체위성 폐쇄성수면무호흡 환자와 비체위성 폐쇄성수면무호흡환자의 임상적 특징 고찰

강현희,강지영,이상학,문화식,Kang, Hyeon-Hui,Kang, Ji-Young,Lee, Sang-Haak,Moon, Hwa-Sik 대한수면의학회 2012 수면·정신생리 Vol.19 No.1

목 적 : 체위성 수면무호흡은 폐쇄성수면무호흡증으로 진단된 환자에서 앙와위 수면시 apnea-hypopnea index(AHI)가 비앙와위 수면시 AHI에 비해 2배 이상인 경우로 정의하며, 일반적으로 전체 폐쇄성수면무호흡 환자의 56%로 알려져 있다. 본 연구는 수면 클리닉을 방문하여 폐쇄성수면무호흡을 진단 받은 환자 중 체위성 수면무호흡의 발생빈도를 알아보고, 체위 의존성에 따른 수면무호흡의 임상 소견 및 수면다원검사를 비교 분석하였다. 방 법 : 코골이 및 목격되는 무호흡으로 내원하여 AHI가 5 이상이면서 앙와위 및 비앙와위 수면 시간이 15분 이상이고, 앙와위 시 AHI가 비앙와위시 AHI에 비하여 2배 이상인 경우를 체위성 수면무호흡으로, 그렇지 않은 경우를 비체위성 수면무호흡으로 분류하였다. 체위 의존성 여부에 따라 인구학적 특성과 수면다원검사에서 나타난 수면 변인 및 호흡 변인을 분석하였다. 결 과 : 폐쇄성수면무호흡으로 진단된 101명 중에서 체위성 수면무호흡 환자는 76명(75.2%), 비체위성 수면무호흡 환자는 25명(24.8%)이었다. 폐쇄성수면무호흡의 중증도별로 체위성 수면무호흡의 유무에 따라 발생빈도가 통계적으로 유의하게 차이가 있었으며, 특히 비체위성 수면무호흡 환자군에서는 중증 환자의 비율이 높았다. 비체위성 수면무호흡환자군이 체위성 환자군에 비하여 체중, 허리둘레, 엉덩이 둘레, 허리-엉덩이 둘레비, 체질량 지수 및 목둘레가 유의하게 더 높았다. 수면다원검사상에서는 체위성 수면무호흡군에서 비교적 수면구조가 잘 유지되었으며 주관적인 졸림도 덜하였다. 비체위성 수면무호흡군에서 체위성 수면무호흡군에 비해 평균산소포화도 및 최저산소포화도가 유의하게 낮았으며 AHI는 통계적으로 유의하게 더 높았다. 결 론 : 폐쇄성수면무호흡 환자중 체위성 수면무호흡 환자의 비율은 75% 정도였으며, 비체위성 수면무호흡 환자에 비해 체위성 수면무호흡 환자는 비만도가 덜 하고 경증 및 중등도의 폐쇄성수면무호흡의 양상을 보이는 것으로 관찰되었다. Objectives: The percentage of positional sleep apnea in obstructive sleep apnea (OSA) varies in different reports from 9% to 60%. If there is a positional dependency in patients with OSA, positional therapy alone could be successful in treating about 50% of all OSA cases. The aim of this report is to compare anthropomorphic and polysomnographic data between the positional sleep apnea group and non-positional sleep apnea group with OSA whose conditions were diagnosed in our sleep clinic. Methods: This is a retrospective study of anthropomorphic and polysomnographic data of patients with OSA who was performed a nocturnal polysomnography. Positional sleep apnea was defined as having a supine apnea-hypopnea index (AHI) of twice or more compared to the AHI in the non-supine position. The patients were divided in the positional sleep apnea group and the non-positional sleep apnea group. Results: In 101 patients with OSA, 81 were male, and the mean age was $49.2{\pm}11.9$ years. Seventy-six (75.2%) were diagnosed as the positional sleep apnea. Waist to hip ratio and body mass index (BMI) were significantly higher in non-positional sleep apnea group. The frequency of severe OSA was significantly higher in this group. In the positional sleep apnea group, nocturnal sleep quality was better preserved, and consequently these patients were less sleepy during daytime. AHI was significantly lower and minimal arterial oxygen saturation during sleep was significantly higher in this group. Conclusion: The percentage of positional sleep apnea in OSA was 75.2%. AHI, BMI, and waist to hip ratio were lower in the positional sleep apnea group. These patients have less severe breathing abnormalities than the non-positional sleep apnea group in polysomnography.

수면 클리닉을 내원한 환자에서 폐쇄성수면무호흡의 선별을 위한 베를린 설문의 유용성

강현희,강지영,이상학,문화식,Kang, Hyeon-Hui,Kang, Ji-Young,Lee, Sang-Haak,Moon, Hwa-Sik 대한수면의학회 2011 수면·정신생리 Vol.18 No.2

목 적 : 베를린 설문은 시행이 간편하고 비용이 들지 않아 전 세계적으로 가장 많이 사용되는 폐쇄성수면무호흡의 선별 검사 중 하나이다. 최근까지 다양한 문헌을 통해 베를린 설문의 유용성에 대한 결과가 보고 되고 있다. 본 연구에서는 수면 클리닉을 내원한 환자들을 대상으로 폐쇄성수면무호흡을 선별하는 도구로서 베를린 설문의 유용성을 평가하였다. 방 법 : 코골이 및 수면 중 무호흡 등의 증상으로 수면 클리닉을 내원한 121명을 대상으로 베를린 설문 및 수면다원검사를 시행하였다. 전체 분석 대상자를 폐쇄성수면무호흡의 중증도에 따라 인구학적 특성 및 수면다원검사상 수면 변인 및 호흡 변인에 따라 분석하였으며 또한 선별검사로서의 유용성을 평가하기 위해 중증도에 따라 베를린 결과의 민감도, 특이도, 양성 예측도, 음성 예측도 등을 통계 분석하였다. 결 과 : 전체 연구 대상을 폐쇄성수면무호흡의 중증도에 따라 분류하였을 때 정상 25명(20.6%), 경도 30명(25%), 중등도 26명(21.4%), 중증 40명(33%)의 분포를 보였다. 베를린 설문 결과상 고위험군은 84명(69.4%), 저위험군은 37명(30.6%)으로 나타났다. 폐쇄성수면무호흡의 진단에 있어 베를린 설문의 민감도와 특이도는 AHI 5를 기준으로 71.9%, 40%, AHI 15를 기준으로 75.8%, 38.2%, AHI 30을 기준으로 77.5%, 34.6%였으며 정확도는 65.3%였다. 결 론 : 베를린 설문은 수면 클리닉을 방문한 환자를 대상으로 하였을 때 폐쇄성수면무호흡의 선별 도구로서의 유용성은 높지 않았다. Objectives: The Berlin Questionnaire (BQ) has been used to help identify patients at high risk of having sleep apnea in primary care. But it has not been validated in a sleep clinic for Korean patients. The aim of this study is to evaluate the usefulness of the BQ as a screening tool for obstructive sleep apnea (OSA) for Korean patients in a sleep clinic. Methods: The BQ was prospectively applied to 121 subjects with OSA suspicion who visited to our sleep clinic. All subjects performed overnight polysomnography. OSA was defined as an apnea-hypopnea index (AHI) ${\geq}5$. We investigated the sensitivity, specificity, positive and negative predictive values of the BQ according to severity by AHI. Results: In 121 subjects, 73.6% were males, with a mean age of $48.8{\pm}13.0$ years. Twenty-five (20.6%) patients did not have OSA (AHI<5), 30 (25%) patients had mild OSA ($AHI{\geq}5$ and <15), 26 (21.4%) had moderate ($AHI{\geq}15$ and <30), and 40 (33%) had severe OSA ($AHI{\geq}30$). The BQ identified 69.4% of the patients as being at high risk for having OSA. The sensitivity and specificity of the BQ were 71.9% and 40%, for $AHI{\geq}5$, 75.8% and 38.2% for $AHI{\geq}15$, 77.5% and 34.6% for $AHI{\geq}30$, respectively. The positive and negative predictive values of the BQ were 82.1% and 27.0% for $AHI{\geq}5$, respectively. Positive and negative likelihood ratios were 1.2 and 0.7, and the overall diagnostic accuracy of the BQ was 65.3%, using an AHI cut-off of 5. Conclusion: Due to modest sensitivity and low specificity, the BQ does not seem to be an appropriate tool for identifying patients with obstructive sleep apnea in a sleep clinic population.

