Earticle

This study aimed to systematically review self-efficacy-based interventions for patients with obstructivesleep apnea (OSA) and identify the relationship between the number of used techniques for promptingself-efficacy and the main outcome variables. This systematic review was conducted in accordance withthe PRISMA guidelines. Experimental studies on the use of self-efficacy-based interventions for patientswith OSA were analyzed. Five databases, EMBASE, CINAHL, PubMed, SCOPUS, and Web of Science, weresystematically searched for articles published until December 2023. Interventions were classified based onthe behavior change technique (BCT) taxonomy and the theoretical sources of self-efficacy to conduct anarrative synthesis. Of the 6,968 articles evaluated, 11 were included for analysis (1,304 participants). Theresults showed that the most frequently employed BCTs in the analyzed studies were “instruction on howto perform a behavior,” “exposure,” and “social support.” Regarding the number of techniques, an averageof 6.0 BCTs (range, 4e8) and 3.2 theoretical sources (range, 2e4) were utilized in studies that showedsignificant improvements in self-efficacy (5 studies), whereas an average of 4.8 BCTs (range, 2e5) and 2.8theoretical sources (2e3) were used in studies that indicated null results related to self-efficacy (6 studies). This review underscores the potential of self-efficacy-based interventions in the management of OSA andprovides a solid theoretical foundation for designing effective interventions. Additionally, the resultsindicate that utilizing a greater diversity of BCTs and theoretical sources may contribute to the effectivenessof self-efficacy interventions. Therefore, clinicians should consider incorporating various behavior changetechniques and four sources of prompting self-efficacy from self-efficacy theory into interventions toenhance self-efficacy, and consequently, treatment adherence in patients with OSA.

Objective: Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that can have a significant impact on the quality of life. According to recent studies, some OSAS patients exhibit swallowing abnormalities, such as the premature entry of food into the hypopharynx, and laryngeal penetration. We aimed to evaluate the swallowing function of OSAS patients and compare swallowing-related parameters between OSAS severity groups through a video fluoroscopic swallowing study (VFSS). Methods: Ninety-two participants with a symptom of snoring were enrolled in this retrospective study. Eighty-four participants were diagnosed with OSAS by polysomnography. The subjects were evaluated using the apnea-hypo-pnea index (AHI) and divided into four groups, namely non-OSAS, mild, moderate, and severe OSAS. Since all pa-tients reported choking symptoms, they underwent VFSS and were evaluated for penetration or aspiration. The tem-poral parameters evaluated were oral transit time, pharyngeal transit time, and pharyngeal delay time. The move-ment parameters assessed were the distance, duration, and velocity of laryngeal elevation (LE). Results: Penetration was detected in six OSAS patients, but aspiration was not observed in any patient. Seventy-four patients showed vallecular and pyriform sinus residue, although the amount was not significantly large. There was no significant difference in any of the temporal parameters between the groups except pharyngeal transit time with 10 ml of yogurt. In the Pearson’s correlation and multivariate linear regression analysis, LE distance and LE veloc-ity, both correlated with AHI scores with 5 ml of liquid, 10 ml of liquid, and 10 ml of yogurt, respectively. Conclusion: Severe OSAS patients showed longer and faster hyolaryngeal movement while swallowing, which may be a compensatory movement to prevent penetration or aspiration.

본 연구는 폐쇄성 수면무호흡증 환자를 대상으로 수면의 질에 미치는 영향요인을 파악하기 위한 후향적 서술조사연구이다. 2017년부터 2018년까지 일 지역 종합병원에서 수면다원검사를 받은 176명의 폐쇄성 수면무호흡증 환자가 작성한 자가보고 설문지와 전자의무기록을 검토하여 자료를 수집하였다. 자료는 기술통계, t-test, Pearson's correlation, 다중회귀분석으로 통계분석을 시행하였다. 대상자의 평균연령은 49.37세이었고, 94.4%가 수면의 질이 낮은 것으로 나타났다. 수면의 질은 주간 졸음, 우울과 유의한 상관관계를 나타내며, 수면의 질에 영향을 미치는 요인은 우울, 두통, 입마름, 성별 이었으며 설명력은 37.1% 이었다. 폐쇄성 수면무호흡증 환자의 수면의 질을 향상하기 위하여 두통, 입마름, 우울을 감소시키는 중재가 필요하다.

