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

Size: px

Start display at page:

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

민영 탁
7 years ago
Views:

1 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 Sleep Stage in Normal Subjects Mi Kyung Ye, MD 1, Dong Won Shin, MD 1, Seung Heon Shin, MD 1, Hyung Wook Chang, MD 1, Jong Min Lee, MD 2 and Sung Pa Park, MD 3 1 Department of Otolaryngology, College of Medicine, Catholic University of Daegu, Daegu; and 2 Department of Diagnostic Radiology and 3 Department of Neurology, College of Medicine, Kyungpook National University, Daegu, Korea ABSTRACT Background and Objectives:Sleep has five different periods manifested by changes in the EEG activity and certain behavioral correlates. It has been proposed that the upper airway mechanics would be influenced by sleep stage. Although several methods have been used to evaluate the regions over which the upper airway collapses during sleep, there were seldom reports about the changes of upper airway according to the sleep stage. The present study was conducted to determine the effect of sleep stage on the upper airway dynamics. Materials and Method:Using electron beam, we studied ten normal subjects who did not have any sleep-disordered breathing. Each patient being monitored with EEG was scanned while sleeping naturally. The images were acquired during light sleep, deep sleep and REM sleep during at least two full respiratory cycles. Results:Upper airway collapse was increased with the progression of sleep, but the level of stenosis was relatively constant throughout the sleep. Sleep stage had differential effects on the upper airway size depending on the investigated site. Conclusion:Our data suggest that upper airway mechanics are influenced by each sleep stage. This would indicate that the study of either point of sleep or either site of airway in isolation may not allow a proper insight on the overall upper airway pathophysiology. (Korean J Otolaryngol 2003;46:491-5) KEY WORDS:Sleep stages Airway obstruction Diagnostic imaging. 491

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

3 예미경외 Table 1. Comparison of cross sectional areas and collapsibility of upper airway according to the sleep stage Stage 2 Slow-wave REM p-value* MVol mm p0.05 MCSA mm p0.05 Overall CI % p0.05 CI of mcsa % p0.05 RP-CSA mm p0.05 RG-CSA mm p0.05 by one-way ANOVA with repeated measures. mvolmean value of minimal oropharyngeal volumes in each patient, mcsamean value of smallest minimal cross-sectional areas in each patient, Overall CI mean value of overall average collapsibility indices of the oropharyngx, CI of mcsamean value of the collapsibility indices at smallest minimal crosssectional areas, RP-CSAmean value of minimal cross sectional areas in retropalatal region, RG-CSAmean value of minimal cross sectional areas in the retroglossal region Estimated Marginal Means of minimal CSA mm Stage 2 Slow wave REM Sleep stages Retropalatal Retroglossal Fig. 2. Comparison of mean values of minimal cross sectional areas between retropalatal and retroglossal regions according to the sleep stage. 493

4 정상인수면단계와상기도변화 REFERENCES 1) Rhee CS, Min YG. Obstructive sleep apnea syndrome. In: Min YG, editors. Clinical Rhinology. 1st ed. Seoul: Ilchokak;1997. p ) Rowley JA, Sanders CS, Zahn BR, Badr MS. Effect of REM sleep on retroglossal cross-sectional area and compliance in normal subjects. J Appl Physiol 2001;91: ) Ye MK, Kim CG, Shin SH, Lee SH, Lee JM, Choi JK. Dynamic Upper Airway Study in Snoring Subjects using Electron Beam Tomography. Korean J Otolaryngol 2003;46: ) Shepard JW Jr, Thawley SE. Localization of upper airway collapse during sleep in patients with obstructive sleep apnea. Am Rev Respir Dis 1990;141: ) Rowley JA, Zahn BR, Babcock MA, Badr MS. The effect of rapid eye movement (REM) sleep on upper airway mechanics in normal human subjects. J Physiol 1998;510: ) Sauerland EK, Harper RM. The human tongue during sleep: electromyographic activity of the genioglossus muscle. Exp Neurol 1976; 51: Korean J Otolaryngol 2003;46:491-5

5 예미경외 7) Sauerland EK, Orr WC, Hairston LE. DMG patterns of oropharyngeal muscles during respiration in wakefulness and sleep. Electromyogr Clin Neurophysiol 1981;21: ) Tangel DJ, Mezzanotte WS, White DP. Influence of sleep on tensor palatini EMG and upper airway resistance in normal men. J Appl Physiol 1991;70: ) Tangel DJ, Mezzanotte WS, White DP. Influences of NREM sleep on activity of palatoglossus and levator palatini muscles in normal men. J Appl Physiol 1995;78: ) Series F, Cote C, Simoneau JA, Gelinas Y, St Pierre S, Leclerc J, et al. Physiologic, metabolic, and muscle fiber type charac-teristics of musculus uvulae in sleep apnea hypopnea syndrome and in snorers. J Clin Invest 1995;95: ) Series F, Cote C, St Pierre S. Dysfunctional mechanical coupling of upper airway tissues in sleep apnea syndrome. Am J Respir Crit Care Med 1999;159: ) Rowley JA, Permutt S, Willey S, Smith PL, Schwartz AR. Effect of tracheal and tongue displacement on upper airway airflow dynamics. J Appl Physiol 1996;80: ) Kitabatake A, Suga H. Diastolic stress-strain relation of nonexcised blood-perfused canine papillary muscle. Am J Physiol 1978;234: H ) Shea SA, Edwards JK, White DP. Effect of wake-sleep transitions and rapid eye movement sleep on pharyngeal muscle response to negative pressure in humans. J Physiol 1999;520: ) Leiter JC, Knuth SL, Bartlett D Jr. The effect of sleep deprivation on activity of the genioglossus muscle. Am Rev Respir Dis 1985;132: ) Series F, Roy N, Marc I. Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med 1994;150:

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar