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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Sleep Medicine and Psychophysiology
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KOREAN ACADEMY OF SLEEP MEDICINE
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Volume & Issues
Volume 11, Issue 2 - Dec 2004
Volume 11, Issue 1 - Jun 2004
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Upper Airway Studies in Patients with Obstructive Sleep Apnea Syndrome
Kim, Jung-Soo ; Lee, Kyu-Yup ;
Sleep Medicine and Psychophysiology, volume 11, issue 1, 2004, Pages 5~9
Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent cessation of breathing due to complete or partial upper airway occlusion during sleep. The incompetent tone of palatal, pharngeal, and glossal muscles which fail to maintain airway patency during sleep causes narrowing of the airway dimension and increased resistance of breathing. The identification of the sites of upper airway obstruction in patients with OSA is important in understanding the pathogenesis and deciding the treatment modality of snoring and/or OSA. Various upper airway imaging modalities have been used to assess upper airway size and precise localization of the sites of upper airway obstruction during sleep. Dynamic imaging modalities enabled assessment of dimensional changes in the upper airway during respiration and sleep. This article focused on reviews of various upper airway imaging modalities, especially dynamic upper airway imaging studies providing important information on the pathogenesis of OSA.
REM-Related Sleep-Disordered Breathing
Shin, Chol ; Lee, Hyun-Joo ;
Sleep Medicine and Psychophysiology, volume 11, issue 1, 2004, Pages 10~16
Sleep is associated with definite changes in respiratory function in normal human beings. During sleep, there is loss of voluntary control of breathing and a decrease in the usual ventilatory response to both low oxygen and high carbon dioxide levels. Especially, rapid eye movement (REM) sleep is a distinct neurophysiological state associated with significant changes in breathing pattern and ventilatory control as compared with both wakefulness and non-rapid eye movement (NREM) sleep. REM sleep is characterized by erratic, shallow breathing with irregularities both in amplitude and frequency owing to marked reduction in intercostal and upper airway muscle activity. These blunted ventilatory responses during sleep are clinically important. They permit marked hypoxemia that occurs during REM sleep in patients with lung or chest wall disease. In addition, sleep-disordered breathing (SDB) is more frequent and longer and hypoventilation is more pronounced during REM sleep. Although apneic episodes are most frequent and severe during REM sleep, most adults spend less than 20 to 25% of total sleep time in REM sleep. It is, therefore, possible for patients to have frequent apneas and hypopneas during REM sleep and still have a normal apnea-hypopnea index if the event-rich REM periods are diluted by event-poor periods of NREM sleep. In this review, we address respiratory physiology according to sleep stage, and the clinical implications of SDB and hypoventilation aggravated during REM sleep.
Nasal Diseases and Its Impact on Sleep Apnea and Snoring
Kim, Chang-Hee ; Rhee, Chae-Seo ;
Sleep Medicine and Psychophysiology, volume 11, issue 1, 2004, Pages 17~21
Nasal congestion is one of the most common symptoms of medical complaints. Snoring is caused by vibration of the uvula and the soft palate. Nasal obstruction may contribute not only to snoring and obstructive sleep apnea (OSA) but also impair application of continuous nasal positive airway pressure (CPAP), which is the most widely employed treatment for OSA. Total or near-total nasal obstruction leads to mouth breathing and has been shown to cause increased airway resistance. However, the exact role of the nasal airway in the pathogenesis of OSA is not clear and there is no consensus about the role of nasal obstruction in snoring and sleep apnea. Some reports have failed to demonstrate any correlation between snoring and nasal obstruction. On the other hand, opposing reports suggest that nasal disease may cause sleep disorders and that snoring can be improved after nasoseptal surgery. Reduced cross-sectional area causes increased nasal resistance and predisposes the patient to inspiratory collapse of the oropharynx, hypopharynx, or both. Discrete abnormalities of the nasal airway, such as septal deformities, nasal polyps, and choanal atresia and with certain mucosal conditions such as sinusitis, allergic rhinitis and inferior turbinate hypertrophy can cause snoring or OSA. Thus, these sources of nasal obstruction should be corrected medically or surgically for the effective management of OSA and adjunctive for CPAP.