Purpose: This study is a retrospective descriptive study to investigate the factors affecting sleep quality of Obstructive Sleep Apnea (OSA) patients. Methods: Data were collected from questionnaires and electronic medical records of 176 patients with obstructive sleep apnea were reviewed from 2017 to 2018. The collected data was analyzed into descriptive statistics, t-test, Pearson's correlation, and multiple regression analysis. Results: The mean age of the subjects was 49.37 years and 94.4%(n=166) had low sleep quality. The quality of sleep of the OSA patients had correlations with daytime sleepiness, and depression. The significant factors influencing quality of sleep were Gender(${\beta}=.18$, p<.004), depression(${\beta}=.50$, p<.001), dry mouth (${\beta}=.15$, p<.016), Headache(${\beta}=.17$, p<.008), explained 37.1% of the variance. Conclusion: To improve their sleep quality, required for OSA patients who have the depression, daytime sleepiness.

본 연구는 허혈성 심뇌혈관질환자의 폐쇄성 수면무호흡증 위험정도를 파악하고 그 영향요인을 규명하기 위해 시도되었다. 심뇌혈관집중치료실에 입원한 허혈성 심뇌혈관질환자 141명을 대상으로 구조화된 자가설문지 사용하였고, 펄스 옥시미터를 사용하여 세 시점에서 수면 중 혈중산소포화도를 측정하였으며 SPSS/WIN 20.0을 이용하여 통계분석을 시행하였다. 연구 결과 대상자의 평균연령은 $64.4{\pm}11.1$세였고 남자가 61%였다. 심뇌혈관질환자의 21.3%가 폐쇄성 수면무호흡증 고위험군으로 파악되었고 71.6%에서 수면의 질이 낮은 것으로 나타났다. 폐쇄성 수면무호흡증 고위험군의 수면 중기와 말기에 측정한 산소포화도는 저위험군보다 통계적으로 유의하게 낮은 것으로 나타났으며, 다중회귀분석 결과, 심뇌혈관질환자의 폐쇄성 수면무호흡증 영향요인으로서 과거흡연, 잦은 코골이, 비만, 운동부족이 확인되었다. 따라서, 본 연구결과는 심뇌혈관질환 간호에 있어 폐쇄성 수면무호흡증 또는 잦은 코골이를 위험요인으로 중요하게 인식하고, 심뇌혈관질환의 이차적 재발 예방을 위해 폐쇄성 수면무호흡증 고위험군의 조기선별 및 환자와 가족을 지지하고 건강행태 개선을 위한 상담과 퇴원교육을 강화하기 위한 기초자료로 활용될 것이다.

This study aimed to investigate the levels of Obstructive Sleep Apnea (OSA), health behavior and sleep quality and to examine the predictors of OSA in patients with ischemic cardio-cerebrovascular disease. 141 patients who were admitted to the vascular unit were recruited and surveyed using structured questionnaires. Saturation of Peripheral Oxygen (SpO2) was measured at three time points using a pulse oximeter. Data were analyzed using SPSS/WIN 20.0. The mean age of the subjects was $64.4{\pm}11.1$ years and 61% was men. The 21.3%(n=30) of the subjects were classified as high-risk for OSA by the cut point and 71.6%(n=101) had low sleep quality. OSA high-risk group showed significant difference in SpO2 in the middle of sleep (p=.006) and at the end of sleep (p=.004) compared to the low-risk group. Multiple logistic regression analysis showed that perceived frequent snoring, smoking, obesity, lack of exercise among health behavior were found as predicting factors on OSA. OSA or persistent snoring should be recognized as a cardiovascular risk factor in the cardiovascular nursing practice. In addition to early treatment of OSA, education and counseling should be provided to patients and their family for prevention of secondary recurrence.

