Seung Hoon Lee

Objectives. Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that is strongly influenced by obesity, the most important modifiable risk factor. Effective weight management is therefore essential for optimal OSA care. This guideline provides updated, evidence-based recommendations for the evaluation and management of obesity in adults with OSA, incorporating recent advances in lifestyle, pharmacologic, and surgical interventions.Methods. The Korean Society of Sleep and Breathing convened a multidisciplinary panel. A systematic literature search was performed across major databases through 2025. Evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and recommendations were formulated by consensus using the Evidence-to-Decision framework.Results. Eight statements were developed. Key recommendations include recognizing obesity as a major risk factor; routinely assessing overweight and obesity; and implementing structured weight reduction through diet, exercise, and behavioral therapy. Glucagon-like peptide-1 receptor agonists are recommended when lifestyle interventions are insufficient, and bariatric/metabolic surgery is advised for severe obesity unresponsive to nonsurgical treatment. Weight loss improves the apnea-hypopnea index, symptoms, and cardiometabolic markers and may reduce positive airway pressure needs. Continued follow-up is recommended even after clinical improvement.Conclusion. Weight management is a core component of OSA treatment. This guideline offers practical, evidence-based strategies to support clinicians in delivering effective, obesity-focused care for adults with OSA.

Background and Objectives: In June 2018, South Korea expanded insurance coverage for polysomnography (PSG) to improve diagnostic access for obstructive sleep apnea (OSA). This study investigated the impact of this policy by analyzing changes in PSG utilization and diagnostic outcomes.Methods: A multicenter retrospective study was conducted using data from 17 tertiary hospitals across South Korea. Patients aged ≥20 years who visited the hospitals for suspected OSA between 2015 and 2023 were included. The pre-coverage period was defined as 2015–2017, and the post-coverage period as 2019–2023. Demographics, PSG implementation rates, and apnea-hypopnea index (AHI) distributions were compared.Results: A total of 29,055 patients were included (7,800 pre-coverage; 21,255 post-coverage). PSG utilization significantly increased from 51.3% to 74.4% (p<0.001). The proportion of female patients rose from 20.0% to 23.0%, and the mean age increased from 45.8 to 49.8 years (p<0.001). The average AHI increased from 31.2 to 35.3. The proportion of patients with severe OSA (AHI ≥30) rose from 42.8% to 48.8%, while cases with normal AHI (<5) declined from 11.6% to 8.3% (p<0.001).Conclusion: The expansion of insurance coverage significantly improved PSG accessibility, particularly for older adults, women, and high-risk patients. The observed shift toward more severe diagnoses suggests enhanced detection of untreated OSA rather than overdiagnosis of mild or normal cases. These findings support the ongoing implementation of inclusive health policies while emphasizing the importance of appropriate patient selection.

Background and Objective This study aimed to assess the effectiveness of acoustic pharyngometry by examining the data before and after adenotonsillectomy in children with sleepdisordered breathing (SDB).Methods This prospective, observational study included 29 children (M/F = 17/12, age = 8.69 ± 2.52 years) with SDB who underwent acoustic pharyngometry before and after adenotonsillectomy. Pre- and postoperative acoustic pharyngometry data, such as the oropharyngeal junction area (OPJ), pharyngeal volume (Vp), glottic area (GL), maximal pharyngeal cross-sectional area (Apmax), minimal pharyngeal cross-sectional area (Apmin), and mean pharyngeal cross-sectional area (Apmean), were compared.Results Before surgery, Apmean was measured at 1.75 ± 0.81 cm2 and increased to 2.24 ± 0.89 cm2 after surgery (p < 0.001); this difference was statistically significant. Moreover, OPJ demonstrated statistically significant changes from 1.03 ± 0.62 cm2 to 1.53 ± 0.77 cm2 (p < 0.001); Apmin measured from 0.99 ± 0.51 cm2 to 1.38 ± 0.69 cm2 (p = 0.003); and Vp increased from 14.45 ± 7.05 cm3 to 18.89 ± 7.72 cm3 (p < 0.001) after surgical treatment.Conclusions Acoustic pharyngometry, a non-invasive and reproducible method, effectively reflects upper airway changes before and after adenotonsillectomy in children with SDB and ATH. This underscores its potential as a valuable tool for objectively evaluating upper airway obstruction caused by ATH in children.

Jeon BJ, et al. J Korean Med Sci. 2024 Aug;39:e259. https://doi.org/10.3346/jkms.2024.39.e259

Chronic rhinosinusitis (CRS) is an inflammation of the nasal and paranasal sinus mucosa, and eosinophilic CRS (eCRS) is a subtype characterized by significant eosinophil infiltration and immune response by T-helper-2 cells. The pathogenesis of eCRS is heterogeneous and involves various environmental and host factors. Proteases from external sources, such as mites, fungi, and bacteria, have been implicated in inducing type 2 inflammatory reactions. The balance between these proteases and endogenous protease inhibitors (EPIs) is considered important, and their imbalance can potentially lead to type 2 inflammatory reactions, such as eCRS. In this review, we discuss various mechanisms by which exogenous proteases influence eCRS and highlight the emerging role of endogenous protease inhibitors in eCRS pathogenesis.

