수면 무호흡 및 코골이 환자의 탄성섬유 및 교원섬유 분포 이에 관련한 중요한 병인 기전으로는 흡기시에 발생하는 있다.4)5) 음압에 대해 인두강을 열린 채로 유지시키려는 힘의 균형에 외래나 수술방에서 이 환자들을 접해보면 인두 점막에 탄 장애가 있을 때 OS가 발생한다

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1 KISEP Rhinology Korean J Otolaryngol 2001;44: 폐쇄성수면무호흡및코골이환자에서구개수조직의탄성섬유및교원섬유의분포 전은주 1 최영철 1 박용수 1 정대건 1 박소영 1 박경신 2 임필규 1 이안희 2 Distribution of Elastic and ollagen Fiber in Uvular Tissue of Patients with Obstructive Sleep pnea and Snorers Eun-Ju Jeon, MD 1, Young-hul hoi, MD 1, Yong-Soo Park, MD 1, Dae-Gun Jeong, MD 1, So-Young Park, MD 1, Gyeong-Sin Park, MD 2, Phil-Kyu Lim, MD and nhi Lee, MD 2 1 Department of Otolaryngology-HNS and 2 linical Pathology, ollege of Medicine, The atholic University of Korea, Inchon, Korea STRT ackground and ObjectivesSleep related obstructive breathing disorders are frequently observed in adults. Despite extensive work of recent years, the essential pathophysiologic mechanism that mediates this process is still unclear. This study was conducted to determine whether distribution of connective tissue in the uvula is different among apneics, snorers and normal controls. Materials and MethodsUvula was obtained by uvulopalatopharyngoplasty in 8 apneics, 6 snorers mean apnea index17.1, 2.43 respectively and by autopsy in 5 individuals not known to have snoring. The surgical specimen of uvula was fixed in 10% formalin and subsequently embedded in paraffin. Each specimen was cut into 5 m-thick section and stained with hematoxylineosin for general appearance, Masson-Trichrome stain for collagen fiber, and Verhoeff stain for elastic fiber. Microscopic examination was performed by two pathologists who were blinded to the polysomnographic data. ResultsInfiltration of inflammatory cells and edema were significantly increased in the snorer and apneic groups compared with the control group p.0001, p.05 respectively. ompared with the normal group, the density of elastic fibers and collagen fibers were significantly decreased in snorers and apneics elastic fiberp.0005, collagen fiberp.01. The distribution of elastic and collagen fiber showed significantly heterogeneous pattern in the snorer and apneic groups compared with the control group elastic fiberp0.001, collagen fiberp onclusionsince connective tissue fibers have the supportive function in the body, this condition may result in increased collapsibility of upper airway and contributes to the development of obstructive sleep apnea. Korean J Otolaryngol 2001;44: KEY WORDSSnoring Sleep apnea Uvula ollagen Elastin. 265

수면 무호흡 및 코골이 환자의 탄성섬유 및 교원섬유 분포 이에 관련한 중요한 병인

4)5) 음압에 대해 인두강을 열린 채로 유지시키려는 힘의 균형에 외래나 수술방에서 이

력이 떨어져 있고 주름이 진 것을 관찰할 수 있는데 이와 환자는 상기도의

인두 단면적을 llapsibility)이 유의하게 증가되어 있는 것으로 밝혀진 바

The grading of infiltration of the inflammatory

normal, mild degree, moderate degree. Fig. 2.

2 수면 무호흡 및 코골이 환자의 탄성섬유 및 교원섬유 분포 이에 관련한 중요한 병인 기전으로는 흡기시에 발생하는 있다.4)5) 음압에 대해 인두강을 열린 채로 유지시키려는 힘의 균형에 외래나 수술방에서 이 환자들을 접해보면 인두 점막에 탄 장애가 있을 때 OS가 발생한다고 생각되고 있으며 OS 력이 떨어져 있고 주름이 진 것을 관찰할 수 있는데 이와 환자는 상기도의 콤플라이언스(compliance)나 함입성(co- 같은 변화는 상기도의 함입성을 증가시키고 인두 단면적을 llapsibility)이 유의하게 증가되어 있는 것으로 밝혀진 바 감소시키므로써 OS의 발생에 기여한다고 생각된다. 한편 Fig. 1. The grading of infiltration of the inflammatory cells in the uvular mucosa (H & E, 100). normal, mild degree, moderate degree. Fig. 2. The grading of edema in the uvular mucosa (H & E, 100). normal, mild degree, moderate degree. 266 Korean J Otolaryngol 2001 ;44 :265-71

The grading of density of collagen fiber

100). normal density, sli-ghtly decreased

3 전은주 외 Fig. 5. Inhomogenous distribution of collagen fiber in the uvula mucosa. lternate zone of dense area and loose area was shown in this photomicrograph (Masson-Trichrome, 40). Fig. 3. The grading of density of collagen fiber in the uvular mucosa (Masson-Trichrome, 100). normal density, sli-ghtly decreased density, moderately decreased density. Fig. 4. The grading of density of elastic fiber in the uvular mucosa (Verhoeff, 100). normal, slightly decreased density, moderately decreased density. Fig. 6. Inhomogenous distribution of elastic fiber in the uvula mucosa. lternate zone of dense area and loose area was shown in this photomicrograph (Verhoeff, 40). 267

