• Journal of Rhinology
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• 제25권2호
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• pp.80-85
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• 2018

Background and Objectives: Obesity is one of the most important risk factors for obstructive sleep apnea (OSA). There is limited evidence regarding the obesity-related anthropometric characteristics of Korean patients. Materials and Method: Medical records of 984 patients referred to 3 tertiary referral hospitals for habitual snoring or sleep apnea were analyzed. We defined OSA as apnea-hypopnea index (AHI) ${\geq}5$ and analyzed data to determine the anthropometric characteristics of patients with OSA such as neck circumference (NC), waist circumference (WC), hip circumference (HC), and waist to hip ratio (WHR). Results: A total of 952 patients (719 men) were included in the analysis. The main findings were: 1) BMI, WC, NC, HC, and WHR were greater among patients with OSA than among controls (AHI <5); 2) for both sexes, the proportion of patients with an OSA diagnosis increased with age; it increased steeply for women aged >50 years; 3) WC and WHR were most strongly correlated with AHI for men and women, respectively. Conclusion: OSA is associated with anthropometric characteristics, although different patterns were observed between men and women. OSA was more strongly associated with NC or WC among men and with WHR among women.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권5호
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• pp.277-283
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• 2022

Objectives: The main purpose of the present study was to investigate the associations between the risk of obstructive sleep apnea (OSA) and chronic orofacial pain in a nationally representative sample of the Korean population. Materials and Methods: Data from the 8th wave Korean national health and nutrition examination survey, which was conducted from 2019 to 2020 were analyzed. This study included 5,780 Koreans (2,503 males, 3,277 females) over 40 years of age. The presence of subjective chronic facial pain lasting more than 3 months was evaluated based on a self-reported questionnaire. The risk of OSA was determined using the STOP-BANG questionnaire. Data related to anthropometric and sociodemographic factors; diagnostic history of hypertension, depression, and OSA; level of health-related quality of life and stress awareness; health-related behaviors, including smoking and alcohol drinking; and sleep duration were collected. The participants were classified into two groups according to the presence of chronic facial pain. Results: The level of health-related quality of life and stress awareness showed significant differences between the two groups. The sleep duration on weekends also presented significant differences. No significant differences were observed in the presence of snoring and observed apnea, while participants with chronic facial pain showed significantly higher levels of tiredness between the groups. The risk of OSA evaluated by STOP-BANG questionnaire showed significant differences between groups; however, the risk of OSA seemed to be higher in participants without chronic facial pain. Conclusion: The participants with chronic facial pain demonstrated decreased sleep duration, lower health-related quality of life, and increased stress and tiredness. Even though, the role of OSA in the development of chronic facial pain was inconclusive from the study, it is possible that ethnicity play a role in relationship between OSA and chronic facial pain.

• Journal of Oral Medicine and Pain
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• 제48권3호
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• pp.96-105
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• 2023

Purpose: Mandibular advancement devices (MAD) are known to be insufficiently effective in all patients with obstructive sleep apnea (OSA). This study aimed to compare the treatment outcomes of MAD therapy according to OSA severity and to investigate the risk factors for the lack of response to MAD therapy. Methods: A total of 29 patients diagnosed with OSA received an adjustable two-piece MAD treatment. Sleep parameters measured with the home sleep apnea test device, including apnea-hypopnea index (AHI) and oxygen saturation (SpO₂), and daytime sleepiness using the Epworth Sleepiness Scale (ESS) were retrospectively assessed both before and after the MAD treatment. Results: The patients were classified into three groups according to AHI severity: mild (n=16, AHI<15), moderate (n=6, 15≤AHI<30), and severe OSA (n=7, AHI≥30). MAD therapy significantly improved the sleep parameters (p<0.001 for AHI and p=0.004 for minimum SpO₂) and daytime sleepiness (p<0.001 for ESS). Furthermore, successful outcomes (reduction in AHI>50% and AHI<10 events/h) were achieved in 83.3% and 71.4% of moderate and severe OSA cases, respectively. Of 13 patients with moderate and severe OSA, 10 were classified as responders and 3 as non-responders. The non-responders had significantly lower baseline value of SpO₂ (p=0.049 for average SpO₂ and p=0.007 for minimum SpO₂) and higher baseline AHI (p=0.049) than the responders. Conclusions: The results of the present study suggest that MAD is effective in the majority of patients with OSA of varying severities. The success of MAD therapy does not seem to depend solely on AHI severity. In addition to AHI, minimum SpO₂ may be a prognostic measure of the efficacy of MAD treatment in clinical dental practice.

