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
정상인수면단계와상기도변화 492 Fig. 1. The picture of EBT scanning on a patient under EEG monitoring. - - Korean J Otolaryngol 2003;46:491-5
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 3 7647 5220 4224 p0.05 MCSA mm 2 26.3 18.3 13.0 p0.05 Overall CI % 48.9 60.7 64.5 p0.05 CI of mcsa % 75.6 80.7 85.7 p0.05 RP-CSA mm 2 59.1 46.8 46.3 p0.05 RG-CSA mm 2 116.8 74.4 55.6 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 2 140 120 100 80 60 40 20 0 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
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