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睡眠時無呼吸症候群の患者数は年々増加傾向にある．また，肥満男性のみが罹患するという認識から，年代，性別や肥満度を問わず罹患する日常で遭遇する頻度の高い疾患として知られるようになった．睡眠は人生の約三割を占めているが，睡眠という行為自体が意識下では無いため症状を自覚するまでに時間を要する．そのため，多くの研究で診断の遅れや多数の未治療者が存在すると報告されている．平成30年の厚生労働省の社会医療診療行為別統計では，睡眠時無呼吸症候群の代表的な治療法であるCPAP療法の患者数は約44万人であったと報告されている．しかし，我が国の無呼吸低呼吸指数が15以上の推定患者数は900万人も存在するという報告もあり，診療体制の強化以外に，睡眠検査の従事者数増加，治療体制の強化，患者支援などを多職種で連携しチーム医療で行うことが必要である．, The incidence of sleep apnea syndrome is on the rise each year. The earlier perception that it affects only obese men has been replaced with the recognition that it is a widely prevalent disorder affecting people of all ages, genders, and body mass indices. Sleep comprises about 30% of our lifespan; however, most people are unaware of the symptoms of the disorder because sleep itself is not a self-conscious act. Therefore, several studies have reported delays in the diagnosis of sleep apnea, leading to a large population of untreated individuals. According to the Statistics of Medical Care Activities in Public Health Insurance published in 2018 by the Ministry of Health, Labour and Welfare, Japan, approximately 440,000 people received continuous positive airway pressure (CPAP) therapy, a typical treatment for sleep apnea syndrome. Another report estimated that as many as 9 million people have an apnea-hypopnea index of > 15 in Japan. Thus, in addition to strengthening the medical care system, it is necessary to increase the number of support staff for sleep testing, strengthen the treatment facilities, and provide patient care through multidisciplinary collaboration and team efforts.

The existing breathing assistance system for people who have sleep apnea syndrome requires air pump and air pressure sensor. CPAP (Continuous Positive Airway Pressure) is a well-known procedure for monitoring and assisting breath during the sleeping time. Based on the procedure in the CPAP, we develop a new breathing assistance system which employing a new piezoelectric device which can act as a small blower as well as an air pressure sensor. Validity of proposed breathing assistance system was examined and confirmed through preliminary experiments.

This paper proposes an evaluation index for the classification of severe Obstructive Sleep Apnea Syndrome (OSAS) by the use of the tongue morphology and the cross sectional area of the narrowest upper airway evaluated by image analysis on the upper airway MRI. In general, polysomnography (PSG) is a gold standard evaluation for severe SAS, but sometimes the symptoms do not occur during PSG screening because of the first night effect. The morphology of the upper airway, on the other hand, gives much information about the severity of OSAS. So, the upper airway MRI is often used for medical diagnosis, but few evaluation indices have been reported objectively. We focused on the tongue region and considered two directions from the center to the edge of the tongue higher correlated with the severity and determined the cross sectional area in the narrowest upper airway. These features are weighted and linearly combined to predict the severity. Finally, the severe patients are detected by judging whether the prediction value is greater than or equal to 30. As a result, the true positive rate is 0.909 and the false positive rate is 0.476 for detecting the severe patients.

Article, 信州医学雑誌 60(6): 357-364(2012)

