Diagnosis and Effect of Maxillary Expansion in Pediatric Sleep-Disordered Breathing / 대한소아치과학회지

The aim of this study was to analyze the changes and improvements in symptoms of sleep-disordered breathing (SDB) using semi-rapid maxillary expansion (SRME) in children with narrow maxilla and SDB symptoms. Subjects were 15 patients with sleep disorder (apnea-hypopnea index, AHI ≥ 1) and narrow maxillary arch between 7 and 9 years of age. Before the SRME was applied, all subjects underwent pediatric sleep questionnaires (PSQ), lateral cephalometry, and portable sleep monitoring before expansion (T0). All subjects were treated with SRME for 2 months, followed by maintenance for the next 3 months. All subjects had undergone PSQ, lateral cephalometry, and portable sleep monitoring after expansion (T1). Adenoidal-nasopharyngeal ratio (ANR), upper airway width and hyoid bone position were measured by lateral cephalometry. The data before and after SRME were statistically analyzed with frequency analysis and Wilcoxon signed rank test. As reported by PSQ, the total PSQ scale was declined significantly from 0.45 (T0) to 0.18 (T1) (p = 0.001). Particularly, snoring, breathing, and inattention hyperactivity were significantly improved (p = 0.001). ANR significantly decreased from 0.63 (T0) to 0.51 (T1) (p = 0.003). After maxillary expansion, only palatopharyngeal airway width was significantly increased (p = 0.035). There was no statistically significant difference in position of hyoid bone after expansion (p = 0.333). From analysis of portable sleep monitoring, changes in sleep characteristics showed a statistically significant decrease in AHI and ODI, and the lowest oxygen desaturation was significantly increased after SRME (p = 0.001, 0.004, 0.023).In conclusion, early diagnosis with questionnaires and portable sleep monitoring is important. Treatment using SRME will improve breathing of children with SDB.

Accuracy Analysis of Embletta X100 for the Diagnosis of Obstructive Sleep Apnea and the Assessment of Sleep Structure

BACKGROUND AND OBJECTIVES: To measure the accuracy of Embletta X100, a level 2 portable sleep monitoring device, for diagnosis of obstructive sleep apnea and assessment of sleep structure. MATERIALS AND METHOD: We enrolled 200 consecutive patients who had been referred due to habitual snoring or witnessed apnea during sleep and had undergone standard polysomnography (PSG). We created a simulated situation similar to that of the Embletta X100 using only data from PSG and scored the sleep stage and the apnea-hypopnea index (AHI). Thereafter, the results of PSG and simulated Embletta X100 were compared. RESULTS: Sensitivity, specificity, and positive and negative predictive values of simulated Embletta X100 based on PSG were nearly 100% at three different cutoff values of AHI (5, 15, and 30). Intraclass correlation (ICC) of simulated Embletta X100 based on PSG was also excellent (≥0.9) for most of the sleep-related parameters and respiratory index. However, ICC of sleep stage percent was variable according to sleep stage (>0.9 for N1 and N2, 0.664 for N3, and 0.864 for R). CONCLUSION: Although sleep staging is not very precise, Embletta X100 matches well with PSG overall.

The Clinical Efficacy of Portable Monitoring Devices(MESAM IV and Edentec) in Evaluating Sleep Apnea Syndrome: A Comparative Study with Simultaneously Recorded Standard Polysomnography / 대한이비인후과학회지

BACKGROUND: Standard polysomnography is generally used in the diagnosis of sleep apnea syndrome. However, this technique is laborious, costly and inconvenient as a screening test or a test for epidemiological study. A simple screening test for sleep apnea, administered at home, would provide physicians with a convenient and less costly means of evaluating possible sleep apnea. OBJECTIVES: The aim of this study was to evaluate the validity of portable sleep monitoring devices. The validity of measurements made by the portable sleep monitoring devices was assessed by comparing respiratory parameters obtained using the portable sleep monitoring devices with those obtained using standard polysomnography. MATERIALS AND METHOD: Eighteen patients were collected and divided into two groups. Direct comparison was made between data obtained by the portable monitoring devices(MESAM IV in group 1 and Edentec in group 2) and data simultaneously obtained by standard polysomnographic techniques. RESULTS: In group 1, oxygen desaturation index(ODI) and heart variation index(HVI) in MESAM IV were significantly correlated with apnea index(AI) and respiratory disturbance index(RDI) in standard polysomnography. In group 2, AI and RDI in Edentec were significantly correlated with those in standard polysomnography. CONCLUSIONS: The results of this study suggest that portable monitoring devices(MESAM IV and Edentec) may be useful in screening test of sleep apnea syndrome.