medicina48巻6号

2011年06月発行

今月の主題 睡眠呼吸障害の克服―内科医が知っておきたい病態・症状・関連疾患 睡眠呼吸障害と治療

CPAP（continuous positive airway pressure）

著者： 櫻井滋¹

所属機関： ¹岩手医科大学医学部睡眠医療学

ページ範囲：P.1024 - P.1030

ポイント

★持続気道陽圧（CPAP）療法は閉塞性睡眠呼吸障害（SAS）の最も確立された治療法である．

★受容性と継続性が課題とされていたが，近年では大きく改善している．

★適切な機器と治療圧を処方するための知識の有無が治療効果を左右する．

参考文献

1）Sullivan CE, et al:Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1:862-865, 1981

2）Teschler H, et al:Adaptive pressure support servo-ventilation；A novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med 164:614-619, 2001

3）Pépin JL, et al:Effective compliance during the first 3 months of continuous positive airway pressure；A European Prospective Study of 121 patients. Am J Respir Crit Care Med 160:1124-1129, 1999

4）Engleman HM, Wild MR:Improving CPAP use by patients with the sleep apnea/hypopnea syndrome. Sleep Med Rev 7:81-99, 2003

5）Sin DD, et al:Long-term compliance rate to continuous positive airway pressure in obstructive sleep apnea. Chest 121:430-435, 2002

6）Kribbs NB, et al:Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am J Respir Crit Care Med 147:887-895, 1993

7）Reeves-Hoche MK, Meck R, Zwillich CW:Nasal CPAP；An objective evaluation of patient compliance. Am J Respir Crit Care Med 149:149-154, 1994

8）Weaver TE, et al:Night to night variability in CPAP use over the first three months of treatment. Sleep 20:278-283, 1997

9）Richards GN, et al:Mouth leak with nasal CPAP increases nasal airway resistance. Am J Respir Crit Care Med 154:182-186, 1996

10）Lavie P, Herer P, Hoffstein V:Obstructive sleep apnea syndrome as a risk factor for hypertension；Population study. BMJ 320:479-482, 2000

11）Nieto FJ, et al:Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study；Sleep Heart Health Study. JAMA 283:1829-1836, 2000

12）Peppard PE, et al:Prospective study of the association between sleep disordered breathing and hypertension. N Engl J Med 342:1378-1384, 2000

13）Peker Y, et al:Reduced hospitalization with cardiovascular and pulmonary disease in obstructive sleep apnea patients on nasal cPAP treatment. Sleep 20:645-653, 1997