Clinical Characteristics and Polysomnographic Features of Patients Visited a Snoring and Sleep Apnea Clinic of Dental Hospital in Korea

  • Kim, Ji-Rak (Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University) ;
  • Chung, Jin Woo (Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University)
  • Received : 2017.02.10
  • Accepted : 2017.03.17
  • Published : 2017.03.30


Purpose: The aims of this study were to evaluate the clinical characteristics and polysomnographic results of patients visited the Seoul National University Dental Hospital (SNUDH) and to suggest guidelines for the management of sleep disordered-breathing patients in a dental clinic. Methods: Five hundred sixty-two patients who visited the Snoring and Sleep Apnea Clinic of SNUDH were evaluated for clinical characteristics including associated comorbidities, age, gender, body mass index (BMI), neck circumference, and daytime sleepiness and among them 217 patients were performed nocturnal polysomnography for evaluating respiratory disturbance index, apnea-hypopnea index (AHI), oxygen saturation levels, and sleep stages. The associations among clinical characteristics, sleep parameters, and positional and rapid eye movement (REM) dependencies of the patients were analyzed. Results: The most common co-morbidities of the patients were cardiovascular (30.2%), endocrine (10.8%), and respiratory diseases (7.9%). Age (${\beta}=0.394$), total AHI (${\beta}=0.223$), and lowest $O_2$ saturation levels (${\beta}=0.205$) were significantly associated with the number of co-morbidities in patients with obstructive sleep apnea (OSA). Mean $O_2$ saturation was not significantly associated with number of co-morbidities. Non-positional OSA patients had higher BMI, longer neck circumferences, more severe AHI values, and lower mean and lowest $O_2$ saturation levels compared to positional OSA patients. Not-REM-related patients were older and had more severe AHI values compared to REM-related patients. Not-REM-related patients have longer duration of stage I sleep and shorter stage II, III, and REM sleep than REM-related patients. There were no significant differences in each sleep stage between positional and non-positional patients. Neck circumference, positional dependency, REM dependency, and percentage of supine position were significantly associated with severity of OSA. Conclusions: Age, total AHI, and lowest $O_2$ saturation level were significantly associated with the number of co-morbidities in patients with OSA. Neck circumference, positional dependency, REM dependency, and percentage of supine position were significantly associated with severity of OSA.


  1. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA 2004;291:2013-2016.
  2. Kim J, In K, Kim J, et al. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med 2004;170:1108-1113.
  3. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-1053.
  4. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-1384.
  5. Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J 2006;28:596-602.
  6. Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 2005;172:1447-1451.
  7. Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 1999;160:1101-1106.
  8. Cartwright RD. Effect of sleep position on sleep apnea severity. Sleep 1984;7:110-114.
  9. Haba-Rubio J, Janssens JP, Rochat T, Sforza E. Rapid eye movement-related disordered breathing: clinical and polysomnographic features. Chest 2005;128:3350-3357.
  10. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8:597-619.
  11. Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med 2005;172:1590-1595.
  12. Rodenstein D. Sleep apnea: traffic and occupational accidents--individual risks, socioeconomic and legal implications. Respiration 2009;78:241-248.
  13. Nieto FJ, Young TB, Lind BK, et al. Association of sleepdisordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;283:1829-1836.
  14. Marin JM, Agusti A, Villar I, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA 2012;307:2169-2176.
  15. Gabbay IE, Lavie P. Age- and gender-related characteristics of obstructive sleep apnea. Sleep Breath 2012;16:453-460.
  16. Marrone O, Lo Bue A, Salvaggio A, Dardanoni G, Insalaco G. Comorbidities and survival in obstructive sleep apnoea beyond the age of 50. Eur J Clin Invest 2013;43:27-33.
  17. Hizli O, Ozcan M, Unal A. Evaluation of comorbidities in patients with OSAS and simple snoring. Sci World J 2013;2013:709292.
  18. Franco CM, Lima AM, Ataide L Jr, et al. Obstructive sleep apnea severity correlates with cellular and plasma oxidative stress parameters and affective symptoms. J Mol Neurosci 2012;47:300-310.
  19. Min HJ, Park AY, Kim DH, Lee JG, Park S, Cho HJ. Neck circumference and lowest oxygen saturation are independently associated with high coexistence of hypertension in obstructive sleep apnea. Yonsei Med J 2014;55:1310-1317.
  20. Oksenberg A, Silverberg DS, Arons E, Radwan H. Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest 1997;112:629-639.
  21. Chung JW, Enciso R, Levendowski DJ, Westbrook PR, Clark GT. Patients with positional versus nonpositional obstructive sleep apnea: a retrospective study of risk factors associated with apneahypopnea severity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:605-610.
  22. O'Connor C, Thornley KS, Hanly PJ. Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med 2000;161:1465-1472.
  23. Oksenberg A, Arons E, Nasser K, Vander T, Radwan H. REMrelated obstructive sleep apnea: the effect of body position. J Clin Sleep Med 2010;6:343-348.
  24. Koo BB, Dostal J, Ioachimescu O, Budur K. The effects of gender and age on REM-related sleep-disordered breathing. Sleep Breath 2008;12:259-264.
  25. Koo BB, Patel SR, Strohl K, Hoffstein V. Rapid eye movementrelated sleep-disordered breathing: influence of age and gender. Chest 2008;134:1156-1161.
  26. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015-3021.
  27. Plywaczewski R, Bielen P, Bednarek M, Jonczak L, Gorecka D, Sliwinski P. Influence of neck circumference and body mass index on obstructive sleep apnoea severity in males. Pneumonol Alergol Pol 2008;76:313-320.
  28. Davidson TM, Patel MR. Waist circumference and sleep disordered breathing. Laryngoscope 2008;118:339-347.
  29. Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 2002;162:893-900.
  30. Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C. Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope 2000;110:1689-1693.
  31. Mo JH, Lee CH, Rhee CS, Yoon IY, Kim JW. Positional dependency in Asian patients with obstructive sleep apnea and its implication for hypertension. Arch Otolaryngol Head Neck Surg 2011;137:786-790.