폐쇄성 수면무호흡증 환자의 상하악 전진술 후 상기도 내 유동해석

김형호(Hyoung-Ho Kim),서상호(Sang-Ho Suh),최진영(Jin-Young Choi),김태윤(Taeyun Kim) 대한기계학회 2015 大韓機械學會論文集B Vol.39 No.5

폐쇄성 수면무호흡증은 수면중 간헐적으로 반복되는 상기도 폐쇄 증상을 말한다. 상하악전진술은 폐쇄성 수면무호흡 치료에 가장 효과적인 외과적 수술 중 하나이다. 상하악 전진술을 통해 상기도의 부피가 증가되어 상기도의 막힘을 치료할 수 있다. 본 연구의 목적은 상하악전진술 전후의 상기도 내 유동해석을 수행하여 폐쇄성 수면무호흡증 환자의 흡기 및 호기 시의 유동현상을 분석하는 것이다. 생체내 CT 이미지로부터 상기도 모델링을 만들고, 상기도 내 상하악전진술 전·후 환자에 대한 단면적 변화 및 음압 효과에 대해 전산유체역학적 방법으로 연구하였다. 연구결과, 수술 후 SMA (section of minimum area)의 면적변화가 가장 컸으며 압력변화와 속도변화가 커진다는 것이 확인되었다. 수면무호흡증 환자에 대한 CFD 해석을 통한 연구는 치료효과에 대한 분석이 가능함을 임상적으로 확인하였다. Obstructive sleep apnea (OSA) is a syndrome characterized by the repetitive episodic collapse of the upper airway. Maxillomandibular advancement surgery is one of the most effective surgical treatment methods in treating obstructive sleep apnea. The advancement of both maxill and mandible can enlarge the cross-sectional areas and volumes of the postero-superior airway. The purpose of this study is to analyze flow patterns in the upper airway before and after maxillomandibular advancement surgery. Here, we analyzed flow phenomena of inspiration and expiration to prevent obstructive sleep apnea patient from happening side effect. Modeling of the upper airway carried out from clinical CT scanned images. We used time-dependent values for boundary condition. CFD analyses were performed and evaluated section of minimum area (SMA), compared with patient inside upper airway before and after maxillomandibular advancement surgery in SMA, and negative pressure effects. The study showed the greatest enlargment of the section of minimum cross-sectional area. Moreover, the velocity and the negative airway pressure were decreased. According to the result of this study, the maxillomandibular advancement surgery stabilizes the airflow in the postero-superior airway of OSA patients.

성인 폐쇄성수면무호흡증이 대사증후군에 미치는 영향

박민정,송인식,주재우,김태민,윤희철,유준혁,홍승노,이승훈 대한비과학회 2016 Journal of rhinology Vol.23 No.2

Background and Objectives: The prevalence of obstructive sleep apnea (OSA) and metabolic syndrome (MS) is increasing and those have been recognized as potential risk factors for cardiovascular disease in adults. The aim of this study is to investigate the association between obstructive sleep apnea syndrome and metabolic syndrome. Materials and Method: We enrolled 127 adults who were evaluated as having OSA. Each subject underwent overnight polysomnography to identify OSA based on the apnea-hypopnea index (AHI); OSA was diagnosed when AHI≥5, and subjects with AHI<5 were classified as the control group. MS was defined according to the Adult Treatment Panel (ATP) III criteria. Results: Among 127 participants, 105 subjects were diagnosed with OSA. The mean age and smoker percentage showed differences between the OSA and control group. The prevalence of MS was significantly higher in the OSA group compared to the control group. As the severity of OSA increases, the prevalence of MS also increase. Conclusion: The MS is significantly related to the OSA in adults. Therefore, we suggest that patient with OSA should be screened to identify the presence of MS.

