軽-中等症閉塞性睡眠時無呼吸症候群例の検討 : AHI 20は参考になるか? [in Japanese] Study on the sleep parameters and symptoms of mild to moderate cases with obstructive sleep apnea-hypopnea syndrome [in Japanese]
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わが国ではPSGから得られたAHIが20以上で, 日中の眠気, 起床時の頭痛など自覚症状を有するOSAHS患者をCPAPの保険適応とするが, AHIが20未満でも眠気を訴える症例は少なくない. そこで, AHIが10～20の15例と20～30の14例との2群に分け, この2群間で日中の眠気, 起床時の頭痛およびそれらがQOLに与える支障について比較し, さらにPSG上の客観的睡眠指標に差があるかを統計学的に検討した. 結果, ESSスコアなど眠気, 頭痛の程度, QOLへの支障において両群間に差はなかった. また覚醒反応指数および睡眠構築にも差は認めなかった. 従って, AHI20をもって, OSAHS患者を差別化することは困難と考えられた.
Introduction-In Japan, continuous positive airway pressure (CPAP) treatment is indicated for the patients with moderate to severe obstructive sleep apnea-hypopnea syndrome (OSAHS) after having the polysomnography (PSG) done, in cases of the apnea-hypopnea index (AHI) indicating 20 and more. However, even the patients with mild OSAHS (AHI<15) occasionally feel excessive daytime sleepiness (EDS) and may need CPAP. In the present study we investigated the difference in the sleep parameters and symptoms between patients with AHI>20 and patients with AHI<20.<BR>Methods-Twenty-nine patients with mild to moderate OSAHS took part in this study. Fifteen of 29 patients had AHI 10-20 (relatively mild; RM) and 14 had AHI 20-30 (relatively severe; RS). The Epworth sleepiness scale (ESS) as a subjective symptom and arousal index (ARI) and sleep architecture (SA) as objective parameters were cpmpared statistically between the RM and RS groups.<BR>Results-The mean ESS scores were 6.3+/-3.3 in the RM group and 7.2+/-3.1 in the RS group. The mean ARI was 24.6+/-13.6 in RM and 22.7+/-12.0 in RS. The mean percentage of the sleep stage 3, 4, and REM were 23.2+/-17.0% and 18.4+/-9.6%, respectively. There was no statistical difference observed between two groups in any of ESS, ARI or SA (Student t test or Welch test).<BR>Conclusion-It seems difficult to categorize the patients with mild to moderate OSAHS by its severity based on AHI.
Stomato-pharyngology 20(3), 341-346, 2008-06-10
Japan Society of Stomato-pharyngology