제목의 단어 가중치를 이용한 중등학교 공문서 자동분류시스템

강현희,진민,Kang, Hyun-Hee,Jin, Min 한국정보교육학회 2003 정보교육학회논문지 Vol.7 No.2

현재 일선 학교와 교육기관의 공문서 분류는 아직도 수작업으로 처리되고 있어 많은 시간이 소요된다. 이러한 문제점을 해결하기 위해 본 논문은 문서 제목의 단어 정보를 이용한 자동 문서 분류 방법을 제안한다. 먼저 기존 문서의 제목 단어 중에서 의미 있는 단어를 추출하여 각 단어에 대해 범주별로 역문헌 빈도(IDF) 가중치를 계산한 후 단어 가중치 사전을 구축한다. 문서의 분류 요구가 들어오면 구축된 단어 가중치 사전을 이용하여 문서 제목에 포함된 단어들의 범주별 가중치 합을 비교하여, 범주별 가중치 합이 최대인 범주로 문서를 분류한다. 실제 중등학교에서의 공문서를 대상으로 제안된 방법의 분류 성능을 평가하였다.

폐쇄성 수면무호흡 과 제2형 당뇨병

강현희,이상학,Kang, Hyeon-Hui,Lee, Sang-Haak 대한수면의학회 2009 수면·정신생리 Vol.16 No.2

Obstructive sleep apnea (OSA) has been definitively shown to be a risk factor for the development of cardiovascular disease and mortality. Recent reports have indicated that obstructive sleep apnea is associated with insulin resistance and impaired glucose metabolism, also have type 2 diabetes. The potential mechanisms leading to the development of type 2 diabetes in OSA patients are likely to be various. Reduced physical activity resulting from daytime somnolence, sympathetic nervous system activation, intermittent hypoxia, sleep fragmentation and sleep loss, dysregulation of the hypothalamic-pituitary axis, alteration in adipokine profiles, and activation of inflammatory pathways have been proposed. Based on the current evidence, clinicians should assess the risk of OSA in patients with type 2 diabetes and, conversely, consider that possibility of glucose intolerance in patients with OSA. Further large-scale and long-term follow-up studies in patient populations with selected by reliable but inexpensive diagnostic measures, controlled for potential confounder factor, are needed.

Disciplinary Session 1 / Sport Philosophy / Values and Ethics in Sport : 스포츠에서의 성차별과 남녀평등의 이상

강현희,황영조,이승규 ( Hyun Hee Kang,Young Jo Hwang,Seung Gyu Lee ) 한국체육학회 1998 국제스포츠과학 학술대회 Vol.1998 No.1

폐쇄성수면무호흡증 환자의 야간뇨 유병률 및 관련인자

강현희,이종민,이상학,문화식,Kang, Hyeon Hui,Lee, Jongmin,Lee, Sang Haak,Moon, Hwa Sik 대한수면의학회 2014 수면·정신생리 Vol.21 No.1