Purpose: This study was conducted to identify the factors associated with obstructive sleep apnea (OSA) risk in patients with metabolic syndrome (MS). Methods: Patients with MS between 30 and 74 years of age were recruited in an outpatient clinic of a cardiovascular center in Seoul, South Korea. MS and the risk of OSA were evaluated by Berlin questionnaire survey, the medical records of the participants were reviewed and a comprehensive lifestyle survey was performed. SPSS WIN 21.0 was used for statistical analysis. Results: BMI (OR: 1.31, CI: 1.14-1.51, p<.001) and lifestyle score (OR: 0.96, CI: 0.93-0.99, p=.028) were associated with the risk of OSA. Physical activity, weight control and diet were specifically associated with the risk of OSA after controlling for age, gender and BMI. Conclusion: This study demonstrated that lifestyle was an important factor associated with OSA risk in patients with MS.

불면증과 우울 증상은 폐쇄성 수면무호흡증후군(obstructive sleep apnea syndrome, OSA) 환자에게 자주 동반된다. 본 연구는 OSA 환자들의 수면 특징, 불면증 및 우울 증상을 비OSA 환자들과 비교하여 살펴봄으로써 OSA 환자를 진단하고 치료하는데 있어 임상적 함의를 발견하고자 수행되었다. 수면센터에 내원하여 OSA로 진단된 환자 145명(남자 126명, 여자 19명, 평균 나이 49.56±12.06세)에게 수면다원검사, 불면증 검사 및 Beck Depression Inventory를 실시하였다. 수면다원검사 결과, OSA 집단은 비OSA 집단에 비해서 수면효율성이 낮고 깊은 수면을 유지하는데 더 어려움을 지니고 있는 것으로 밝혀졌다. OSA 집단과 비OSA 집단 모두 유의한 수준의 불면증과 우울 증상을 지니고 있었으나 비OSA 집단이 OSA 집단보다 더 높은 수준의 불면증과 우울 증상을 나타냈다. 불면 및 우울 증상과 관련이 있는 수면다원검사의 지표들을 확인하기 위하여 상관분석을 실시한 결과, OSA 환자들은 불면증을 호소하는 정도가 높을수록 실제로 “수면효율성”이 낮고 “수면 중 각성” 지표가 높으며, 우울함을 호소할수록 “총 수면시간”이 적고 “수면효율성”이 낮으며 “수면 중 각성” 지표가 높은 것으로 밝혀졌다. 그러나, 비OSA 환자들의 경우에는 불면 및 우울 증상과 중요한 수면 지표들의 상관이 발견되지 않았다. 이 결과는 OSA 환자를 진료할 때 수면다원검사와 같은 생리적 검사에만 의존할 것이 아니라 불면증이나 우울감 등과 같은 주관적 임상 증상의 유무와 정도를 체계적으로 파악한다면, 치료에서 발생할 수 있는 어려움들을 미리 예견할 수 있고 치료에 도움이 될 수 있음을 시사한다.

Insomnia and depression are common to patients with obstructive sleep apnea syndrome (OSA). This study was conducted in order to explore the objective sleep characteristics, insomnia, and depressive symptoms of OSA and non-OSA patients and to provide clinical implications for diagnosis and treatment of OSA. A total of 145 patients (126 men, 19 women, average age: 49.56±12.06 years), who had been diagnosed as OSA, were administered polysomnography (PSG), the insomnia inventory, and the Beck Depression Inventory. The PSG showed that subjects in the OSA group had lower Sleep Efficiency (SE) and more difficulty in maintaining deep sleep than those in the non-OSA group. Although both the OSA and non-OSA groups had a significant level of insomnia and depressive symptoms, the non-OSA group showed more severe insomnia and depression than the OSA group. Correlation analysis was performed for identification of the significant indices of PSG relating to insomnia and depression. In the OSA group, patients who complained of more severe insomnia showed low SE and high Wakefulness After Sleep Onset (WASO). In addition, with greater depression, they showed high WASO and low Total Sleep Time (TST) and SE. However, in the non-OSA group, no correlation was observed between ISI or BDI and important sleep indices of PSG. Thus, for assessment of patients with OSA, it is necessary to examine not only physiological indices of the PSG but also the subjective clinical symptoms, such as insomnia and depression, so that we can anticipate problems that may occur during treatment and design tailored and efficient treatment plans.

