소아치과 환자의 깊은 진정시 호기가스 제거 방법에 따른 호흡대역에서 Nitrous Oxide 농도 변화

이충원,윤형배 大韓小兒齒科學會 2003 大韓小兒齒科學會誌 Vol.30 No.1

The concentration of nitrous oxide in dental environment has increased especially in pediatric department. In pediatric department frequently met the behavior disordered patients who need the deep sedation. As the deeply sedated patients could not respond well to verbal command, the amount of mouth breathing would be increased especially with mouth prop which backward transposition of mandible. Inhalation of low concentration of nitrous oxide for a long duration has caused various side effects such as spontaneous abortion and inhibition of methionine synthetase activity which is harmful to DNA synthesis. For evaluation of factors of mouth breathing during deep sedation, The author measured the concentration of nitrous oxide in breathing zone by the change of the scavenging methods. One is drain the gas through the tail part of reservoir bag of Jackson Rees system naturally. Another is scavenge from tail portion of reservoir bag with negative pressure. Last one is scavenge from nasal mask with negative pressure. The nitrous oxide concentration in breathing zone was the lowest in nasal part drainage but high above the recommended concentration of NIOSH. The order of nitrous concentration in breathing zone was: natural drainage, tail part with negative pressure, nasal part with negative pressure. This would reflect the order of resistance of nasal airway and showed the amount of mouth breathing. From the above experiment, the resistance of nasal airway by the increment of gas flow in corrugating tube and reservoir bag would be one of the causative factors of mouth breathing in deeply sedated patients. 최근 치과영역에서 아산화질소(Nitrous 0xide)를 이용한 의식하 진정과 깊은 진정의 임상 적용이 증가함에 따라 수술실 또는 진료실 환경이 아산화질소로 오염될 수 있다. 비록 낮은 농도일지라도 장기간 아산화질소에 노출 시 자연유산의 증가, 기형아 출산 증가, 말초신경염 및 운동신경 장애 등과 같은 부작용을 초래하는 것으로 알려져 있다. 호흡시 흡입 공기의 구성성분의 변화를 줄 수 있는 구강 입구로부터 반경 12inch 이내 영역인 호흡대역(Breathing zone)에서 아산화질소 농도는 치료자에게 영향을 주게된다. 소아 환자에게 주로 적용되는 깊은 진정시는 환자의 구호흡양에 따라서 호흡대역에서 아산화질소의 농도에 영향을 주게되므로, 깊은 진정시 구호흡의 증가 원인을 규명하기 위해 잉여가스 배출방법을 달리하여 호흡대역에서 아산화질소 농도를 측정 비교하여 다음과 같은 결론을 얻었다. 1._ 깊은 진정을 시행하는 경우 호홉대역에서 아산화질소의 농도는 공급 가스량 증가에 의한 비기도 저항 증가에 따라 증가하는 양상을 보였다. 호흡대역에서 아산화질소 농도 증가는 구호흡 증가에 의한 것이며 구호흡은 비기도 저항과 관계가 있다 할 수 있다. 즉 비기도 저항 증가는 구호흡의 한 요인이라 할 수 있다. 음압을 사용한 호기가스 배출장치를 사용하여도 NIOSH에서 권장하는 허용치에는 미치지 못하였고 이를 위해서는 팬이나 다른 제거 장치가 함께 사용되어야 한다. 2. 구강편도의 크기는 기도 저항이 적은 경우 즉 음압을 사용하여 호기가스 제거하는 경우 구호흡에 영향을 주었다.

Nasal Obstruction and Palate-Tongue Position on Sleep-Disordered Breathing

김효열,정종인,동훈종,손정협,홍상덕,김준호,장성윤,정용기,정승규 대한이비인후과학회 2013 Clinical and Experimental Otorhinolaryngology Vol.6 No.4

Objectives. We wanted to evaluate whether the presence of nasal obstruction makes a change on the association between the modified Mallampati score and the severity of sleep-disordered breathing (SDB) and the sleep quality. Methods. Polysomnography (PSG), the modified Mallampati score (MMS), the body-mass index, and a questionnaire about nasal obstruction were acquired from 275 suspected SDB patients. The subjects were divided into two groups according to the presence of nasal obstruction. The clinical differences between the two groups were evaluated and the associations between the MMS and PSG variables in each group were also assessed. Results. Significant correlations were found between the MMS and many PSG variables, including the apnea-hypopnea index,the arousal index and the proportion of deep sleep, for the patients with nasal obstruction, although this was not valid for the total patients or the patients without nasal obstruction. Conclusion. The severity of SDB and the quality of sleep are well correlated with the MMS, and especially for the patients with nasal obstruction. The MMS can give more valuable information about the severity of SDB when combined with simple questions about nasal obstruction.

