SAS SAS SAS SAS
SAS SAS
1 SleepApneaSyndromeSAS 15 2 26 JR 270km 8 SAS 3 7 SAS SAS NASVA SAS SAS 2006 (ACCPACOEMNSF) SAS 1
2 3 3 SAS (ATS) (ERS) SAS 2004 4 SAS SAS SAS SAS 2
1 Vol.14No.4 56 2003p.2532 2) 3) 4) 5) 6) 7) 3
10% 259 68% Multiple sleep latency testmslt, 11.4 6 13% SAS 1 2 3SAS 3 Multiple sleep latency test Timothy R et al.,daytime Sleepiness and Alertness, In Principle and Practice of Sleep Medicine IVth edition 2004 4
5 H1 H2
2 6 2 6 NREM Dawson 28 Dawson D et al., Nature 388:235, 1997 12 17 7 1 0.05 0.25mg/L 0.05% 2 6
Dawson D et al., Nature 388:235, 1997 1 a 63 3 3 7
24 1 100 Froberg JE : Twenty-four-hour patterns in human performance, subjective and physiological variables and differences between morning and evening active subjects. Biol Psychol 5:119-134, 1977 Bolbery Daan process-s process-c Two-process process-c process-c process-c process-s process-s process-c process-s process- C process-s process-c process-c process- C 8
process-s GABA Two-process Daan S : Timing of human sleep: recovery process gated by a circadian pacemaker. Am J Physiol: 246:R161-183, 1984 9
10 10
SAS SAS AHI 5 SAS SAS SAS SAS SAS polysomnography:psg MSLT PSG MSLT PSG REM 11
Epworth sleepiness ScaleESS ESS ESS AHI30 / OSAS ESS11 35 1/3 SAS MSLT maintenance of wakefulness testmwt SAS 10 11 12 SAS 6070 12
PLMD SAS PLMD http://jssr.jp/ 13
Epworth sleepiness ScaleESS Johns MW:A new method for measuring daytime sleepiness:the Epworth sleepiness scale.sleep 14:540-545,1991 14
Doi Y,Minowa M:Gender differences in excessive daytime sleepiness among Japanese workers.soc Sci Med :56:883-94 2003 Roehrs T, Shore E, Papineau K,Rosenthal L,Roth T.A two week sleep extension in sleepy normals.sleep :19:576-82 1996 Roth B.Narcolepsy and hypersomnia :review and classification of 642 personally observed cases.schweiz Arch Neurol Neurochir Psychiatr :119:31-41 1976 Bonnet MH.:Effect of sleep disruption on sleep,performance and mood.sleep, 8:11-19,1985 Young T,Palta M,Dempsey J,et al:the occurrence of sleep-disordered breathing among middleaged adults. N Engl J Med 328:1230-1235,1993 Hamilton,G.S.et al.:obstructive sleep apnoea and cardiovascular disease.intern. Med.J.,34(7):420-426,2004 Phillips,B.:sleep-disordered breathing and cardiovascular disease.sleep Med.Rev., 9(2):131-140,2005 Gottlieb, D.J.,et al:relation of sleepiness to respiratory disturbance index; The Sleep Heart Health Study, Am J Respir Crit Care Med, 159:502-507, 1999 10Sullivan CE,Issa FG,Berthon-Jones M et al.reversal of obstructive sleep apnoea by continuos positive airway pressure applied through the nares.lancet.18;1 8225:862-5,1981 11Lowe AA,Sjoholm TT.Ryan CF et al:treatment,airway and compliance effects of a titratable oral appliance.sleep.15;23 Suppl 4:S172-8.2000 12Prinsell JR:Maxillomandibular advancement surgery in a sitespecific treatment approach for obstructive sleep apnea in 50 consecutive patients.chest.1166: 1519-29,1999 15
SAS SAS SAS 1987 George 1988 Findley Virginia OSAS 2.6 1997 Young Wisconsin cohort study OSAS apnea hypopnea index: AHI>15 7.3 1999 Teran-Santos OSAS AHI>10 6.3 2004 Sassani 19802003 MEDLINE-Pubmed OSAS 2.5295 95CI1.84 3.45 (1) Wisconsin cohort study Sleep heart health study SAS SAS 1416 24 SAS SAS AHI 16
5 10.9 7 9 18 8 SAS AHI 5AHI30 1014 94 9.3 30 AHI60 726 71 9.8 60AHI 434 67 15.4 SAS AHI 4560 60 OSAS 2.37 95CI1.354.163.9395CI2.47-6.24 (4) 17
18
1 George(1987) OSAS27 93 Findley(1988) OSAS29 35 OSAS 41 6 Findley(1988) OSAS46 SAS Findley(1989) OSAS12 SAS CPAP Findley(1991) 3 Haraldsson (1992) Martikainen (1994) SAS 2.2 1,214 23 1,600 4.5 19
Stoohs(1994) 90 SAS SAS 2 Stoohs(1995) 350 MESAM-4 ODI5 73 ODI10 10 60 Findley(1995) Haraldsson (1995) 62 SAS Steer Clear 13 SAS UPPP UPPP Wu(1996) 253 SAS 31 15 Teran-Santos (1999) Shiomi2002448 OSAS Case-control study OSAS 6.3 PSG OSAS OSAS AHI Mc Nicholas OSAS ERS (2002) Sassani (2004) OSAS OSAS 2.52 95 19802003 CL:1.84-3.45 MEDLINE- PubMed Howard (2005) 2,342 PSG161 ESS OSAS 24 EDS 59.6 SDB 15.8 Hartenbaum (2006) OSAS ACCP, ACOEM, NSF. Chest 130: 902-5, 2006. 3 20
