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2 小 児 の睡眠呼吸 障害の特徴 に関す る研究 図1 耳展 50: 3 終夜 ポ リグラ フ検 査 会 認 定 技 師 に よ る 終 夜 監 視 の も と検 査 を 行 っ た 機 器 はAlice4:(Respironics (Sensormedics care Co.Ltd),Somnostar Co.Ltd),Sandman(Tycho Co.Ltd)お health- よ びPolymate(Degetech の デ ジ タ ル ポ リ グ ラ フ を 用 い,脳 O1,O2),眼 球 運 動:EOG,顎 下 肢 筋 電 図:Leg Nasal&oral sure),胸 α Co.Ltd) 波:EEG(C3,C4, 筋 電 図:chin EMG,心 電 図:ECG,口 Airflow(thermisterお 腹 部 運 動:Chest EMG, 鼻 換 気: よ びnasal and Abdominal presmove- ment(straingage,inductance plethysmography), 動 脈 血 酸 素 飽 和 度:SaO2,さ ら に 同 意 が と れ た54 例 に は 先 端 カ テ ー テ ル 型 圧 トラ ン ス デ ュ ー サ ー 食 道 内 圧 計(TK技 ン プ(GMS 研Co.Ltd,Miller Co.Ltd)を Co.Ltd)と 携 帯 ア 用 い た 食 道 内 圧 変 動,こ ら を 同 時 に モ ニ タ ー し,同 時 に 映 像,音 れ 声 監 視,バ イ タ ル サ イ ン お よ び 行 動 異 常 等 の 観 察 シ ー トの 記 録 を 行 っ た(図1) 図2 睡 眠 段 階 判 定 はR&K8)の 醒 反 応 は1992年 に,呼 (2呼 国 際 交基 準 に,脳 のASDAの ス コ ア リ ン グ ル ー ル9) 吸 イ ベ ン ト はICSD2の 吸 以 上)お 頭 部X線 規格 写 真(側 貌) 波上 覚 よ びAASMの 小 児 の ク ラ イ テ リ ア6) 成 人 のResearch defi- い てCyclic alternating pattern(以 に つ い てTerazanoのCAPス 下CAPと コ ア リ ン グ ア トラ ス11) nition 10)に 従 い 視 察 で 判 定 し た 食 道 内 圧 変 動 測 定 に 従 い,CAP解 析 ソ フ ト(の か ら は 呼 吸 パ タ ー ン 分 類 を 行 い,さ ム ズCo.Ltd)を 用 い 自 動 解 析 を行 っ た あ っ た22例 らに解析 可 能 で に は 食 道 内 圧 解 析 ソ フ ト(の い と シ ス テ ム ズCo.Ltd)を 評 価 を 試 み た ま た,解 るぶ ろ ら 用 い努 力 性 呼 吸 の定 量 析 可 能 で あ っ た55例 に つ 2) 頭 部X線 略 す)11) 規 格 写 真(側 る ぷ ろ らい と シ ス テ 貌)に よ る顎 顔 面 形 態分析 頭 部X線 規 格 写 真(側 貌)を 撮 影 し(図2),解 (143) 15
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13 7) American Academy of Sleep Medicine : International Classification of Sleep Disorders, second edition : Diagnostic and Coding Manual, American Academy of Sleep Medicine, One Westbrook Corporate Center, Suite 920, Westchester, IL, 200, 30 `40. 8) Rechtscaffen A, Kales A : Manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles, brain information service/brain research instutute, University of California at Los Angeles, ) American Sleep Disorders Association : EEG arousals : scoring rules and examples : a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15 : 174 `184, ) Kushida CA, Littner MR, Morgenthaler T : Practice parameters for the indications for polysomnography and related procedures : an update for Sleep 28 : , ) Terzano MG, Parrino L, Smerieri A, Chervin R, Chokroverty S, et al : Atlas, rules, and recording techniques for the scoring of cyclic alternating pattern (CAP) in human sleep. Sleep Med 2 : 537 `553, Black J, et al : Upper airway sleep disordered 05/h0508-1a.html#top 2) Irwin M, Mascovich A, G1lin JC, Willoughby R, Pike J, et al : Partial sleep deprivation reduces natural killer cell activity in humans. Psychosma Med 56 : 493 `498, ) Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, et al : Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 165 : 863 `867, ) Suka M, Yoshida K, Sugimori H : Persistent insomnia is predictor of hypertension in Japanese male worker. J Occup Health 45 : 344 `350, ) Brouillette RT, Fernbach SK, Hunt CE : Obstructive sleep apnea in infants and children. J Pediatr 100 : 31 `40, ) Gozal D, Pope DW Jr : Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics 107 : 1394 `1399, ) Guilleminault C, Stoohs R, Kim YD, Chervin R, breathing in women. Ann Intern Med 122 : 493 `501, ) Guilleminault C, Bashi A : Clinical features and evaluation of obstructive sleep apnea hypopnea syndrome and upper airway resistance syndrome : Principles and practice of sleep medicine : Kreyger MH, Roth T, Dement WC : Elisevier Saunders, Philadelphia, 2005, 1047 ` ) Katz ES, Marcus CL : Diagnosis of obstrictive sleep apnea syndrome in infants and children : Principles and practice of pediatric sleep medicine, Sheldon SH, Ferber R, Kryger MH : Elseviere Saunders, Philadelphia, 2005, 197 ` ) Guilleminault C, Poyares D, Palombini L, Koester U, Pelin Z, et al : Variability of respiratory effort in relationship with sleep stages in normal controls and upper airway resistance syndrome patients. Sleep Med 2 : , ) Bruni O, Ferri R, Miano S, Verrillo E, Vittori E, et al : Sleep cyclic alternating pattern in normal preschool-aged children. Sleep 28 : 220 `230, 26 (154)
14 ) Nezu H, Nagata K, Yoshida Y, Kosaka H, Kikuchi M : Cephalometric comparison of clinical norms between the Japanese and Caucasians. Nippon Kyosei Shika Gakkai Zasshi 41 : 450 ` 465, Respir Dis 146 : 1231 `1234, ) Guilleminault C, Li K, Khramtsov A, Palombini L, Pelayo R : Breathing patterns in prepubertal children with sleep-related breathing disorders. Arch Pediatr Adolesc Med 158 : 153 `161, ) Arens R, Marcus CL : Pathophysiology of upper airway obstruction : a developmental perspective. Sleep 27 : 997 `1019, ) Frank Y, Kravath RE, Pollak CP, Weitzman ED : Obstructive sleep apnea and its therapy : clinical and polysomnographic manifestations. Pediatrics 71 : 737 `742, ) Guilleminault C, Tilkian A, Dement WC : The sleep apnea syndromes. Annu Rev Med 27 : 465 `484, ) Guilleminault C, Eldridge FL, Simmons FB, Dement WC : Sleep apnea in eight children. Pediatrics 58 : 23 `30, ) Clinical practice guideline : diagnosis and management of childhood obstructive sleep apnea syndrome : Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics Pediatrics 109 : 704 `712, ) Owen GO, Canter RJ, Robinson A : Snoring, apnoea and ENT symptoms in the paediatric community. Clin Otolaryngol Allied Sci 21 : 130 ` 134, ) Ali NJ, Pitson DJ, Stradling JR : Snoring, sleep disturbance, and behaviour in 4-5 year olds. Arch Dis Child 68 : 360 `366, ) Gislason T, Benediktsdottir B : Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence. Chest 107 : 963 `966, ) Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, et al : Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med 159 : 1527 `1532, ) Guilleminault C, Pelayo R, Leger D, Clerk A, Bocian RC : Recognition of sleep-disordered breathing in children. Pediatrics 98 : 871 `882, ) Rosen CL, D' Andrea L, Haddad GG : Adult criteria for obstructive sleep apnea do not identify children with serious obstruction. Am Rev 32) Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C : Sleep apnea syndrome : a comparison between Far-East Asian and white men. Laryngoscope 110 : 1689 `1693, ) Mograss MA, Ducharme FM, Brouillette RT : Movement/arousals. Description, classification, and relationship to sleep apnea in children. Am J Respir Crit Care Med 150 : 1690 `1696, ) McNamara F, Issa FG, Sullivan CE : Arousal pattern following central and obstructive breathing abnormalities in infants and children. J Appl Physiol 81 : 2651 `2657, ) Kohyama J, Hasegawa T : Subcortical arousal response in child patients with obstructive sleep apnea. Sleep Med 3 (Suppl 2) : S33 `36, ) Marcus CL, Carroll JL, Koerner CB, Hamer A, Lutz J, et al : Determination of growth in children with the obstructive sleep apnea syndrome. J Pediatr 125 : 556 `562, ) Bar A, Tarasiuk A, Segev Y, Phillip M, Tal A : The effect of adenotonsillectomy on serum insulin-like growth factor-i and growth in children with obstructive sleep apnea syndrome. J Pediatr 135 : 76 `80, ) Takahashi Y, Kipins DM, Daughaday WH : Growth Hormone Secretion during sleep. J Clin Invest 47 : 2079 `2090, ) Narui K : Endocrine disturbances in sleep apnea syndrome. Nihon Rinsyou 58 : 57 `61, ) Cooper BG, White JE, Ashworth LA, Alberti KG,
15 Gibson GJ : Hormonal and metabolic profiles in subjects with obstructive sleep apnea syndrome and the acute effects of nasal continuous positive airway pressure (CPAP) treatment. Sleep 18 : 172 `179, ) Kikuchi M : Orthodontic treatment in children to prevent sleep-disorderd breathing in adulthood. Sleep Breathing 9 : 146 `158, ) Bresolin D, Shapiro P, Shapiro GG, Chapko MK, Dassel S : Mouth breathing in allergic children : Its relationship to dentofacial development. Am J Orthod 83, 334 `340, ) Shapiro G : The role of nasal airway obstruction in sinus disease and facial development, J Allergy Clin Immunol 82 : 935 `940, ) Gozal D, Pope DW Jr : Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics 107 : 1394 `1399, Summary THE CLINICAL STUDY OF PEDIATRIC OBSTRUCTIVE SLEEP APNEA March 30, Of the 100 children, 99 were diagnosed with OSA using diagnostic criteria of the International Classification of Sleep Disorders II. Children with OSA did not show much apnea but showed hypopnea as a respiratory event and their sleep architecture was almost normal. Esophageal measurement was useful in the evaluation of respiratory effort and PAP scoring was useful in the evaluation of sleep instability. In this study, many OSA children had hypertrophy of the tonsils, nasal obstruction, and a small jaw strong predictors of childhood OSA. Two years after treatment (tonsillectomy), SD scores of body weight and height showed significant growth. The degree of the facial axis of the small jaw showed significant growth. In conclusion, new, accurate methods for the evaluation of respiratory effort and sleep stability associated with neurocognitive functions are needed. Early treatment is important for children with OSA to ensure normal physical and mental growth. The evaluation of the craniofacial structure is very important because many adult Japanese patients with OSA without obesity show small jaws. Childhood craniofacial structure may influence adult OSA and early treatment for children with OSA should prove useful in preventing adult OSA. Key words : pediatric obstructive sleep apnea, adenoidism, international classification of sleep disorders II (ICSD II), tonsil hypertrophy, cyclic alternating pattern (CAP) Shintaro Chiba, MD Department of Otorhinolaryngology, The Jikei University School of Medicine I report the retrospective study of 100 children who suspected of having obstructive sleep apnea (OSA) and undergoing polysomnography from April 1, 2002, to 28 (156)
日本 小 児 呼 吸 器 疾 患 学 会 雑 誌,6(2),1995 図5 図3 肺 抵 抗 に関 す る圧 気 道抵 抗 に関 す る圧 い で シ ャ ッ タ ー を 開 い て ΔV/ΔPb ΔVbを 求 め れ ば,次 or ΔV/ の式 か ら気 道 抵 抗 を求 め る こ とが で き る Raw=(ΔPalv/(ΔPb or ΔVb))/(ΔV/(ΔPb or ΔVb))=ΔPalv/ΔV
または Type 3 PM を用いる 脳波記録の誘導数が睡眠ポリグラフ検査と同等であっても 検査室外で非監視下 ( アテンドなし ) に行う場合は Type 2 PM 検査とし アテンドによる睡眠ポリグラフ検査 (Type 1) とは区別する Type 3 PM では気流 呼吸努力 酸素飽和度の連続
エキスパートコンセンサス 2(EC2) 検査施設外睡眠検査 (out of center sleep testing;ocst) 1. 検査施設外睡眠検査 (OCST) の位置づけ : OCST は睡眠呼吸障害 特に閉塞性睡眠時無呼吸 (OSA) の診断および治療効果判定を目的として 検査施設外へ容易に移動可能な携帯型生体信号 行動記録装置 (Portable Monitor:PM) を用いて行う検査室外検査である
Key words : Adverse reactions, Egg allergy, IgG antibody, Mills allergy, FAST
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level at age 6 in order to overcome gstagnation. h 4. A revised check-list and criteria of language ability (first plan) were made based on the above
Effect and Limit of Preschool Speech Therapy by Auditory Training Method, Aiming to Overcome gstagnation of Development at Age 9 h \ Summary of findings for 23 years \ Toshiko Mori Abstract : A retrospective
Fig. 1 Clinical findings and extent of inflammation area in female urethrocystitis Fig. 2 Classification and distribution of female patients with blad
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特殊病態下感染症における抗菌薬治験の手引き作成委員会報告書（案）
VOL.51 NO.6 JUNE 2003 JUNE 2003 9) Niederman MS et al: Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy and prevention.
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Fig. 1 Chest X-ray on admission, with infiltrative shadow in the right upper lung field. Fig. 2 Chest CT scan shows an infiltrative shadow, multiple b
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1) Waardenburg PJ : A new syndrome combining developmental anomalies of the eyelids, eyebrows and nose root with pigmentary defects of the iris and head hair and with congenital deafness. Am J Hum Genet
The clinical characteristics of Mycoplasma pneumoniae pneumonia in children younger than 6 years old Nobue Takeda1,2),Tomomichi Kurosaki1),Naruhiko Ishiwada2),Yoichi Kohno2) 1)Department of Pediatrics,Chiba
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Journal of Oral Health and Biosciences 臨 床 指 導 講 演 キーワード:Obstructive sleep apnea syndrome, Oral appliance, Bite-jumping appliance Oral Appliance for Treatment of Obstructive Sleep Apnea Syndrome Keisuke
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章 a 図 b 口蓋垂軟口蓋咽頭形成術 uvulopalatopharyngoplasty UPPP a 術前 b 術後 睡眠障害 睡眠呼吸障害クリニックの つではないかと思われる 当初多かった不眠症にかわって 睡眠呼吸障害が漸増し 耳鼻咽喉科などと連携し 病因の解明や治療法に向けた研究がスタートし
章 診療のポイント 2 CPAP 閉塞性睡眠時無呼吸症候群 (obstructive sleep apnea syndrome: OSAS) は, 睡眠中に上気道の抵抗が増大し, 無呼吸 低呼吸 いびきをきたし, 睡眠が障害され, 種々の合併症をきたす病態である. 本邦では池松 (96) ), 林 (96) 2) がいびきに対して軟口蓋形成術を報告している. しかし 960 年代当時は OSAS の概念はまだなかった.
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An Application of an Objective Structured Clinical Examination for Learning Skills in Assessment of Physical Therapy A Task Involving Measurements on the Range of Motion Test Chikako Fujita1) Hiroyasu
Jap. J. of Educ. Psychol., 1985, 33, 295 \306 A STUDY ON EGO IDENTITY IN MIDDLE AGE Yuko OKAMOTO The purposes of this study were to clarify the charac
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Yamagata Journal of Health Sciences, Vol. 8, 2005 Chikako SAITOU, Miharu NISHIWAKI This study has been undertaken to make clear the relationship of menstruation pattern to self-awareness, premenstrual
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* Department of Health Science Health Sociology Section, Juntendo University School of Health and Sports Science, Chiba, Japan (WHO: Ottawa Charter for Health promotion, 1986.) (WHO: Bangkok Charter
Key words: pure red cell anemia, allogeneic bone marrow transplantation.
Complete Recovery of Hemopoiesis Following Bone Marrow Transplantation in a Patient with Unresponsive Congenital Pure Red Cell Anemia Masami SHIMADA, Hideo MUGISHIMA, Mitsuhiko HARA, Masahiro MISAWA, Hideo
Characteristics of WPPSI Intelligence Test Profiles of Hearing-Impaired Children Tsutomu Uchiyama, Ryoko Ijuin and Hiroko Tokumitsu Abstract: We analy
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