• 음성과학
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• 제8권2호
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• pp.23-37
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• 2001

The primary sound produced by the vibration of vocal folds reaches the velopharyngeal isthmus and is directed both nasally and orally. The proportions of the each component is determined by the anatomical and functional status of the soft palate. The oral sounds composed of oral vowels and consonants according to the status of vocal tract, tongue, palate and lips. The nasal sounds composed of nasal consonants and nasal vowels, and further modified according to the status of the nasal airway, so anatomical abnormalities in the nasal cavity will influence nasal sound. The measurement of nasal sounds of speech has relied on the subjective scoring by listeners. The nasal sounds are described with nasality and nasalization. Generally, nasality has been assessed perceptually in the effect of maxillofacial procedures for cleft palate, sleep apnea, snoring and nasal disorders. The nasalization is considered as an acoustic phenomenon. Snoring and sleep apnea is a typical disorders due to abundant velopharynx. The sleep apnea has been known as a cessation of breathing for at least 10 seconds during sleep. Several medical and surgical methods for treating sleep apnea have been attempted. The uvulopalatopharyngoplasty(UPPP) involves removal of 1.0 to 3.0 cm of soft palate tissue with removal of redundant oropharyngeal mucosa and lateral tissue from the anterior and sometimes posterior faucial pillars. This procedure results in a shortened soft palate and a possible risk following this surgery may be velopharyngeal malfunctioning due to the shortened palate. Few researchers have systematically studied the effects of this surgery as it relates to speech production. Some changes in the voice quality such as resonance (nasality), articulation, and phonation have been reported. In view of the conflicting reports discussed, there remains some uncertainty about the speech status in patients following the snoring and sleep apnea surgery. The study was conducted in two phases: 1) acoustic analysis of oral and nasal sounds, and 2) evaluation of nasality.

• 생물정신의학
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• 제22권1호
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• pp.14-19
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• 2015

Objectives The purpose of this study is to find the cephalometric variables which are significantly correlated with the apnea-hypopnea index (AHI) in suspected Korean obstructive sleep apnea (OSA) patients. Methods We examined lateral cephalogram and attended-full night laboratory polysomnography of the 40 participants who complained of OSA symptoms. The correlation analysis was conducted to find the cephalometric variables which are significantly correlated with the AHI. Results The correlation analysis showed that the higher AHI was associated with the longer distance between hyoid and mandibular plane (p = 0.023), the longer distance between C3 and hyoid (p = 0.014), the longer tongue length (p = 0.003), the larger inferior tongue area (p = 0.008), the larger anterior displacement of the hyoid bone (p = 0.024), the longer distance between posterior nasal spine and the tip of the soft palate (p = 0.021), and the larger cross-sectional area of soft palate (p = 0.001) of cephalogram in erect position. The higher AHI was correlated with the longer distance between hyoid and mandibular plane (p = 0.008), the longer tongue length (p = 0.037), the larger inferior tongue area (p = 0.013), the thicker uvula (p = 0.004), the longer distance between retrognathion and hyoid (p = 0.025), and larger cross-sectional area of soft palate (p = 0.001) of cephalogram in supine position. Conclusions The present preliminary results showed the candidate measurements of cephalogram which are significantly correlated with the AHI in suspected OSA.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.33.1-33.11
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• 2018

Background: Bimaxillary orthognathic surgery with maxillomandibular setback is often accompanied by changes in airway space. We analyzed the changes in airway space before and after surgery and assessed their association with obstructive sleep apnea. Methods: This study is based on the cohort of 13 adult patients (9 males, 4 females, average age 23.85 years) who underwent bimaxillary orthognathic surgery with maxillomandibular setback. We performed computed tomography and portable polysomnography before and after the surgery to assess changes in airway space and Apnea-Hypopnea Index (AHI) values (total, supine, non-supine). Results: The oropharyngeal airway volume decreased by 29% after the surgery, which was statistically significant (p < .05). The upper airway volume and hypopharyngeal airway volume were decreased, but not significantly (4 and 19%, respectively). The changes in airway surface area were statistically significant at all levels examined (p < .05). Changes in the maximum anteroposterior width of the airway were also significant at all levels (p < .05). However, the changes in maximum lateral width were only statistically significant at C2 level (p < .05). AHI values were increased after the surgery but not significantly at any position. Conclusions: Although bimaxillary surgery with maxillomandibular setback significantly reduces the airway space, it does not affect AHI values or induce obstructive sleep apnea.

