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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 15, Issue 2 - Dec 2008
Volume 15, Issue 1 - Jun 2008
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Overlap Syndrome：Obstructive Sleep Apnea-Hypopnea Syndrome in Patients with Chronic Obstructive Pulmonary Disease
Choi, Young-Mi ;
Sleep Medicine and Psychophysiology, volume 15, issue 2, 2008, Pages 67~70
Overlap syndrome can be defined as a coexistence of chronic obstructive pulmonary disease (COPD) and sleep apnea-hypopnea syndrome (SAHS). The association of COPD and SAHS has been suspected because of the frequency of both diseases. Prevalence of COPD and SAHS is respectively 10 and 5% of the adult population over 40 years of age. However, a recent study has shown that the prevalence of SAHS is not higher in COPD than in the general population. The coexistence of the two diseases is only due to chance. SAHS does not affect the pathophysiology of COPD and vice versa. Prevalence of overlap syndrome is expected to occur in about 0.5% of the adult population over 40 years of age. Patients with overlap syndrome have a more profound hypoxemia, hypercapnia, and pulmonary hypertension when compared with patients with SAHS alone or usual COPD patients without SAHS. To treat the overlap syndrome, nocturnal noninvasive ventilation (NIV) or nasal continuous positive airway pressure (nCPAP) can be applied with or without nocturnal oxygen supplement.
Differences of EEG and Sleep Structure in Pediatric Sleep Apnea and Controls
Ahn, Young-Min ; Shin, Hong-Beom ; Kim, Eui-Joong ;
Sleep Medicine and Psychophysiology, volume 15, issue 2, 2008, Pages 71~76
Introduction: In this study, we compared sleep structure, EEG characteristic of pediatric obstructive sleep apnea (OSA) and normal controls which were matched in sex and age. Methods: Fifteen children (male：female=4：11) who complained snoring and were suspected to have sleep apnea and their age and sex matched normal controls (male：female=5：10) have been done nocturnal polysomnography (NPSG). Sleep parameters, sleep apnea variables and relative spectral components of EEG from NPSG have been compared between both groups. Results: Pediatric OSA group were distinguished from normal controls in terms of apnea index, respiratory disturbance index and nadir of oxyhemoglobulin desaturation. Pediatric OSA group showed increased percent of sleep stage 1, decreased rapid eye movement sleep percent and increased delta power in O1 EEG channel. However other sleep parameters and spectral powers were not different between two groups. Conclusion: In pediatric OSA group, sleep structure parameter disruption may be not prominent as the previous studies for adult OSA group because of including mild OSA data in diagnostic criteria. In addition, EEG changes might not be distinct due to low arousal index compared to adult OSA patients. We can observe general characteristics and particularity of pediatric OSA through this study.
Clinical and Polysomnographic Characteristics of REM Sleep-Dependent Obstructive Sleep Apnea
Lee, Yu-Jin ; Lee, Soon-Jeong ; Kang, Dong-Jin ;
Sleep Medicine and Psychophysiology, volume 15, issue 2, 2008, Pages 77~81
Introduction: REM sleep which shows characteristic muscle atonia and increased resistance of upper respiratory track is known to be vulnerable to sleep apnea. Previous studies reported that REM sleep-dependent (or related) obstructive sleep apnea syndrome (REM-dependent OSA) could be one of sleep disordered breathing. The present study aimed to investigate clinical findings and polysomnographic variables of REM-dependent OSA. Methods: Fifty-six patients diagnosed with mild to moderate obstructive sleep apnea by overnight polysomnography (5
years, 42 males). REM-dependent OSA was defined as AHI-REM/AHI-NREM ratio>2. We compared clinical and polysomnographic findings between REM-dependent OSA and No REM-dependent OSA patients. Results: Among 56 patients, 37.5% (n=21, average age of
years, 14 males) met the REM-dependent OSA criteria. There were no significant differences in age, sex and body mass index between two groups. After controlling for age, sex, body mass index and periodic leg movements index, REM-dependent OSA patients showed significantly lower AHI, lower number of oxygen desaturation events and higher stage 2 sleep proportion compared to No REM-dependent OSA patients (p=0.010, p=0.006, p=0.031, respectively). After controlling for age, sex, body mass index and periodic legs movements index, AHI-REM was positively correlated with the number of oxygen desaturation events in REM-dependent OSA group (p=0.002). Conclusion: Current results suggested that 37.5% of patients with mild to moderate severity of obstructive sleep apnea could be classified into REM-dependent OSA. REM-dependent OSA was more common in mild severity of OSA, equally prevalent in both sexes and accompanied with sleep architecture changes, i.e. increased proportion of stage 2. In addition, apneic events during REM sleep in REM-dependent OSA were related to oxygen desaturation.