• 수면정신생리
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• 제13권2호
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• pp.45-51
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• 2006

폐쇄성 수면무호흡증 환자의 수면 구조는 정상인에 비해 서파수면과 렘수면이 줄어들고 1단계 수면, 각성, 수면 분절이 증가한다는 것은 잘 알려져 있으며 이는 각 수면 단계의 분율에 양적인 변화를 의미한다. 그러나 정상 수면 구조를 규정하는 중요한 요소인 야간 수면의 렘수면-비렘수면의 주기성과 비대칭성에 대한 비교 연구는 드물다. 이 연구는 수면전반부와 후반부의 비대칭성이 폐쇄성 수면무호흡증 환자에서 손상될 것이라는 가정을 검증해 보고자 하였다. 코골이를 주소로 을지병원 수면클리닉을 방문한 49명의 남자(평균 연령: $39.1{\pm}12.2$세)를 대상으로 야간 수면다원검사를 실시하여 수면무호흡-저호흡 지수(AHI) 15를 기준으로 나눈 단순 코골이(SSN) 군 13명과 폐쇄성 수면무호흡증(OSA) 군 34명의 수면 구조를 독립적 t 검정으로 비교하고 각 군 별로 수면 전반부 후반부의 수면 변인을 따로 구하여 짝지어진 t 검정을 하였다. 연령과 체질량 지수 등의 신체적 조건은 두 군간에 차이가 없었다. OSA 군에서 1단계 수면 비율이 유의하게 늘고, 2단계 수면 비율은 유의하게 감소하였고, 렘수면 비율은 유의하게 감소하였다. 또 전체각성지수와 호흡각성지수가 유의하게 증가하였고, 평균 심박수가 유의하게 더 높았다. 평균 동맥혈 산소포화도의 저하와 산소포화도저하지수(ODI)의 증가, 평균 무호흡시간과 최장 무호흡시간의 증가 등도 OSA 군에서 유의하게 관찰되었다. 총검사시간을 중심으로 수면을 전후반으로 나누어 각 수면 변인을 보았을 때 SSN 군에서 비대칭성(p<0.05)을 보인 변인은 2단계수면 비율, 서파수면 비율, 렘수면 비율, 자발적 각성지수, 총각성지수, 평균 동맥혈산소포화도, 심박수인 반면, OSA 군은 2단계수면 비율, 서파수면 비율, 렘수면 비율, 자발적 각성지수, 평균 무호흡시간, 최장 무호흡시간, 평균 동맥혈산소포화도, 심박수가 비대칭성(p<0.05)을 보였고, 총각성지수는 비대칭성을 보이지 않았다. 가정과 다르게 폐쇄성 수면무호흡증에서 단순 코골이에 비해 달라진 부분은 평균 수면무호흡 시간과 최장 수면무호흡 시간이 증가한 것 뿐이었고, 유일하게 총각성지수만이 비대칭성이 붕괴되어 전반부와 후반부의 차이가 없어졌다. 흥미로운 것은 알려진 수면단계의 비대칭성(전반부에 2단계수면과 서파수면의 비율이 높고, 후반부에 렘수면 비율이 높아지는 점) 이외에도 수면전반부에 총각성지수와 자발적 각성지수, 평균 심박수가 높고 후반부에 평균 동맥혈산소포화도가 높다는 사실이다. 정상 남녀 성인에서도 이러한 경향을 확인할 수 있는지 추가적인 연구가 필요하다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권5호
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• pp.338-345
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• 2003

