코골이의 임상적 의의

조석현 대한비과학회 2016 Journal of rhinology Vol.23 No.2

Snoring is the most common symptom, along with increased daytime sleepiness, in patients with obstructive sleep apnea (OSA). However, doctors often neglect snoring in clinical practice, and snoring is not addressed in the treatment guidelines of OSA. Therefore, study about snoring and its clinical implications in sleep medicine are needed. The natural history of snoring shows that snoring can evolve into OSA, and the most important risk factors for this continuum are obesity and male sex. Snoring can be a social problem causing annoyance and family difficulties. Animal and human studies have shown that snoring involves the four injury mechanisms of upper airway inflammation, peripheral neuropathy, parasympathetic hypofunction, and endothelial injury. Previous studies have reported that systemic diseases such as atherosclerosis, metabolic syndrome, hypertension, and cardiac diseases were comorbid with snoring. However, most of these studies enrolled patients characterized by survey or questionnaire; therefore, data were biased with effects of OSA. Thus, consensus on the definition and detection of snoring is lacking. Additional studies are required to determine the exact clinical implications of snoring.

Prevalence of Self-Perceived Snoring and Apnea and Their Association with Daytime Sleepiness in Korean High School Students

양광익,김지현,황보영,구대림,김대영,황경진,홍승봉 대한신경과학회 2017 Journal of Clinical Neurology Vol.13 No.3

Background and Purpose There has been no nationwide population-based study of the prevalence of self-perceived snoring/apnea in Korean adolescents. The purpose of this study was to estimate prevalence of self-perceived snoring/apnea in Korean high-school students and to evaluate their association with daytime sleepiness. Methods An online survey was used to investigate 12,672 students at 75 high schools across the 15 nationwide districts of South Korea. The variables were obtained using a self-reported questionnaire. The students answered questions about self-perceived snoring/apnea during the past 30 days. Daytime sleepiness was measured using a validated Korean version of the Epworth Sleepiness Scale, which was modified for adolescents. Covariates were the sex, school grade, frequency of self-perceived snoring/apnea, body mass index, sleep duration during a school day, and subjective perception of sleep duration. Results The prevalence of self-perceived snoring/apnea was 22.8% (26.4% for males vs. 18.8% for females, p<0.001) and 9.2% (10.5% for males vs. 7.7% for females, p<0.001). Obesity was significantly associated with self-perceived snoring [odds ratio (OR)=2.18, 95% confidence interval (CI)=1.94–2.46] and apnea (OR=1.57, 95% CI=1.33–1.86). Multivariate analysis showed that any frequency of self-perceived snoring/apnea was significantly associated with excessive daytime sleepiness (EDS). The OR of EDS increased significantly with the frequency of snoring and apnea. Female, sleep duration of <5 hours during a school day, and subjective perceptions of insufficient and considerable sleep durations were also significantly associated with EDS. Conclusions The prevalence of self-perceived snoring/apnea was significantly higher in students who were male and obese. Students with self-perceived snoring/apnea exhibited more significant EDS and an increased risk of EDS as the frequency of snoring and apnea increased.

코골이 환자와 배우자에서 코골이 소음과 난청과의 관계

최성용,김덕수,정영도,신승헌,예미경 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.11

Background and Objectives Snoring is a condition that affects a large percentage of population and is associated with various medical and social complications. However, there are only few published reports investigating the effects of chronic snoring exposure on hearing. In the present study, we examined whether there is an association between chronic snoring noise exposure and noise induced hearing impairment not only in snorers but also in their spouses. Subjects and Method Sixty snorers and 27 spouses under the age of 55 were recruited. All participants had more than 5 years of exposure to snoring. Questionnaire for snoring and pure tone audiometry were conducted. Subjects were classified into normal hearing group and hearing impairment group. Results Forty percent of snorers and 25.9% of spouses had hearing impairment. The snorers with hearing impairment had longer duration of snoring than the snorers with normal hearing. However, there were no statistical differences in loudness of snoring between the two groups. In the spouse group, there were statistical differences in loudness of exposed snoring and in duration of snoring exposure between the hearing impairment group and the normal hearing group. Conclusion The result of this study indicated that chronic exposure to snoring noise may be associated with hearing impairment in snorers and their spouses. But in the snorers, further studies are required to identify the factors other than snoring noise associated with hearing impairment. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(11):770-4

