Development of the Korean Version of the Sleep Apnea Quality of Life Index

OBJECTIVES: Obstructive sleep apnea (OSA) is a disorder characterized by repetitive partial or complete occlusion of the upper airway during sleep that affects quality of life. The aim of this study was to develop the Korean version of the sleep apnea quality of life index (K-SAQLI) and apply it in Korean patients with OSA. METHODS: Ninety-three patients with OSA completed the K-SAQLI. Its construct validity and responsiveness were tested by comparing the baseline and change scores obtained in each domain (i.e., daily functioning, social interactions, emotional functioning, and symptoms) using the medical outcome survey-short form 36 (SF-36). RESULTS: The Cronbach alpha coefficients of internal reliability exceeded 0.60 in all the domains (daily functioning, 0.89; social interactions, 0.88; emotional functioning, 0.92; symptoms, 0.67; and total, 0.94). The K-SAQLI had a high test-retest correlation coefficient of 0.73 in the 20 randomized selected patients. The construct validity was confirmed by significant correlations with SF-36 subscale scores. CONCLUSION: The results of this study demonstrate that the K-SAQLI may be applicable for clinical purposes.

Comparison of Upper Airway Morphology between Position-Dependent Sleep Apnea Patients and Position-Independent Sleep Apnea Patients

BACKGROUND AND OBJECTIVES: The aim of this study is to compare polysomnography (PSG) data and upper airway morphology between a position-dependent sleep apnea (PDSA) group and a position-independent sleep apnea (PISA) group. MATERIALS AND METHODS: This is a retrospective analysis into which 58 patients who were evaluated with overnight polysomnography, lateral cephalometry, and multidetector computed tomography (MD-CT, spiral CT scan) to diagnosis obstructive sleep apnea were enrolled. The patients were divided in two groups: the PDSA group who had a supine apnea-hypopnea index (AHI) that was at least two times higher than the non-supine AHI and the PISA group in whom the AHI in the supine position was less than twice that in the lateral position. Twelve cephalometric variables were measured. MD-CT measurements were evaluated in four neck levels from the hard palate to the top of the epiglottis. Minimal cross-sectional area (mCSA) and collapsibility index (CI) were calculated at each level. RESULTS: AHI was significantly higher in the PISA compared with PDSA. None of the cephalomeric measurements were significantly different between the two groups. In the MD-CT measurements, the mCSA of the low retropalate area (LRP) in the awake state was significantly lower in the PISA group compared to that in the PDSA group. In the sleep state, the CI was significantly higher in the high and low retroglossal areas (HRG and LRG) in the PISA compared to those in the PDSA group. CONCLUSION: In the supine position, PISA had increased collapsibility at the levels of the HRG and LRG during sleep compared to those in PDSA. In the future, a further evaluation with MD-CT in a non-supine position is needed.

Gene Expression Analysis in Nasal Polyp Using Microarray / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A nasal polyp is a chronic inflammatory disease that affects 1~4% of the general adult population. It is characterized by edematous inflamed mucosa prolapsing into the nose, leading to nasal obstruction, abnormal secretions, loss of smell, headache, and a reduced quality of life. We sought to screen for diseases related genes in nasal polyp by using DNA microarray and to validate the altered expression of selected genes. SUBJECTS AND METHOD: The samples were obtained from nine patients with nasal polyps and two patients with pituitary adenoma. DNA microarrays containing 22,063 genes were used to compare individual gene profiles of nasal polyp samples and normal mucosal samples. A study of mRNA expression of selected genes was performed using RT-PCR. RESULTS: 126 genes were up-regulated at least 2-fold, and 161 genes were down-regulated at least 50% in nasal polyps compared with the normal sinus mucosa. The three most up-regulated genes (STATH, TCN1, DMBT1) and one most down-regulated gene (SCGB1A1) were retested by means of RT-PCR. RT-PCR confirmed the differential expressions of all the genes in nasal polyp compared with normal sinus mucosa. CONCLUSION: This study could provide a clue for investigating possible pathophysiologic processes involved in nasal polyps.

The Effect of Septoturbinoplasty for Quality of Life in Patients with Sleep-Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal obstruction is common in patients with sleep disordered breathing (SDB). Polysomnography (PSG) is a standard diagnositc tool for sleep disorders, but it can not evaluate the quality of life (QOL). We tried to assess the efficacy of the septoturbinoplasty on patients with SDB and nasal obstruction by using self reported measures that have been known as a tool for evaluating the general and disease specific QOL. SUBJECTS AND METHOD: Thirty-five patients who had snoring and sleep apnea confirmed by PSG and symptomatic nasal obstruction caused by deviated nasal septum were enrolled. All patients underwent septoturbinoplasty to improve nasal obstruction. QOL was assessed before and 2 months after surgery. Medical Outcome Study Short Form 36 (SF-36) and Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Stanford Sleepiness Scale (SSS), Insomnia Severity Index (ISI), Beck Depression Inventory (K-BDI), Nasal Obstruction Symptom Evaluation (NOSE) scale were included in the measures. A statistical analysis was performed using a paired t-test. RESULTS: Snoring sound level, PSQI, ESS, ISI, and NOSE were improved significantly (p0.05). CONCLUSION: QOL in patients with SDB and nasal obstruction was improved by nasal surgery. Different kinds of self-reported measures could be more informative as they can provide pre and post treatment results with respect to psychosomatic effects in patients with SDB.

