수면무호흡증의 다원수면기록 소견 : 폐색성 수면무호흡증을 중심으로

이선우,왕성근 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

To identify the clinical characteristics and sleep parameter of sleep apnea syndrome, author performed for statistical analysis of polysomnographic findings of 31 cases, were diagnosed as sleep apnea syndrome from December, 1993 to June, 1995. The results were summarized as follows. 1) Male were predominantly more (M:F=14.5:1) and subject's mean age 41.0±10.7 years. All subjects were obstructive type sleep apnea syndrome, and diastolic blood pressure have met the criteria for hypertension, and that many subjects had ECG abnormality finding. 2) Significant correlations were found among various polysomnographic variables. Respiration disturbance index (RDI) correlated significantly with sleep period during oxygen saturation below 85%, episodes of waking, duration of waking, episodes of obstructive apnea, and episodes of obstructive apnea with heart rate drop & oxygen saturation drop. Same results showed when comparison of two groups were divided by median value of RDI. Sleep period during oxygen saturation below 85% was especially important to select in more severe apnea patients. Also the more episode was apnea, the more episode was waking and time of waking. 3) Sleep apnea episodes during REM sleep were as sleep apnea episodes during NREM sleep, but apnea episodes during REM sleep were more longer time apnea episodes during NREM sleep. This result explain that sleep apnea episode of REM sleep was more adverse effect to cardiovascular system. 4) Subjects with obstructive sleep apnea syndrome had central and mixed type apneas too, and hypopneas with oxygen saturation drop were relatively more that central and mixed type apnea, therefore author thought, when diagnoses of sleep apnea syndrome, hypopnea episode should be considered for more specific diagnoses.

한국인 폐쇄수면무호흡 환자에서 수면무호흡두통

김정민,김정수,김종근,최재갑,이호원 대한신경과학회 2017 대한신경과학회지 Vol.35 No.1

Background: The prevalence of sleep apnea headache has not been established and its possible mechanism is unclear. This study evaluated the frequency of sleep apnea headache in Korean patients with obstructive sleep apnea (OSA) with the aim of identifying their clinical characteristics as well as the sleep parameters that are correlated with headache intensity. Methods: Between January 2005 and December 2014, 2000 patients who were referred to our sleep clinic underwent overnight polysomnography and were interviewed by a neurologist. The neurologist also reviewed the medical records and headache questionnaires of 1659 patients with OSA. We selected patients with sleep apnea headache based on diagnostic criteria of the International Classification of Headache Disorders (III beta version). Descriptive statistics were applied to analyze clinical characteristics and various sleep parameters. Pearson’s correlation coefficient and single/multivariate linear regression analysis were used to identify predictors of headache intensity. Results: Sleep apnea headache was diagnosed in 139 (8.4%) of the patients in this single-center study. The diagnosed patients had male dominancy (87.8%), severe sleep apnea (mean apnea-hypopnea index [AHI]>30), and were middle-aged (mean of 43.5 years old). The ratio of the apnea-hypopnea time to the total sleep time, AHI, the oxygen desaturation index, and the arousal index were positively correlated with headache intensity. AHI was the best predictor of headache intensity in the patients with sleep apnea headache. Conclusions: The frequency of sleep apnea headache among the Korean patients in this study was lower than in previous studies. We found that there was a strong positive correlation between OSA severity (mostly, AHI) and headache intensity in patients with sleep apnea headache.