The carotid artery intima-media thickness (IMT) measured by ultrasound has attracted attention as a significant predictor of cardiovascular events. An increase of IMT is found earlier in OSAS patients and these changes have been reported to be correlated with the severity of OSAS. This study was performed to clarify the effect of continuous positive airway pressure (CPAP) on the carotid IMT in SAS patients. Twenty-three consecutive male patients (group C; 56 ± 13 years, BMI of 29.9 ± 4.0kg/m^2, AHI of 35.9 ± 15.6/h) who had been newly diagnosed as suffering from SAS by polysomnography (PSG) at our hospital and were given adequate CPAP therapy were and enrolled, as well as 12 consecutive male patients who did not receive CPAP for various reasons (group N; 53 ± 16 years old, BMI of 28.8 ± 5.5kg/m^2, and AHI of 36.8 ± 17.0/h). Carotid artery ultrasonography was performed at the time of PSG and after 18 months of CPAP treatment. The changes of maxmum value of IMT (ΔmaxIMT) and mean value of IMT (ΔmeanIMT) between the two point were compared. There were no differences between the two groups with regard to meanlMT (group C, 0.881 ± 0.235; group N, 0.894 ± 0.086mm; NS) or maxIMT (group C, 1.1241 ± 0.491; group N, 1.070 ± 0.086mm; NS) at the time of PSG. However, it was found that both of ΔmeanIMT (group C, 0.011 ± 0.005; group N, 0.013 ± 0.005mm; p

SAS患者は日中の眠気や倦怠感などの疾患に起因する症状を紛らわすために睡眠にとって悪い習慣を取ってしまっている可能性が指摘されている。しかしSAS患者の生活実態は明らかになっていない。そこで本研究はSAS患者の生活習慣の実態を明らかにし、Apnea Hypopnea Index (AHI)、Epworth Sleepiness Scale (ESS)、Pittsburgh Sleep Quality Index (PSQI)、Body Mass Index(BMI)との関連を検討することを目的として行った。方法は質問紙およびAHIのデータをカルテより転載し、分析を行った。対象者は睡眠時無呼吸症候群と診断され治療前の方、56名を対象として行い、回収率は86%であった。AHI、ESS、PSQI、BMIと喫煙、飲酒、カフェインの摂取、睡眠時間などとの関連をみたところ、飲酒とBMIとの間に有意な関連がみられた。また喫煙とPSQIに有意な関連がみられ、睡眠の質が低いと評価している人ほど喫煙本数が多かった。睡眠時間とESSおよび希望睡眠時間と睡眠時間の差とESSの間に相関がみられ、SASによる睡眠障害だけでなく、睡眠時間の不足も問題である可能性があると考えられた。ベッドパートナーの有無が睡眠を阻害する因子になりうる可能性が示唆された。今回の対象者では治療開始前であったが、SASの治療の第一選択であるCPAP療法には家族のサポートも重要である。そのため今後ベッドパートナーの有無がCPAP療法にどのような影響を及ぼすのかについても検討していくことが重要であると考える。, It has been pointed out that Sleep Apnea Syndrome (SAS) patients may have adopted life-styles which are poor for their sleep in order to alleviate symptoms that originate in disorders such as sleepiness and fatigue during the day. However, there is no clear evidence of what kind of maladaptive life-styles have been adopted by SAS patients. This research was therefore conducted with the aim of revealing the life-styles of SAS patients, and exploring the relationships between those life-styles and their correlation with the Apnea Hypopnea Index (AHI) data, the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and the Body Mass Index (BMI). It was conducted on 56 pre-treated patients diagnosed with SAS via analysis of questionnaires and AHI data from their medical records. The response-rate was 86%. An analysis of the relationships between the data derived from AHI, ESS, PSQI, and BMI to smoking, alcohol consumption, caffeine intake and sleeping hours showed a significant relationship between alcohol consumption and BMI data. Furthermore, a significant relationship was evident between smoking and PSQI data, with those who evaluated their sleep quality as poor smoking the most. A correlation could also be seen between sleeping time and the ESS data, and the difference between desired hours of sleep and actual sleeping time and the ESS data, indicating that not only sleep disturbance was caused by SAS, but also the lack of sleep time could be a problem. In addition, it was also suggested that the existence of a bed partner could be one factor disturbing sleep. While the subjects of this research had not yet been treated, family support is important to CPAP treatment. For this reason, it will also be essential to study the effect of a bed partner on CPAP treatment in the future.