비중격 교정술 및 비갑개성형술이 수면 호흡장애 환자의 삶의 질에 미치는 영향

장현욱,정상식,남예모,김정수 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.4

Background and Objectives Nasal obstruction is common in patients with sleep disordered breathing (SDB). Polysomnography (PSG) is a standard diagnositc tool for sleep disorders, but it can not evaluate the quality of life (QOL). We tried to assess the efficacy of the septoturbinoplasty on patients with SDB and nasal obstruction by using self reported measures that have been known as a tool for evaluating the general and disease specific QOL. Subjects and Method Thirty-five patients who had snoring and sleep apnea confirmed by PSG and symptomatic nasal obstruction caused by deviated nasal septum were enrolled. All patients underwent septoturbinoplasty to improve nasal obstruction. QOL was assessed before and 2 months after surgery. Medical Outcome Study Short Form 36 (SF-36) and Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Stanford Sleepiness Scale (SSS), Insomnia Severity Index (ISI), Beck Depression Inventory (K-BDI), Nasal Obstruction Symptom Evaluation (NOSE) scale were included in the measures. A statistical analysis was performed using a paired t-test. Results Snoring sound level, PSQI, ESS, ISI, and NOSE were improved significantly (p< 0.05). SSS, BDI and total SF-36 were improved but not significantly (p>0.05). Conclusion QOL in patients with SDB and nasal obstruction was improved by nasal surgery. Different kinds of self-reported measures could be more informative as they can provide pre and post treatment results with respect to psychosomatic effects in patients with SDB.

구호흡이 안모골격 형태에 미치는 영향

이민정,김재곤,양연미,백병주 大韓小兒齒科學會 2012 大韓小兒齒科學會誌 Vol.39 No.4

이 연구는 장기간의 호흡 양상이 성장기의 안모골격 형태에 미치는 영향을 알아보고자, 전북대학교 소아치과에 내원하여 교정 진단을 받은 환자 중, 골격성 I, II, III급 부정교합자들을 비호흡자와 구호흡자로 각각 20명씩 나누어 총 120명을 선택하 였다. 측모두부규격방사선사진으로 기도공간과 안모골격 형태를 분석하여 연령별로 평가한 결과, 다음과 같은 결과를 얻었다. 골격성 I, II, III급 부정교합에서 비호흡자와 구호흡자를 비교한 결과, 안모골격 형태를 분석한 항목에서 유의한 차이를 발 견할 수 없었다(p > 0.05). 그러나 12세 이상에서 골격성 I급 부정교합의 비호흡자가 구호흡자에 비해 Ad-S가 유의성 있게 증가하였고, H-Pc는 유의성 있게 감소하였다. 또한 골격성 II급 부정교합의 비호흡자는 구호흡자에 비해 Ar-Go가 유의성 있 게 증가하였고, ML-NSL은 유의성 있게 감소하였다. 골격성 Ⅲ급 부정교합자에서는 구호흡자가 비호흡자에 비해 SNA, SNB가 유의성 있게 감소하였다(p < 0.05). 골격성 I, II, III급 부정교합에 따른 호흡 양상과 안모골격 형태는 큰 연관성을 보이지 않았으나 구호흡을 하는 12세 이상 의 골격성 II급 부정교합자에서 하악지의 길이 성장이 저해되고, 전안면 고경이 증가하였으며, 골격성 III급 부정교합에서는 상악골 성장 저해 및 하악의 시계방향 회전 경향이 유의성을 보이므로, 장기간 구호흡이 지속되는 경우 안모골격 형태에 악영 향을 미칠 수 있다. There still remains a controversial debate whether facial skeletal morphological differences exist between patients with nasal and mouth breathing habits. The aim of this study is to assess a relationship between over a period of time mouth breathing and facial skeletal morphology by analyzing lateral cephalometric radiographs of patients with nasal or mouth breathing habits. A total of 120 patients with skeletal class I, II, and III, who had undergone orthodontic diagnosis in department of pediatric dentistry - chonbuk national university, were chosen and their lateral cephalometric radiographs were analyzed. These patients were divided into six groups of 20, each with or without mouth breathing habits. The result of this study has not showed noticeable differences in cephalometric measurements between nasal and mouth breathing children of skeletal class I, II, and III (p > 0.05). However, when the groups were divided by age factor, mouth breathers of age 12 and older showed significant differences in cephalometrics such as decreased ramus height, maxillary retrusion, and clockwise pattern of mandible than children under age 12 (p < 0.05). In conclusion, a longer period of mouth-breathing habits in children displayed a greater chance of impaired facial growth.