Purpose : This study was intended to perform cephalometric comparison between the patients with and without obstructive sleep apnea (OSA). The factors influencing the OSA in the lateral cephalogram was also investigated. Patient and Method : Twenty four patients who visited Sleep Disorder Clinic in Dongsan Medical Center, Keimyung University and evaluated with polysomnograph(PSG) and cephalogram were included in the study. The patients had apnea-hypopnea episode(AHI) over 10 times per hour was diagnosed as OSA after overnight PSG. To evaluate hard and soft tissue profile, cephalometric radiogram were taken at maximal intercuspation(P1) and mandibular protruding position(P2). The diffefence between the OSA and normal group were evaluated statistically and the stepwise regression analysis was applied to analyse the cephalometric influencing factors to OSA. Result : The OSA Group(n=14) had significantly higher Body Mass Index(BMI) than control group(n=10). Lower facial height(ANSGn) was longer in OSA group. However statistically significant difference was not detected in other anteroposterior craniofacial measurements. The soft palate lenth (PNS-P), hyoid position (MP-Hyoid) had positive correlation between AHI (r=0.496, r=0.413, respectively, p<0.05). However, the measurements of oropharyngeal airway was not different between the two groups. The hypothesis, the antero-posteriorly narrow oropharyngeal airway might aggravate the airway resistance and can give rise to higher AHI, was not accepted in the study. This can be attributed by inclusion of the patients performed uvulopalatopharyngoplasty because of the tonsilar or soft palate hypertrophy in the present study. The results of regression analysis revealed that PNS-P, upper airway width(Nph1), upper facial heght(N-ANS), and lower facial height(ANS-Gn) could influence the degree of AHI (F value < 0.0001, $R^2$ = 0.829). Conclusion : We suggest lateral cephalogram may utilized as a useful method to evaluate OSA. The patient with long soft palate, narrow upper airway width, long upper & lower facial height can be expected to have high risk of OSA. However, it should be emphasized the comphrehensive intraoral inspection including soft palate and tonsilar hypertrophy because lateral cepahlogram cannot visualize oropharyngeal status completely.

• 한국응용과학기술학회지
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• 제31권4호
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• pp.642-652
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• 2014

The synthesis of octenyl succinyl ${\beta}$-gucan (OSA-${\beta}$-glucan) was carried out and its interfacial properties at the oil-water interface and in emulsion systems were investigated. An aqueous ethanol system as a reaction media was used to facilitate the synthesis process; 10% (w/w) ethanol found to be the best as it showed a maximum degree of substitution (DS: 0.0132). FT-IR showed a characteristic absorption spectrum at $1736cm^{-1}$, indicating the esterification of octenyl succinyl groups to ${\beta}$-glucan backbone. As for interfacial tension measurements, it was decreased with increasing concentration of OSA-${\beta}$-glucan in the aqueous phase and when NaCl was added to aqueous OSA-${\beta}$-glucan solution in the range of 0.01 M to 0.1 M and also when pH was raised (pH 3 ~ pH 9). In systems of emulsion stabilized with OSA-${\beta}$-glucan, fat globule size found to decrease with increasing concentration of OSA-${\beta}$-glucan, showing a critical value of about $0.32{\mu}m$ at 0.5 wt%. When the OSA-${\beta}$-glucan emulsions were stored, it was found that fat globule size was increased with storage time and particularly pronounced increase was observed in emulsion with 1% OSA-${\beta}$-glucan, possibly due to depletion flocculation. Results of creaming stability evaluated by light scattering technique showed that it was more stable in emulsions containing smaller fat globule size. Surface load of OSA-${\beta}$-glucan in emulsions increased with increasing concentration of OSA-${\beta}$-glucan, suggesting a multilayer adsorption.

• 수면정신생리
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• 제3권2호
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• pp.32-42
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• 1996