Purpose: This study was performed to compare characteristics to the risk levels of obstructive sleep apnea (OSA) in men aged 51 years and older. Methods: This study involved secondary data analysis utilizing data from the Korea National Health and Nutrition Examination Survey. Three thousand eight hundred forty-six men aged 51 years or older participated in the study. Data were analyzed via descriptive statistics, 𝜒² test, and logistic regression using SPSS/WIN 27.0 software. Results: Study participants were divided into low (26.2%), intermediate (58.4%), and high (15.4%) OSA risk groups. Factors that correlated with OSA risk level included age, high-risk drinking, subjective health status, perceived stress, central obesity, and dyslipidemia. Subjects diagnosed with dyslipidemia were 2.25 fold elevated risk of being in the intermediate-risk group and at 4.17 fold elevated risk of being in the high-risk group of OSA (p<.001). In the case of central obesity, the respective likelihoods of being in the intermediate and high-risk groups of OSA increased by 2.10 and 6.46 fold (p<.001). Conclusion: Multiple strategies are required to manage OSA risk factors depending on risk level and to develop nursing intervention approaches to prevent individuals from progressing into the high-risk group for OSA.

본 연구에서는 폐쇄성 수면 무호흡증 환자(obstructive sleep Apnea, OSA)의 연령수준에 따른 주의력 결함 특성을 알아보고, 이들의 주의력 결함이 어떤 수면다원검사 지표들과 관련이 있는지 검토하고자 하였다. 두 하위 연령집단 및 정상군에 대해 전산화 주의력측정검사인 연속수행과제와 변화맹시과제를 실시하였다. 추가적으로 수면다원검사의 하위 지표들을 추출하고 주관적 주간졸음을 측정하는 엡워스 주간 졸리움 척도도 실시하였다. 연구결과, OSA군은 정상군과 비교하여 연속수행과제에서 누락 오류와 오경보 오류의 수가 유의하게 많은 것으로 나타났고, 변화맹시 과제에서 정반응률이 유의하게 낮은 것으로 나타났다. 상관분석 결과, OSA군의 주의력 결함은 수면다원검사 지표들 중 저산소혈증과 유의한 상관을 보였다. 결론적으로, OSA군은 부주의하고, 반응억제에 어려움을 보이며, 환경적 자극들 사이에서 일어나는 중요한 변화를 탐지하는데 결함이 있는 것으로 나타났다. 이러한 주의력 결함의 정도는 연령이 증가함에 따라 더욱 심화되었다. 특히 주의력 결함과 비가역적 대뇌 손상을 초래하는 저산소혈증과의 관련성은 OSA 환자의 인지기능의 손상을 예방하기 위해 조기치료가 필요함을 시사한다.

This study tried to examine the characteristics of attention deficits in patients with Obstructive Sleep Apenea(OSA) with different age levels, and to examine which indices of polysomnograms might be related to the indices of attention deficits in OSAs. Two age-level groups and a normal control group were subjected to two computerized attention tests, including a continuous performance test(CPT) and a change blindness task(CBT). In addition, the three groups were subjected to a Polysomnography to extract several sub-indicators of polysomnogram, and an Epworth Sleepiness Scale which measures subjective sleepiness. As results, the OSAs showed significantly more omission and commission errors in CPT, and they showed lower accuracy in CBT compared to the normal group. The results of a correlational analysis showed that attention deficits in OSA are significantly correlated with arterial oxygen saturation among sub-indicators of polysomnograms. In conclusion, OSAs seems to be less attentive, having difficulties in response inhibition, and having deficiencies in noticing important environmental changes. Age seems to make these deficiencies even worse. Especially, the relationship between attention deficiency and hypoxia which could cause irreversible cerebrum damage has an implication in cognitive impairment prevention through early treatment.