목 적: 본 연구는 수면 무호흡증이 의심되어 수면 클리닉을 내원한 남성 환자를 대상으로 야간뇨의 유병률 및 이를 예측할 수 있는 인자를 알아보고자 하였다. 방 법: 2009년부터 2012년까지 수면무호흡증이 의심이 되어 수면 클리닉을 방문한 남성 환자를 대상으로 임상적 소견 및 수면다원검사 결과를 후향적으로 분석하였다. 배뇨 증상은 국제전립선증상점수를 기준으로 측정하였다. 임상적으로 유의한 야간뇨은 밤 동안에 2회 이상 배뇨를 하기 위해 깨는 경우로 정의하였다. 폐쇄성수면무호흡증은 무호흡-저호흡 지수가 5 이상인 경우로 정의하였다. 결 과: 전체 161명의 분석 대상자의 평균 연령은 $46.7{\pm}14.1$세였다. 이 중 27명은 단순 코골이 환자였으며 134명은 폐쇄성수면무호흡증 환자로 진단 되었다. 야간뇨는 53명의 폐쇄성수면무호흡증 환자, 8명의 단순 코골이 환자에서 관찰되었다. 전체 분석 대상환자에서 야간뇨의 유병률은 37.9%, 폐쇄성수면무호흡증 환자에서 야간뇨의 유병률은 39.6%였으나, 폐쇄성수면무호흡증의 유무에 따른 야간뇨 발생의 통계학적 차이는 없었다. 야간뇨를 호소한 환자가 야간뇨가 없는 환자보다 무호흡-저호흡 지수가 통계적으로 유의하게 더 높았다(p=0.001). 야간뇨를 동반한 폐쇄성수면무호흡증 환자는 야간뇨를 호소하지 않은 폐쇄성수면무호흡증 환자에 비하여 각성 지수가 더 높았고, 혈중 산소 포화도는 더 낮은 것으로 분석 되었다. 다중회귀분석에서 나이와 무호흡-저호흡 지수가 야간뇨의 유무를 예측할 수 있는 인자로 분석 되었으며, 나이에 따른 야간뇨의 위험도는 1.4, 무호흡-저호흡 지수에 따른 위험도는 1.02로 나타났다. 결 론: 본 연구에서 폐쇄성수면무호흡증 환자에서 야간뇨의 빈도는 높은 것으로 나타났다. 폐쇄성수면무호흡증 환자에서 야간뇨의 동반여부를 예측할 수 있는 유용한 인자는 나이와 무호흡-저호흡 지수였다. Objectives: Several studies suggest that nocturia may be related to obstructive sleep apnea syndrome (OSAS). The mechanism by which OSAS develops nocturia has not been determined. The present study aimed to determine the prevalence of nocturia among adults with OSAS and to identify factors that may be predictive in this regard. Methods: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the sleep clinics of the St. Paul's Hospital between 2009 and 2012. The urinary symptoms were assessed on the basis of the International Prostate Symptom Score (IPSS). Pathologic nocturia was defined as two or more urination events per night. OSAS was defined as apnea-hypopnea index (AHI) ${\geq}5$. A multivariate analysis using logistic regression was performed to examine the relationship between polysomnographic variables and the presence of pathologic nocturia, while controlling for confounding factor. Results: A total of 161 men >18 years of age (mean age $46.7{\pm}14.1$), who had been referred to a sleep laboratory, were included in the present study. Among these, 27 patients with primary snoring and 134 patients with obstructive sleep apnea were confirmed by polysomnography. Nocturia was found in 53 patients with OSAS (39.6%) and 8 patients with primary snoring (29.6%). The AHI was higher in patients with nocturia than in those without nocturia (p=0.001). OSAS patients with nocturia had higher arousal index (p=0.044), and lower nadir oxyhemoglobin saturation (p=0.001). Multiple regression analysis showed that age (${\beta}$=0.227, p=0.003), and AHI (${\beta}$=0.258, p=0.001) were associated with nocturia, and that the presence of pathologic nocturia was predicted by age (OR 1.04 ; p=0.004) and AHI (OR 1.02 ; p=0.001). Conclusion: Nocturia is common among patients with OSAS. The strongest predictors of nocturia are age and AHI in patients with OSAS.