2002年12月～2003年11月の間の糖尿病教育入院で睡眠時無呼吸症候群（SAS）の合併が認められた５症例の臨床像について検討した．5例とも男性で，年齢46±4歳（Mean±SD），BMI35.3±4.9kg/m2と肥満があり，糖尿病発症は38±6歳と若年であった．4例に高血圧，全例に高脂血症，脂肪肝が合併していた．糖代謝関連検査では，HbA１C8.8±2.1％，FPG146±38mg/dl，IRI10.3±2.1μU/ml，HOMA-IR3.8±0.6，尿中CPR１３１±６３μg／日とインスリン抵抗性の存在を示していた．5例とも網膜症はなく，神経障害は2例，腎症は5例（早期腎症４例）に認められた．動脈硬化関連検査では，頸動脈IMT1.0±0.1mm，baPWV1,437±140cm／秒で，2例は心筋梗塞を若年発症（36，42歳）していた．Apnomonitor ではApnea Index45±25／時，最長Apnea９９±７１秒と全例でnasal CPAP の適応であった．以上，SAS を有する糖尿病では，肥満・インスリン抵抗性・高血圧・脂質代謝異常を若年時より高率に兼有し，早期から大血管障害が急速に進展することが示唆された．

We report on a 22 years old female patient who underwent orthodontic treatment after mandibular distraction osteogenesis. The mandibular distraction osteogenesis was used successfully to treat the patient's obstructive sleep apnea syndrome which was due to mandibular micrognathia. The orthodontic treatment was carried out to resolve the crowding of the front teeth that remained after the distraction osteogensis. Resolution of the crowding was achieved by the lateral expansion of the maxillary dental arch and the distal movement of the molar into the mandibular dental arch. No mandibular relapse was observe after the distraction osteogensis. The sleep apnea syndrome remained well controlled during the orthodontic treatment., 論文

We report on a 22 years old female patient who underwent orthodontic treatment after mandibular distraction osteogenesis. The mandibular distraction osteogenesis was used successfully to treat the patient's obstructive sleep apnea syndrome which was due to mandibular micrognathia. The orthodontic treatment was carried out to resolve the crowding of the front teeth that remained after the distraction osteogensis. Resolution of the crowding was achieved by the lateral expansion of the maxillary dental arch and the distal movement of the molar into the mandibular dental arch. No mandibular relapse was observe after the distraction osteogensis. The sleep apnea syndrome remained well controlled during the orthodontic treatment.

肥満においては睡眠時呼吸障害の合併が高率にみられる.睡眠障害および呼吸障害(低酸素血症,高炭酸ガス血症)の合併は覚醒水準の低下や認知機能障害をもたらしうる.肥満の治療は,睡眠時呼吸障害の発症やこれに基づく高次脳機能障害の発症を予防する上で重要である.重症の睡眠時無呼吸症候群を合併した肥満肺胞低換気症候群の1例における睡眠ポリグラフおよび事象関連電位の結果を提示し,肥満の神経生理学的側面について考察した., Sleep respiratory disorder is high frequency in morbidly obese patients and can develop cognitive dysfunction. A treatment of obesity is important to prevent coincidence of higher cortical dysfunction. I presented a case of obesity hypoventilation syndrome patient who accompanied severe sleep apnea syndrome and discussed results of polysomnography and event-related potential. I also reviewed literatures about neurophysiological aspects in obese patients.

睡眠時無呼吸症候群は肥満を伴うことはよく知られている。治療の第一選択肢は経鼻的持続気道陽圧療法であるが対症療法である。したがって、長年使用する必要がある。多くの日本の睡眠時無呼吸症候群患者は重症度が同程度にもかかわらず白色人種の睡眠時無呼吸症候群患者ほどの肥満ではない。それは、日本人では肥満に加えて顔面軸角(FX : facial axis)が睡眠時無呼吸症候群に影響されやすいための因子である可能性がある。すなわち、日本人の側頭蓋計測においては白色人種に比べて顔面軸角が狭いことが要因と考えられる。