• 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.1
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• pp.24-31
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• 2017

Objectives: Periodic limb movement disorder (PLMD) has been debated with regard to its clinical significance and diagnostic criteria. The current diagnostic criterion for PLMD in adults has been changed from periodic limb movement index (PLMI) > 5/hour to PLMI > 15/hour by the International Classification of Sleep Disorders (ICSD). In this study, we aimed to investigate the changes in polysomnographic sleep variables according to PLMI and to determine the relevance of the diagnostic criterion for PLMD. Methods: Out of 4195 subjects who underwent standard polysomnography, we selected 666 subjects (370 males and 296 females, aged $47.1{\pm}14.8$) who were older than 17 years and were not diagnosed with primary insomnia, sleep apnea, narcolepsy, or REM sleep behavior disorder. Subjects were divided into three groups according to PLMI severity: group 1 ($PLMI{\leq}5$), group 2 (5 < $PLMI{\leq}15$), and group 3 (PLMI > 15). Demographic and polysomnographic sleep variables and Epworth sleepiness scale (ESS) were compared among the three groups. Results: There were significant differences among the three groups in age and gender. Sleep efficiency (SE) and stage 3 sleep percentage in group 1 were significantly higher than those in groups 2 and 3. The wake after sleep onset (WASO) score in group 1 was significantly lower than those in groups 2 and 3. However, there were no significant differences in SE, stage 3 sleep percentage, or WASO between groups 2 and 3. Sleep latency (SL) in group 1 was significantly lower than that in group 3, but there was no difference in SL between group 2 and group 3. ESS score in group 1 was significantly higher than that in group 3, but there was no difference between group 2 and group 3. Partial correlation analysis adjusted by age showed that PLMI was significantly related to SE and WASO. Conclusion: This study suggests that PLMI influences polysomnographic sleep variables. In addition, we found the individuals who did not have PLMD but had PLMI > 5 were not different in polysomnographic sleep variables from the individuals who had PLMD according to the current criterion. These results raise questions about the relevance of the current diagnostic criterion of PLMD.

• Proceedings of the Korea Contents Association Conference
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• 2015.05a
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• pp.145-146
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• 2015

폐쇄성수면무호흡증(Obstructive sleep apnea syndrome : OSAS)은 신경근육계, 호흡계, 심혈관계의 복합적인 질환으로서 사회적, 생리학적으로 심각한 문제를 발생시킬 수 있는 질병이다. 수술적치료를 결정하기에 앞서 환자의 증상 및 징후, 신체 상태와 습관 등을 정밀검사하고, 기도폐쇄가 일상생활 및 정신건강에 미치는 영향을 고려하여 수술여부를 결정하여야 한다. 폐쇄성수면무호흡증후군의 진단에 유용한 검사인 수면다원검사와 Videofluoroscopy의 검사결과를 바탕으로 수술소견을 비교분석하고자 하였다.

• Journal of Korean Academy of Nursing
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• v.37 no.7
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• pp.1108-1118
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• 2007

Purpose: The purpose of this study was to identify the effects of hand acupuncture therapy on sleep quality by means of a sleep questionnaire, polysomnography and a cerebral blood flow test in $30{\sim}59$ year old adults. Methods: The study was a sham controlled design. Twenty-two adults were assigned to the pellet stimulating group (11) or sham group (11). The pellet stimulating group received hand acupuncture therapy using New Seoam Press Pellets number 1 for 4 weeks. On the other hand, the sham group used the same Adhesive tape in terms of shape, size and quality as New Seoam Press Pellets number 1 for 4 weeks. A Transcranial Doppler Ultrasonography and Carotid Duplex Ultrasonography examination were used for evaluating cerebral blood flow. Data was analyzed using the SPSS 12.0 version program with $X^2-test$, Fisher's exact test and Mann Whitney U-test. Results: In the pellet stimulating group, subjective sleep quality significantly improved more than that of the sham group. Among the sleep indices of the polysomnography, total sleep time and sleep latency of the sham group significantly improved. The cerebral blood flow test didn't show any differences. Conclusion: These results suggest that hand acupuncture therapy is effective for subjective sleep improvement only, not polysomnographical sleep indices and cerebral blood flow.