국내 3년제 응급구조과의 교양교육과정 분석

강현희,김효식,Kang, Hyun-Hee,Kim, Hyo-Sik 한국응급구조학회 2014 한국응급구조학회지 Vol.18 No.2

Purpose: This study aims to provide suggestions for improving the liberal arts curriculum for the 3-year emergency medical technology course by conducting a comparative research on the liberal arts curricula across 10 colleges. Methods: Various aspects of liberal arts subjects, such as basic directions set out by the curriculum, credit scores, and distribution, were studied. Results: Of the 10 colleges, 9 did not stated purpose of liberal arts education. All 10 offered courses including foreign language, computer, and self-management, however each subjects did not have reflections of course visions. Findings revealed the credit score ratio of liberal arts subjects to be relatively lower than the major subjects. Students had limited opportunity to choose liberal arts subjects, with only a small proportion of the course available for elective subjects. Most liberal arts subjects were completed in the first year. Subjects' experience was not expanded and deepened gradually. Subject choices often overlapped, with limited variety of available subjects. Conclusion: For competent emergency medical technicians, the 3-year emergency medical technology course should improve the quality of its liberal arts offerings. The study of liberal arts provides the opportunity to develop broad perspectives and mature attitudes.

노인의 웰빙을 위한 치료 마사지의 가치

강현희 ( Hyun Hee Kang ) 안양대학교 사회과학연구소 2008 社會科學硏究 Vol.14 No.-

심한 고삼투압을 동반한 요독증 환자에서 첫 혈액투석 후 발생한 삼투성 탈수초 증후군

강현희 ( Hyun Hee Kang ),송주용 ( Joo Yong Song ),윤나리 ( Na Ri Youn ),강귀영 ( Kwi Young Kang ),김은숙,김영수 ( Young Soo Kim ),윤선애 ( Sun Ae Yoon ),김영주 ( Young Joo Kim ),김영옥 ( Young Ok Kim ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.6

Osmotic demyelination syndrome (ODS) is a distinctive clinical syndrome with characteristic MR features in the central pons (central pontine myelinolysis) and in other brain locations (extrapontine myelinolysis). Rapid correction of hyponatremia is associated with ODS, but hyperosmolality rarely causes it. Here we report a case of ODS developed in a hemodialysis patient with severe uremia and concomitant hyperosmolality. A 67-year-old male was presented with general weakness and dyspnea. Laboratory findings showed severe uremia (blood urea nitrogen, 167 mg/dL; serum creatinine, 15 mg/dL), hyperosmolality (336 mOsm/kg H2O), and normal range of sodium (145 mEq/L). After the first hemodialysis treatment, his consciousness was changed to lethargic state. We initially suspected dialysis disequilibrium syndrome, but the symptoms were aggravated. MRI showed edema in central pons and symmetrical extrapotine lesions in the subcortical white matter, lateral thalamus, and posterior capsule, consistent with ODS. In spite of aggressive measures including continuous renal replacement therapy, he died of sepsis at the 26th hospital day. (Korean J Nephrol 2006;25(6):1035-1039)

중학생을 위한 성인지 감수성 교육 프로그램의 효과

강현희 ( Kang Hyun-hee ),박희현 ( Park Hui-hyun ),고나윤 ( Go Na-yoon ) 동신대학교 2023 창의융복합연구 Vol.1 No.1

This study aimed to develop a gender sensitivity education program for middle school students and examine its effects on gender sensitivity, self-esteem, and interpersonal relationship abilities. The research participants consisted of 24 1st-grade middle school students from J region, with 12 students assigned to the experimental group and 12 to the control group. The experimental group underwent a total of 8 sessions of gender sensitivity education program. To validate the effects of the program, a pre-post-follow-up comparison was conducted using self-report questionnaires on gender sensitivity, self-esteem, and interpersonal relationship abilities. Data analysis was performed using SPSS 23.0, employing analysis of covariance (ANCOVA). The results of the study showed that the experimental group exhibited significant improvements in gender sensitivity, self-esteem, and interpersonal relationship abilities compared to before the program implementation. This suggests that gender sensitivity education can enhance gender sensitivity and self-esteem, as well as improve interpersonal relationship abilities. In the follow-up assessment conducted four weeks after the gender sensitivity education program, there were no significant differences between the groups. However, the experimental group showed sustained effects in the subdimension of gender sensitivity within gender sensitivity even after some time had passed. These findings indicate that educational interventions can enhance gender sensitivity in middle school students and have positive effects on self-esteem and interpersonal relationship abilities. This underscores the importance of actively introducing and promoting educational programs aimed at improving gender sensitivity in middle school students.