• 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 Preventive Medicine and Public Health
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• v.29 no.4 s.55
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• pp.747-764
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• 1996

This study intended to obtain an useful information for health management of lead exposed workers and determine biological monitoring interval in early period of exposure by measuring the lead exposure indices and work duration in all male workers (n=433 persons) exposed less than 1 year in 6 storage battery industries and in 49 males who are not exposed to lead as control. The examined variables were blood lead concentration (PBB), Zinc-protoporphyrin concentration (ZPP), Hemoglobin (HB) and personal history; also measured lead concentration in air (PBA) in the workplace. According to the geometric mean of lead concentration in the air, the factories were grouped into three categories: A; When it is below $0.05mg/m^3$, B; When it is between 0.05 and $0.10mg/m^3$, and C; When it is above $0.10mg/m^3$. The results obtained were as follows: 1. The means of blood lead concentration (PBB), ZPP concentration and hemoglobin(HB) in all male workers exposed to lead less than 1 year in storage battery industries were $29.5{\pm}12.4{\mu}g/100ml,\;52.9{\pm}30.0{\mu}g/100ml\;and\;15.2{\pm}1.1\;gm/100ml$. 2. The means of blood lead concentration (PBB), ZPP concentration and hemoglobin(HB) in control group were $5.8{\pm}1.6{\mu}g/100ml,\;30.8{\pm}12.7{\mu}g/100ml\;and\;15.7{\pm}1.6{\mu}g/100ml$, being much lower than that of study group exposed to lead. 3. The means of blood lead concentration and ZPP concentration among group A were $21.9{\pm}7.6{\mu}g/100,\;41.4{\pm}12.6{\mu}g/100ml$ ; those of group B were $29.8{\pm}11.6{\mu}g/100,\;52.6{\pm}27.9{\mu}g/100ml$ ; those of group C were $37.2{\pm}13.5{\mu}g/100,\;66.3{\pm}40.7{\mu}g/100ml$. Significant differences were found among three factory group(P<0.01) that was classified by the geometric mean of lead concentration in the air, group A being the lowest. 4. The mean of blood lead concentration of workers who have different work duration (month) was as follows ; When the work duration was $1\sim2$ month, it was $24.1{\pm}12.4{\mu}g/100ml$, ; When the work duration was $3\sim4$ month, it was $29.2{\pm}13.4{\mu}g/100ml$ ; and it was $28.9\sim34.5{\mu}g/100ml$ for the workers who had longer work duration than other. Significant differences were found among work duration group(P<0.05). 5. The mean of ZPP concentration of workers who have different work duration (month) was as follows ; When the work duration was $1\sim2$ month, it was $40.6{\pm}18.0{\mu}g/100ml$, ; When the work duration was $3\sim4$ month, it was $53.4{\pm}38.4{\mu}g/100ml$ ; and it was $51.5\sim60.4{\mu}g/100ml$ for the workers who had longer work duration than other. Significant differences were found among work duration group(P<0.05). 6. Among total workers(433 person), 18.2% had PBB concentration higher than $40{\mu}g/100ml$ and 7.1% had ZPP concentration higher than $100{\mu}g/100ml$ ; In workers of factory group A, those were 0.9% and 0.0% ; In workers of factory group B, those were 17.1% and 6.9% ; In workers of factory group C, those were 39.4% and 15.4%. 7. The proportions of total workers(433 person) with blood lead concentration lower than $25{\mu}g/100ml$ and ZPP concentration lower than $50{\mu}g/100ml$ were 39.7% and 61.9%, respectively ; In workers of factory group A, those were 65.5% and 82.3% : In workers of factory group B, those were 36.1% and 60.2% ; In workers of factory group C, those were 19.2% and 43.3%. 8. Blood lead concentration (r=0.177, P<0.01), ZPP concentration (r=0.135, P<0.01), log ZPP (r=0.170, P<0.01) and hemoglobin (r=0.096, P<0.05) showed statistically significant correlation with work duration (month). ZPP concentration (r=0.612, P<0.01) and log ZPP (r=0.614, P<0.01) showed statistically significant correlation with blood lead concentration 9. The slopes of simple linear regression between work duration(month, independent variable) and blood lead concentration (dependent variable) in workplace with low air concentration of lead was less steeper than that of poor working condition with high geometric mean air concentration of lead. The study result indicates that new employees should be provided with biological monitoring including blood lead concentration test and education about personal hygiene and work place management within $3\sim4$ month.