睡眠呼吸障害における夜間血圧への影響
睡眠呼吸障害における夜間血圧への影響を知るために, 65名の患者に終夜モニター及び夜間連続血圧測定を施行した. さらに31名に手術加療を施行し, 術前後の比較を行った. 重症度は, AHI, 低酸素暴露時間 (Desaturation Time: DT), 及び血圧変動値 (BP change) について判定を行った. 術前の検討において, DTと血圧変動との間に有意な相関を認め, 夜間血圧への影響を推測するのに有効であると思われた. 手術加療による改善率50%以上の割合 (有効率) はAHI 19/31 (61.3%) で, DT・BP changeはそれぞれ21/31 (67.7%), 1...
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| Published in | 日本耳鼻咽喉科学会会報 Vol. 100; no. 6; pp. 678 - 684 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本耳鼻咽喉科学会
1997
日本耳鼻咽喉科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0030-6622 1883-0854 |
| DOI | 10.3950/jibiinkoka.100.678 |
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| Abstract | 睡眠呼吸障害における夜間血圧への影響を知るために, 65名の患者に終夜モニター及び夜間連続血圧測定を施行した. さらに31名に手術加療を施行し, 術前後の比較を行った. 重症度は, AHI, 低酸素暴露時間 (Desaturation Time: DT), 及び血圧変動値 (BP change) について判定を行った. 術前の検討において, DTと血圧変動との間に有意な相関を認め, 夜間血圧への影響を推測するのに有効であると思われた. 手術加療による改善率50%以上の割合 (有効率) はAHI 19/31 (61.3%) で, DT・BP changeはそれぞれ21/31 (67.7%), 14/31 (45.2%) であった. 術前の重症度判定においてAHI≧50, DT≧40%のものがそれぞれ10例, 18例あり, さらにBP change≧40mmHgのものは19例認められた. これらが術後には, それぞれ1, 5, 2例となり, 他はすべて満足のいく効果が得られ, 手術加療による効果が認められた. |
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| AbstractList | 睡眠呼吸障害における夜間血圧への影響を知るために, 65名の患者に終夜モニター及び夜間連続血圧測定を施行した. さらに31名に手術加療を施行し, 術前後の比較を行った. 重症度は, AHI, 低酸素暴露時間 (Desaturation Time: DT), 及び血圧変動値 (BP change) について判定を行った. 術前の検討において, DTと血圧変動との間に有意な相関を認め, 夜間血圧への影響を推測するのに有効であると思われた. 手術加療による改善率50%以上の割合 (有効率) はAHI 19/31 (61.3%) で, DT・BP changeはそれぞれ21/31 (67.7%), 14/31 (45.2%) であった. 術前の重症度判定においてAHI≧50, DT≧40%のものがそれぞれ10例, 18例あり, さらにBP change≧40mmHgのものは19例認められた. これらが術後には, それぞれ1, 5, 2例となり, 他はすべて満足のいく効果が得られ, 手術加療による効果が認められた. |
| Author | 森島, 夏樹 西村, 忠郎 柴田, 修宏 長谷川, 清一 |
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| DOI | 10.3950/jibiinkoka.100.678 |
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| References | 16) Robert DB: Continuous, real-time, noninvasive monitor of blood pressure: Penaz methodology applied to the finger. J Clin Monit 3: 282-287, 1987. 38) Michael BJ, Colin ES: Ventilation and Arousal Responses to Hypercapnea in Normal Sleeping Humans. The American Physiological Society: 59-67, 1984. 29) Shiomi T, Guilleminault C, Maekawa M, Nakamura A, Yamada K: Flow velocity paradoxus and pulsus paradoxus in obstructive sleep apnea syndrome. Chest 103: 1629-1631, 1993. 26) Coccagna G, Mantovani M, Brignani F, Manzini A, Lugaresi E: Arterial pressure changes during spontaneous sleep in man. Electroenceph clin Neurophysiol 31: 277-281, 1971. 27) Virend KS, Mark ED, Allyn LM, Francois MA: Sympathetic-nerve Activity During Sleep in Normal Subjects. N Engl J Med 328: 303-307, 1993. 41) 塩見利明, 篠邉龍二郎, 小林正: 閉塞性睡眠時無呼吸の治療前後における循環動態の比較. 日気食会報47: 79-83, 1996. 3) 塩見利明, 小林正, 新井太, 野村博彦, 水谷浩也, 他: 睡眠ポリグラフイによる異型狭心症の検討. 心臓19: 819-827, 1987. 15) 塩見利明, 小林正: 高血圧の原因としての睡眠呼吸障害. Annual Review呼吸器1994, 中外医学社: 1-7頁, 1994. 28) Shimizu T, Takahashi Y, Suzuki K, Kogawa S, Tashiro T,: Muscle Nerve Sympathetic Activity During Sleep and its Change with Arousal Response. J Sleep Res 1: 178-185, 1991. 14) 宇野芳史, 斎藤龍介, 金谷真: 閉塞型睡眠時無呼吸症候群に対する手術療法. 