• Journal of Oral Medicine and Pain
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• 제41권1호
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• pp.7-15
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• 2016

Purpose: Mandibular advancement device (MAD) is widely recognized as an important treatment option for obstructive sleep apnea (OSA) and is readily accepted than any other treatment options owing to its simplicity and ambulatory nature. At this time, there are a multitude of MAD designs and their efficacies may be influenced by adjustment and retention mechanism. The MAD with the anterior connector (anteriorly adjustable mandibular advancement device, AAMAD) was newly developed in the Department of Oral Medicine, Dankook University Dental Hospital (Cheonan, Korea) and was prescribed for the OSA patients including snoring patients. Thus, this study was aimed to objectively investigate the effectiveness of the AAMAD on the OSA patients using the self-applied portable device (ApneaLink), and evaluate the treatment outcomes among patients with various severity of OSA level. Methods: Results of the treatment of fourteen patients (13 male, 1 female) with the AAMAD were retrospectively analyzed. Each patient underwent home sleep test before treatment and were divided into two groups, i.e., those with mild (apnea-hypopnea index [AHI] ${\geq}5$ and <15) to moderate OSA (AHI ${\geq}15$ and <30) and severe OSA (AHI ${\geq}30$). After treatment, home sleep test was conducted again and treatment outcomes were compared between mild to moderate and severe OSA patients. Results: Of all patients, 78.6% showed more than 50% AHI reduction. We found a significant reduction (85.3%) of AHI in the severe OSA patients. Patients with mild to moderate OSA showed the reduced AHI (56.1%). Conclusions: We concluded that AAMAD is an effective oral appliance for the majority of OSA patients.

• Healthcare Informatics Research
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• 제24권4호
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• pp.346-358
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• 2018

Objectives: The association between obstructive sleep apnea (OSA) and mortality or serious cardiovascular events over a long period of time is not clearly understood. The aim of this observational study was to estimate the clinical effectiveness of continuous positive airway pressure (CPAP) treatment on an outcome variable combining mortality, acute myocardial infarction (AMI), and cerebrovascular insult (CVI) during a follow-up period of 15.5 years ($186{\pm}58$ months). Methods: The data set consisted of 978 patients with an apnea-hypopnea index (AHI) ${\geq}5.0$. One-third had used CPAP treatment. For the first time, a data-driven causal Bayesian network (DDBN) and a hypothesis-driven causal Bayesian network (HDBN) were used to investigate the effectiveness of CPAP. Results: In the DDBN, coronary heart disease (CHD), congestive heart failure (CHF), and diuretic use were directly associated with the outcome variable. Sleep apnea parameters and CPAP treatment had no direct association with the outcome variable. In the HDBN, CPAP treatment showed an average improvement of 5.3 percentage points in the outcome. The greatest improvement was seen in patients aged ${\leq}55$ years. The effect of CPAP treatment was weaker in older patients (>55 years) and in patients with CHD. In CHF patients, CPAP treatment was associated with an increased risk of mortality, AMI, or CVI. Conclusions: The effectiveness of CPAP is modest in younger patients. Long-term effectiveness is limited in older patients and in patients with heart disease (CHD or CHF).

• 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.

• 동의신경정신과학회지
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• 제31권4호
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• pp.329-336
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• 2020

Objectives: This case report intended to examine how herbal medicine treatment for breathingrelated sleep disorders applied with polysomnography affected the structure of sleep. Methods: From January to November 2019, we retrospectively reviewed the progress records and polysomnography reports of patients who visited Korean medical hospitals in Daejeon and Cheonan. Results: In case 1, the patient complained of daytime sleepiness and snoring and was diagnosed with obstructive sleep apnea disorder and treated with Ukgan-san-gami. There were significant changes in the polysomnographic parameters, such as sleep efficiency, waking after sleep onset, sleep latency, the total arousal index, and the apnea-hypopnea index after herbal treatment. In case 2, the patient complained of frequent waking after sleep onset, daytime sleepiness, and snoring, and was diagnosed with obstructive sleep apnea disorder and treated with Yeoldahanso-tang-gami. There were significant changes in the polysomnographic parameters, such as the total arousal index and the apnea-hypopnea index after herbal treatment. In case 3, the patient complained of daytime sleepiness and was diagnosed with obstructive sleep apnea disorder and treated with Bangpungtongsung-san. There was no significant change in the polysomnographic parameters after herbal treatment. Conclusions: It is meaningful to note that objectively identifying the outcome of treatment for breathing-related sleep disorders is necessary in the clinical practice of Korean medicine.