불면증은 공존 질환 유무에 따라 다른 양상으로 나타날 수 있으며, 정확한 진단과 치료에 있어 환자가 가진 불면증의 특성을 적절히 파악하는 것이 매우 중요하다. 본 연구는 MMPI 프로파일을 통해 불면증 환자들에게서 나타나는 심리적 특성을 파악하고자 하였다. 이를 위해 다른 수면 장애를 동반하지 않은 불면증 환자군 31명, 불면증과 폐쇄성 수면 무호흡증을 모두 동반한 환자군 50명, 그리고 정상군 43명을 대상으로 수면다원검사, 주간 졸림증 척도(ESS), Beck 우울척도(BDI) 그리고 다면적 인성 검사(MMPI-2)를 실시하였다. 분석 결과, 불면증 환자군은 폐쇄성 수면 무호흡증의 유무와 상관없이 공통적으로 정상군보다 우울 수준은 더 높고 정신병리적 문제를 호소할 가능성이 더 큰 것으로 나타났다. 특히 다른 수면 장애를 동반하지 않은 불면증 환자군은 폐쇄성 수면 무호흡증을 동반한 불면증 환자군과 정상군보다 공격성 성향을 더 높게 보였으며. 정상군보다 사회적으로 내향적인 성향을 가질 가능성이 더 큰 것으로 밝혀졌다. 이러한 결과는 불면증 환자군의 심리적 특성이 수면 중 생리적 과각성으로 이어져 결과적으로 불면증의 취약요인으로 작용할 가능성이 있음을 시사한다. 본 연구는 이러한 요인들을 다루고 예측하여 불면증을 예방하고 치료적 개입을 설계하는데 도움이 될 수 있다는 점에서 의의가 있다.

This study aimed to identify psychological characteristics in insomnia patients with Minnesota Multiphasic Personality Inventory-2 (MMPI-2). All participants including insomnia patients without other sleep disorders (PPI), insomnia patients with Obstructive Sleep Apnea (OSA-I) and healthy controls (CON) underwent polysomnography and completed Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Insomnia patients with and without OSA had significantly higher scores on the depression scales and were more likely to report psychopathological symptoms compared to CON. PPI patients had a higher risk of developing psychotic features and also tend to be more introverted compared to CON. Additionally, Aggression differentiated PPI from OSA-I and CON. These findings suggest that psychological factors in insomnia patients may be linked to hyperarousal state and can be vulnerability to insomnia. Current study would be helpful to prevent and treat insomnia by considering psychological traits of insomnia patients.

Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders that can lead to serious consequences, including hypertension and/or cardiovascular diseases, if not treated promptly. Continuous positive airway pressure (CPAP) is widely recognized as the most effective treatment for OSA, which needs the proper titration of airway pressure to achieve the most effective treatment results. However, the process of CPAP titration can be time-consuming and cumbersome. There is a growing importance in predicting personalized CPAP pressure before CPAP treatment. The primary objective of this study was to optimize the CPAP titration process for obstructive sleep apnea patients through EEG feature engineering with machine learning techniques. We aimed to identify and utilize the most critical EEG features to forecast key OSA predictive indicators, ultimately facilitating more precise and personalized CPAP treatment strategies. Here, we analyzed 126 OSA patients' PSG datasets before and after the CPAP treatment. We extracted 29 EEG features to predict the features that have high importance on the OSA prediction index which are AHI and SpO2 by applying the Shapley Additive exPlanation (SHAP) method. Through extracted EEG features, we confirmed the six EEG features that had high importance in predicting AHI and SpO2 using XGBoost, Support Vector Machine regression, and Random Forest Regression. By utilizing the predictive capabilities of EEG- derived features for AHI and SpO2, we can better understand and evaluate the condition of patients undergoing CPAP treatment. The ability to predict these key indicators accurately provides more immediate insight into the patient’s sleep quality and potential disturbances. This not only ensures the efficiency of the diagnostic process but also provides more tailored and effective treatment approach. Consequently, the integration of EEG analysis into the sleep study protocol has the potential to revolutionize sleep diagnostics, offering a time-saving, and ultimately more effective evaluation for patients with sleep-related disorders.

