine the sites of narrowing/obstruction and to measure the regional severity of narrowing through the evaluation of dynamic changes in upper-airway of healthy subjects. The selected 9 subjects were proved not to have any sleep-related disorder such as snoring or obstructive sleep apnea through clinical examination, radiological examination, sleep study with a portable recording system. Afterward, the Electron Beam Tomography was performed during the waking and sleeping state of subjects, with their mandible in resting and protruded position. Intravenous injection of Dormicum$^{(R)}$ was used for the induction of sleep. The maximum and minimum cross-sectional areas at each airway level during tidal ventilation were measured and the Collapsibility Index for each level of cross-section was also computed. In a comparison with results under variable conditions, the result was showed that the significant difference between each airway level divided with upper, middle, lower region of upper airway is not observed in the average minimum cross-sectional areas and Collapsibility Index. The significant difference only between in wake and sleep state was observed in the average minimum cross-sectional area at the lower region. Also, in wake state, the significant difference between resting and protrusive position of mandible for the average minimum was also observed in cross-sectional area at middle region. In sleep state, no significant difference between resting and protrusive position of mandible was observed in cross-sectional area and the Collapsibility Index.

• The korean journal of orthodontics
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• v.30 no.3 s.80
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• pp.287-296
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• 2000

It is well known that oral appliance could improve respiratory difficulty in patients with obstructive sleep apnea (OSA). To evaluate the effect of oral appliance, polysomnography and cephalometry were performed in OSA patients before and after oral appliance was used. Twenty four OSA patients were included in this study. Respiratory difficulty index (RDI) was obtained from polysomnography and the movement of soft palate, tongue, posterior pharygeal wall, hyoid bone, and mandible and the variables of the facial pattern were measured on the cephalogram. The changes of cephalometric parameters were compared to the RDI changes and the correlation was tested. After oral appliance was used, RDI decreased from 46.8 to 13.3. There was significant relationship between RDI improvement and the anterior movement of the mandible and superior movement of the hyoid bone. In 8 patients whose RDI was most improved, RDI improvement rate was correlated with the anterior movement of the tongue and anterior-posterior (AP) diameter of the airway at the levels between the lower portion of the soft palate and epiglottis. These results could conclude that anterior movement of the tongue and superior movement of the hyoid bone would be favorable cephalometric parameters for the improvement of OSA.

• Sleep Medicine and Psychophysiology
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• v.24 no.2
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• pp.118-123
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• 2017

Central sleep apnea (CSA) is a highly prevalent comorbidity in patients with heart failure and may present in 25 to 40 percent of heart failure patients. Continuous positive airway pressure (CPAP) is the primary therapeutic option and effective in treatment of obstructive sleep apnea (OSA). In heart failure patients with CSA, several trials of CPAP showed a number of positive effects in heart failure treatment. A 58-year-old male visited the hospital because of dyspnea and he was diagnosed as heart failure with ischemic heart disease. He underwent coronary angiography and received percutaneous coronary intervention due to stenosis at the middle of left anterior descending coronary artery. However, dyspnea was not completely improved after treatment with percutaneous coronary intervention. The patient also experienced snoring and sleep apnea which worsened with symptom of dyspnea in the recent year. We suspected CSA and the patient underwent polysomnography to confirm whether sleep apnea was present. During the polysomnography, CSA with Cheyne-Stokes respiration (CSR) was observed and apnea-hypopnea index was 45.9/hr. The patient was treated with CPAP. After CPAP treatment, hypoxemia and CSA were resolved and dyspnea was improved with reducing NYHA class. We report a case successfully treated with clinical improvement by presuming CSA in a patient with heart failure.