Prevalence and Public Awareness of Sleep Apnea Syndrome in South Korea

김근태,박혜리,조재욱,김지현,한수현,문혜진,이서영,조용원 대한수면연구학회 2022 Journal of sleep medicine Vol.19 No.3

Objectives: In South Korea, a significant number of patients with obstructive sleep apnea have benefited from the insured continuous positive pressure for sleep apnea as of 2018. However, there is limited information on public awareness of sleep apnea syndrome in the country. A nationwide survey was conducted to evaluate the current status of public awareness on the diagnosis and treatment of sleep apnea. Methods: We conducted an online survey using structured questionnaires on symptoms and knowledge of diagnosis and treatment modalities for sleep apnea. A total of 4,000 participants aged 21 to 69 were proportionally allocated according to the residential area, gender, and age group. Results: The STOP questionnaire, a screening tool for sleep apnea, revealed that 1,044 (21.6%) scored ≥2 points, 327 (8.1%) scored ≥3 points, and 64 (1.6%) scored 4 points. However, only 19 of the 1,044 patients were being treated for sleep apnea, and 13 had been using continuous positive airway pressure. For the diagnosis of sleep apnea, 1,318 participants (33.0%) responded that polysomnography was necessary. For sleep apnea treatment, 1,954 (48.9%) participants responded that lifestyle modification was the treatment of choice, while 1,036 (25.9%) chose continuous positive pressure. Conclusions: Although one-fifth were at high risk for sleep apnea, this disorder is still underestimated. Therefore, publicity and support are needed to improve public awareness of sleep apnea.

수면클리닉에 방문하는 한국인 환자들의 수면무호흡증에 대한 위험요인

도소영,김소현,김근태,조용원 대한신경과학회 2019 대한신경과학회지 Vol.37 No.4

Background: Sleep apnea is a common sleep disorder. Since polysomnography is essential for the diagnosis of sleep apnea, patient screening or selection is an important issue in the sleep clinic. The purpose of this study was to investigate the clinical risk factors of sleep apnea in a representative sleep clinic in South Korea. Methods: The medical records of the 7,559 adult patients who visited the sleep clinic from 2009 to 2018 were reviewed. We investigated the demographic data and the results of the sleep questionnaires and polysomnography to determine clinical risk factors of sleep apnea for patients at the sleep clinic. Apnea-hypopnea index over 15 was regarded as clinically significant sleep apnea. Results: A total of 4,581 patients were finally analyzed. In order of significance, age (odds ratio [OR]=1.224 from 50 to 64, p=0.027; OR=1.858 in 65 or more, p<0.001), sex (male) (OR=5.900, p<0.001), body mass index (OR=2.833 from 25 to 29.9 kg/m2, p<0.001; OR=9.388 over 30 kg/m2, p<0.001) and hypertension (OR=1.537, p<0.001) were independent risk factors of sleep apnea. Conclusions: In South Korea, it is necessary to specify the risk factors of sleep apnea according to the health related characteristics of Koreans. Further research to develop new instruments for screening sleep apnea in Korean sleep clinics is needed.

폐쇄성수면무호흡증후군의 무호홉-저호흡 지수에 따른 수면양상의 비교

진복희 ( Bok Hee Jin ) 대한임상검사과학회 2007 대한임상검사과학회지(KJCLS) Vol.39 No.3

Obstructive sleep apnea syndrome (OSAS) is defined by sleep apnea with decreased oxygen saturation, excessive snoring with daytime sleepiness, and frequent awakening during the night time sleep. The present study was performed to investigate how apnea-hypopnea, that possibly causes breathing disturbance during sleep, can affect sleep pattern in patients with OSAS. We included 115 patients (92 men, 23 women) who underwent a polysomnography from January 2006 to May 2007. As the frequency of sleep apnea-hypopnea increases, the proportion of non-rapid eye movement (REM) sleep (p<0.001), and stage I sleep (p<0.001) increased, while that of stage II sleep (p<0.001), stage III and IV sleep (p<0.01), and REM sleep (p<0.05) decreased. Furthermore, sleep apnea-hypopnea was closely correlated with REM sleep (r=0.314, p<0.001), stage I sleep (r=0.719, p<0.001), stage II sleep (p=-0.342, p<0.05), stage III and IV sleep (r=-0.414, p<0.001), and REM sleep (r=-0.342, p<0.05). Stage I sleep could account for the 51% of the variance of apnea-hyponea. Our study shows sleep apnea-hypopnea affects sleep pattern in pattern with OSAS significantly, and the change of stage I sleep is the most important factor in estimating the disturbance of sleep pattern.