건강을 유지하고 회복하기 위해서 편안한 수면을 하지 못하면 일상생활에 많은 지장을 초래하게 된다. 편안한 숙면을 방해하는 원인으로 코골이와 폐쇄성 수면무호흡증과 이갈이, 이 악물기, 구호흡 등으로 이를 해결하기 위한 구강내 장치중에 하악을 전방으로 이동시켜 안정화 시키는 장치는 수술적 요법과 양압기를 대체하는 요법으로 효과 를 나타내고 있다. 장치의 사용중에는 하악이 원래의 자리로 가려는 힘의 발생 때문에 스크류, 고무줄 등으로 고정시 키는 장치가 이용되고 있으며, 장치의 효과를 보기 위해서는 윗니와 아랫니를 물고 있어야 한다. 수면하는 동안 계속 다물로 있어야 하는 불편함을 해소하기 위하여 장치는 상악에만 제작하면서 key & key way의 구조의 형상으로 하 악 설측 embarasure에 수직적인 유도로를 만들어 접번운동은 허용하고 전방운동과 측방운동을 차단하는 기능으로 장치를 착용중에도 입을 벌릴 수 있고 수면중에 기도확장을 유도하여 수면무호흡을 해결하는 기능은 발휘하는 장치 의 개발에 관한 것이다.

If you are unable to get comfortable sleep to maintain and recover your health, it will cause a lot of disruption to your daily life. Among the intraoral devices used to resolve snoring, obstructive sleep apnea, bruxism, teeth clenching, and mouth breathing, which interfere with a comfortable sleep, devices that stabilize the lower jaw by moving it forward are a treatment that replaces surgical therapy and positive airway pressure. It is showing effect. During use of the device, a force is generated that causes the lower jaw to return to its original position, so a device that fixes it with screws, rubber bands, etc. is used. To see the effect of the device, you must bite your upper and lower teeth. In order to eliminate the inconvenience of having to stay closed while sleeping, the device is manufactured only in the upper jaw and creates a vertical guideway in the lingual embarasure of the lower jaw in the shape of a key & key way structure, allowing twisting movements and allowing forward and lateral movements. It is about the development of a device that has a blocking function that allows the mouth to be opened while wearing the device and has a function that solves sleep apnea by inducing airway expansion during sleep.

Background and Objectives Although studies of test-retest reliability of the standard polysomnographyhas been reported numerous times, studies of portable sleep devices have beenreported in very few cases to date. The purpose of this study is to investigate the test-retest reliabilityof level III devices, to examine the characteristics of patients with tendency of underestimationand to determine whether there are factors that can predict when retest is needed. Subjects and Method We enrolled 74 patients for this study from April 2014 to March2019. Two indicators were used to assess night to night variability. If the difference of apneahypopneaindex (AHI) score was less than 10 or there is no difference of severity of obstructivesleep apnea (OSA) between two nights, we decided that the results have a reliability. Results Seventeen out of 57 patients with an AHI difference of less than 10 showed unreliableresults based on severity, and 3 out of 17 patients with the AHI difference more than 10showed reliable results based on severity. Eight out of 74 patients were diagnosed at Night 2but not at Night 1. In other words, about 11% of the subjects needed retest. Based on thechange in severity of OSA, subjective sleep scores showed a statistically significant difference,indicating that the subjective sleep score should be considered when deciding a retest. AHI differed by more than 10 in about 23% of the subjects in this study, falling within “15%-32%,” which has been reported in the literature on the level I test. Conclusion This suggests that there is no significant difference in reliability between level Iand III.