코골이와 폐쇄성수면무호흡증에 대한 연구개 임플란트의 효과

최지호,조재훈 대한비과학회 2011 Journal of rhinology Vol.18 No.2

Snoring and obstructive sleep apnea are caused by the vibration and narrowing of upper airway structures, and the soft palate is believed to be the most common obstruction site. Several surgical procedures for the soft palate have been introduced, but are frequently accompanied by low success rates and morbidities. The ideal surgical procedure is minimally invasive, single-staged, and has minimum morbidity. Palatal implants are a new treatment modality for snoring and mild-moderate obstructive sleep apnea. The implants induce foreign body responses with subsequent fibrosis and submucosal scarring in the soft palate, which improves snoring and obstructive sleep apnea. The effectiveness of implants has been demonstrated in recent studies. After insertion, snoring intensity is decreased 32-66%. For mild-moderate obstructive sleep apnea patients, apnea-hypopnea index and Epworth Sleepiness Scale scores are decreased 17-50% and 18-43%, respectively. No severe complications have been reported and the extrusion rate is usually less than 10-20%. In conclusion, soft palate implants are effective in some patients and are very safe. However, to collect more comprehensive data about the effectiveness of palatal implants, more studies are needed.

다양한 수면장애의 주기성사지운동증의 임상적 의의

이소진 대한수면의학회 2023 수면·정신생리 Vol.30 No.1

Periodic limb movements during sleep (PLMS) are prevalent in various sleep disorders, such as restless legs syndrome (RLS), periodic limb movements disorder, obstructive sleep apnea (OSA), REM sleep behavior disorder (RBD), and narcolepsy. PLMS has been hypothesized to be related to the decline of dopaminergic transmission. In RLS, PLMS is suggested to be related to iron deficiency and symptom severity. PLMD is a rare sleep disorder, and the role of PLMS in PLMD has not been clearly investigated yet. PLMS in OSA, which remain after proper PAP therapy, may need further management. The clinical relevance of PLMS in RBD and narcolepsy have not been investigated thoroughly and need further studies. Whether PLMS are to be considered as a mere symptom of individual sleep disorders or not can be elucidated through studies investigating the efficacy of therapeutic approaches to reduce PLMS in various sleep disorders.

폐쇄성 수면무호흡증과 상기도저항증후군의 임상적 특징 비교

은영규,김성완,이건희,조중생 대한이비인후과학회 2006 대한이비인후과학회지 두경부외과학 Vol.49 No.9

Background and Objectives:Most of the patients with upper airway resistance syndrome (UARS) remain undiagnosed and areleft untreated because of the disagreement with diagnostic criteria of obstructive sleep apnea syndrome (OSAS). The aim of thisstudy is to help understanding UARS through evaluating differences of polysomnographic findings and subjective symptoms betweenUARS and OSAS. Subjects and Method:One hundred nineteen patients, who visited for snoring and/or apnea, excessivedaytime sleepiness, were included. All patients underwent full night polysomnography (PSG) and performed tests on the 10cm visual analogue scale (VAS) for 14 symptoms and Epworth sleepiness scale (ESS). PSG results and VAS score were comparedbetween UARS group and OSAS group. Results:Among 119 patients, 4 patients had simple snoring, 19 patients had UARS and96 patients had OSAS. Patients with UARS were younger and had lower BMI than OSAS. Apnea index, hypopnea index, respiratorydisturbance index, arousal index, portion of slow wave sleep, mean and lowest oxygen saturation were more severe in patientswith OSAS than UARS. But subjective symptoms and ESS were similar in both groups. Conclusion:Although significantdifferences were found in PSG results in patients with UARS and OSAS, complaints and symptoms were similar in both groups. Wesuggest that diagnosis and treatment for sleep-disordered breathing should not be based solely upon the presence of apnea/hypopnea.We also suggest that more consideration should be given to UARS diagnosis and treatment. (Korean J Otolaryngol 2006;49:908-11)