Assessment of Change in Palatal Sensation in Obstructive Sleep Apnea Patients by Using Two-Point Palatal Discrimination

정경화,양영수,최혜랑,조재훈,김기태,김진국 대한이비인후과학회 2016 Clinical and Experimental Otorhinolaryngology Vol.9 No.3

Objectives. Patients with obstructive sleep apnea syndrome (OSAS) have impaired responses to inspiratory resistive loading during sleep. This may be due, in part, to a change in the upper airway sensation. Therefore, we hypothesized that patients with OSAS have diminished upper airway sensation due to snoring. Methods. A total of 53 participants were selected based on clinical evaluation and polysomnography. Two-point discrimination was measured with modified calipers in the tongue and soft palate. Results. A total of 10 participants were included in the control group, 12 participants in the simple snoring group, and 27 participants in the OSAS group. There were 12 patients in the impaired sensation group of the OSAS group. On comparing polysomnography, patients with impairment of their palatal sensory input in two-point discrimination (TPD) had a more protracted duration of the longest snoring episode than those with simple snoring and normal sensation. Patients with decreased sensory input in TPD had longer average duration of snoring episodes and relative snoring time than those with simple snoring and normal sensory input in cold uvular TPD. Comparison of the cold uvular TPD for normal sensation and impaired sensation in patients with OSAS after treatment showed a different trend. Conclusion. Impaired sensation of the soft palate was correlated with the longest snoring episode duration, average snoring episode duration, and relative snoring time. It is helpful in detecting the early stage of neural degradation in OSAS patients by assessing snoring components of polysomnography and TPD in the soft palate.

Polyvinylidene Fluoride 진동센서를 이용한 코골이 검출

지덕근 ( Duk Keun Jee ),위연 ( Ran Wei ),김희선 ( Hee Sun Kim ),임재중 ( Jae Joong Im ) 한국감성과학회 2011 감성과학 Vol.14 No.3

코골이 및 수면 무호흡증 등의 수면 질환은 정신적, 육체적 피로감을 유발하고 정상적인 활동에 심각한 영향을 미치고 있다. 코골이는 공기가 좁아진 기도를 통과할 때 진동에 의해서 일어나는 호흡잡음이고, 수면 무호흡은 기도 주변의 조직이 이완됨에 따라 기도가 일시적으로 막히게 될 때 일어나는 현상이다. 이러한 문제를 해결하기 위해 수면 중 코골이를 검출하고 이를 경감하려는 많은 시도가 이루어져왔다. 본 연구에서는 수면 중 코골이 신호의 검출에 있어서 오류가 발생되는 원인인 주변 잡음이나 기타 영향을 제거하기 위한 새로운 센싱 시스템과 분석 알고리즘의 개발을 수행하였다. 센싱 시스템은 베개 내부에 내장되는 두 개의 polyvinylidene fluoride (PVDF) 진동 센서를 포함하고 있으며 검출되는 신호를 수집, 저장하는 하드웨어부와 코골이 신호를 판단하는 신호처리부로 이루어졌다. 베개에 내장되는 PVDF 센서 중 제 1센서는 코골이 신호를 검출하고 제 2센서는 코골이 신호 및 주변의 잡음을 검출한다. 본 실험에는 10명의 피험자가 참여하였으며 수면 중 잡음이 발생할 수 있는 다양한 환경 조건 하에서 신호를 검출하여 분석하였다. 그 결과 다양한 잡음환경 하에서 코골이 신호가 코골이가 아닌 잡음에 비해 약 70% 이상의 에너지 값을 가지는 것을 확인하였고 이를 통해 잡음으로부터 코골이 신호를 정확하게 검출하는 것을 확인하였다. 본 연구의 결과는 수면 중 발생하는 코골이의 경감을 위한 베개의 개발과 정량적인 수면상태 평가를 통해 건강한 수면 환경을 제시할 수 있는 숙면 유도 시스템의 개발에도 활용될 것이다. Sleep diseases such as snoring and sleep apnea are physically, mentally harmful and results serious health problems. Snoring, known as breathing noise, is caused by coupled oscillation of the airway when the air passes through the trachea, and sleep apnea is caused by upper airway blockage. In order to solve these problems, many attempts have been made to detect the snoring during sleep and alleviate it. In this study, a new sensing system and analysis algorithm were developed in order to detect snoring sounds correctly under various sleep environments. Two polyvinylidene fluoride (PVDF) vibration sensors were used inside the pillow. The first PVDF sensor detects vibration transmitted through skull caused by snoring. And the second PVDF sensor detects both snoring sounds and ambient noises. The signals of two sensors were acquired through the designed analog circuits, and analyzed for snoring detection. Ten volunteers were participated for the experiment under five different conditions. Data from two PVDF sensors were processed by the established analysis algorithm, and snoring sounds were compared to noises. The results indicated that the energy of snoring is 70% bigger than that of ambient noise, which proves effectiveness of sensing system and analysis algorithm. Further study would be continued for more wide clinical studies with various environment noises. Based on this study, development of anti-snore pillow and sleep monitoring system for comfort sleep could be developed.