폐쇄성 수면무호흡증의 발병기전

정유삼 대한비과학회 2009 Journal of rhinology Vol.16 No.2

Obstructive sleep apnea has a close relationship with the anatomical characteristics of the upper airway. But we should consider that obstructive sleep apnea always occurs only when the patients are asleep. Diminishing of neural signal to pharyngeal dilator muscles during the sleep state has a great role in the pathogenesis of obstructive sleep apnea. Narrowing of the upper airway could be due to aging, abnormality of craniofacial skeleton, obesity, narrowing of nasal cavity, adhesive force of mucosa, gravity, sleep, vibratory trauma of upper airway when snoring, compliance of pharyngeal dilator muscle, and apnea threshold according to blood carbon dioxide concentration. Understanding of these possible causes may help to develop treatment modality for obstructive sleep apnea and to introduce individual treatment. Obstructive sleep apnea has a close relationship with the anatomical characteristics of the upper airway. But we should consider that obstructive sleep apnea always occurs only when the patients are asleep. Diminishing of neural signal to pharyngeal dilator muscles during the sleep state has a great role in the pathogenesis of obstructive sleep apnea. Narrowing of the upper airway could be due to aging, abnormality of craniofacial skeleton, obesity, narrowing of nasal cavity, adhesive force of mucosa, gravity, sleep, vibratory trauma of upper airway when snoring, compliance of pharyngeal dilator muscle, and apnea threshold according to blood carbon dioxide concentration. Understanding of these possible causes may help to develop treatment modality for obstructive sleep apnea and to introduce individual treatment.

폐쇄성 수면 무호흡증에서 활동기록기의 주기성 사지운동 진단에 관한 타당도 검증

윤영훈,이민환,김천식,정유삼,김우성,김민주,이상암 대한수면연구학회 2010 Journal of sleep medicine Vol.7 No.2

Objectives: Several validation studies of actigraphy for periodic limb movements (PLMs) detection reported a high sensitivity and specificity in restless leg syndrome and periodic limb movement disorder. But PLMs also arise in association with a variety of other sleep disorders such as the sleep apnea syndrome. We compared PLM counts obtained with polysomnography (PSG) to those obtained from actigraphy with PAM-RL and assess the validity in patients with obstructive sleep apnea. Methods: Sixty patients with obstructive sleep apnea underwent actigraphy from both legs and simultaneous PSG during awakeness and sleep. Each of left and right PLM indices by unilateral actigraphy were calculated automatically and compared to PLM index by PSG of ipsilateral leg. Additionally, a comparison among the severity of apnea-hypopnea index (AHI) in obstructive sleep disorder was performed. Results: PLM index obtained with actigraphy were not different from PLM index by PSG [7.93(±11.65)/h vs. 6.50(±12.45)/h; p=0.257]. The sensitivity and specificity of actigraphy identifying patients with PLM index ≥15/h against respective PLM index determined by PSG were calculated (sensitivity/specificity: 0.53/0.88). The actigraphy didn’t overestimate PLM in overall OSA, but overestimate only in severe OSA. Conclusions: This discrepancy between PSG and actigraphy in patient with OSA may be due to overestimate of actigraphy in severe OSA and to underestimate of PLM as PLM index increases. Actigraphy can’t replace PSG in the diagnostic assessment of PLM using cut-off values in patients with obstructive sleep apnea on account of this problem 울산대학Objectives: Several validation studies of actigraphy for periodic limb movements (PLMs) detection reported a high sensitivity and specificity in restless leg syndrome and periodic limb movement disorder. But PLMs also arise in association with a variety of other sleep disorders such as the sleep apnea syndrome. We compared PLM counts obtained with polysomnography (PSG) to those obtained from actigraphy with PAM-RL and assess the validity in patients with obstructive sleep apnea. Methods: Sixty patients with obstructive sleep apnea underwent actigraphy from both legs and simultaneous PSG during awakeness and sleep. Each of left and right PLM indices by unilateral actigraphy were calculated automatically and compared to PLM index by PSG of ipsilateral leg. Additionally, a comparison among the severity of apnea-hypopnea index (AHI) in obstructive sleep disorder was performed. Results: PLM index obtained with actigraphy were not different from PLM index by PSG [7.93(±11.65)/h vs. 6.50(±12.45)/h; p=0.257]. The sensitivity and specificity of actigraphy identifying patients with PLM index ≥15/h against respective PLM index determined by PSG were calculated (sensitivity/specificity: 0.53/0.88). The actigraphy didn’t overestimate PLM in overall OSA, but overestimate only in severe OSA. Conclusions: This discrepancy between PSG and actigraphy in patient with OSA may be due to overestimate of actigraphy in severe OSA and to underestimate of PLM as PLM index increases. Actigraphy can’t replace PSG in the diagnostic assessment of PLM using cut-off values in patients with obstructive sleep apnea on account of this problem교 의과대학, 서울아산병원 신경과학교실