주변 온도가 폐쇄성 수면무호흡증에 미치는 영향에 관한 전산유체역학 연구

박세현(Se-Hyun Park),최영호(Young-Ho Choi),유수타카 바바(Yasutaka Baba),선상원(Sang Won Sun),이창제(Chang Je Lee),곽태수(Tae-Soo Kwak),김경욱(Kyungwuk Kim),김형호(Hyoung-Ho Kim) 대한기계학회 2021 大韓機械學會論文集B Vol.45 No.11

비강과 인두로 구성된 상기도는 호흡 시 표면을 통한 열전달을 포함한 여러 기능을 가지고 있다. 호흡 시 주변 공기온도는 상기도 내부 유동에 관계가 있다. 이때 주변 온도가 폐쇄성 수면무호흡증에 미치는 영향을 분석하기 위해, 폐쇄성 수면무호흡증 환자의 주변 온도(16°C, 20°C, 24°C)에 의한 영향과 상기도의 유동 패턴은 전산유체역학을 이용하여 분석하였다. 상기도 내부 열교환은 비강부분에서 안정화되었으며, Re 수와 Nu 수는 주변 온도가 낮을 때보다 주변 온도가 높을 때 감소하였다. 압력강하는 주걱턱 수술 전에는 16°C에서 4.71 Pa, 24°C에서 4.50 Pa로 감소하였고, 수술 후에도 16°C에서 11.78 Pa, 24°C에서 11.64 Pa로 미소하게 감소하는 경향을 보였다. 상기도 내 유동저항은 압력강하와 같은 경향을 나타내었다. 결론적으로 따뜻한 주변 공기온도에서 호흡하는 것이 폐쇄성 수면무호흡증에 저감에 유리할 것으로 보인다. The upper airway comprising the pharynx and nasal cavity has several functions, including heat transfer during the respiratory cycle to the surface. The ambient temperature is generally consistent in the air flow of the upper airway. Computational fluid dynamics (CFD) was therefore used to analyze the effects of ambient temperatures (16°C, 20°C, and 24°C) and flow patterns of obstructive sleep apnea (OSA) patients. Heat transfer was observed to be stable in the anterior zone, and the Reynolds (Re) and Nusselt (Nu) numbers tended to decrease when the ambient temperature increased. The pressure drops in the pre-orthognathic operation condition were 4.71 Pa at 16°C and 4.50 Pa at 24°C, whereas those in the post-operation condition were 11.78 Pa at 16°C and 11.64 Pa at 24°C. The airway resistance also exhibited the same tendency as the pressure drop. Thus, a higher ambient temperature is likely to be beneficial for reducing OSA.

폐쇄성 수면무호흡증 환자에서 하지불안증후군과 우울, 불안 및 불면과의 연관성

김주완(Ju-Wan Kim),김성완(Sung-Wan Kim),김재민(Jae-Min Kim),신일선(ll-Seon Shin),윤진상(Jin-Sang Yoon),배경렬(Kyung-Yeol Bae) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.3

Objectives:An association between obstructive sleep apnea syndrome(OSAS) and restless legs syndrome(RLS) has long been reported. Both syndromes are associated with depression, anxiety, insomnia, and daytime sleepiness. However, these relationships have not been studied extensively, and many questions remain unanswered. This study investigated the prevalence of RLS and its association with depression, anxiety, insomnia, and daytime sleepiness in OSAS patients in Korea. Methods:The study enrolled 152 Korean OSAS in patients Chonnam National University Hospital. The International Restless Legs Syndrome Study Group criteria and International Restless Legs Scale were used to determine the diagnosis and severity of RLS. To assess depression, anxiety, insomnia, and day time sleepiness, all patients completed the Beck Depression Inventory(BDI), Beck Anxiety Inventory(BAI), Insomnia Severity Index(ISI), and Epworth Sleepiness Scale(ESS). Results:Overall, 65(42.6%) patients met least one of the RLS diagnostic criteria, and 17(11.1%) were diagnosed with RLS. The mean BDI, BAI, and ISI scores were higher in subjects with RLS symptoms compared with those without such symptoms. ESS scores were not significantly associated with RLS symptoms. There were significant positive correlations between RLS severity and BDI(r=0.246, p=0.049), BAI(r=0.247, p=0.031), and ISI(r=0.275, p=0.026) scores. Conclusion:There were significant relationships between RLS symptoms and depression, anxiety, and insomnia. We recommend that patients with OSAS be evaluated for symptoms of RLS.

