Ｄｅｓａｔｕｒａｔｉｏｎ　Ｉｎｄｅｘの導入による老年者夜間呼吸障害の検討

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タイトル別名
  • Analysis of Nocturnal Disturbed Breathing in the Elderly Using Desaturation Index.
  • Desaturation Index ノ ドウニュウ ニ ヨル ロウネンシャ

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This study was conducted to examine the nocturnal ventilatory parameters and gas exchange in the elderly with nocturnal disturbed breathing. In order to facilitate analysis of ventilatory parameters with minimum manpower, we developed an unattendant continuous nocturnal monitoring system for ventilation and arterial oxygen saturation. Using this system, nocturnal ventilatory parameters and gas exchange were investigated in our geriatric ward. We investigated 30 elderly subjects aged between 65 and 94 (mean age 77.8±6.5 years, male; female=15:15). The subjects were free of severe cardiovascular and cerebrovascular disorders, and underwent 10 hours of continuous monitoring of ventilation and arterial oxygen saturation (SaO<sub>2</sub>). Number of significant desaturation (SDS; desaturation greater than 4% in SaO<sub>2</sub> from the baseline value) and desaturation index (DI; ΣSDS(%)×duration(hour)) were calculated using the same system. The number of apnea episodes significantly correlated with DI and the number of SDS. DI also significantly correlated with lowest SaO<sub>2</sub>, while the number of SDS and the number of apneas were not found to be correlated with lowest SaO<sub>2</sub>. The number of SDS and the number of apnea episodes did not correlated with lowest SaO<sub>2</sub>. From the view point of gas exchange during the night, newly introduced DI is more comprehensive parameter when compared with the number of apneas or SDS. Subjects with a DI of over 0.5 were assigned to the group A (n=8, mean age=77.8) and the remaining subjects were assigned to group B (n=22, mean age=77.8). We compared the group A with the group B regarding nocturnal ventilatory parameters and SaO<sub>2</sub>. The group A had significantly smaller ventilatory volume during sleep than the group B, while there were no difference in pulmonary function tests during day- time. The mean inspiratory flow of the group A also significantly decreased, compared with the group A. Additionally, the lowest SaO<sub>2</sub> of the group A was significantly lower than that of the group B, while there was no difference in baseline values between the group A and the group B. Therefore, DI can be useful for characterization of nocturnal disturbed breathing in the elderly. However, further studies are needed to clarify the usefulness of DI in health and disease.

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