수면무호흡증과 수면변수가 인지기능에 미치는 영향과 우울증의 매개효과

박경원,김형욱,최말례,김병조,김태형,송옥선,은헌정 대한수면의학회 2017 수면·정신생리 Vol.24 No.2

목 적:본 연구는 폐쇄성 수면무호흡증 환자에서 수면무호흡지수, 수면관련척도, 기분관련척도, 그리고 인지기능간의 연관성을 보고자 하였다. 방 법:폐쇄성 수면무호흡증후군을 보이는 105명의 환자를 선정하였다. 수면무호흡지수로 RDI, AHI가 사용되었고, 수면관련척도로는 PSG에서 측정되는 TST, Duration N1, Duration N2, Duration N3, Duration R, Arousal Index, PLM Index, Snoring Index, Mean SpO2, Minimum SpO2 와 설문지로 측정되는 PSQI, ESS, SIS (snoring index by scale)를 사용하였으며 기분관련척도로는 BDI, 인지기능관련 척도로는 Moca-K, MMSE-K, CDR을 사용하였다. 이를 이용하여 수면무호흡증 환자에서 수면무호흡지수, 수면및 기분관련척도와 인지기능간의 상관관계를 분석하였으며수면무호흡증 환자에서 보이는 인지기능장애의 기전을 밝히고자 우울증의 매개효과를 분석하였다. 결 과:Duration N1가 증가할수록 그리고 TST가 감소할수록 MOCA-K에 부적 인과관계를 나타내었다(p < 0.01). BDI와 Supine RDI가 증가할수록 MOCA-K에 부적인과관계를 보였다(p < 0.01). PSQI가 증가할수록(p < 0.001) 그리고 MMSE-K가 감소할수록(p < 0.01) 또한 SIS가 증가할수록(p < 0.01) BDI에 정적 인과관계를 보였다. 폐쇄성수면무호흡증 환자에서 나이가 MOCA-K에 미치는 영향에BDI가 부분 매개하는 것으로 확인되었다. 결 론:수면무호흡증 환자에서 Duration N1, TST, BDI, Supine RDI가 인지기능과 연관성이 있었으며, 특히 BDI로측정되는 우울증상이 수면무호흡증 환자의 인지기능저하에 부분적으로 매개 하였다. Objectives: This study aimed to analyze causality among sleep apnea, depression and cognitive function in patients with obstructive sleep apnea. Methods: We reviewed the medical records of 105 patients with sleep apnea and snoring who underwent overnight polysomnography (PSG). We analyzed various biological data, sleep variables (sleep duration and percentage) and respiratory variables [arousal index (AI), periodic leg movement index (PLM index), snoring Index (SI), mean SpO2, minimum SpO2, apnea-hypopnea index (AHI), and respiratory disturbance index (RDI)]. We also analyzed various data by sleep, cognition, and mood related scales: Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), snoring index by scale (SIS), Montreal Cognitive Assessment-Korean (Moca-K), Mini-mental State Examination-Korean (MMSE-K), clinical dementia rating (CDR), and Beck Depression Inventory (BDI). We analyzed causation among sleep, and respiratory, mood, and cognition related scales in obstructive sleep apnea patients. We analyzed the mediating effects of depression on sleep apnea patient cognition. Results: As Duration N1 increased and Total sleep time (TST) decreased, MOCA-K showed negative causality (p < 0.01). As BDI and supine RDI increased, causality was negatively related to MOCA-K (p < 0.01). As PSQI (p < 0.001) and SIS (p < 0.01) increased and as MMSE-K (p < 0.01) decreased, causality was positively related to BDI. BDI was found to mediate the effect of age on MOCA-K in patients with obstructive sleep apnea. Conclusion: Duration N1, total sleep time, BDI, and supine RDI were associated with cognitive function in obstructive sleep apnea patients. Depression measured by BDI partially mediated cognitive decline in obstructive sleep apnea patients.