1.OSA ( 1. ) ( ) 2. 2 (1) BMI 35 kg/m 2 (2) 17 16 (3) ( 2 ) 3.Epworth 11 16 3.Epworth 16 18 30 21
(split-night) OSA (CPAP) 2. CPAP OA(oral appliance; ) OA OA 2. 5 OA 10 ( 5 ) 10 22
SAS Lenne SAS Findley OSAS OSAS EEG OSAS Matthew OSAS 15 ; AI 46.9 25.5 15 10 23
OSAS OSAS Turkington SAS CPAP CPAP CPAP CPAP CPAP CPAP 24
OSAS SAS 25
1) Michael G.Lenne, Thomas J.Triggs, Jennifer R.Redman.Interactive Effects of Sleep Deprivation, Time of Day, and Driving Experience on a Driving, SLEEP, vol.21,no.1, 1998 2) Findley, L.J.,et al. Vigilance and Automobile Accidents in Patients with Sleep Apnea or Narcolepsy, Chest, 108: 619-624, 1995. 3) Matthew R.Risser MS, J. Catesby Ware PhD, Frederick G. Freeman PhD. Driving Simulation with EEG Monitoring in Normal and Obstructive Sleep Apnea Patients, SLEEP, Vol.23,No3,2000 4) P M Turkington, M Saralaya, M W Elliott. Time Course of Changes in driving Simulator Performance with and without Treatment in Patients with Sleep Apnoea Hypopnoea Syndrome, Thorax, 59: 56-59, 2004 5) Pierre Philip, MD, PhD, et al. Fatigue, Sleepiness, and Performance in Simulated Versus Real Driving Conditions, SLEEP, vol.28,no.12,2005. 26
1-3% 16-20% 1 27
2001 2005 34,490 1,215 3.5% 1,215 28
24 12 2 12 34 1516 12 SAS SAS 30.3%18.1% 29
30 20-24 17.4%13.8% 67.7%74.0%
32.2%27.6% 38.9%13.7% 13.7% 11.9%6.5% 31
63.3%55.4% 32
(1) Van Den Berg, J., Landstrom, Ulf. Symptoms of sleepiness while driving and their relationship to prior sleep, work and individual characteristics. Transportation Research Part F 9, 207-226:2006 (2) Flatly, D., Reyner, L.A., Horne, J.A. Sleep-related crashes on sections of different road types in the UK(1995-2001) Road Safety Research Report No.52: 2004,London: Department of Transport. (3)..., pp.260-268:1996 (4) Pack, A.I., Pack, A.M., Rodgman, E., Cucchiara, A., Dinges, DF.,Schwab, C.W. Characteristic of crashes attributed to the driver having fallen asleep. Accident Analysis Prevention, 27, 769-775:1995 33
SAS 5,235 3,235 61.8 SAS 3,235 SAS 221 6.8 SAS 34 1.1 SAS SAS SAS 34
SAS SAS SAS 30 35
SAS SAS 30 400 SAS SAS 67.0 36
1.7 SAS 50.0% 1.2 SAS SAS 3.5 2.9 SAS 37
1.6 30 SAS 1.4 SAS 29.0 2.4 SAS 2.2 SAS SAS 38
SAS 38.9 1.9 SAS 41.2 2.0 SAS 23.1 2.2 SAS 32.4 3.1 SAS 39
SAS SAS 73.0% 78.3% 69.9% 81.0% 78.5% 59.2% SAS SAS SAS SAS 34 50.0 17 26.5 9 SAS 17.3% SAS 22.2 40
SAS 23.5 12.9% SAS 41
( ) 1 10 20 30 40 50 60-64 65-69 70 3 4 5 6 1 3 3 10 10 20 20 30 30 1 0 1 2 3 4 2 30 30100 100200 200400 400 3 10 1 10 10 10 30 30 2 2 11 12 13 42
14 SAS SAS 15 SAS 16 SAS ( 19 ) 17 SAS 18 SAS 19 SAS SAS 20 43
(SAS) SAS SAS SAS 1980 SAS SAS AHI SAS SAS SAS SAS SAS SAS SAS SAS OSAS 35 SAS 44
SAS SAS SAS (1) SAS SAS SAS SAS SAS SAS SAS SAS SAS (2) SAS SAS SAS SAS SAS SAS 45
46
SAS SAS
(1) 47
48
49
(2) SAS 50
(1) 51
52
(2) SAS 53
54
(1) 55
56
57
58
59
60
61
62
63
64
(2) SAS 65
66
(1) 67
68
69
70
(2) SAS 71
SAS 72
SAS 73
74
(1) 75
(2)SAS 76
(1) 77
(2) SAS 78
REM OSAS 7.3 OSAS 7.3 (PolysomnographyPSG) (Sleep Apnea SyndromeSAS) (Multiple sleep latency test MSLT) 79
NREM NREM Rapid EyeMovement; REM REM CPAP (apnea hypopnea index;ahi) 80
(Periodic Leg Movement Disorder; PLMD) ACCP ACOEM AHI CPAP (nasa1 Continuous Positive American College of Chest Physicians American College of Occupational and Environmental Medicine Airway Pressure; ) EDS (Excessive daytime sleepiness) Epworth (Epworth sleeping scale; ESS) ESS FMCSA GABA Maintenance of wakefulness test, MWT MSLT Multiple sleep latency test NSF OA Epworth - MSLT National Sleep Foundation mm (oral appliance; ) ODI 81
OSA Obstructive Sleep Apnea; OSAS (Obstructive Sleep Apnea Syndrome) REM SAS SDB (Sleep Disordered Breathing) UPPP (uvulopalatopharyngoplasty) OSA (Rapid EyeMovement) 82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97