• Journal of the korean academy of Pediatric Dentistry
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• v.37 no.3
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• pp.338-344
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• 2010

The purpose of this study was to evaluate the effect of children's tonsil size on the behavior during pediatric dental sedation. The sedation records of thirty five children were examined in this study. All the sedations had been performed using chloral hydrate/hydroxyzine, nitrous oxide/oxygen or/and submucosal midazolam, and the subjects were divided into 4 groups according to their tonsil size using Brodsky's tonsil classification. The results were as follows: 1. The patients with enlarged tonsils showed negative behaviors in all behavior rating aspects(sleep, movement, crying, overall behavior) during sedation than those with normal tonsils(p<0.05). 2. Enlarged tonsils were correlated with mouth breathing(p<0.05) but not with snoring and coughing(p>0.05) during sedation. 3. For the patients with enlarged tonsils, significantly higher doses of midazolam were administered during sedation than for those with normal tonsils(p<0.05).

• Sleep Medicine and Psychophysiology
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• v.11 no.1
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• pp.50-54
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• 2004

The obstructive sleep apnea syndrome can occur due to various etiologies in children. In otherwise healthy children, adenotonsillar hypertrophy is the leading cause of childhood obstuctive sleep apnea. Obstructive sleep apnea caused by adenotonsillar hypertrophy can lead to a variety of symptoms and sequelae such as behavioral disturbance, enuresis, failure to thrive, developmental delay, cor pulmonale, and hypertension. So if obstructive sleep apnea is clinically suspected, proper treatment should be administered to the patient after diagnostic examinations. More than 80% improvement is seen in symptoms of obstructive sleep apnea caused by adenotonsillar hypertrophy in children after tonsillectomy and adenoidectomy. However, when it is impossible to treat the patient using surgical methods or residual symptoms remained after tonsillectomy and adenoidectomy, additional treatments such as weight control, sleep position change, and continuous positive airway pressure (CPAP), should be considered. This paper reports a case using weight control and Auto-PAP to control mild sleep apnea and snoring, which in long-term follow-up were not resolved after tonsillectomy and adenoidectomy for severe obstructive sleep apnea.

• Sleep Medicine and Psychophysiology
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• v.19 no.2
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• pp.89-96
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• 2012

Objectives: Individuals differ in their biological rhythms. This study investigated the association between the morningness-eveningness and sleep patterns, daytime sleepiness and fatigue in Korean male adolescents. Methods: Participants were 501 eleventh grade male students ($16.9{\pm}0.2$ years of age) in one male high school in Seoul. Each student completed the Korean translation of composite scale (KtCS), Epworth sleepiness scale (ESS), Fatigue Severity Scale (FSS) and a questionnaire about their sleep schedule. Results: The evening group had shorter weekday sleep time than the intermediate (p<0.001) or morning group (p=0.029). The evening group had more daytime napping (16.8%, p<0.001), high rate of caffeine use (58.8%, p<0.001) and snoring (18.5%, p=0.037). The evening group showed more daytime sleepiness (8.7, SD=3.2, p<0.001) and severe fatigue (4.4, SD=1.2, p<0.001) than the intermediate or morning group. Conclusion: Adolescents with eveningness have higher problems in weekday sleep, daytime sleepiness and fatigue. An intervention program for sleep problem in these adolescents should be considered.

• Tuberculosis and Respiratory Diseases
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• v.42 no.4
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• pp.610-617
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• 1995

Sleep apnea occurs in approximately 50% of patients with acromegaly, and sleep apnea is associated with increased cardiovascular diseases and mortality. In view of these findings, sleep apnea may be a factor in the increased incidence of cardiovascular deaths in acromegaly patients. We experienced a case of active acromegaly patient, 54-yr-old man, associated with obstructive sleep apnea syndrome, congestive heart failure with dilated cardiomyopathy and serious cardiac arrhythmias. He was treated for obstructive sleep apnea syndrome, diagnosed by overnight polysomnography, with nasal continuous positive airway pressure(CPAP) for 4 months, which successfully controlled his loud snoring, sleep apnea, nocturnal hypoxemia and apnea-related symptoms. And also he was treated for underlying acromegaly and cardiac complications with bromocriptine and cardiogenic drugs for 4 months, but still had elevated growth hormone(GH) and insulin like growth factor-1(IGF-1) levels and serious cardiac arrhythmias. We describe our experience about the effect of CPAP treatment in an active acromegaly patient associated with obstructive sleep apnea syndrome and cardiac complications with review of literature.

