• Journal of Oral Medicine and Pain
• /
• v.39 no.2
• /
• pp.35-45
• /
• 2014

Many therapeutic modalities including continuous positive airway pressure, surgery, and oral appliances are used to treat patients with sleep-disordered breathing. However, there are no definitive treatment modalities for individual patients due to various causes of sleep-disordered breathing. Clinicians should have select best options for individual patients and it is quite challenging process. Oral appliances attracted clinical attention for its convenience and safety. Several designs of oral appliances are introduces such as soft palate lifter, tongue retaining device, and various appliances which aimed to mandibular advancement. Among these oral appliances, mandibular advancement devices (MADs) are considered the most excellent based on their effectiveness and patient tolerance. Although MADs are not guarantee dramatic outcome and less consistent than continuous positive airway pressure, they offer several advantages over continuous positive airway pressure and surgical methods, including non-invasiveness, silence, portability, and tolerability, simplicity. Therefore, general dental practitioner who had passed sleep dental curriculum or coursework can treat the patients with sleep problems. This article reviews the history, clinical indications, suggested mechanism of actions, various positive effects and several side effects, factors predicting a favorable outcome, determining amounts of mandibular advancement, compliance and long-term efficacy of MADs use.

• Speech Sciences
• /
• v.9 no.2
• /
• pp.167-177
• /
• 2002

Uvulopalatopharyngoplasty (UPPP) is one of the popular surgical procedure for snoring and sleep apnea syndrome. The main principle of this procedure is to reduce abundant velopharyngeal soft tissues resulting in a shortened soft palate, which may cause some alterations in speech sound. The purpose of this study is to evaluate the change of velopharyngeal function after UPPP in the view of aerodynamics. Thirty three patients who received uvulopalatopharyngoplasty for correcting snoring and sleep apnea were included in this study. The airflow, airflow rate and air pressure during the production of oral and nasal consonants were measured before surgery and 4 week and 8 week after surgery. The oral air flows and pressures for oral and nasal consonants were not changed after surgery. However, oral air pressure for nasal consonants were increased significantly after surgery. The nasal air flows for oral consonants were not changed after surgery, but for nasal consonants were decreased at 8 weeks after surgery. The nasal flow rate for oral and nasal consonants were increased at 8 weeks after surgery. The uvulopalatopharyngoplasty may result in affecting the aerodynamic air streams during speech production.

• Journal of Biomedical Engineering Research
• /
• v.40 no.4
• /
• pp.132-136
• /
• 2019

This study proposes an auto-titrating algorithm for auto-titrating positive airway pressure (APAP). The process of the proposed algorithm is as follows. First, sleep apnea-hypopnea and snoring events were detected using nasal pressure. Second, APAP base pressure and SDB events were used for automatic titration of optimal pressure. And, auto-titrating algorithm is built into M3 (MEK-ICS CO. Ltd., Republic of Korea) for evaluation. The detection results of SDB showed mean sensitivity (Sen.) and positive predictive value (PPV.) of 85.7% and 87.8%, respectively. The mean pressure and apnea-hypopnea index (AHI) of auto-titrating algorithm showed $13.0{\pm}5.2cmH_2O$ and $3.0{\pm}2.4$ events/h, respectively. And, paired t-test was conducted to verify whether the performance of our algorithm has no significant difference with AutoSet S9 (p>0.05). These results represent better or comparable outcomes compared to those of previous APAP devices.

• Sleep Medicine and Psychophysiology
• /
• v.24 no.2
• /
• pp.86-96
• /
• 2017

Objectives: This study aimed to analyze causality among sleep apnea, depression and cognitive function in patients with obstructive sleep apnea. Methods: We reviewed the medical records of 105 patients with sleep apnea and snoring who underwent overnight polysomnography (PSG). We analyzed various biological data, sleep variables (sleep duration and percentage) and respiratory variables [arousal index (AI), periodic leg movement index (PLM index), snoring Index (SI), mean SpO2, minimum SpO2, apnea-hypopnea index (AHI), and respiratory disturbance index (RDI)]. We also analyzed various data by sleep, cognition, and mood related scales: Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), snoring index by scale (SIS), Montreal Cognitive Assessment-Korean (Moca-K), Mini-mental State Examination-Korean (MMSE-K), clinical dementia rating (CDR), and Beck Depression Inventory (BDI). We analyzed causation among sleep, and respiratory, mood, and cognition related scales in obstructive sleep apnea patients. We analyzed the mediating effects of depression on sleep apnea patient cognition. Results: As Duration N1 increased and Total sleep time (TST) decreased, MOCA-K showed negative causality (p < 0.01). As BDI and supine RDI increased, causality was negatively related to MOCA-K (p < 0.01). As PSQI (p < 0.001) and SIS (p < 0.01) increased and as MMSE-K (p < 0.01) decreased, causality was positively related to BDI. BDI was found to mediate the effect of age on MOCA-K in patients with obstructive sleep apnea. Conclusion: Duration N1, total sleep time, BDI, and supine RDI were associated with cognitive function in obstructive sleep apnea patients. Depression measured by BDI partially mediated cognitive decline in obstructive sleep apnea patients.