耳鼻臨85: 943-950, 1992. 31) Neil JD, David PW, John VW, Cheryl KP, Richard JM,: Hypoxic Ventilatory Response Decreases During Sleep in Normal Men. Am Rev Respir Dis 125: 286-289, 1982. 7) Guilleminault C, Stuart JC, Roger AW: Cardiac Arrythmia and Conduction Disturbances During Sleep In 400 Patients with Sleep Apnea Syndrome. Am J Cadiol 52: 490-494, 1983. 37) Michael BJ, Colin ES: Ventilation and Arousal Responses to Hypoxia in Sleeping Humans. Am Rev Respir Dis 125: 632-639, 1982. 8) Guilleminault C, Tilkian A, Dement DC: The Sleep Apnea Syndromes. Annu Rev Med 27: 465-484, 1976. 30) Shiomi T, Guilleminault C, Stoohs R, Schnittger I: Leftward shift of the interventricular septum and pulsus paradoxus in obstructive sleep apnea syndrome. Chest 100: 894-902, 1991. 35) Eloise H, James WW, Jay Block A, Loulie MF: Sleep-disordered breathing and oxygen desaturation in obese patients. Chest 79: 256-260, 1981. 19) Coccagna G, Mantovani M, Brignani F, Parchi C, Lugaresi E: Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing. Bull Physio-path 8: 1159-1172, 1972. 24) Davies RJO, Belt PJ, Roberts SJ, Ali NJ, Stradling JR: Arterial blood pressure responses to graded transient arousal from sleep in normal humans. The American Physiological Society: 1123-1130, 1993. 2) Douglas BT, Ruth R, Ronald FG, Frank L, Noe Z,: Role of daytime Hypoxemia in the Pathogenesis of Right Heart failure in the Obstructive Sleep Apnea Syndrome. Am Rev Respir Dis 131: 835-839, 1985. 13) 佐藤公則, 光増高夫, 平野実, 小鳥居, 坂本哲郎, 他: 閉塞型睡眠時無呼吸症候群に対する手術治療. 耳鼻臨83: 897-903, 1990. 40) Ali NJ, Davies RJO, Fleetham JA, Stradling JR: The acute effects of continuous positive airway pressure and oxygen administration on blood pressure during obstructive sleep apnea. Chest 101: 1526-1532, 1992. 43) 西村忠郎: 睡眠時無呼吸症候群への手術的治療の適応. 治療学2: 195-199, 1996. 11) 山川浩治, 戸川清, 宮崎総一郎, 板坂芳明, 多田裕之: 閉塞性睡眠時呼吸障害およびいびき症の治療とその選択基準. JOHNS 7: 925-932, 1991. 22) Ali NJ, Davies RJO, Fleetham JA, Stradling JR: Periodic movements of the legs during sleep associated with rises in systemic blood pressure. Sleep 14: 163-165, 1991. 34) James BJ, Stephen CW, Larry JF, Paul MS: Oxyhemoglobin saturation during sleep in subjects with and without the obesity-hypoventilation syndrome. Chest 88: 9-15, 1985. 1) Markku K, Jaakko K, Tiina T, Markku P, Kauko H,: Snoring as a risk factor for ischemic heart disease and stroke in men. Br Md J 294: 16-19, 1987. 9) Wynne JW, JayBlock A, Hunt LA, Flick MR: Disorded breathing and oxygen desaturation during sleep in patients with chronic obstructive lung disease. Am J Med 66: 573, 1979. 12) 朝倉光司, 中野勇治, 新谷朋子, 松田史郎, 秋田信人, 他: 成人の睡眠時無呼吸症候群に対するUPPPの治療効果. 日耳鼻会報93: 1241-1249, 1990. 18) Ben PM, Jos JS, Anton HM, Karel HW, Wouter W: Non-invasive continuous finger blood pressure measurement during orthostatic stress compared intraarterial pressure. Cardiovasc Res 24: 214-221, 1990. 32) Neil JD, David PW, John VW, Cheryl KP, Clifford WZ: Hypercapneic Ventilatory Response in Sleeping Adults. Am Rev Respir Dis 126: 758-762, 1982. 23) Shimizu T, Kogawa S, Tashiro T, Sato Yo, Sato Ya,: Mechanism of Transient Marked Elevasion of Arterial Blood Pressure in Patients with Sleep Apnea Syndrome. Sleep 90: 182-184, 1990. 