Sleep Fragementation Decreases during the nCPAP Titration Night in Obstructive Sleep Apnea Syndrome
Lee, Jin-Seong ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 15, issue 2, 2008, Pages 82~86
Objectives: Obstructive sleep apnea syndrome (OSAS) not only causes respiratory disturbances during sleep but also decreases the quality of nocturnal sleep through sleep fragmentation and sleep structure change. We aimed at comparing the changes in sleep fragmentation and structure between baseline (diagnostic) nocturnal polysomnography (NPSG) and nCPAP (nasal continuous positive airway pressure) titration trial. Methods: One hundred and three patients with a baseline night of respiratory disturbance index (RDI) of 5 or greater and reduced RDI score during nCPAP titration night were retrospectively selected for the study. Sleep fragementation and sleep structure between baseline NPSG and the NPSG during nCPAP titration were compared. Sleep fragmentation index (SFI) was defined as the total number of awakenings and shifts to stage 1 sleep divided by the total sleep time in hour. SFI and other polysomnographic parameters were statistically compared between the two nights. Results: SFI during baseline NPSG and nCPAP titration nights were
, respectively, indicating a significant SFI decrease during nCPAP titration (t=9.7, p<0.01). SFI showed significant negative correlations with sleep efficiency (r=-0.60, p<0.01) and total sleep time (r=-0.45, p<0.01) and a positive correlation with RDI (r=0.28, p<0.01). Conclusion: Use of nCPAP, even during the titration, significantly decreases sleep fragmentation and improves sleep structure in OSAS patients. We suggest that SFI may be utilized as a measure of assessing OSAS severity and nCPAP efficacy.
Sleep Patterns and Academic Performance in Medical Students
Shin, Seo-Yeon ; Lee, Jin-Seong ; Jeong, Do-Un ;
Sleep Medicine and Psychophysiology, volume 15, issue 2, 2008, Pages 87~93
Introduction: Although it is well known that medical students are not getting an adequate amount of sleep, there have been only few studies on the sleep patterns of medical students in Korea. Therefore, the present study aimed to investigate the life style and sleep patterns of Korean medical students and the impact they have on the students' academic performance. Methods: A questionnaire package was administered to the
year medical students at the Seoul National University to examine their sleep patterns on weekdays and weekends. It consisted of questions asking about their lifestyles as well as Pittsburgh sleep quality index (PSQI) and GPA (Grade Point Average) that are considered relevant to their sleep patterns. A total of 110 students (85 males and 25 females, mean age
) responded to the survey and the result was analyzed using the independent t-test, the chi-square test, the paired t-test, Pearson's rank correlation and ANOVA. P-values of less than 0.05 were considered statistically significant in all analyses. Results: The weekend bedtime was significantly delayed (01：24 on weekday；03：12 on weekend; t=-5.23, p<0.01), the weekend rise time was delayed (07：36 on weekday；10：30 on weekend ; t=-24.48, p<0.01) and the total sleep time was increased on weekends (5：57 on weekday；8：17 on weekend ; t=15.94, p<0.01). They wished to sleep for 7 hours 6 minutes which was different from their actual weekday total sleep time (t=-11.41, p<0.01). The poor sleeper group had lower GPAs than the good sleeper group (t=2.05, p<0.05). The GPA of medical students were negatively correlated with age (r=-0.23, p<0.05), daily amount of smoking (r=-0.78, p<0.01), total amount of smoking (r=-0.75, p<0.01), weekday sleep latency (r=-0.23, p<0.05), weekend sleep latency (r=-0.23, p<0.05) and PSQI score (r=-0.30, p<0.01). Conclusion: Medical students were experiencing a lack of sleep during weekdays as they have a later bedtime and earlier rise time, and consequently had more hours of sleep on weekends. Overall, the responded students were experiencing poor sleep quality, and the GPAs of the poor sleeper group were lower than those of the good sleeper group.
A Case of Child with Obstructive Sleep Apnea Syndrome Recurred after Adenotonsillectomy
Kim, Cu-Rie ; Kim, Dong-Soon ; Seo, Hyun-Joo ; Shin, Hong-Beom ; Kim, Eui-Joong ; Shim, Hyun-Joon ; Ahn, Young-Min ;
Sleep Medicine and Psychophysiology, volume 15, issue 2, 2008, Pages 94~99
The most common cause of obstructive sleep apnea syndrome (OSAS) in childhood is adenotonsillar hypertrophy. Adenotonsillectomy improves the symptoms quite well in most cases. However, some patients could experience the OSAS again after adenotonsillectomy, who might have several risk factors such as incomplete operation, misdiagnosis, combined anatomical malformation, sinusitis or chronic allergic rhinitis, obesity, initial severe OSAS, and early onset OSAS. We report a case of 11-year-old obese boy who presented with snoring for several years. He was obese with body mass index (BMI) of
and also found to have fatty liver by ultrasonogram. Initial polysomnography (PSG) showed that he met the criteria of severe OSAS with the apnea-hypopnea index (AHI) of 70.5. He underwent adenotonsillectomy and symptoms improved immediately. Four months later symptoms were relieved with AHI of 0, but 1 year after the adenotonsillectomy he started to complain snoring again and the subsequent PSG results showed that OSAS has relapsed with AHI of 43. Paranasal sinus X-ray and physical examination showed sinusitis and re-growth of adenoid. Obesity was proved not to be a contributing factor because his BMI decreased to normal range (
) after diet control and regular exercise. Also, liver transaminase was normalized and fatty liver was disappeared on follow-up abdominal ultrasonogram. After treatment of sinusitis, symptoms were relieved with decreased AHI (8.5). This case suggests that simple adenotonsillectomy might not be the end of OSAS treatment in childhood. Patients who had adenotonsillectomy should be followed by subsequent PSG if symptoms recur. It is also important to be aware of risk factors in the recurrent OSAS for the proper intervention according to the cause.