Differential Factors of Obstructive Sleep Apnea in Subjects whose Main Sleep Complaint was Insomnia
Kim, Seog-Ju ; Lee, Yu-Jin ; Kim, Eui-Joong ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 11, issue 1, 2004, Pages 22~28
Objective: The purpose of this study is to investigate the prevalence rate of OSA in subjects whose main sleep complaint is insomnia and to find differential factors of OSA in these insomniac subjects. Method: We reviewed the medical records and polysomnographic findings of patients referred to the Sleep Laboratory at Seoul National University Hospital from January 1996 to December 2002. Four-hundred and seventy subjects complained of insomnia as their main sleep problem (235 males and 235 females, mean age
). First, we investigated the prevalence rate of OSA in these insomniac patients. Second, we compared the clinical and demographic characteristics of the OSA-associated group with those of the non-associated group. Third, we examined whether the degree or presence of differential factors within the OSA group correlate with severity of OSA, as determined by the respiratory disturbance index (RDI). Results: Among 470 insomniac subjects, 125 subjects (26.6%) were diagnosed as OSA by nocturnal polysomnography. OSA-associated subjects were significantly older (
, p<0.01), and had significantly higher body mass index (BMI) (
, p=0.44) than non-associated subjects. The OSA-associated group had more subjects with male gender (64.0% vs. 44.9%, p<0.01), hypertension (20.0% vs. 9.3%, p<0.01) or snoring (96.0% vs. 63.5%, p<0.01). Within the OSA-associated group, age had a significant positive correlation with RDI (p=0.01). Conclusion: We found that a considerable portion of patients complaining of insomnia as their main sleep problem were diagnosed as OSA. Snoring, old age, male gender, obesity, and comorbid hypertension were found to be differential factors of OSA in insomniac patients. We suggest that diagnostic efforts including nocturnal polysomnography are needed for insomniac patients with any of the above risk factors of OSA.
The Changes of Short-Term Memory and Autonomic Neurocardiac Function after 4-10Hz Sound and Light Stimulation - A Pilot Study -
Lee, Seung-Hwan ; Kim, Jin-Hwan ; Park, Joong-Kyu ; Lee, Kyung-Uk ; Yang, Dae-Hyun ; Hong, Keun-Young ; Chae, Jeong-Ho ;
Sleep Medicine and Psychophysiology, volume 11, issue 1, 2004, Pages 29~36
Objectives: Sound and light (SL) stimulation has been used as a method to induce some useful mental states in the fields of psychology and psychiatry. It is believed that sound and light entrainment device (SLED) has some specific effects through synchronization of EEG in patients who use it. Theta frequency is believed to stimulate deep relaxation and short term memory processing. This study was conducted to evaluate if 4-10 Hz SL stimulation can induce relaxation and improve short term memory function. Methods: Ten medical students with no medical or psychiatric problems participated in this study. Subjects were randomly divided into two groups. One group was applied with real SLED was applied to one group (R group) and pseudo SLED to the other group (P group). The two groups were exposed to SL stimulation with SLED 15 minutes a day for 5 days, and after two days rest the two groups were switched over. The Korean Wechsler Adult Intelligence Scale (K-WAIS), Academic Motivation Tests (AMT), Test Anxiety Scale (TAS), Korean Auditory Verbal Learning Test (K-AVLT), and digit span were used to evaluate short term memory. Spielberger's State-Trait anxiety inventory and heart rate variability (HRV) test were used to evaluate degree of relaxation. Results: Compared with S group, R group showed a significant improvement in K-AVLT and digit span after a single application of SL stimulation. But 5-day long application did not reveal any differences between the two groups. A significant change in HRV was observed in 5-day long application of SL stimulation after being switched over to other SLED. Conclusion: This pilot study suggests that 4-10 Hz SL stimulation has some positive influences on short term memory and relaxation.