• Sleep Medicine and Psychophysiology
• /
• v.1 no.1
• /
• pp.60-67
• /
• 1994

Objectives: The Obstructive sleep apnea syndrome is characterized by snoring, observed apnea during sleep and excessive daytime sleepiness. The overnight polysomnographic recording is used to investigate patients with possible obstructive sleep apnea syndrome. But the overnight polysomnographic recording is time consuming, expensive, and labor-intensive. Recently in diagnosis of obstructive sleep apnea syndrome, several simple screening tests have been suggested. Methods: This study was performed to assess the probability of application of clinical features and the degree of oxygen desaturation as a screening test for the obstructive sleep apnea syndrome. The sensitivity and specificity of the self-report of clinical features including snoring, observed apnea during sleep, excessive daytime sleepiness and insomnia were tested. And the degree of oxygen desaturation measured by oximetry in 42 subjects were compared with the overnight polysomnographic recording results. Results: In the prediction of apnea index more than 5, the sensitivity of observed apnea during sleep, snoring, excessive daytime sleepiness and insomnia were 96.8%, 93.5%, 38.7%, 25.8% and the specificity of those clinical features were 182%, 36.4%, 100%, 72.7%, respectively. In the prediction of apnea index more than 5, the sensitivity and specificity of the combination of more than three self-report clinical features were 54.8% and 90.9%. The degree of oxygen de saturation and maximal apnea duration in the group of apnea index more than 5 were significantly different from those in the group of apnea index below 5(P<0.001). And the apnea index was significantly correlated with the degree of oxygen desaturation and maximal apnea duration(P<0.001). Conclusion: These results suggest that application of clinical features alone as a screening test for the obstructive sleep apnea syndrome is inadequate because of it's high rate of false positive and false negative results. The degree of oxygen desaturation measured by oximetry is possibly applicable to screening test and follow up evaluation of treatment efficacy for the obstructive sleep apnea syndrome.

• Sleep Medicine and Psychophysiology
• /
• v.1 no.2
• /
• pp.163-171
• /
• 1994

Objectives: Symptoms of sleep apnea consisted of insomnia, excessive sleepiness during daytime, impaired cognitive functions and emotional disturbances. It was not so well known how these symptoms are correlated with various parameters of sleep and respiration, and what kind of psychophysiological processes are involved in development of these symptoms. Methods: In sixty patients with sleep apnea, sleep and respiration were studied by polysomnography of one night, also symptoms of sleep apnea were evaluated with the scales of insomnia, daytime sleepiness, emotional disturbance and cognitive impairment We studied correlations between apnea symptoms, and various parameters of sleep and respiration such as sleep efficiency, number severity of apnea, $O_2$ desaturation and number of snoring. Results: The result showing significant correlations are as follows. The patients with better sleep in insomnia scale showed more number of apnea, particularly more central type, and much more snoring in stage 3 sleep and mild desaturation of $O_2$. Excessive sleepiness during daytime correlated significantly with stage 1 sleep and its snoring, but correlated negatively with stage 2 sleep. However, no significant correlation was found with degree of $O_2$ desaturation. Emotional disturbance was more apparent in the patients with severe $O_2$ desaturation and smaller amounts of stage 4 sleep. Cognitive function was more impaired in cases of more REM sleep and less apnea. Conclusions: Symptoms of sleep apnea may occur through different causes and processes. The evaluation of apnea symptoms may be helpful to understand in some degree the condition of sleep and respiration during sleep in clinical setting.

• Journal of Oral Medicine and Pain
• /
• v.42 no.1
• /
• pp.1-7
• /
• 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.

• Sleep Medicine and Psychophysiology
• /
• v.12 no.1
• /
• pp.64-67
• /
• 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
• /
• v.51 no.6
• /
• pp.590-596
• /
• 2001

The hallmarks of sleep apnea syndrome include daytime hypersomnolence, snoring, obesity, disturbed nocturnal sleep, and apneic episodes. Thyroid deficiency states are now a well recognized cause of sleep apnea. Central, obstructive, and mixed patterns of sleep apnea may be observed in hypothyroidism. A-33-yr-old man was admitted complaining of daytime hypersomnolence, snoring, sleep apnea and obesity. A polysomnogram showed obstructive pattern of sleep apnea syndrome. Physical examination and hormonal study revealed a narrowing of the upper airway and primary hypothyroidism. Dilated cardiomyopathy was diagnosed by echocardiogram. The poctients was treated for obstructive sleep apnea syndrome with nasal continuous positive airway pressure(CPAP) for 2 months and the underlying hypothyroidism with thyroid hormone therapy. This successfully controlled the snoring, sleep apnea, and other apnea-related symptoms. Here, we describe our experience of nasal CP AP and thyroid hormone therapy in a patient with primary hypothyroidism associated with obstructive sleep apnea syndrome and dilated cardiomyopathy with review of the relevant literature.

• Sleep Medicine and Psychophysiology
• /
• v.10 no.2
• /
• pp.88-92
• /
• 2003

Sleep-disordered breathing (SDB), including snoring, sleep apnea and upper airway resistance syndrome are common problems in children. The pathophysiological mechanism of SDB in children is unclear but may include hypoxemia and changes in sleep architecture. Children with SDB show reduced neurocognitive function, and memory and attentional capacity. Furthermore, these children show increased problematic behaviour and reduced school performance. Whether early recognition and treatment of SDB in children may improve neurocognitive function and school performance remains to be fully evaluated in the future.