Objective This study aimed to evaluate the association between obstructive sleep apnea (OSA) and humoral immunity to varicella zoster virus (VZV). Methods This retrospective cohort study included patients who underwent polysomnography and concurrently agreed for blood collection between January 2018 and February 2021. Habitual snorers and patients with severe obstructive sleep apnea were evaluated to compare the VZV immunoglobulin G (IgG) antibody titer between habitual snorer group and OSA group. Correlation between VZV IgG antibody titer and various sleep related respiratory parameters were also evaluated. Results We found that the VZV IgG antibody titer of the habitual snorer group (n = 60) was significantly higher than that of the severe OSA group (n = 54) (244.1 ± 80.9 and 163.09 ± 48.39, respectively. Data are presented as mean ± standard deviation, P < 0.001). According to Spearman’s correlation analysis, the VZV IgG antibody titer was moderately negatively correlated with apnea hypopnea index (r = -0.477, P < 0.001), apnea index (r = -0.496, P < 0.001), hypopnea index (r = -0.398, P < 0.001), respiratory disturbance index (r = -0.467, P < 0.001), arousal index (r = -0.467, P < 0.001) and oxygen desaturation index (r = -0.475, P < 0.001). Minimal oxygen saturation was moderately positively correlated with VZV IgG antibody titer (r = 0.474, P < 0.001). Conclusion Humoral immunity to VZV is significantly reduced in patients with severe OSA, and VZV IgG antibody titer was inversely correlated with respiratory events during sleep.

The aim of this study was to evaluate the association between obstructive sleep apnea and morning headache and to assess the improvement of morning headache following positive airway pressure therapy. One hundred and sixteen participants were enrolled in this study; all of them received positive airway pressure therapy for at least 3 months. We checked the differences in various sleep apnea-related parameters according to the presence of morning headache and evaluated the improvement of morning headache following positive airway pressure therapy. Among the 116 study participants, 103 were men, with a mean age and body mass index of 50.34 ± 10.23 years and 28.00 ± 4.21 kg/m², respectively. The severity of morning headache was higher in the severe obstructive sleep apnea group than in the mild to moderate group (2.16 ± 1.70 vs. 1.50 ± 1.57, P = 0.027). However, the various polysomnographic parameters did not significantly differ according to the presence of headache. The Epworth sleepiness scale score was significantly higher in the morning headache presence group than in the absence group (10.90 ± 5.45 vs. 8.13 ± 4.27, P = 0.003). Furthermore, a notable correlation was observed between the reduction in daytime sleepiness and the improvement in morning headache following PAP treatment (r = 0.503, P < 0.001). Morning headache significantly improved following positive airway pressure therapy (prevalence: 53.4–16.4%; severity: 1.92 ± 1.67 vs. 0.86 ± 0.80, all P < 0.001), especially in the patients with morning headache before positive airway pressure therapy. Morning headache is significantly associated with daytime sleepiness and positive airway pressure therapy improves morning headache.

Background and Objectives The aim of this study was to identify the frequency of indicators of National Health Insurance (NHI) coverage for positive airway pressure (PAP) therapy and to investigate the changes in patients receiving coverage for PAP therapy after the alterations were made in the insurance benefit standards for mild obstructive sleep apnea (OSA).Subjects and Method We divided the mild OSA patients into two groups according to altered categorization in insurance benefit standards (Mild1: 5≤AHI<10; Mild2: 10≤AHI<15). Eight indicators related to the NHI coverage were identified: four symptoms, three complications, and the minimal blood oxygen saturation during polysomnography (min SpO2) of ≤85% during polysomnography. We also investigated the change in the number of patients receiving insurance benefits under the altered insurance benefit standards.Results Of the 233 OSA patients, 66, 57, and 110 patients were diagnosed as mild, moderate and severe OSA, respectively. For all of them, the most common indicator related to NHI coverage for PAP therapy was the minimum SpO2 of less than 85% during polysomnography, and the second most common indicator was daytime sleepiness. In the mild OSA group, however, daytime sleepiness was found to be the most common indicator, found in 46 (70%) patients, followed by 38 (58%) patients with min SpO2 of less than 85%. In this group, 59 (89.4%) would have been benefited before the change in the insurance benefit standards whereas 51 patients (77.3%) would now be benefited under the changed insurance benefit standards.Conclusion Daytime sleepiness was the most commonly observed indicator in the mild OSA patients. The number of patients receiving insurance benefits for PAP therapy significantly decreased after the change was made in the NHI benefit standards for mild OSA

Background and Objectives The aim of this study was to evaluate the effect of sleep position and nasal cavity dimension according to minimal cross-sectional area (MCA) on the severity of obstructive sleep apnea (OSA).Subjects and Method This study enrolled 528 consecutive patients who completed overnight polysomnography (PSG) and acoustic rhinometry. Positional sleep time and apnea-hypopnea index (AHI) were compared between the right and left lateral sleep positions (RLSP vs. LLSP), and between the wide and narrow lateral side sleep position (WLSP vs. NLSP) according to MCA.Results The sleep time was longer for LSP than for WLSP (20.35%±19.69% and 15.92%±16.35%, respectively) with a statistically significant difference (p=0.001). However, the AHI was not significantly different between the two groups. The sleep time was longer for RLSP than for LLSP (20.65%±19.31% and 15.39%±16.05%, respectively) with a statistically significant difference (p<0.001). In the RLSP-dominant group, there were fewer left nasal cavity narrowed patients than right nasal cavity narrowed patients (91 vs. 129, respectively). Furthermore, in the LLSP-dominant group, there were fewer right nasal cavity narrowed patients than left nasal cavity narrowed patients (60 vs. 85, respectively, p=0.001). However, we found that the AHI value was not significantly different according to sleep posture and nasal cavity dimension.Conclusion Snoring patients preferred RLSP to LLSP, and preferred to sleep on the lateral side of the narrow nasal cavity. The OSA severity was not different according to sleep position and nasal cavity dimension.