비강압력신호를 이용한 수면호흡장애 환자의 수면/각성 분류

박종욱,정필수,강규민,이경중,Park, Jong-Uk,Jeoung, Pil-Soo,Kang, Kyu-Min,Lee, Kyoung-Joung 대한의용생체공학회 2016 의공학회지 Vol.37 No.4

This study proposes the feasibility for automatic classification of sleep/wakefulness using nasal pressure in patients with sleep-disordered breathing (SDB). First, SDB events were detected using the methods developed in our previous studies. In epochs for normal breathing, we extracted the features for classifying sleep/wakefulness based on time-domain, frequency-domain and non-linear analysis. And then, we conducted the independent two-sample t-test and calculated Mahalanobis distance (MD) between the two categories. As a results, $SD_{LEN}$ (MD = 0.84, p < 0.01), $P_{HF}$ (MD = 0.81, p < 0.01), $SD_{AMP}$ (MD = 0.76, p = 0.031) and $MEAN_{AMP}$ (MD = 0.75, p = 0.027) were selected as optimal feature. We classified sleep/wakefulness based on support vector machine (SVM). The classification results showed mean of sensitivity (Sen.), specificity (Spc.) and accuracy (Acc.) of 60.5%, 89.0% and 84.8% respectively. This method showed the possibilities to automatically classify sleep/wakefulness only using nasal pressure.

비호흡 장애가 치열에 미치는 영향에 관한 안모 형태별 비교 연구

이희경,진병로,이창곤,박진호,김종섭,이명진 영남대학교 의과대학 1993 Yeungnam University Journal of Medicine Vol.10 No.1

인두편도 증식으로 인한 비호흡 장애가 치열 및 혀의 위치에 미치는 영향을 안모형태에 따라 비교 연구하기 위해 인두편도 증식으로 인두편도 절제술을 시행하기로 한 환자의 안모를 형태에 따라 mesofacial, brachyfacial, dolichofacial type으로 분류하여 각 type별로 20명의 환자를 설정하여 서로 비교 연구한 결과 1. 상악 구치부 치열궁 폭경에 있어서 안모형태에 따른 유의한 차이를 보였으며, dolichofacial type의 안모를 가진 환자에서 가장 좁은 상악 구치부 치열궁 폭경을 보였다. 2. 혀의 수직적 위치에 있어서 안모형태에 따른 유의한 차이를 보였으며, dolichofacial type의 안모를 가진 환자에서 혀가 가장 하방에 위치함을 보였다. It is commonly assumed that nasorespiratory function can exert a dramatic effect upon the development of the dentofacial complex. Specially, it has been stated that chronic nasal obstruction leads to mouth breathing, which causes altered tongue and mandibular positions. If this occurs during a period of active growth, the outcome is development of the "adenoid facies". Such patients characteristically manifest a vertically long lower third facial height, narrow alar bases, lip incompetence, a long and narrow maxillary arch and a greater than normal mandibular plane angle. But several authors have reported that so-called adenoid facies is not always associated with adenoids and mouth breathing, and that a particular type of dentition is not always found in mouth breathers with or without adenoids. Some authors have believed adenoids lead to mouth breathing in cases with particular facial characteristics and types of dentition. We assumed that the ability to adapt to individual's neuromuscular complex is various. So, we compared the difference of influence of mouth breathing between childrens who have different facial types. This study included 60 patients and they were divided into three groups by Rickett's facial type. Their dentition and tongue position were compared. The results are as follows. 1. There is a significant difference in arch width of upper molars between different facial types. Especially dolichofacial type patients have narrowest arch width. 2. There is a significant difference in tongue position between different facial types. Especially dolichofacial type patients have lowest positioned tongue.