• Sleep Medicine and Psychophysiology
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• v.5 no.1
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• pp.111-117
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• 1998

Objectives : 'First-night effect' has been a well-known concept since 1960's. It is important because it is one of the major factors to be considered in assessing the reliability of polysomnographic data. However, 'reverse first-night effect' has also been described, resulting in the inconsistency of conceptualization. We attempted to investigate on the first-night effect in adults by having each of them take two nights of polysomnography in a controlled environment. Young healthy adult volunteers were chosen as subjects in order to rule out age- or health-related confounders. Methods : Polysomnography was performed on eight male medical students (mean $age=23.5\;{\pm}\;0.9$) for two nights with Grass model 78 polysomnograph. We scored manually under the standard protocol each epoch of the sleep records. Sleep variables were obtained and compared between the two nights. Results : Sleep period time(SPT) and total sleep time(TST) of the third fraction of night were significantly longer on the first night than on the second night (p<0.05). However, other sleep variables such as percentage of each sleep stage, sleep latency, REM sleep latency, number of waking, and sleep efficiency were not different between the two nights. Conclusion : We could not confirm the existence of first-night effect in this study. In healthy young male adults, it may not happen at all or may happen to a very negligible degree. Young healthy adults may have more adaptability to a new sleep environment. Also, the provision of a reasonably comfortable sleep environment could have helped them with abolition of first-night effect.

• Sleep Medicine and Psychophysiology
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• v.11 no.1
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• pp.22-28
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• 2004

Objective: The purpose of this study is to investigate the prevalence rate of OSA in subjects whose main sleep complaint is insomnia and to find differential factors of OSA in these insomniac subjects. Method: We reviewed the medical records and polysomnographic findings of patients referred to the Sleep Laboratory at Seoul National University Hospital from January 1996 to December 2002. Four-hundred and seventy subjects complained of insomnia as their main sleep problem (235 males and 235 females, mean age $53.6{\pm}12.4\;years$). First, we investigated the prevalence rate of OSA in these insomniac patients. Second, we compared the clinical and demographic characteristics of the OSA-associated group with those of the non-associated group. Third, we examined whether the degree or presence of differential factors within the OSA group correlate with severity of OSA, as determined by the respiratory disturbance index (RDI). Results: Among 470 insomniac subjects, 125 subjects (26.6%) were diagnosed as OSA by nocturnal polysomnography. OSA-associated subjects were significantly older ($58.4{\pm}12.3\;years$ vs. $51.8{\pm}11.2\;years$, p<0.01), and had significantly higher body mass index (BMI) ($23.4{\pm}3.3\;kg/m^2$ vs. $22.5{\pm}3.1\;kg/m^2$, p=0.44) than non-associated subjects. The OSA-associated group had more subjects with male gender (64.0% vs. 44.9%, p<0.01), hypertension (20.0% vs. 9.3%, p<0.01) or snoring (96.0% vs. 63.5%, p<0.01). Within the OSA-associated group, age had a significant positive correlation with RDI (p=0.01). Conclusion: We found that a considerable portion of patients complaining of insomnia as their main sleep problem were diagnosed as OSA. Snoring, old age, male gender, obesity, and comorbid hypertension were found to be differential factors of OSA in insomniac patients. We suggest that diagnostic efforts including nocturnal polysomnography are needed for insomniac patients with any of the above risk factors of OSA.