A Case of Cervical Thoracic Duct Cyst / 대한이비인후과학회지

Cysts of thoracic duct are uncommon. The most commonly involved site is the thoracic segment of the thoracic duct followed by the abdominal and cervical segments of the thoracic duct. To date, about 15 cases of cervical thoracic duct cysts have been described in the literature. Information regarding the natural history of these cysts and their pathogenesis is limited. The primary symptom and sign are generally a palpable soft left supraclavicular swelling. We report a case of cervical thoracic duct cyst with a review of literature.

Clinical Review of Chronic Otitis Media in Patients with Contracted Mastoid / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High resolution computed tomography (HRCT) helps locating the anatomical structure within the temporal bone preoperatively. Contracted mastoid has lots of changed anatomical structure and outside in technique tympanomastoidectomy procedure cannot provide safe and effective access. The aims of this study are to analyze changed anatomical structure and to suggest safer and more effective surgical procedures in chronic otitis media patients with contracted mastoid. SUBJECTS AND METHOD: We measured distances between important surgical landmarks and cross sectional area of pneumatized air cells in contracted mastoid, and compared with normal groups. We analyzed postoperative complications between outside in technique and inside out technique tympanomastoidectomy. RESULTS: The shortest distance between the posterior wall of external auditory canal and the anterior edge of the sigmoid sinus, the vertical shortest distance between the superior wall of external auditory canal and the tegmen, and the cross-sectional area of mastoid air cells were significantly small in contracted mastoid group (p<0.05). There were 2 cases of postoperative facial weakness by outside in technique tympanomastoidectomy. CONCLUSION: Contracted mastoid has lots of changed anatomical structure. We suggest that inside out technique tympanomastoidectomy procedure is safer and more effective in patients with contracted mastoid.

The Effects of Hypertonic Saline Irrigation on Nasal Mucus Secretion in Patient with Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various saline solution formulae for nasal irrigation have been used frequently in patients with rhinosinusitis. However, there are not enough scientific evidences supporting the effect of irrigation of the nose with saline solution. We investigated the effects of saline irrigation on mucus secretion, subjective symptoms, and nasal cavity air-space volume changes in patients with rhinosinusitis. SUBJECTS AND METHOD: The nasal cavities of patients with rhinosinusitis were washed with 0.9%, 3%, and 6% of saline solutions consecutively with about 10 minute intervals. Lavage fluids were collected from the ipsilateral sides to determine the concentrations of mucin and lysozyme. Patients recorded subjective symptoms and each patient's nasal cavity air-space volume was assessed by acoustic rhinometry after each irrigations. RESULTS: The sensation of rhinorrhea, pain, and nasal blockage were increased as the concentration of saline increased. The concentrations of mucin increased with the increasing concentration of saline solution. However, the concentration of lysozyme decreased with the increase in the concentration of saline solution. Futhermore, hypertonic saline solution (6%) decreased the air-space volume significantly. CONCLUSION: The saline solution induces mucin secretion but not lysozyme secretion in patients with chronic rhinosinusitis. These changes in the secretion pattern may change the physical properties of mucus. The hypertonic saline solution may increase the edema of nasal cavity and decrease air-space vol

Effects of the Body Position Changes on Upper Airway Caliber in Obstructive Sleep Apnea during Sleep / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is the intermittent cessation of breathing during sleep due to the collapse of the pharyngeal airway. Pharyngeal collapsibility and oropharyngeal caliber are affected by the respiratory cycle and the body position. Several methods have been used to evaluate the states of upper airway in patients with OSA according to body positions during wakefulness, but there were no reports about the upper airway states according to body positions during sleep. The aim of this study is to evaluate the states of upper airway in patients with OSA according to body position changes during sleep. MATERIALS AND METHOD: Using a multi detector CT, we studied 10 patients with OSA. Each patient was scanned at supine position during the awake state and then induced to sleep using Midazolam. According to body positions (supine, decubitus, and prone), images were acquired during sleep state. The following 4 transverse levels were obtained to evaluate the minimal cross sectional area, collapsibility index, and airway volume: 1) high retropalate level, 2) low retropalate level, 3) high retroglossal level, 4) low retroglossal level. RESULTS: During sleep, the upper airway cross sectional area was decreased and the airway wall collapsibility was increased. Cross sectional area and airway volume were larger at prone and decubitus positions than supine position. Airway wall collapsibility index was lower at prone and decubitus positions than at the supine position. CONCLUSION: In this study, we confirm that the upper airway collapsibility decreases and the airway caliber increases according to body position changes (prone, decubitus) during sleep. Furthermore, the decubitus position is better than the prone position for improving upper airway patency during sleep.