일부 농촌지역 주민의 코골이와 고혈압의 연관성

최진수,이정애,신희영,Choi, Jin-Su,Rhee, Jung-Ae,Shin, Hee-Young 대한예방의학회 2001 예방의학회지 Vol.34 No.3

본 연구는 지역사회 주민을 대상으로 코골이와 고혈압과의 연관성을 파악하고자 하였다. 일부 전남 농촌지역 역학조사에 참여한 1,763명을 연구대상으로 성별, 연령, 교육수준, 결혼상태, 직업, 흡연 및 음주여부, 고혈압의 유무, 코골이의 유무 등에 대해 직접면접법을 통해 설문조사 하였고 비만은 체질량지수(BMI)로 측정하였다. 고혈압은 측정된 수축기 혈압이 140 mmHg이상이거나 이완기 혈압이 90mmHg이상인 경우와 과거에 고혈압으로 진단 받고 현재 고혈압 치료 중인 경우로 하였다. 코골이 전체 유병률은 41.0%이었고 남자에서 42.7%, 여자에서 39.8%이었다. 연령에 따른 코골이 유병률은 45세-64세 중년층에서 44.3%로 젊은층(33.9%)과 노년층(38.7%)에 비해 높았다. 비만도에 따른 코골이 유병률은 체질량지수가 증가할수록 증가했고 흡연과 음주 여부에 따른 코골이는 유의한 차이가 없었다. 코골이 군에서 코골이가 없는 군보다 고혈압이 많았다(교차비: 1.25, 95% CI=1.01-1.55). 그러나 성별, 연령, 비만, 흡연 및 음주 등의 인자들을 보정한 후 고혈압에 대한 코골이의 유의한 영향은 없었다(교차비: 1.13, 95% CI = 0.90-1.41). 본 연구의 결과는 코골이가 고혈압과 직접적인 연관성이 있기보다는 비만과 같은 교란변수에 의한 효과일 수 있음을 나타낸다. Objectives : To evaluate the association of snoring and hyper-tension in a rural population. Methods : A population-based sample of 1,763 adults in Chonnam, Korea was investigated with questionnaires and height, weight, and blood pressure measurements. Information on the demographic characteristics, cigarette smoking, alcohol consumption, hypertension and snoring was collected through a person-to-person interview using a structured questionnaire. The level of obesity was measured by the body mass index(BMI). Hypertension was considered to be present if the average of two blood pressure measurements was greater than 140mmHg systolic or 90mmHg diastolic, or if they were currently on antihypertensive treatment. Results : The prevalence of snoring was 42.7% in men and 39.8% in women. With regard to age, snoring prevalence was 44.3% in the middle-aged group(45 to 64 years), greater than 33.9% in the younger(<45 years) group or 38.7% in the elderly($\geq65$ years) group. The snoring prevalence increased progressively with increasing BMI, but cigarette smoking and alcohol consumption was not associated with snoring. Hypertension occurred more frequently in snorers than in non-snorers (Odds ratio: 1.25, 95% confidence interval : 1.01-1.55). However after adjusting for sex, age, obesity, smoking, and alcohol use, an effect of snoring on hypertension was no longer present (Odds ratio: 1.13, 95% confidence interval = 0.90-1.41). Conclusion : These results suggest that snoring might not be associated with hypertension.

비강 호흡 공기 흐름을 이용한 코골이 호흡 특성 분석

현광민,김환석,김백기 한국지식정보기술학회 2019 한국지식정보기술학회 논문지 Vol.14 No.6

In this paper, a method for analyzing breathing characteristics in real time by measuring the change in air pressure intensity flowing through the nasal cavity when snoring occurs, and an algorithm for separating and detecting signal components with converting the measured continuous time signal into discrete time signal were proposed. A commercial digital miniature piezo-resistive sensor was inserted into the nasal cavity to measure changes in air pressure intensity during breathing. The snoring phenomenon was analyzed with snore-breathing vibration within the audible frequency band, using the magnitude of the change in respiratory air pressure and the frequency characteristic causing the auditory effects. Although the digital small piezo-resistive sensor used in this experiment works slowly, we used the undersampled data for the digital signal processing because the purpose of the signal measurement is to obtain slowly varying respiratory air pressure signal and to detect and existence of snoring itself, not to analyze the exact frequency components of a snoring signal. Through this process, the normal respiratory signal component and the abnormal snoring signal component were separated using a real-time digital filter with the characteristic of they have different frequencies each other. And the snoring signal was detected with the envelope detection method to detect the length of time for snoring duration. Further, it is necessary to study the medical meaning analysis of the separated abnormal signal components, and to apply it to various types of snoring phenomena to be applied in real life.

학동기 아동에서 코골이의 유병률과 관련인자

조성종,김은영,노영일,양은석,박영봉,문경래,이철갑,Cho, Sung Jong,Kim, Eun Young,Rho, Young Il,Yang, Eun Suk,Park, Young Bong,Moon, Kyung-Rye,Lee, Chul-Gab 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.11

목 적 : 코골음은 소아에서 흔히 보이는 증상 중 하나로, 일부에선 주간의 과다졸음, 주의력 결핍, 과잉행동, 야뇨증, 두통 등의 행동장애와 수면 시간 감소와 수면 중 잦은 깸 등의 수면장애를 일으키고 심한 경우엔 수면 무호흡 증후군을 동반하기도 한다. 수면 무호흡의 고위험 인자로 비만이나 코골음의 가족력 그리고 동반질환의 연관성이 보고되고 있다. 이에 저자들은 초등학교 아동들을 대상으로 설문 조사를 이용하여 코골음의 유병율, 유발인자, 동반되는 수면장애에 대해 알아보는 것이 소아에서 수면 장애를 대처하는데 도움이 될 것으로 판단되어 본 연구를 시행하였다. 방 법: 2001년 7월 광주광역시에 소재 2개 초등학교 학생 1,707명(남학생 816명, 여학생 891명)을 대상으로 설문지를 배분하여 부모님의 지도하에 무기명으로 기입하도록 하여 최근 6개월 이내의 코골음의 발생 빈도 그리고 코골음으로 인해 수면시간 감소, 잠꼬대, 낮잠, 졸음 및 학교 성적 저하 등의 수면장애로 인한 결과들과 비만이나 여러 질환 등의 유발인자와 코골음과 연관성을 연구하였다. 결 과 : 1) 전체 대상 아동 29.0%에서 최근 6개월 이내에 코골음을 경험하였고 15.6%에서는 1주일에 1회 이상씩 자주 경험하였고 거의 매일 코를 고는 아이들은 4.3%이었다. 코골음군에서는 남녀 각각 19.5%, 12.0%로 남아에서 유의하게 높았으나, 연령의 차이는 없었다. 2) 두 군 모두 저녁에 잠자는 시간은 8-10시간이 가장 많았고, 코를 자주 고는 군에서 8시간 미만으로 자는 경우와 수면 중 잠꼬대를 하는 경우가 의의있게 많았으며, 주간에 과다하게 졸음을 느끼는 경우가 많았으나 낮잠, 야뇨증, 학교 성적 저하, 피로감, 아침에 일어나 두통을 호소하는 경우 등은 별다른 차이가 없었다. 3) 코를 자주 고는 군에서는 남아인 경우, 편도 비대, 기관지 천식, 알레르기성 비염, 부비동염, 비만 등이 의의있게 많았고, 의의있는 관련 요인들 중에서 남아인 경우, 편도 비대, 비만, 부비동염 등이 의의있는 위험요인이었다. 특히, 비만인 경우는 고도 비만일수록 코골음과의 연관성은 증가하였다. 결 론 : 1주일에 1회 이상 자주 코를 고는 아이들의 유병율은 15.6%이었고 코골음으로 인해 수면시간의 감소, 수면 중 잠꼬대, 주간의 심한 졸음 등 수면장애로 인한 증상들이 의의있게 많았다. 유발인자들 중에서 편도 비대, 비만, 기관지 천식, 부비동염의 병력이 유의한 위험요인으로 작용하였다. 학동기 아동에서 적극적인 체중 조절과 호흡기 및 알레르기성 질환에 대한 적극적인 대처로 코골음의 발생을 줄여 수면장애를 줄일 수 있을 것으로 판단된다. Purpose : We studied the prevalence of snoring and its association with diseases, obesity and environmental factors, as well as sleep disturbance arising from snoring, in school-aged children. Methods : The survey was performed by a special questionnaire on 1,707 children at elementary schools from 1 to 30 July 2001 in Gwangju City. The prevalence of snoring, associated factors, and sleep disturbance were evaluated. Results : 266(16.5%) of the children snored at least once a week. 73(4.3%) of the children snored almost every day. Regarding the associated factors of snoring : There was a statistically significant difference between snoring and nonsnoring groups due to gender, obesity, sinusitis, tonsillar hypertrophy, bronchial asthma and allergic rhinitis. Of them, male gender, tonsillar hypertrophy, and obesity were significant risk factors for development of snoring. Especially, the odds ratio increased to 1.048(CI, 1.004-1.659), 1.748(CI, 1.175-2.599), and 2.266(CI, 1.300-3.950) in children with an obesity index of 20-29%, 30-49%, ${\geq}50%$, respectively. There was a statistically significant association of snoring with decreased sleep duration, sleep talking, and drowsiness during the day as a result of sleep disturbance. Conclusion : 16.5% of school-aged children snored at least once a week. The association of snoring with tonsillar hypertrophy, obesity and gender as risk factors was demonstrated in this study.