Obstructive sleep apnea (OSA), most common respiratory disorder of sleep, is characterized by intermittent partial or complete occlusions of the upper airway due to loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxemia, which leads to poor quality of sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences. Untreated OSA may cause, or be associated with, several adverse outcomes, including daytime sleepiness, increased risk for motor vehicle accidents, cardiovascular disease, and depression. Various treatments are available, including non-surgical treatment such as medication or modification of life style, continuous positive airway pressure (CPAP) and oral appliance (OA). Skeletal surgery for obstructive sleep apnea (OSA) aims to provide more space for the soft tissue in the oropharynx to prevent airway collapse during sleep. Conventional surgical techniques include uvopalatopharyngoplasty(UPPP), genioglossus advancement (GA), and maxillomandibular advancement (MMA). Surgical techniques, efficacy and complications of skeletal surgery are introduced in this review.

Obstructive sleep apnea (OSA), most common respiratory disorder of sleep, is characterized by intermittent partial or complete occlusions of the upper airway due to loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxemia, which leads to poor quality of sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences Untreated OSAS can cause various problems such as hypertension, diabetes, stroke, cardiac disease, daytime sleepiness. Various treatments are available, including non-surgical treatment such as medication or modification of life style, surgical treatment, continuous positive airway pressure (CPAP) and oral appliance (OA). Oral appliance is known to be effective in mild to moderate OSA, also genioglossus muscle advancement (GA) or maxillomandibluar advancement (MMA) is a good option for OSA patients with muscular or skeletal problems. Although the prevalence of OSA is increasing, the proportion of the patient treated by dentist is still very law. Dentists need to understand the mechanism of OSA and develop abilities to treat OSA patients with dental problems. The purpose of this paper is to give a brief overview about OSA and the dentist's role in OSA patients.

Background and Purpose Discrepancies between objectively measured sleep and subjective sleep perception in patients with insomnia have been reported. However, few studies have investigated sleep-state misperception in patients with obstructive sleep apnea (OSA). We designed this study to 1) delineate the factors that could afect this discrepancy and 2) infer an underlying mechanism in patients with OSA. Methods We recruited patients who visited our sleep clinic for the evaluation of their snoring and/or observed OSA. Participants completed a structured questionnaire and underwent overnight polysomnography. On the following day, fve sessions of the multiple sleep latency test (MSLT) were applied. We divided the patients into two groups: normal sleep perception and abnormal perception. The abnormal-perception group included patients whose perceived total sleep time was less than 80% of that measured in polysomnography. Results Fify OSA patients were enrolled from a university hospital sleep clinic. Excessive daytime sleepiness, periodic limb movement index (PLMI), and the presence of dreaming were positively associated with poor sleep perception. REM sleep near the sleep termination exerted important efects. Respiratory disturbance parameters were not related to sleep perception. Tere was a prolongation in the sleep latency in the frst session of the MSLT and we suspected that a delayed sleep phase occurred in poor-sleep perceivers. Conclusions As an objectively good sleep does not match the subjective good-sleep perception in OSA, physicians should keep in mind that OSA patients who perceive that they have slept well does not mean that their OSA is less severe.

Objectives. To develop a simple algorithm for prescreening of obstructive sleep apnea (OSA) on the basis of respiratory sounds recorded during polysomnography during all sleep stages between sleep onset and offset. Methods. Patients who underwent attended, in-laboratory, full-night polysomnography were included. For all patients, audio recordings were performed with an air-conduction microphone during polysomnography. Analyses included all sleep stages (i.e., N1, N2, N3, rapid eye movement, and waking). After noise reduction preprocessing, data were segmented into 5-s windows and sound features were extracted. Prediction models were established and validated with 10-fold cross-validation by using simple logistic regression. Binary classifications were separately conducted for three different threshold criteria at apnea hypopnea index (AHI) of 5, 15, or 30. Prediction model characteristics, including accuracy, sensitivity, specificity, positive predictive value (precision), negative predictive value, and area under the curve (AUC) of the receiver operating characteristic were computed. Results. A total of 116 subjects were included; their mean age, body mass index, and AHI were 50.4 years, 25.5 kg/m2, and 23.0/hr, respectively. A total of 508 sound features were extracted from respiratory sounds recorded throughout sleep. Accuracies of binary classifiers at AHIs of 5, 15, and 30 were 82.7%, 84.4%, and 85.3%, respectively. Prediction performances for the classifiers at AHIs of 5, 15, and 30 were AUC, 0.83, 0.901, and 0.91; sensitivity, 87.5%, 81.6%, and 60%; and specificity, 67.8%, 87.5%, and 94.1%. Respective precision values of the classifiers were 89.5%, 87.5%, and 78.2% for AHIs of 5, 15, and 30. Conclusion. This study showed that our binary classifier predicted patients with AHI of ≥15 with sensitivity and specificity of >80% by using respiratory sounds during sleep. Since our prediction model included all sleep stage data, algorithms based on respiratory sounds may have a high value for prescreening OSA with mobile devices.