• 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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• 제8권2호
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• pp.113-120
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• 2001

배 경 : 폐쇄성 수면무호흡증은 다양하고 심각한 임상 증상과 합병증을 유발하는 질환으로 국내에서도 흔히 진단되고 있다. 그러나 현재까지 수면다원기록법을 사용해 폐쇄성 수면무호흡증을 확진한 환자들의 대규모 국내 연구를 찾아 볼 수 없었다. 본 연구에서는 종래의 연구에서보다 더 큰 집단을 대상으로 수면다원기록법을 사용해 폐쇄성 수면무호흡증으로 확진된 한국인 환자의 임상적 특성과 수면 양상에 관해 조사하였다. 방 법 : 서울대학교병원 수면다원검사실에 의뢰된 환자들 중 수면다원검사 결과 폐쇄성 수면무호흡증으로 진단된 환자 801명을 대상으로 하였다. 중추성 무호흡증, 주기성 사지운동증, 기면병, 렘수면관련행동장애, 그리고 외국인 환자는 제외하였다. 연구 대상 군의 임상적 특징을 조사하였으며 수면 변인들을 연령, 성별에 따른 정상치와 비교하였다. 그리고 호흡장애지수가 수면변인에 미치는 영향을 분석하였다. 결 과 : 전체 연구대상자 801명 중 남자가 83.4%, 여자가 16.4%이었고 평균 연령은 46.6세였다. 평균 비만정도 지수는 25.8이었고 비만한 환자가 22.8%를 차지하였다. 전체 대상 중 6.2%가 벤조디아제핀계 약물을 복용 중이었다. 연구 대상군에서 정상치에 비해 입면잠복시간은 증가되었고 수면효율, 렘수면 분율, 그리고 서파수면 분율은 감소하였다. 서파수면 분율과 렘수면 분율은 각각 호흡장애지수와 음의 상관성을 보였으나 수면효율과 입면잠복시간은 모두 호흡장애지수와 유의한 상관관계가 없었다. 결 론 : 본 연구에서 다수의 폐쇄성 수면무호흡증 환자가 비만과 무관하였다. 또한 6.2%의 폐쇄성 수면무호흡증 환자가 벤조디아제핀계 약물을 복용하고 있었다. 폐쇄성 수면무호흡증의 발병은 수면효율도 낮추고 서파수면과 렘수면 분율을 감소시키나 호흡장애지수가 커져도 서파수면과 렘수면 분율이 감소할 뿐 수면효율은 별 다른 변화가 없었다. 즉, 수면효율보다는 수면 구조의 변화가 수면 중 호흡장애의 정도에 더 관련되었음을 알 수 있었다.

• 수면정신생리
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• 제12권2호
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• pp.93-97
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• 2005

Nasal obstruction may cause or aggravate sleep disordered breathing but exact pathogenesis is not clear. The possible mechanism could be combination of alteration in upper airway aerodynaimcs, loss of nasal reflex or sensation, effect of mouth opening, and a genetic predisposition. Anatomical narrowing of nasal airway cause more rapid airflow and induce more negative inspiratory air pressure. So, it increases collapsibility of pharyngeal airway. Loss of nasal sensation to airflow block nasal reflex. Mouth opening decreases the activity of pharyngeal airway dilator muscles and narrowing the pharyngeal airway may occur. The treatment of nasal obstruction should be done according to the cause. The causes of nasal obstruction are various from problems of external nasal opening to nasopharynx. Relief of nasal obstruction may not cure sleep disordered breathing always. In some mild obstructive sleep apnea patients, treatment of nasal obstruction only may cure sleep disordered breathing. In some severe sleep apnea patients, treatment of nasal obstruction may increase compliance of continous nasal positive airway pressure.