연구배경 : 상기도 저항증후군 (UARS)으로 진단 받은 환자 및 이들의 수면다원검사 소견을 정상인 및 수면 무호흡증(OSA) 환자의 그것과 비교 연구함으로서 UARS의 이해에 도움을 얻고자하였다. 방법 : 임상적인 면담, 신체검사 및 식도내 음압 (Pes)의 측정을 포함하는 수면다원검사를 통하여 UARS로 진단받은 20 명의 환자와 OSA로 진단 받은 30명의 환자를 대상으로 하였고, Williams 등 (10)의 자료를 정상비교치로 이용하였다. 결과 : UARS는 OSA 보다 젊고 비만도가 낮은 환자특성을 보이고 수면다원검사시 OSA의 진단기준이 되는 RDI와 $SaO_2$가 정상에 가까운 특정을 보임을 알 수 있다. 기타 수면지표들은 정상범위에 속하거나 이상소견이 있더라도 OSA 환자의 그것보다는 경미하여 UARS가 OSA보다는 가벼운 상태의 장애임을 시사한다. 그러나 UARS 환자들의 ESS의 점수는 병적인 수준으로 낮 동안의 졸림기로 일상생활에 많은 장애를 받고 있음을 시사한다. 결론 : 본 연구결과는 UARS 환자의 특성 및 이들의 특정 적인 수면다원검사 소견을 보여줬다고 생각하며 지금까지 발표되고있는 UARS에 대한연구결과들을 지지한다. 즉 UARS는 임상적, 실험실적으로 OSA와는 다른특징이 있는 수면관련 호흡장애의 아형이다. 따라서 임상적으로 수면관련 호흡장애가 의심되는 환자의 나이가 젊고 BMI가 정상이고, 일반수면다원검사에서 RDI와 $SaO_2$ 등이 수면관련 호흡장애 진단기준에 미흡하더라도 수면중 코를 고는 등의 상기도 저항(upper airway resistance)을 시사하는 증상이 있고, 뇌파상 이유없이 자주 반복되는 전기 생리적인 각성이 있다면 UARS를 의심하여야한다. UARS 환자들이 호소하는 낮 동안의 졸림기는 OSA 환자들의 그것과 비슷하여 일상생활에 많은 고통을 주고 반복적인 흉곽내 압력의 지나친 상승은 심혈관계에 해로운 영향을 미치는 바 UARS에 대한관심이 필요하다.

• 대한치과교정학회지
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• 제40권2호
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• pp.115-126
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• 2010

이 증례보고는 심한 수면무호흡증으로 진단된 환자로, 다른 구강 내 OSA치료 장치와 nCPAP치료에 적응을 못하는 66세 남자 환자였다. 하악골에 2개의 교정용 마이크로 임프란트를 식립한 후, 식립 2주 후부터 구강외 고정원인 개조된 안면마스크에서 마이크로 임프란트에 힘을 가하여 하악골을 전진시켰다. 마이크로 임프란트를 이용한 하악골전진술(MiMA)은 심한 수면 무호흡환자의 AHI (apnea-hypopnea index), 코골이 및 심한 수면 무호흡증상을 개선할 수 있었다.

• Journal of Oral Medicine and Pain
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• 제37권4호
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• pp.213-219
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• 2012

구강내 장치 요법은 가벼운 혹은 중간 정도의 폐쇄성 수면 무호흡증의 일차 치료법이며 심한 폐쇄성 수면 무호흡증의 경우에도 CPAP 또는 수술요법에서 효과가 없을 때 좋은 대안적 치료법이 될 수 있다. 하지만 다양한 구강내 장치들마다 치료 효과가 다르며 또한 모든 환자들에서 효과를 기대하기 어려운 것도 사실이다. 본 연구는 목젖입천장인두절제술(uvulopalatopharyngoplasty, UPPP) 을 받았으나 증상의 개선이 없는 심한 폐쇄성 수면 무호흡증 (obstructive sleep apnea, OSA) 환자에서 단국대 치대 구강내과에서 개발한 구강내 조절성 하악전방이동형 코골이 방지장치 (Adjustable Anterior Positioner, AAP)를 사용하여 치료한 증례를 보고하고 그에 대한 고찰을 한다.

• Clinical and Experimental Pediatrics
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• 제53권10호
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• pp.872-879
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• 2010

Obstructive sleep apnea (OSA) in children is a frequent disease for which optimal diagnostic methods are still being defined. Treatment of OSA in children should include providing space, improving craniofacial growth, resolving all symptoms, and preventing the development of the disease in the adult years. Adenotonsillectomy (T&A) has been the treatment of choice and thought to solve young patient's OSA problem, which is not the case for most adults. Recent reports showed success rates that vary from 27.2% to 82.9%. Children snoring regularly generally have a narrow maxilla compared to children who do not snore. The impairment of nasal breathing with increased nasal resistance has a well-documented negative impact on early childhood maxilla-mandibular development, making the upper airway smaller and might lead to adult OSA. Surgery in young children should be performed as early as possible to prevent the resulting morphologic changes and neurobehavioral, cardiovascular, endocrine, and metabolic complications. Close postoperative follow-up to monitor for residual disease is equally important. As the proportion of obese children has been increasing recently, parents should be informed about the weight gain after T&A. Multidisciplinary evaluation of the anatomic abnormalities in children with OSA leads to better overall treatment outcome.