4 Table 1. Patient characteristics pneics N8 Snorers N6 ge MF ody mass index kg/m Respiratory disturbance index pnea index Snoring sound d SaO2 % Table 2. The numbers of patients according to the grading of inflammation and edema Inflammation Edema ontrol Snorer pneics ontrol Snorer pneics Normal Mild degree Moderate degree Korean J Otolaryngol 2001;44:265-71

5 Table 3. The numbers of patients according to the grading of density of elastic and collagen fiber Elastic fiber ollagen fiber ontrol Snorer pneics ontrol Snorer pneics Normal Slightly decreased Moderately decreased Table 4. The numbers of patients according to the distribution pattern of elastic and collagen fiber Elastic fiber ollagen fiber ontrol Snorer pneics ontrol Snorer pneics Homogenous Slightly inhomogenous Moderately inhomogenous

6 270 REFERENES 1) Young T, Palta M, Dempsey J, Skatrud J, Weber S, adr S. The occurrence of sleep-disordered breathing among middleaged adults. N Eng J Med 1993;328: ) Hicks R, Lucero-Gorman K, hing P. Ethnicity, sex and snoring. Percept Mot Skills 1997;85: ) Ong K, lerk. omparison of the severity of sleep-disordered breathing in sian and aucasian patients seen at a sleep disorders center. Respir Med 1998;92: ) rown IG, radley TD, Phillipson E, Zamel N, Hoffstein V. Pharyngeal compliance in snoring subjects with and without obstructive sleep apnea. m Rev Respir Dis 1985;132: ) Strohl KP, Olson LG. oncerning the importance of pharyngeal muscles in the maintenance of upper airway patency during sleep. n Opinion hest 1987;92: ) Remmers JE, degroot WJ, Sauerland EK, nch M. Pathogenesis of upper airway occlusion during sleep. J ppl Physiol 1978;44: ) adr MS. Pathophysiology of upper airway obstruction during sleep. lin hest Med 1998;19: ) Edstrom L, Larsson H, Larsson L. Neurogenic effects on the palatopharyngeal muscle in patients with obstructive sleep apnoea: a muscle biopsy study. J Neurol Neurosurg Psychiatry 1992;55: ) Series F, ote, Simoneau J-, Gelinas Y, St. Pierre S, Leclerc J, et al. Physiologic, metabolic, and muscle fiber type characteristics of musculus uvulae in sleep apnea hypopnea syndrome and in snorers. J lin Invest 1995;95:20-5. Korean J Otolaryngol 2001;44:265-71

7 10) Van de Graaff W. Thoracic influence on upper airway patency. J ppl Physiol 1988;65: ) Wasicko MJ, Hutt D, Parisi R, Neubauer J, Mezrich R, Edelman NH. The role of vascular tone in the control of upper airway collapsibility. m Rev Respir Dis 1990;141: ) Van der Touw T, rawford, Wheatley JR. Effects of a synthetic lung surfactant on pharyngeal patency in awake human subjects. J ppl Physiol 1997;82: ) Shelton KE, Woodson H, Gay S, Suratt PM. Pharyngeal fat in obstructive sleep apnea. m Rer Respir Dis 1993;148: ) Friberg D, Gazelius, Hokfelt T, Nordlander. bnormal afferent nerve endings in the soft palatal mucosa of sleep apneics and habitual snorers. Regulatory Peptides 1997;71: ) adr MS, Toiber F, Skatrud J, Dempsey J. Pharyngeal narrowing/ occlusion during central sleep apnea. J ppl Physiol 1995;78: ) Fawcett DW. Textbook of histology. 10th ed. Philadelphia: W Saunders ompany;1986. p ) Stauffer JL, uick MK, ixler EO, Sharkey FE, bt, Manders EK, et al. Morphology of the uvula in obstructive sleep apnea. m Rev Respir Dis 1989;140: ) Woodson T, Garancis J, Toohill RJ. Histopathologic changes in snoring and obstructive sleep apnea syndrome. Laryngoscope 1991; 101: ) Sekosan M, Zakkar M, Wenig L, Olopade O, Rubistein I. Inflammation in the uvula mucosa of patient with obstructive sleep apnea. Laryngoscope 1996;106: ) Zohar Y, Schwartz, Sabo R, Gal R, Strauss M, Oksenberg. Oropharyngeal fatty infiltration in obstructive sleep apnea patients. histologic study. nn Otorhinol Laryngol 1998;107:

정상인수면단계와상기도변화 492 Fig. 1. The picture of EBT scanning on a patient under EEG monitoring. - - Korean J Otolaryngol 2003;46:491-5

정상인수면단계와상기도변화 492 Fig. 1. The picture of EBT scanning on a patient under EEG monitoring. - - Korean J Otolaryngol 2003;46:491-5 KISEP Rhinology Korean J Otolaryngol 2003;46:491-5 정상인의수면단계에따른상기도의변화 대구가톨릭대학교의과대학이비인후과학교실, 1 경북대학교의과대학진단방사선과학교실, 2 신경과학교실 3 예미경 1 신동원 1 신승헌 1 장형욱 1 이종민 2 박성파 3 Changes of Upper Airway According to the