수면무호흡과 수면구조변인과의 상관관계

이희상,이성훈,이정권,김경수 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

연구목적 : 저자들은 수면호흡장애가 수면구조 및 수면과 관련된 여러 변수들과 어떤 관계를 갖고 있는지를 살펴봄으로써, 수면호흡장애가 수면에 미치는 영향을 알아보기 위해 본 연구를 수행하였다. 연구방법 : 코골기와 수면무호흡 증상으로 연정 뇌기능 수면 연구소에 수면다윈검사가 의뢰한 남녀환자 60명을 대상으로 하루밤 동안 수면다윈검사를 시행하였으며, 수면변수와 호흡변수간의 상관관계 SPSS-PC+ Version 3.1을 이용하여 Pearson 상관계수를 구하여 조사하였다. 연구결과 : 수면무호흡, 특히 폐쇄성 수면무호흡은 제 2단계 수면양과 유의한 정 상관관계를 보였으며 제3단계 수면 양, REM수면양과는 유의한 역 상관관계를 보였다. 또한 폐쇄성, 혼합형 수면 무호흡 저호흡 순으로 이들 횟수가 증가할수록 평균 혈중산소포화도가 떨어지는 양상을 보였으나 중추성 수면무호흡의 횟수와 평균 혈중산소포화도 사이에는 유의한 상관관계가 없는 것으로 나타났다. 코골기 삽화와 수면효율, 제2단계 수면양, 폐쇄성 수면 무호흡의 횟수, 혼합형 수면 무호흡의 횟수 등은 유의한 정 상관관계가 있는 것으로 나타났으나 REM수면 양과는 유의한 역 상관관계가 있는 것으로 나타났다. 결론 : 수면무호흡, 특히 폐쇄성 수면무호흡은 각성을 유발시켜 수면의 분절을 야기하며 평균 혈중 산소포화도를 떨어뜨리는 효과가 있음이 시사되었고 코골기와 폐쇄성 수면 무호흡이 유의한 상관관계를 보여 두 질환 사이에 밀접한 관계가 있음을 시사했다. Objectives : This research was performed in order to observe the effects of the sleep breathing disorder on the sleep by studying correlations between variables related to sleep breathing disorder and other variables related to sleep. Methods : We studied 60 patients with snoring and sleep apnea syndrome, using the polysomnography and investigated correlations between sleep variables and respiratory variables with Pearson's correlation coefficients. Results : Total number and total duration of obstructive sleep apnea were significantly correlated with total duration of stage 2 sleep and negatively correlated with stage 3 sleep and REM sleep. The more frequent obstructive mixed sleep apnea and hypopnea occured, the more the oxygen saturation decreased. However, no significant correlation between central sleep apnea and oxygen saturation was found. Frequency of snoring episode was significantly correlated with sleep efficiency, total duration of stage 2 sleep, and frequency of obstructive and mixed sleep apnea, but negatively correlated with total time of REM sleep. Conlusion : This study suggests that sleep apnea, especially, obstructive sleep apnea induces the fragmentation of sleep with frequent arousals and that there is significant correlation between episodic snoring and obstructive sleep apnea.