Comparison of Clinical Characteristics and Polysomnographic Features between Manifest and Latent REM Sleep Behavior Disorders
Kim, Seog-Ju ; Lee, Yu-Jin ; Kim, Eui-Joong ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 11, issue 1, 2004, Pages 37~43
Objective: The purpose of this paper is to study the possible differences in clinical and polysomnographic findings, depending on the presence or absence of subjective complaints of abnormal sleep behavior, in patients with RWA on polysomnography. Method: We reviewed patient records and polysomnographic data of patients referred to the Sleep Laboratory at Seoul National University Hospital from June 1996 through October 2002. We defined the manifest RBD group (n=32) as patients having both complaints of abnormal sleep behavior and RWA on polysomnography. The latent RBD group (n=20) consisted of patients who exhibited RWA on polysomnography but did not complain of abnormal sleep behavior. The clinical characteristics and polysomnographic findings between the two groups were compared and analyzed. Results: Fifty-two subjects had RWA, as detected by polysomnography (42 males and 10 females, mean age of
). Subjects in the manifest RBD group were significantly older than those in the latent RBD group (
, independent t-test, p<0.01). More subjects in the manifest RBD group exhibited abnormal REM behavior on polysomnography than did subjects in the latent RBD group (81.3 vs. 50.0%, Fisher's exact test, p<0.05). No significant differences between the groups were found in the prevalence of brain disorders and primary sleep disorders, gender proportion, and sleep architecture. Conclusion: No difference in sleep architecture was found between the manifest and the latent RBD groups. Only age and the presence of abnormal sleep behavior on polysomnography differentiated the two groups. We suggest that RWA on polysomnography without complaints of abnormal sleep behavior may be early manifestation of manifest RBD. Attention to RWA on polysomnography is necessary to help prevent full-blown RBD from developing.
Symptoms and Cognitive Function in Chronic Schizophrenia： 6 Months Follow-up Study
Kim, Chul-Kwon ; Kim, Seong-Hwan ; Choe, Byeong-Moo ;
Sleep Medicine and Psychophysiology, volume 11, issue 1, 2004, Pages 44~49
Objectives: The purpose of this study was to investigate whether longitudinal changes in positive and negative symptoms affect cognitive functioning in chronic schizophrenia. Methods: Sixty-eight patients diagnosed with DSM-IV schizophrenia were examined on two occasions over 6 months for symptoms and cognitive changes. Symptoms were measured by PANSS. Cognitive functions were examined for sustained attention, executive function, concentration and attention, and verbal memory and learning using Degraded Stimulus Continuous Performance Test, Wisconsin Card Sorting Test, Digit Span, and Rey Auditory Verbal Learning Test, respectively. Twenty control subjects were assessed to compare the cognitive scores of remitted schizophrenic patients. Results: Patients showed significant improvement in symptoms and all cognitive tests after 6 months treatments. Significant improvements in positive and negative symptoms did not predict improvements in any aspect of cognitive functioning measured. Normal controls performed significantly better than remitted schizophrenic patients on all cognitive tests. The results show no relationship between change in symptoms and change in cognition in chronic schizophrenia. Conclusion: We suggest that symptomatic and cognitive impairment may be a distinct construct. These findings highlight the importance of treating cognitive impairment in addition to the clinical symptoms of schizophrenia.
A Case of Obstructive Sleep Apnea Syndrome in Childhood
Lee, Seung-Hoon ; Kwon, Soon-Young ; Lee, Sang-Hag ; Chang, Ji-Won ; Kim, Jin-Kwan ; Shin, Chol ;
Sleep Medicine and Psychophysiology, volume 11, issue 1, 2004, Pages 50~54
The obstructive sleep apnea syndrome can occur due to various etiologies in children. In otherwise healthy children, adenotonsillar hypertrophy is the leading cause of childhood obstuctive sleep apnea. Obstructive sleep apnea caused by adenotonsillar hypertrophy can lead to a variety of symptoms and sequelae such as behavioral disturbance, enuresis, failure to thrive, developmental delay, cor pulmonale, and hypertension. So if obstructive sleep apnea is clinically suspected, proper treatment should be administered to the patient after diagnostic examinations. More than 80% improvement is seen in symptoms of obstructive sleep apnea caused by adenotonsillar hypertrophy in children after tonsillectomy and adenoidectomy. However, when it is impossible to treat the patient using surgical methods or residual symptoms remained after tonsillectomy and adenoidectomy, additional treatments such as weight control, sleep position change, and continuous positive airway pressure (CPAP), should be considered. This paper reports a case using weight control and Auto-PAP to control mild sleep apnea and snoring, which in long-term follow-up were not resolved after tonsillectomy and adenoidectomy for severe obstructive sleep apnea.