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김천식,이용석,조천웅,배상호,이상암 대한임상검사과학회 2012 대한임상검사과학회지(KJCLS) Vol.44 No.2
Patients with obstructive sleep apnea (OSA) often have more aggravated symptoms in the supine position. We tried to investigate the clinical characteristics and the predictive factors for positional OSA. Polysomnographic data were reviewed for OSA patients (apnea hypopnea index, AHI≥5) from April, 2008 to April, 2011 at the Asan Medical Center. Clinical data, comorbid medical condition data and questionnaires (SF-36, MFI-20, ESS, BDI, STAI) were assessed. All patients were classified into two groups: positional patients (PP) group and non-positional patients (NPP) group. PP was defined as a patient who had the AHI in the supine position was at least twice as high as that in the lateral position. The body position of patients was confirmed by sleep position sensor and video monitor. All patients had at least 30 minutes of positional and 30 minutes of non-positional sleep. We compared clinical, medical, polysomnographic data, and questionnaire results between two (PP and NPP) groups and investigated predictive factors for the PP group using binary logistic regression analysis. In total, 371 patients were investigated. 265 (71.4%) was categorized as PP group and 106 (28.5%) as NPP group. The mean age (mean±SD) was higher in the PP group (52.4±9.8) than in the NPP group (49.5±11.9) (p<0.05). Comparison of sleep parameters between the PP and the NPP group showed that the PP group had significantly lower BMI (PP: 26.1±3.2 kg/m2; NPP: 27.8±4.3kg/m2, p<0.001), neck circumference (PP: 39.7±2.8 cm; NPP: 41.5±3.7 cm, p<0.001) and hypertension rate (PP: n=89/265 (33.5%); NPP: n=48/106 (45.2%), p=0.0240). In the PP group, the percentage of deep sleep (PP: 8.7±8.1%; NPP: 5.6±7.0%, P=0.001) and rapid eye movement (REM) (PP: 17.5±6.1%; NPP: 14.0±6.9%, p<0.001) were significantly higher whereas the percentage of light sleep (stage N1) was significantly lower than the NPP group (PP: 30.4±12.3; NPP: 44.5±20.8%, p<0.001). During the sleep, the AHI in the supine position (PP: 48.6±19.5; NPP: 60.5±22.6, p<0.001) and in the non-supine position (PP: 9.4±8.9; NPP: 48.4±24.8, p=<0.001) were significantly lower and the minimal arterial oxygen saturation in non-REM sleep was significantly higher in the PP group (PP: 80.3±7.6; NPP: 75.1±9.9, p=<0.001). There were no significant differences in all questionnaires including quality of life. The results of the binary logistic regression analysis showed that age, the amount of REM sleep(%) and AHI were significant predictive factors for positional OSA. The significant predictive factors for positional OSA were older age, higher percentage of REM and lower AHI. The questionnaire results were not significantly different between the two groups. .
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김대식,김천식,이용석,조천웅 대한임상검사과학회 2011 대한임상검사과학회지(KJCLS) Vol.43 No.2
Mandibular advancement devices (MAD) are therapeutic options for obstructive sleep apnea (OSA). The aim of study was to investigate treatment outcomes of before and after insertion of MAD in OSA patients. We retrospectively selected a total of 13 patients who were diagnosed with OSA syndrome. All sleep-related parameters including apnea-hypopnea index (AHI), oxygen desaturation index (ODI), wake after sleep onset (WASO), total arousal were measured by before and after MAD. The use of MAD proves to be efficient in reducing snoring, apnea-hypopne index (17.2±14.6 vs 20.9±14.6), WASO (27.4±28.8 vs 47.9±43.6 ), oxygen desaturation index (9.0±11.6 vs 16.4±11.7), stage N3 (54.8±45.2 vs 36.6±22.0), REM sleep times (73.3±19.4 vs 66.0±31.0) and increases sleep efficiency (92.6±6.6 vs 87.2±11.2). The decreases in apnea index based on a reduction in the overall and supine AHI values after MAD therapy were significantly greater for the positional OSA than nonpositional OSA patients. The use of MAD proves to be efficient in snoring, WASO, sleep efficiency, reduced AHI and associated with good compliance of patients. .
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김천식,김대식,이용석,조천웅,배상호,김원태 대한임상검사과학회 2013 대한임상검사과학회지(KJCLS) Vol.45 No.2
Uvulopalatopharyngoplasty (UPPP) is one possibility for the treatment of Obstructive Sleep Apnea (OSA). The aim of this study was study the analysis of polysomnography of pre-UPPP and post-UPPP. All patients were evaluated by means of a physical examination, the epworth sleepiness scale (ESS), the beck depression inventory (BDI) and the nocturnal polysomnography (PSG) before surgery, and 6∼12 months after surgery. A total of 15 patients were investigated. All underwent UPPP. The patients were between 26 and 62 years old (mean±SD; 39.7±10.9) with a lean body mass index (BMI) of mean±SD; 26.2±3.0 kg/m2. The comparison of sleep questionnaires showed that after UPPP, the patients had a significantly lower BMI (26.2±3.0 kg/m2 vs 26.0±3.4 kg/m2, p =0.241), ESS (10.0±5.4 vs 6.9±3.2, p =0.022), BDI (9.2±8.2 vs 4.2±4.3, p =0.343) and higher blood pressure (127.5±12.1 vs 123.7±12.0, p =0.272) compared to before UPPP. The comparison of sleep parameters showed that after UPPP, patients had a significantly lower stage N1 (108.8±53.1 vs 82.2±48.9, p =0.016), lower sleep latency (4.9±4.4 vs 2.0±1.7, p =0.083), a lower total arousal number (210.6±90.3 vs 147.1±87.3, p =0.019), lower oxygen desaturation index (ODI) (30.2±20.9 vs 10.2±15.1, p =0.006), lower apnea-hypopnea index (AHI) (31.6±22.4 vs 10.9±15.4, p =0.005), and a lower respiratory disturbance index (RDI) (37.4±21.3 vs 18.5±16.5, p =0.008) compared to after UPPP. The comparison of sleep parameters showed that after UPPP, patients had a significantly higher stage N2 (154.0±39.9 vs 180.5±49.5, p =0.017), higher REM (58.5±29.7 vs 72.6±34.0, p =0.249), higher meanSaO2 (94.3±2.0 vs 95.9±0.9, p =0.043), and higher minSaO2 (79.3±8.5 vs 83.1±7.9, p =0.116) than before UPPP. After UPPP, 6 patients were cured, 2 showed marked improvement, and 7 did not improve. After surgery, the success of the treatment was at 53%. The subjective patient satisfaction was higher than before the surgery.
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