2012年5月2日水曜日

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Q҂ւ̃Av[`G   August 2000.

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siAj̊҂͂΂ΐQsłȌXgXł肷鎖BȖȊł炪ꂽA҂𐇖ɑB

AȎiߏȒԂ̖Cŕs𔺂Ȃ␇ċzAiRvV[Al^QȂǂ̕a^鎞B
𗈂_ (e.g., •aAs)ƈwIaC (e.g.,bB@\i͒ቺASsSjTAbɂԂÂB
ǂ̖sɖ򕨗Ö@͔B̑K؂ȐAAC]AFmsÂsB
NȐ̂ߎ̎߂G
@PGƖڊoߎԂŒ肷B
@QGQ⒋QBR[q[ނ͔BỎߏȃ`R[gA^oRAAR[ B; @
@RGQO4`6ԑO܂łɋKIȉ^͂B
@SGdXgXƊ֌W痣ĐQꏊB
@TGxbh͖邽߂ZbNẌׂɎgpB
@UG1ԔȏxbhŖȂ,NオǏȂǂ̃XgX̊|ȂB

ߐ̕s̊҂2`3TԂȂQOɈޖ򕨎ÂlBi e.g., zolpidem, 5 to 10 mg, ͓ɕsȌȂ benzodiazepine  ZV 7.5 to 30 mg.Ȃǁj

Qւ̗zIȎÂthe International Classification of Sleep Disordersɂ‚ĒmĂtQ4ނ̂P‚ɑ銳҂ׂƂ邱Ƃn܂BQ̂銳҂͍L͈͂ȐLǧ󂯂Bʂɂ̌̌͗Տffm肷B]łdvȓ_łB
Oł悭銳҂4‚ɕB
@@(1) s
@@(2) ߓxɒԂ˂ނ
@@(3) ُ^͍s
@@(4) K؂ȎԂɖ鎖oȂ [\ 1].

@@@\ 1. ̎ȕ
@@ށ@@@ @@@@@@@@@@@@@@@@@@@@Lq
@@Insomnia @@@@@ @@@@@@@@@@@@@@ ɗĐQ܂܂ɂȂ̂
@@Excessive daytime sleepiness @@@@ @@ɖڊo߂Ă鎖łȂ
@@Abnormal movements during sleep @@@ ɑȂǂ̌JԂُ^
@@Inability to sleep when expected @@@ @KȎԂɖ̂

s͐FXȕaIȏԂNǏłB͓͖Ă鎖iIɍ̎dWQƒ`B s͍łő̏Ǐ悷B [\ 7]. s͑̔ߌ̌łAߏȖ̎gpKɂ悭sB̕s҂̎Â̌oLB

@@@@@\ 7. s̎ȏǏ
@@BāXoBڂo߂Bs\ȐB͔JA͂˂ނB炢疔͏W
@@̌@ Bs,ɂԁBY₷BSgǗlǏB

悭鐇̂QԖڂߏȓ̖CiEDS)hypersomnolence hypersomniaƂBEDS̊҂͓̔JAsK؂ȎԂƏꏊŖ荞ތXAW͌@A⑼̖ii\WjB̏Ǐ͐ffsĂɂ鍇ǂ̏Ǐ𕹔鎖BႦΓ̖C̒ł̐AE͔A}qAÖonarcolepsy^킹BꏏɐQĂlɂ钷̑傢тEDSƐċz͐ċzB
@@@@@@@
@@@@@@@@\ 8. ̉ߏȖC͉ߐ̂悭Ǐ
@@ߏȓ̖CBsK؂ȎƏꏊŐQĂ܂BXɖĂǏ̌y͖BԂ̔JBW͕s\B
@@^\͂Fm\͂̏QBL̏ǏiċzAiRvV[Ȃǁj悭鐇̂RԖڂُȑ̈グ̂̉^Ɋ֌WłB̃^Cv restless-legs njQ (RLS), -l-^Q,̓PCȂǂ̐ff^킹B.

Ō̂悭鐇D₻ɔCvɖȂ炭łB͕̋sKȐK̊҂ɌBႦΑwAwXPA̐ƁAs@AƃgbN^]Ax@AΖҁȂ̓Yς󋵉ɐĂlA΂𔃂ďolȂǂłB

Qɂ‚̐ffIތnG
@@ the International Classification of Sleep Disorders (ICSD);
@@ the International Classification of Diseases, Ninth revision;
@@ Clinical Modification (ICD-9-CM);
@@ the ICD, Tenth Revision (ICD-10).
̗LƐM͖mĂȂB.

ICSD ͐oQ̐ffނŐQ̐ƂɂꂽB͏ڂLqƐffAxAԂ̊₻ꂼ̕aC̑̏Ȃǂ񋟂BICSD͂S‚̍LނɂWS̔FꂽQĂB
@@@@(1) dyssomnias, (2) parasomnias, (3) wyѐ_aɊ֌WQ (4) NꂽQ.
@Dyssomnias ͏QꂽԐ͊oQ̌ʁAsߏȖC𗈂ałB  dyssomnias͈قȂ̂̌n炭Q̍ł[\ 2]BႦΓO͊OߐAɓoƕsNBdyssomnias ͍XɕēAOA̓YQƂBQAႦ΃iRvV[AǐċznjQiOSAS)A restless-legs njQ(RLS)͓̌ŋNB O͓T^Iɂ͊‹qɂB Circadian-rhythm Q͐õTCN̏QłB

@@@\ 2. International Classification of Sleep Disorders:
@Dyssomnias
@Q G Psychophysiologic insomniaCSleep-state misperceptionA˔sCOߖǁCNarcolepsyC
@@JԂߐ A˔ߐCObstructive sleep apnea syndrome (OSAS)AċznjQC
@@xE ካNnjQAQɎl^CRestless-legs njQAɓ肳ȂQ
@OQ G sK sleep hygieneC‹̐QAsCAdjustment sleep disorderCInsufficientQ
@@‚QCJn֘AaCHAM[sAÖˑQ
@@AR[ˑQAԈHnjQCŕɂ鐇QAɓłȂOQ
@Circadian-rhythm Q G Time-zone (jet lag) njQAΖQCsKȐo^Q
@@Delayed-sleep-phase njQCNon-24-hour sleep-wake disorderAAdvanced-sleep-phase syndromeC
@@ɓ肳ȂCircadian-rhythm sleep disorders

@@@\ 3. International Classification of Sleep Disorders:
@Parasomnias
@oQ G Ԃł̊oCSleepwalkingVaCSleep terrors
@oڍsQ G Rhythmic movement disordersCSleep startsAQC leg cramps
@REM sleepɔParasomnias  G C}qAƊ֌WuNQLɐuN
@@REM-sleep-related sinus arrestS~CREM-sleep sQ
@ parasomnias G Sleep bruxismCSleep enuresisACƊ֌WُݍݏnjQAԓ˔ dystoniaC
@@s̋}ԎSnjQAтCcċzCVካNnjQA
@@}cSnjQCǐV myoclonusAɓ肳Ȃ parasomnias

@@Parasomnias [\ 3]͐o𐶂މߒُ̈ł͂ȂAނ됇ɋNFXȎނ̍D܂ȂۂłB @@@@@@Parasomniasɂ (REM)-related parasomnias ƊoƐoڍs̕aC܂łB

@@@\ 4. Q̍ە
@@wyѐ_Ȏ𔺂Q
@@_I G _oǁCCQCsQC|QA@Alcoholism
@@_oG]ϐCsCParkinsonismAvIƑsCSleep-related epilepsyCdCIeJd
@@@Sleep-related
@@̈wIG Sleeping sicknessCԐSAǐxCɊ֘Ab ݐHtC
@@@@ᇁCFibromyalgia

 EꂽQ̕ނ [\ 5] aC݂̑mFł錻ݏ[ȏ񂪂Ȃ̂BႦΒZԋyђԐ҂Q̔eɓ邩Ƃ͒Pɐ͈͓̔̋ɒ[Ȃ̂ĂȂB

@@@@\ 5. International Classification of Sleep Disorders: EĂꂽQ
@@ZԋyђԐҁCo njQCFragmentary myoclonusA ߑCDPɊ֘A鐇Q
@@낵 hypnagogic oAƊ֌W_oߌċzAPCCSleep chokingnjQ

@/aԐ

SĂ̐Q̌aԐ̋c_̘_͈̔͂𒴂邵Ǎ͕słBsōłTO͐S_A10%w_owA10%`15%򕨂ƃAR[A10%̐QA10%̑łBԂ̉ߏȖCōł̂͐DłBЂƂ‚悭̂͌UwIɋobstructive sleep apnea syndrome (OSAS)łB _o؏QAǎA]ċz̃tB[hobNRg[sSi Cheyne-Stokes ċz̗l) 炪̐ċžłB

  ԓIlv/uw

uwIł͐ϑƂĂB 1979N Institute of Mediciněł͕čl1/3ߋ12Ԃɉ炩̐QoĂB͎̌ŊmFꂽB1NԂ18˂VX˂̊Ԃ̑l̂RTA,͗̏QB1981 `1985N̊Ԃɍsꂽ US National Institute of Mental Health Epidemiologic Catchment Area Studył͂PWˈȏ̂VXWSl̉񓚎҂̓POUȏ㑱s łB
WOOOl̊҂ɂQ‚̑{݌ɂ poly-somnographic (PSG) eXgȂ̊҂̒ōłQwyѐ_ɔċz, narcolepsy, ƕsłB PSG-tested ҂̒ōłʂ̐͉ߐ (51%), si31%), parasomnia (15%),  sleep-wake-vQ (3%)łB
ɔq͘VlAAsAЉoϏԁAŋ߂̃XgXA򕨗pȂǂłB
s͐l33%ɋNpx͔N100lɂ‚33lłB OSAS ͔얞ANj (4% of such individuals) Ə(2%)ɍł悭NBE͔N narcolepsy̕px10l 50` 60 ŔN1000lɂPlłB narcolepsyƑɂƑNacolepsy̕px͂TO{ɂȂBċz͏dǂ̖SsS҂̂TOȏɁAA_o̓@҂̂QOȏɌBŕ̏Ռɂ炸,ŝPTȉÂ󂯂B@ffGa

Ɛɂ‚Ċ҂ƈꏏɐQlɐq˂B͂Pł̕s̏ǏߏȒԂ̖Cs̊‹󋵓IȂǂłB

@@@@

\ 6. SȐq˂̂ɕׂ
@@[G@^Aerϐ CEƏ̎d CNaps CAlcoholێAH CێCZbNX CQOVCComputer
@@钆G@ C_eCo̐ƒAGetting out of bedCSmokingCH C򕨐ێ C‹
@@@G@ڊo߂̎ԁCCC,Š,sAJƖC CNčŏ̊
@@ԁG@o CCCNapsCActivityCHA CCaffeineێ C CsyтŠA

@@@@


"何がシンスプリントの治療法ですか？"
\ 7. s̏dvȏǏ
@@薰ȂA΂Ζڊo߂Cɖڊo߂AsȐCԂ̔JCC炢疔͏W͂̌@
@@s,ɂ•aCYۂCSgǓIǏ

@@@@\ 8. ߓx̒Ԃ̖C͉ߖ̂悭Ǐ
@@ߏȒԂ̖CCsK؂ȏꏊƏ󋵉Ŗ荞ށAljǏ̊ɉȂCԂ̔JAW͒ቺC
@@Fm͂^\͂̏QAɓقȏǏ (e.g., ċz, narcolepsy)

@@@@\@9. ߐ͒Z̕š
@@‹̕ω (ł)CߏȎGCڂJet lagAΖAsȎC CNS}܂̒~
@@XgXȐl̏oC}ȓȖ͊OȂ̕aCAh̐ێ (e.g., theophylline, beta blockers, corticosteroids,
@@ bronchodilators, thyroxine)

@҂̓X̌ȏSĂffɂ͏dvŁAJnAAyіڊo߂Ɋւ𓾂BRLS̏ǏAႦ
@тsȎl̓A͑ɂBтÅoA̔JށAċz̒fAߑǑ㔼ł̔J
@  OSASBsK؂ȎԂɉ䖝łȂC narcolepsyɒӁB  parasomniasُ̈s,ႦΖV
@AsA|ȂǁȂɋNBREM-sQ͖钆͖̌㔼ɋNBPĈ͖ǂ̕
@łNB̑傫(jŁ17 inches A >16 inches)  OSAS͑ւB

҂ƈꏏɐQlɈwA_IAЉIAwIȎq˂B
t͊҂̊wZAdAƂł̌oq˂B̎gpCȂǂ͌NȐɉeBbl⓯Ύ҈ُȌċž^AsׁAɊւ͐ffɏdvłBΎ҂Ҏg̐ȁA򕨎gpAXgXA̐̌oȂǂ͔̏ؖے肷鎖oB 

\gBG
͍L͈͂̐₻̌^AтɈw_owIȎA򕨎gpɊւ𓾂鎖oB


 @@@@@2TԂ̐o‚悤Ɋ҂ɋ߂ [} 1].