20) Jack R, Robert CB, Richard S, Richard S, Harold M,: Hypoxemia alone does not explain blood pressure elevations after obstructive apneas. The American Physiological Society: 2143-2148, 1990. 6) John WS: Hypertension, Cardiac Arrythmias, Myocardial Infarction, and stroke in Relation to Obstructive Sleep Apnea. Clin Chest Med 3: 437-458, 1992. 25) Harley SS, Peter S, George WP: Reflex regulation of arterial pressure during sleep in mam. Circulation Res 24: 109-121, 1969. 4) 大井元晴, 陳和夫, 久野建志: 突然死の原因としての睡眠時呼吸・循環障害. Mebio 11: 42-47, 1994. 36) John WS, Michael WG, Debra AG, Gerald FD: Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest 88: 335-340, 1985. 42) Eugene CF, Richard DB, Michael SL, Arnold BG: Undiagnosed sleep apnea in patients with essential hypertension. Ann intern med 103: 190-195, 1985. 33) Jay Block A, Philip GB, James WW, Lynn AH: Sleep apnea, hypopnea and oxygen desaturation in normal subjects. N Engl J Med 300: 513-517, 1979. 10) 久野健志: 睡眠時呼吸・循環障害の確定診断とその基準. Mebio 11: 63-67, 1994. 17) Gianfranco P, Roberto C, Antonella G, Marco DR, Giusappe M: Comparison of finger and intraarterial blood pressure monitoring at rest and during laboratory testing. Hypertension 13: 647-655, 1989. 39) Ray Dolly F, Jay Block A: Effect of flurazepam on sleep-disordered breathing and nocturnal oxygen desaturation in asymptomatic subjects. Am J Med 73: 239-243, 1982. 21) Joost GA, John MK: Repetitive apneas induce periodic hypertension in normal subjects through hypoxia. The American Physiological Society: 821-827, 1992. 5) Victor H, Charles KC, Arthur SS: Sleep apnea and systemic hypertension: A causal association review. Am J Med 91: 190-196, 1991. |
| References_xml | – reference: 27) Virend KS, Mark ED, Allyn LM, Francois MA: Sympathetic-nerve Activity During Sleep in Normal Subjects. N Engl J Med 328: 303-307, 1993. – reference: 9) Wynne JW, JayBlock A, Hunt LA, Flick MR: Disorded breathing and oxygen desaturation during sleep in patients with chronic obstructive lung disease. Am J Med 66: 573, 1979. – reference: 24) Davies RJO, Belt PJ, Roberts SJ, Ali NJ, Stradling JR: Arterial blood pressure responses to graded transient arousal from sleep in normal humans. The American Physiological Society: 1123-1130, 1993. – reference: 43) 西村忠郎: 睡眠時無呼吸症候群への手術的治療の適応. 治療学2: 195-199, 1996. – reference: 7) Guilleminault C, Stuart JC, Roger AW: Cardiac Arrythmia and Conduction Disturbances During Sleep In 400 Patients with Sleep Apnea Syndrome. Am J Cadiol 52: 490-494, 1983. – reference: 31) Neil JD, David PW, John VW, Cheryl KP, Richard JM,: Hypoxic Ventilatory Response Decreases During Sleep in Normal Men. Am Rev Respir Dis 125: 286-289, 1982. – reference: 19) Coccagna G, Mantovani M, Brignani F, Parchi C, Lugaresi E: Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing. Bull Physio-path 8: 1159-1172, 1972. – reference: 23) Shimizu T, Kogawa S, Tashiro T, Sato Yo, Sato Ya,: Mechanism of Transient Marked Elevasion of Arterial Blood Pressure in Patients with Sleep Apnea Syndrome. Sleep 90: 182-184, 1990. – reference: 38) Michael BJ, Colin ES: Ventilation and Arousal Responses to Hypercapnea in Normal Sleeping Humans. The American Physiological Society: 59-67, 1984. – reference: 10) 久野健志: 睡眠時呼吸・循環障害の確定診断とその基準. Mebio 11: 63-67, 1994. – reference: 25) Harley SS, Peter S, George WP: Reflex regulation of arterial pressure during sleep in mam. Circulation Res 24: 109-121, 1969. – reference: 37) Michael BJ, Colin ES: Ventilation and Arousal Responses to Hypoxia in Sleeping Humans. Am Rev Respir Dis 125: 632-639, 1982. – reference: 3) 塩見利明, 小林正, 新井太, 野村博彦, 水谷浩也, 他: 睡眠ポリグラフイによる異型狭心症の検討. 心臓19: 819-827, 1987. – reference: 42) Eugene CF, Richard DB, Michael SL, Arnold BG: Undiagnosed sleep apnea in patients with essential hypertension. Ann intern med 103: 190-195, 1985. – reference: 4) 大井元晴, 陳和夫, 久野建志: 突然死の原因としての睡眠時呼吸・循環障害. Mebio 11: 42-47, 1994. – reference: 36) John WS, Michael WG, Debra AG, Gerald FD: Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest 88: 335-340, 1985. – reference: 21) Joost GA, John MK: Repetitive apneas induce periodic hypertension in normal subjects through hypoxia. The American Physiological Society: 821-827, 1992. – reference: 17) Gianfranco P, Roberto C, Antonella G, Marco DR, Giusappe M: Comparison of finger and intraarterial blood pressure monitoring at rest and during laboratory testing. Hypertension 13: 647-655, 1989. – reference: 22) Ali NJ, Davies RJO, Fleetham JA, Stradling JR: Periodic movements of the legs during sleep associated with rises in systemic blood pressure. Sleep 14: 163-165, 1991. – reference: 18) Ben PM, Jos JS, Anton HM, Karel HW, Wouter W: Non-invasive continuous finger blood pressure measurement during orthostatic stress compared intraarterial pressure. Cardiovasc Res 24: 214-221, 1990. – reference: 33) Jay Block A, Philip GB, James WW, Lynn AH: Sleep apnea, hypopnea and oxygen desaturation in normal subjects. N Engl J Med 300: 513-517, 1979. – reference: 40) Ali NJ, Davies RJO, Fleetham JA, Stradling JR: The acute effects of continuous positive airway pressure and oxygen administration on blood pressure during obstructive sleep apnea. Chest 101: 1526-1532, 1992. – reference: 1) Markku K, Jaakko K, Tiina T, Markku P, Kauko H,: Snoring as a risk factor for ischemic heart disease and stroke in men. Br Md J 294: 16-19, 1987. – reference: 20) Jack R, Robert CB, Richard S, Richard S, Harold M,: Hypoxemia alone does not explain blood pressure elevations after obstructive apneas. The American Physiological Society: 2143-2148, 1990. – reference: 32) Neil JD, David PW, John VW, Cheryl KP, Clifford WZ: Hypercapneic Ventilatory Response in Sleeping Adults. Am Rev Respir Dis 126: 758-762, 1982. – reference: 6) John WS: Hypertension, Cardiac Arrythmias, Myocardial Infarction, and stroke in Relation to Obstructive Sleep Apnea. Clin Chest Med 3: 437-458, 1992. – reference: 13) 佐藤公則, 光増高夫, 平野実, 小鳥居, 坂本哲郎, 他: 閉塞型睡眠時無呼吸症候群に対する手術治療. 