이진우 선생님, 군자출판사와 제휴를 통해 책 내용 및 그림을 제공합니다.
무단 복제/배포 금지.
..The respiratory disturbance variation
i. Apnea : the cessation of airflow at the nose and mouth for 10 seconds or
ii. Hypopnea : a reduction in airflow at the nose and mouth
Fig 1. Abnormal airway during sleep. Multiple sites of obstruction often occur in patients with obstructive
sleep apnea. An elongated and enlarged soft palate impinges on the posterior airway at the level
of the nasopharynx and oral pharynx. In additon, a retruding jaw pushes an enlarged tongue
posteriorly to impinge on the hypopharyngeal space.
2. Excessive daytime sleepiness
ii. Abnormal motor activity : flail out, throw and may sit up or get out of bed.
iii. Nocturia (even enuresis)
Small or retruding jaw
iv. GERD symptoms : negative intrapleural pressures developed during obstructed
i. Excessive daytime sleepiness
ii. Cognitive impairement : correlates best with noctural hypoxemia
iii. Morning headache, nausea : resulting from nocturnal hypercapnia
▶ Many patients are not aware of their heavy snoring and nocturnal arousals,
therefore it is helpful to question the bedroom partner of a patient with
chronic sleepiness and fatigue.
..여성인 경우 snoring, excessive daytime sleepiness를 호소하는 남성에 비해
morning headache, depression, fatigue를 더 호소하는 경향이 있다.
▶ The snoring and apneic episodes may be worse after the patient drinks alcohol
or takes sleeping pills, because these sedatives decrease pharyngeal muscle tone
and can exacerbate obstructive sleep apnea.
1. Polysomnography : 총 검사 시간은 6시간으로 만일 최소 검사 시간인 2시간 검사결과
가 OSA진단기준에 부합된다면, 통상적으로 CPAP titration-a split night study를 시행하
▶ 6시간의 야간 수면 중에 1시간 동안 5회 이상의 폐쇄성 무호흡이나 저호흡이 발생하면
A suggested self-administered screening questionnaire may be helpful at primary care
The Root of ambulatory care
If you snore excessively and have any of the additional problems listed
below, you may have sleep apnea. Please consider discussing a sleep
evaluation with your doctor.
1. Do you snore loudly? Yes/No
2. Does your bedroom partner complain about your snoring? Yes/No
3. Does your snoring wake you up at night? Yes/No
4. Do you or your bedroom partner notice that you make gasping and choking
noises during sleep? Yes/No
5. Do you have a dry mouth, sore throat or headache in the morning?
6. Do you often fall asleep during the daytime when you want to stay awake?
7. Are you often tired during the day? Yes/No
8. Do you have high blood pressure? Yes/No
Fig 2. A suggested self-administered questionnaire for use in the diagnosis of obstructive sleep apnea.
Fig 3. Prevalence of obstructive sleep apnea (OSA) in patients with cardiovascular and cerebrovascular
..Depression, mood changes, poor memory, irritability, impaired concentration,
nocturnal panic attacks also associated with sleep apnea.
The Root of ambulatory care
1. Abstaining from the use of alcohol and sedatives
2. Avoiding the supine position
3. Weight loss : A modest (10~20%) weight loss has also been shown to reduce the
Respiratory Disturbance Index (RDI) by as much as 50% in some individuals.
4. CPAP (Continuous positive airway pressure) : In general, heavier patients with
thicker necks require higher pressure settings.
5. Surgery (Uvulopalatopharyngoplasty, Laser-assisted uvulopalatoplasty) : often
effective in elimination snoring but not necessarily curative for obstructive sleep apnea,
because areas of the airway other than the soft palate also collapse in most patients
with this sleep disorder.
6. Tongue-retaining devices/bite guards
i. Sneezing and rhinorrhea : reduced by steroid nasal sprays
ii. Dry mucus membranes : reduced by humidification
iii. Dermal irritation : reduced by changing the mask size or trying a different kind of
..현재까지 밝혀진 효과적인 약물요법은 없다.
Lyle D. Victor, M.D., M.B.A. : Treatment of Obstructive Sleep Apnea in Primary Care.A journal of the
American Family Physicains 2004 ; 69(3) : 561-568, 572-574
Lee K. Brown : Sleep Apnea, in Saunders Manual of Medical Practice, 2nd ed,Robert E. Rakel(ed).
Philadelphia, Saunders, 2000, P 270-272
최환석 : 수면 무호흡, in 가정의학 임상편. 서울, 계측문화사, 2002, P 844-849
Charles A. Polnitsky, M.D. : Obstructive Sleep Apnea, in Conn's Current Therapy 2004, Robert
E.Rakel(ed), Edward T. Bope(ed). hiladelphia, Saunders, 2004, P 239-243
Lyle D. Victor, M.D. : Obstructive Sleep Apnea. A journal of the American Family Physicains 1999 ;
60(8) : 2279-2286