코골이와 혈중산소포화농도와의 상관관계

정의필 한국공학안전보건예술학회 2015 한국공학예술학회 논문지 Vol.7 No.1

코골이(snoring)는 대부분의 중장년층 (middle aged class)이 가지고 있는 질병의 일종이며 심해지면 폐쇄성 수면 무호 흡(obstructive sleep apnea syndrome, OSAS)증으로 악화될 수 있으며 그 외 저산소증(hypoxemia), 고혈압(hypertension) 등 각종 질병(diseases)의 원인이 될 수 있는 요인이다. 때문에 코골이를 할 때의 혈중산소포화농도를 측정하여 분석함으로 서 향후 악화 될 수 있는 수면 무호흡증(obstructive sleep apnea)의 상태를 미리 예측한다. 본 논문은 혈중산소포화농도 측정 장치를 통하여 피실험자(subject)가 수면 중 일 때의 코골이 상태에 따른 혈중산소포화농도를 측정하고 분석하여 피 실험자의 코골이 시의 혈중산소포화농도(SpO2) 변화를 통하여 향후 발생할 수 있는 수면 무호흡증 증상을 예측 가능성을 검토하였다. 코골이가 심한 사람의 경우 혈중산소포화농도의 변화폭이 코골이가 심하지 않은 사람의 경우보다 더 큰 것을 확인할 수 있었다. Snoring is a kind of diseases which is occurred by middle aged class. Serious snoring leads to cause hypoxemia, hypertension with obstructive sleep apnea syndrome, OSAS). So, we predict the OSAS in the future by measuring and analyzing the SpO2 when human has the snoring. In this paper, we reviewed the OSAS for snoring people depending on the condition of snoring through the measurement of SpO2 while the subject keeps snoring. The results of the experiments are that the ranges of changes of SpO2 for loud snoring people are larger than lower sound snoring people.

코골기 환자에서 레이저 구개수구개 인두성형술의 임상적 효과

김재영,김성민,이민우 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.8 No.-

It is reported that 15-30% of middle aged persons have a snoring problem. The snoring gives a very annoying problem to patient's family, especially to a bed partner, and induces obstructive sleep apnea that is associated with cardiopulmonary complication. LAUP(Laser Assisted Uvulopalatopharyngoplasty) is a new and effective surgical method for the treatment of habitual loud snoring. It can be easily performed under the local anesthesia without hospitalization. LAUP was performed in 25 snoring patients from August 1994 to May 1997 and its clinical effect was evaluated. The degree of snoring improvement by bed partner was compared. Each postoperative symptom was compared with preoperative symptom. The result showed the degree of snoring was improved in 72% of the patients. Serious complications were not noted.