耳鼻臨83: 897-903, 1990. – reference: 16) Robert DB: Continuous, real-time, noninvasive monitor of blood pressure: Penaz methodology applied to the finger. J Clin Monit 3: 282-287, 1987. – reference: 29) Shiomi T, Guilleminault C, Maekawa M, Nakamura A, Yamada K: Flow velocity paradoxus and pulsus paradoxus in obstructive sleep apnea syndrome. Chest 103: 1629-1631, 1993. – reference: 34) James BJ, Stephen CW, Larry JF, Paul MS: Oxyhemoglobin saturation during sleep in subjects with and without the obesity-hypoventilation syndrome. Chest 88: 9-15, 1985. – reference: 35) Eloise H, James WW, Jay Block A, Loulie MF: Sleep-disordered breathing and oxygen desaturation in obese patients. Chest 79: 256-260, 1981. – reference: 28) Shimizu T, Takahashi Y, Suzuki K, Kogawa S, Tashiro T,: Muscle Nerve Sympathetic Activity During Sleep and its Change with Arousal Response. J Sleep Res 1: 178-185, 1991. – reference: 2) Douglas BT, Ruth R, Ronald FG, Frank L, Noe Z,: Role of daytime Hypoxemia in the Pathogenesis of Right Heart failure in the Obstructive Sleep Apnea Syndrome. Am Rev Respir Dis 131: 835-839, 1985. – reference: 12) 朝倉光司, 中野勇治, 新谷朋子, 松田史郎, 秋田信人, 他: 成人の睡眠時無呼吸症候群に対するUPPPの治療効果. 日耳鼻会報93: 1241-1249, 1990. – reference: 11) 山川浩治, 戸川清, 宮崎総一郎, 板坂芳明, 多田裕之: 閉塞性睡眠時呼吸障害およびいびき症の治療とその選択基準. JOHNS 7: 925-932, 1991. – reference: 15) 塩見利明, 小林正: 高血圧の原因としての睡眠呼吸障害. Annual Review呼吸器1994, 中外医学社: 1-7頁, 1994. – reference: 39) Ray Dolly F, Jay Block A: Effect of flurazepam on sleep-disordered breathing and nocturnal oxygen desaturation in asymptomatic subjects. Am J Med 73: 239-243, 1982. – reference: 14) 宇野芳史, 斎藤龍介, 金谷真: 閉塞型睡眠時無呼吸症候群に対する手術療法. 耳鼻臨85: 943-950, 1992. – reference: 26) Coccagna G, Mantovani M, Brignani F, Manzini A, Lugaresi E: Arterial pressure changes during spontaneous sleep in man. Electroenceph clin Neurophysiol 31: 277-281, 1971. – reference: 5) Victor H, Charles KC, Arthur SS: Sleep apnea and systemic hypertension: A causal association review. Am J Med 91: 190-196, 1991. – reference: 41) 塩見利明, 篠邉龍二郎, 小林正: 閉塞性睡眠時無呼吸の治療前後における循環動態の比較. 日気食会報47: 79-83, 1996. – reference: 8) Guilleminault C, Tilkian A, Dement DC: The Sleep Apnea Syndromes. Annu Rev Med 27: 465-484, 1976. – reference: 30) Shiomi T, Guilleminault C, Stoohs R, Schnittger I: Leftward shift of the interventricular septum and pulsus paradoxus in obstructive sleep apnea syndrome. Chest 100: 894-902, 1991. |
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| Snippet | 睡眠呼吸障害における夜間血圧への影響を知るために, 65名の患者に終夜モニター及び夜間連続血圧測定を施行した. さらに31名に手術加療を施行し, 術前後の比較を行った. 重症度は, AHI, 低酸素暴露時間 (Desaturation Time: DT), 及び血圧変動値 (BP change)... 睡眠呼吸障害における夜間血圧への影響を知るために, 65名の患者に終夜モニター及び夜間連続血圧測定を施行した. さらに31名に手術加療を施行し, 術前後の比較を行った. 重症度は, AHI, 低酸素暴露時間(Desaturation Time: DT), 及び血圧変動値(BP change)について判定を行った.... |
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| SubjectTerms | 低酸素暴露時間 夜間血圧 手術的治療 睡眠呼吸障害 |
| Title | 睡眠呼吸障害における夜間血圧への影響 |
| URI | https://www.jstage.jst.go.jp/article/jibiinkoka1947/100/6/100_6_678/_article/-char/ja http://mol.medicalonline.jp/library/journal/download?GoodsID=dz0jibik/1997/010006/004&name=0678-0684j |
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| ispartofPNX | 日本耳鼻咽喉科学会会報, 1997/06/20, Vol.100(6), pp.678-684 |
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