• Journal of the korean academy of Pediatric Dentistry
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• v.49 no.4
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• pp.357-367
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• 2022

Sleep disordered breathing (SDB) is a disease characterized by repeated hypopnea and apnea during sleep due to complete or partial obstruction of upper airway. The prevalence of pediatric SDB is approximately 12 - 15%, and the most common age group is preschool children aged 3 - 5 years. Children show more varied presentations, from snoring and frequent arousals to enuresis and hyperactivity. The main cause of pediatric SDB is obstruction of the upper airway related to enlarged tonsils and adenoids. If SDB is left untreated, it can cause complications such as learning difficulties, cognitive impairment, behavioral problems, cardiovascular disease, metabolic syndrome, and poor growth. Pediatric dentists are in a special position to identify children at risk for SDB. Pediatric dentists recognize clinical features related to SDB, and they should screen for SDB by using the pediatric sleep questionnaire (PSQ), lateral cephalometry radiograph, and portable sleep monitoring test and refer to sleep specialists. As a therapeutic approach, maxillary arch expansion treatment, mandible advancement device, and lingual frenectomy can be performed. Pediatric dentists should recognize that prolonged mouth breathing, lower tongue posture, and ankyloglossia can cause abnormal facial skeletal growth patterns and sleep problems. Pediatric dentists should be able to prevent these problems through early intervention.

• Pediatric Infection and Vaccine
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• v.29 no.2
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• pp.70-76
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• 2022

Coronavirus disease 2019 (COVID-19) in patients with underlying diseases, is associated with high infection and mortality rates, which may result in acute respiratory distress syndrome and death. Mucopolysaccharidosis (MPS) type II is a progressive metabolic disorder that stems from cellular accumulation of the glycosaminoglycans, heparan, and dermatan sulfate. Upper and lower airway obstruction and restrictive pulmonary diseases are common complaints of patients with MPS, and respiratory infections of bacterial or viral origin could result in fatal outcomes. We report a case of COVID-19 in a 16-year-old adolescent with MPS type II, who had been treated with idursulfase since 5 years of age. Prior to infection, the patient's clinical history included developmental delays, abdominal distension, snoring, and facial dysmorphism. His primary complaints at the time of admission included rhinorrhea, cough, and sputum without fever or increased oxygen demand. His heart rate, respiratory rate, and oxygen saturation were within the normal biological reference intervals, and chest radiography revealed no signs of pneumonia. Consequently, supportive therapy and quarantine were recommended. The patient experienced an uneventful course of COVID-19 despite underlying MPS type II, which may be the result of an unfavorable host cell environment and changes in expression patterns of proteins involved in interactions with viral proteins. Moreover, elevated serum heparan sulfate in patients with MPS may compete with cell surface heparan sulfate, which is essential for successful interaction between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein and the host cell surface, thereby protecting against intracellular penetration by SARS-CoV-2.

• Journal of Advanced Navigation Technology
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• v.25 no.6
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• pp.562-568
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• 2021

Seat reservations and civil complaints in the library reading room have been done face-to-face by managers, and efficient management has been difficult. In addition, there is a problem that it is difficult to take action in the event of a civil complaint due to user inconvenience, such as a noise problem between users in the reading room. In this study, an online reservation system was developed for efficient management of seats in the library reading room so that it could be serviced non-face-to-face. In addition, when using the library reading room, it is possible to apply for non-face-to-face civil complaints when complaints occur due to noise problems between users, loss of belongings, and snoring during the user's sleep. Managers can smoothly manage library reading rooms through non-face-to-face inconvenience reports. It is possible to increase the satisfaction of using the library by resolving the inconvenience of users. The developed service app allows seat reservations and anonymous inconvenience reports. The administrator can check the received inconvenience report and warn the user of the seat with an IoT sensor-based LED. When corrective action is completed, the result of the action may be fed back to the reporter.