폐쇄성 수면 무호흡증후군 환자에서 자동형 양압 호흡기치료의 순응도 예측인자 분석

김명진,김민재,배승희,박찬흠,김동규 대한비과학회 2015 Journal of rhinology Vol.22 No.2

Background and Objectives: Application of automatic positive airway pressure (APAP) is regarded as the primary therapy for patients with obstructive sleep apnea syndrome (OSAS). However, a low adherence rate is a major problem with APAP treatment in OSAS patients. Therefore, the aim of the present study is to assess factors related to good adherence of APAP therapy in OSAS Korean patients. Materials and Method: Of 112 consecutive newly diagnosed moderate to severe OSAS patients, 70 were enrolled in this study. All patients received APAP therapy for 2 weeks, along with reinforcing intervention, consisting of motivational reinforcement and technical support. All APAP therapy involved a device rental service. After 2 weeks of treatment, patients had to choose the kind of treatment for OSAS [APAP therapy (good adherence) or alternative treatment options (poor adherence)]. Results: After 6 months, the adherence rate to APAP therapy was 35.7% (n=25). No statistically significant difference was observed between the good and poor adherence groups with regard to snoring intensity, apnea-hypopnea index, and mean O2 saturation after adjusting for age, sex, body mass index, marital status, and socioeconomic status. However, we found that excessive daytime sleepiness and lowest O2 saturation were significantly associated with good adherence [adjusted odds ratios (ORs)=9.515 and 2.327] after adjusting for age, sex, body mass index, marital status, and socioeconomic status. Conclusion: Our findings suggest that excessive daytime sleepiness and lowest O2 saturation are important factors to identify good adherence to APAP treatment in Korean OSAS patients.

불면 증상과 우울 증상에 따른 폐쇄성 수면무호흡 환자의 심리적 특성

장은주,강연욱,신원철 한국임상심리학회 2013 Korean Journal of Clinical Psychology Vol.32 No.2

Insomnia and depression are common to patients with obstructive sleep apnea syndrome (OSA). This study was conducted in order to explore the objective sleep characteristics, insomnia, and depressive symptoms of OSA and non-OSA patients and to provide clinical implications for diagnosis and treatment of OSA. A total of 145 patients (126 men, 19 women, average age: 49.56±12.06 years), who had been diagnosed as OSA, were administered polysomnography (PSG), the insomnia inventory, and the Beck Depression Inventory. The PSG showed that subjects in the OSA group had lower Sleep Efficiency (SE) and more difficulty in maintaining deep sleep than those in the non-OSA group. Although both the OSA and non-OSA groups had a significant level of insomnia and depressive symptoms, the non-OSA group showed more severe insomnia and depression than the OSA group. Correlation analysis was performed for identification of the significant indices of PSG relating to insomnia and depression. In the OSA group, patients who complained of more severe insomnia showed low SE and high Wakefulness After Sleep Onset (WASO). In addition, with greater depression, they showed high WASO and low Total Sleep Time (TST) and SE. However, in the non-OSA group, no correlation was observed between ISI or BDI and important sleep indices of PSG. Thus, for assessment of patients with OSA, it is necessary to examine not only physiological indices of the PSG but also the subjective clinical symptoms, such as insomnia and depression, so that we can anticipate problems that may occur during treatment and design tailored and efficient treatment plans.

폐쇄성 수면 무호흡 측정기의 설계 및 구현에 관한 연구

백정현(Jeong-Hyun Baek) 한국컴퓨터정보학회 2014 한국컴퓨터정보학회 학술발표논문집 Vol.22 No.1