• Sleep Medicine and Psychophysiology
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• v.15 no.2
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• pp.82-86
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• 2008

Objectives: Obstructive sleep apnea syndrome (OSAS) not only causes respiratory disturbances during sleep but also decreases the quality of nocturnal sleep through sleep fragmentation and sleep structure change. We aimed at comparing the changes in sleep fragmentation and structure between baseline (diagnostic) nocturnal polysomnography (NPSG) and nCPAP (nasal continuous positive airway pressure) titration trial. Methods: One hundred and three patients with a baseline night of respiratory disturbance index (RDI) of 5 or greater and reduced RDI score during nCPAP titration night were retrospectively selected for the study. Sleep fragementation and sleep structure between baseline NPSG and the NPSG during nCPAP titration were compared. Sleep fragmentation index (SFI) was defined as the total number of awakenings and shifts to stage 1 sleep divided by the total sleep time in hour. SFI and other polysomnographic parameters were statistically compared between the two nights. Results: SFI during baseline NPSG and nCPAP titration nights were $29.0{\pm}13.8$ and $15.2{\pm}8.8$, respectively, indicating a significant SFI decrease during nCPAP titration (t=9.7, p<0.01). SFI showed significant negative correlations with sleep efficiency (r=-0.60, p<0.01) and total sleep time (r=-0.45, p<0.01) and a positive correlation with RDI (r=0.28, p<0.01). Conclusion: Use of nCPAP, even during the titration, significantly decreases sleep fragmentation and improves sleep structure in OSAS patients. We suggest that SFI may be utilized as a measure of assessing OSAS severity and nCPAP efficacy.

• Science of Emotion and Sensibility
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• v.14 no.4
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• pp.545-554
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• 2011

In this study, the parameters of Polysomnography (PSG) test, such as total sleep time, snoring time, had been analyzed to evaluate the effectiveness of a developed anti-snore pillow. The developed anti-snore pillow is made up of two polyvinylidene fluoride (PVDF) vibration sensors, pumps, valves, and air bladders. The two PVDF sensors inside the pillow can acquire the sound signals and the algorithm was perfectly designed to extract snoring by removing unwanted noise accurately and automatically. Once the pillow recognizes snore, a pump inside the hardware activates, and a bladder under the neck area inside the pillow will be inflated. The PSG test was used and two volunteers were participated for the study. The parameters of the PSG results were analyzed to evaluate the effectiveness of the anti-snore pillow. The total sleep time of each volunteer was similar on each phase of test, but the snoring time and the longest snoring episode were significantly decreased with the use of anti-snore pillow. The overall results showed excellent possibilities for reducing snoring for the person who snores during sleep by using the anti-snore pillow. The effectiveness of the anti-snore pillow can be evaluated by the PSG test. Moreover, the relationship between each parameter of PSG test and the quality of sleep will be used for further researches.

• Journal of Oral Medicine and Pain
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• v.38 no.2
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• pp.203-213
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• 2013

Objecives : The purpose of the study was to evaluate treatment outcome of mandibular advancement device(MAD) in obstructive sleep apnea (OSA) patients using full night polysomnography and cephalometry. Methods : Twenty-seven OSA patients were confirmed by full night, lab-attended polysomnography. Cephalometric examinations were conducted to obtain SNA, ANB, $AH{\bot}MP$, AH-C3, SPT, PNS-U, NAS, SOAS, MOAS, and HAS. Mandibular advancement devices (MADs) were fabricated and delivered for all subjects. After acclimation period of MAD, the second polysomnographic examinations were conducted in the same manner. Polysomnographic variables were compared between before and after MAD placement. Also, correlation coefficients were calculated between apnea-hypopnea index (AHI) and each item of cephalometric parameters. Results : There were significant improvements in total AHI, lowest $SpO_2$, and total arousal index after MAD therapy. Also, there were significant improvements in NREM $SpO_2$ and NREM AHI, but not in REM $SpO_2$ and REM AHI with MAD. Stratifying the sleep stage, there were significant decrease in stage I and significant increases in stage II and REM, but change in stage III was not significant. SNA and SOAS were significantly correlated with total AHI and NAS was significantly correlated with supine AHI. ANB was significantly associate with the effect of MAD. Conclusions : MAD is an effective treatment in OSA patients comparing polysomnographic variables before and after treatment. Cephalometric examination can be useful to evaluate OSA patients and predict treatment outcome of MAD.

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