臨床検査58巻3号

2014年03月発行

今月の特集2 知っておくべき睡眠呼吸障害のあれこれ

睡眠呼吸障害―歴史と現状

著者： 野沢胤美¹

所属機関： ¹虎の門病院　神経内科・臨床生理学科

ページ範囲：P.342 - P.349

●Pickwick症候群は肥満-低換気症候群の代表疾患である．

●肥満-低換気症候群の特徴は高度肥満（BMI＞30kg/m²），日中覚醒時の高CO₂血症である．

●肥満-低換気症候群に高頻度に睡眠時無呼吸・低換気症候群が合併している．

●「睡眠障害国際分類 第2版」では，肥満-低換気症候群は神経・筋疾患/胸郭異常による睡眠関連低換気/低酸素血症の項目に含まれる．

●無呼吸の診断には鼻・口に熱センサー（サーミスタなど）の装着，低呼吸の診断には圧センサーの装着が推奨されている．

参考文献

1）American Academy of Sleep Medicine：International classification of sleep disorders, 2nd ed: Diagnostic and coding manual, Westchester, Illinois，2005

2）American Academy of Sleep Medicine：The AASM manual for the scoring of sleep and associated events: Rules, terminology and technical specification, Version 2, Darien，2012

3）Burwell CS, Robin ED, Whaley RD, et al：Extreme obesity associated with alveolar hypoventilation; aPickwickian syndrome. Am J Med　21：811-818，1956

4）野沢胤美：睡眠時無呼吸症候群の病態と対策．共済医報　32：20-29，1983

5）Auchincloss JH Jr, Cook E, Renzetti AD：Clinical and physiological aspects of a case of obesity, polycythemia and alveolar hypoventilation. J Clin Invest　34：1537-1545，1955

6）Severinghaus JW, Mitchell RA：Ondine’s curse─failure of respiratory center automaticity while awake. Clin Res　10：122，1962

7）Lugaresi E, Coccagna G, Berti Ceroni G, et al：“Ondine’s curse”: the disorder of respiration and sleep in primary alveolar hypoventilation. Sist Nerv　20：27-37，1968

8）Jung R, Kuhlo W：Neurophysiological studies of abnormal night sleep and the Pickwickian syndrome. Prog Brain Res　18：140-159，1965

9）Gastaut H, Tassinari CA, Duron B：Polygraphic study of the episodic diurnal and nocturnal (hypnic and respiratory) manifestations of the Pickwick syndrome. Brain Res　1：167-186，1966

10）Lugaresi E, Coccagna G, Mantovani M, et al：Effect of tracheotomy in hypersomnia with periodic respiration. Rev Neurol (Paris)　123：267-268，1970

11）Lugaresi E：Organizer symposium: hypersomnia with periodic breathing. Rimini, Italy, May 25-27, Bull Physiopath Resp　8：967-1292，1972

12）Guilleminault C, Eldridge FL, Dement WC：Insomnia with sleep apnea: a new syndrome. Science　181：856-858，1973

13）Guilleminault C, Van den Hoed J, Mitler MM：Clinical overview of the sleep apnea syndrome. In : Sleep apnea syndrome (Guilleminault C, Dement WC, eds), Alan R. Liss, Inc, New York，pp1-12，1978

14）Rochester DF, Enson Y：Current concepts in the pathogenesis of the obesity-hypoventilation syndrome. Mechanical and circulatory factors. Am J Med　57：402-420，1974

15）Block AJ, Boysen PG, Wynne JW, et al：Sleep apnea, hypopnea and oxygen desaturation in normal subjects, A strong male predominance. N Engl J Med　300：513-517，1979

16）Gould GA, Whyte KF, Rhind GB, et al：The sleep hypopnea syndrome. Am Rev Respir Dis　137：895-898，1988

17）Guilleminault C, Stoohs R, Clerk A, et al：A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest　104：781-787，1993

18）Diagnostic classification of sleep and arousal disorders. 1979 first edition. Association of Sleep Disorders Centers and the Association for the Psychophysiological Study of Sleep. Sleep　2：1-154，1979

19）American Sleep Disorders Association：International classification of sleep disorders: Diagnostic and cording manual (Diagnostic Classification Steering Committee, Thorpy MJ, Chairman), Rochester，1990

20）Sleep-related breathing disorders in adults：recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep　22：667-689，1999

21）Carroll D：Pickwickian syndrome, 20 years later. Trans Am Clin Climatol Assoc　86：112-127，1975

22）Walsh RE, Michaelson ED, Harkleroad LE, et al：Upper airway obstruction in obese patients with sleep disturbance and somnolence. Ann Intern Med　76：185-192，1972

23）Olson AL, Zwillich C：The obesity hypoventilation syndrome. Am J Med　118：948-956，2005

24）野沢胤美：睡眠ポリグラフィ．臨床神経生理学　34：180-188，2006