Nasal Breath in the Lateral Position for Sleep Apnea: a Retrospective Case Series

김호선,김태훈 대한한의학회 2014 대한한의학회지 Vol.35 No.2

Objectives: This was a retrospective case series about the clinical effect of integrated approach with behavior therapy for obstructive sleep apnea (OSA). Methods: Medical records of twelve patients with OSA who were treated with behavior modification including nasal breathing with oral appliances and sleep in lateral position, oral administration of herbal medicines and acupuncture treatment between January and September of 2013 were reviewed. Apnea-hypopnea index (AHI), day time sleepiness, apneas and hypopneas counts during sleep, risk indicator (RI), oxygen desaturation index, average saturation during sleep, lowest desaturation, lowest saturation, snoring events ratio and number of desaturations (%) were assessed before and after treatments with the ApneaLink device, which is a portable diagnostic apparatus for monitoring airflows of the patient's breath at home. Results: After an average 62.67 (SD 37.16) days of treatment, AHI (from 17.67, 12.79 to 8.75, 8.25, p=0.007), RI (from 22.00, 13.26 to 12.09, 8.03, p=0.004), oxygen desaturation index (from 17.33, 12.17 to 8.17, 7.86, p=0.005), and number of desaturations (from 7.00 times, 9.79 to 0.92 times, 1.39, p=0.044) showed significant improvement. Daytime sleepiness improved from 6.5 (3.2) to 3.8 (1.8) but there was no significant difference after treatment (p=0.17). No adverse events related to treatment were observed during participation in the treatment. Conclusion: From this case series, we found that behavior modification with herbal medication and acupuncture may be effective for improving sleep apnea without serious adverse events. Future randomized controlled trials with larger sample size will be necessary for concrete evidence on the benefit of this integrated treatment for OSA.

Nasal Breath in the Lateral Position for Sleep Apnea: a Retrospective Case Series

Kim, Ho-Sun,Kim, Tae-Hun The Society of Korean Medicine 2014 대한한의학회지 Vol.35 No.2

Objectives: This was a retrospective case series about the clinical effect of integrated approach with behavior therapy for obstructive sleep apnea (OSA). Methods: Medical records of twelve patients with OSA who were treated with behavior modification including nasal breathing with oral appliances and sleep in lateral position, oral administration of herbal medicines and acupuncture treatment between January and September of 2013 were reviewed. Apnea-hypopnea index (AHI), day time sleepiness, apneas and hypopneas counts during sleep, risk indicator (RI), oxygen desaturation index, average saturation during sleep, lowest desaturation, lowest saturation, snoring events ratio and number of desaturations (%) were assessed before and after treatments with the ApneaLink device, which is a portable diagnostic apparatus for monitoring airflows of the patient's breath at home. Results: After an average 62.67 (SD 37.16) days of treatment, AHI (from 17.67, 12.79 to 8.75, 8.25, p=0.007), RI (from 22.00, 13.26 to 12.09, 8.03, p=0.004), oxygen desaturation index (from 17.33, 12.17 to 8.17, 7.86, p=0.005), and number of desaturations (from 7.00 times, 9.79 to 0.92 times, 1.39, p=0.044) showed significant improvement. Daytime sleepiness improved from 6.5 (3.2) to 3.8 (1.8) but there was no significant difference after treatment (p=0.17). No adverse events related to treatment were observed during participation in the treatment. Conclusion: From this case series, we found that behavior modification with herbal medication and acupuncture may be effective for improving sleep apnea without serious adverse events. Future randomized controlled trials with larger sample size will be necessary for concrete evidence on the benefit of this integrated treatment for OSA.

Nasal Breath in the Lateral Position for Sleep Apnea: a Retrospective Case Series

Ho-Sun Kim,Tae-Hun Kim 대한한의학회 2014 대한한의학회지 Vol.35 No.2

A COMPARISON STUDY OF THE EFFECTS OF NASAL BREATHING DYSFUNCTION DUE TO ADENOID OBSTRUCTION ON DENTITION BY FACIAL TYPE

Lee, Hee Kyung 대한치과교정학회 1996 대한치과교정학회지 Vol.26 No.6

In discussing the effects of adenoids on the development of the face and dentition, it is important to note their influence on the mode of breathing and to relate this to specific facial types and dentition. This study, therefore, assumed that the ability to adapt to individual`s neuromuscular complex is various. And tried to investigate the effects of reduced nasal respiratory function on the development of dentition by facial type. This paper is based on children patients with enlarged adenoids and comparing them to data taken from a control group with normal respiratory function. Among the three facial types, the most statistical significant difference was observed from dolichofacial type between experimental and control group. In dolichofacial type, the experimental group showed labioversion of upper incisor, decrease in the width of upper arch, increase in overjet, increase in the rate of cross-bite, and increase in the height of palatal vault. No significant difference was observed between the two groups in the inclination of upper and lower incisors in mesofacial type, but the experimental group was observed to show decrease in the width of upper arch and increase in the height of palatal vault. On the other hand, in brachyfacial type, no significant difference was observed between the two groups in dentition variables except showing linguoversion of upper incisor. The results, which were observed in dolichofacial type, consist with Nordlund`s theory of Compression.