Objective This study aims to analyze how much heart rate variability (HRV) indices discriminatively respond to age and severity of sleep apnea in the obstructive sleep apnea syndrome (OSAS). Methodsaa176 male OSAS patients were classified into four groups according to their age and apnea-hypopnea index (AHI). The HRV indices were compared via analysis of covariance (ANCOVA). In particular, the partial correlation method was performed to identify the most statistically significant HRV indices in the time and frequency domains. Stepwise multiple linear regressions were further executed to examine the effects of age, AHI, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and sleep parameters on the significant HRV indices. ResultsaaThe partial correlation analysis yielded the NN50 count (defined as the number of adjacent R-wave to R-wave intervals differing by more than 50 ms) and low frequency/high frequency (LF/HF) ratio to be two most statistically significant HRV indices in both time and frequency domains. The two indices showed significant differences between the groups. The NN50 count was affected by age (p<0.001) and DBP (p=0.039), while the LF/HF ratio was affected by AHI (p<0.001), the amount of Stage 2 sleep (p=0.005), and age (p=0.021) in the order named in the regression analysis. ConclusionaaThe NN50 count more sensitively responded to age than to AHI, suggesting that the index is mainly associated with an age-related parasympathetic system. On the contrary, the LF/HF ratio responded to AHI more sensitively than to age, suggesting that it is mainly associated with a sympathetic tone likely reflecting the severity of sleep apnea.

Objectives. The relationships among positional obstructive sleep apnea (POSA), obstructive sleep apnea (OSA), and peri- odic limb movements during sleep (PLMS) remain unclear. We investigated these relationships with respect to the se- verity of OSA and explored the underlying mechanisms. Methods. We retrospectively reviewed 6,140 eligible participants who underwent full-night diagnostic polysomnography at four clinical centers over a 5-year period, utilizing event-synchronized analysis. We evaluated the periodic limb move- ment index (PLMI) and the periodic limb movement with arousal index (PLMAI). The impacts of POSA on the PLMI, PLMAI, and PLMS were analyzed in relation to the severity of OSA. Results. The mean PLMI, the mean PLMAI, and the prevalence of PLMS were significantly lower in participants with se- vere OSA compared to the mild and moderate OSA groups. The mean PLMI among those with mild OSA exceeded that of control participants. Furthermore, the mean PLMI (4.8±12.7 vs. 2.6±9.8 events/hr, P <0.001), the mean PLMAI (0.9±3.7 vs. 0.5±3.3 events/hr, P <0.001), and the prevalence of PLMS (11% vs. 5.3%, P <0.001) were higher in patients with POSA than in those with non-positional OSA. This PLMS finding was particularly pronounced among those with severe OSA (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.065?2.267) and was less evi- dent in the mild (OR, 0.559; 95% CI, 0.303?1.030) and moderate (OR, 1.822; 95% CI, 0.995?3.339) groups. Conclusion. Patients with POSA, especially those with severe OSA, exhibit a comparatively high prevalence of PLMS. In cases involving prominent PLMS, the diagnosis and treatment of POSA and OSA should be considered.