수면무호흡증이 혈압에 미치는 영향

이희상,이성훈,조현상,남궁기,한승진,방승규 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.1

본 연구에서는 수면무호흡증이 혈압에 미치는 영향을 살펴보고자 하였다. 연구대상은 1995년 1월1일부터 1995년 10월 31일까지 코골기와 수면무호흡 증상으로 인해 연정 뇌기능 수면 연구소에 수면다원검사가 의뢰된 140명의 환자를 대상으로 하였으며 그 중에서 원발성 고혈압을 제외한 심혈관계 질환이 있거나 항고혈압제를 복용하고 있는 환자, 그리고 자료가 불충분하거나 수면무호흡증으로 진단되지 않은 24명을 제외하고 나머지 116명을 최종분석 대상으로 하였다. 이들 대상 환자들로부터 얻은 자료를 수면변수와 호흡변수로 나누어 혈압과의 관계를 Pearson 상관관계와 다중회귀분석을 통해 다음과 같은 결과를 얻었다. 1) 평균 수축기 및 확장기 혈압과 유의한 상관관계가 있는 변수는 수면무호흡의 총시간 및 총횟수, 총수면시간중 평균 혈중산소포화도, 무호흡지수, 중추성 수면무호흡의 총시간 및 횟수, 폐쇄성 수면무호흡의 총시간등 이었다. 2) 다중회귀분석 결과 평균 수축기 및 확장기 혈압에 유의한 영향을 미치는 것으로 나타난 변인은 수면무호흡의 총시간이었으며 이것이 평균 수축기 및 확장기 혈압에 미치는 영향의 도는 각각 7.9%와 6.2%였다. 이상의 결과로 볼 때, 수면무호흡증이 혈압에 미치는 영향은 적은 것으로 나타났으며 무호흡의 유형에 관계없이 수면무호흡의 총시간만이 혈압에 영향을 주는 것으로 나타났다. 그리고 중추성 수면무호흡의 경우 평균 혈중 산소포화도의 감소, 각성에 따른 교감신경계 활성도의 증가이외에도 다른 기전에 의해 혈압 상승이 나타날 가능성이 있을 것으로 생각된다. Objects : This study was conducted to investigate the effects of sleep apnea syndromes on th systemic blood pressure. Methods : The subjects were 140 patients who were consulted to Yon-jung brain function and sleep research center for polysomnography due to snoring and sleep apnea from Jan. 1st 1995 to Oct. 31st 1995. Twenty-four out of 140 were excluded due to cardiovascular diseases other than systemic hypertension, antihypertensive medication, inadequate data or diagnosis other than sleep apnea syndrome. The remaining 116 were accepted as proper subjects. Using Pearson's correlation and multiple regression analysis, we looked for the relationship between sleep and respiratory variables to systemic blood pressure. Results : The results were as follows : 1) According to the correlation analysis, statistically significant variables to mean systolic and diastolic blood pressure were the total time and total number of sleep apnea, degree of oxygen saturation of total sleep time, apnea index, total time and total number of central apnea, and the total time of obstructive apnea. 2) According to the multiple regression analysis, only the total time of sleep apnea significantly affected mean systolic and diastolic blood pressure, and the degrees of affection were 7.9% and 6.2% respectively. Conclusion : these findings showed that sleep apnea syndrome had lower influence over systemic blood pressure than expected and regardless of the type, only the total time of sleep apnea influenced systemic blood pressure. In the case of central apnea, mechanisms other than hypoxemia and the increase of sympathetic activity during arousal may make it possible to increase systemic blood pressure.