͓L͕zcɓAJnAoAQȂǂLڂB͊҂̋CAȀԁȂƂ̊֌W\ĂB


Ƒ̒ɐQ҂邩q˂B narcolepsy RLS҂̖1/3͉ƑɐQBVA|AAǁAOSAS̉Ƒ̊Ԃɂ͈vB
@@@@@@ } 1QƁI.@@ 24-Ԑo ̖͔͌^łB
̓̑O2TԊ҂ɂ芮ׂłB̓̊eԗɁG (1)K؂ȗɁ~łĐoԂB (2) QNŎB (3) ɒ[ȖCSŎB

ffGǧ

_oASǁAAċzȂwIaCTBSg̍ǁACAbB@\ቺǁAWl OSAS̎|ɂȂ. pAkAዅˏoAbB͍bB@\iǂBOB͐WQ̖AɂȂ"\BSsS͎̒ċzɂ鐇Q𗈂B_o؃}qAǂ̕aCAɂ݂̌𒲂ׂB_ԌŕsA_oǗlAǏ󂪉B

F

ɂ̕aC␇Q̂mF邽ߌBbB@\iǂƐċz^킵 thyroid-hz (TSH)BSx`^鎞͋ʐ^ƂB򕨗pȂΓŕBNarcolepsy̑̊҂ (90%` 95%) lpR(HLA)-DR2złB]ĉA͐ffے肷Bz͐ffm͏oȂBȂȂ HLA-DR2 ͕ʂ̐l̒ɂ݂̂ŁB
ċzANarcolepsyAIl^Q^Ƃ͐B
Polysomnography (PSG) multiple sleep latency testing (MSLT)ŎԂ邪NarcolepsyaI(e.g., Jn <5)̐ffɂ͏dvł . PSG ͔]g (EEG), Sd} (ECG), ċz, ዅ^, muscle tone, hemoglobin _fOaxӒ̋L^łB
\IȈُOɂMagnetic resonance Ƒ̉fKvłBcircadian-rhythmQ^鎞Actigraphyɂ̂̓vԂ͐o𒲂ׂ鎖oB ċz̊ӕʂ͌ċžvƌċzC𒲂ׂ. @sɓIȕaI PSG ^͂ȂB

ːwI

CSx^鎞͕ːwI˗B
zgD̎ʐ^ǐċzɂȂ얞⋐AGBAmicrognathia,bB@\ቺ^킵UwImF"\łBǐx̊҂̋ʐ^͉ߖcAu̕RA㋹ȏBʂŁAAQAċzA_fǂ𗈂SsSmFłB

NPI

Q𗈂_o𒲂ׂ邽߂ɂ͐NPIKvłBCTAMRIAUdʁA_o`Ȃǂ̔NPIɉĐNPI͐_ǒɕKvłBA]ALymeaAdǂȂǂ̕aČɂ͐ťdvłB]ǎBe idigital-subtraction arteriographyӂށj]̌ɂ͕KvłB̐NPI͔]A]]gBӕʐff 

̊bɂ錴T [}@Q].
}QQƁI. Sleep disorders algorithm: Sleep disturbances BPSG, polysomnography.
}RQƁI@ Sleep disorders algorithm: Hypersomnias GNS, central nervous system; EMG, electromyography;
@@MAOI, monamine oxidase inhibitor; MSLT, multiple sleep latency testing; PSG, polysomnography;
@@SDC, sleep disorder center.
}SQƁI Sleep disorders algorithm: Affective and behavioral disturbances GEG, electroencephalogram;
@@MAOI, monamine oxidase inhibitor; MSLT, multiple sleep latency testing; PSG, polysomnography.
@}QFQ
@@PFsGRTȓ--ΖAڂȂǏ󋵈ql---.>RASAZԂ̍Ö
@@@@@RTȏ--
@@@@@ꏊs--->ǂꏊAhoCX
@@@@@ꏊ͐--->
@@@@@XgXɖ֌W--->@̒ɂ--‚ĎÁ@ARestles@legnjQAI^A
@@@@@@@@@@@ċzAċzsSȂǂl---ff̂PSG
@@@@@XgXɊ֌W--->@_a---̕aC̎ÁBAAR[͖򕨎gp--->~BBSI
@@@@@@@@@@@--->XgX̌AbNXAh̐AX̉^A󋵂Eo---PSGňS@@
@@QFߖ--->}R
@@RFɔƍsQ---->}Sց@@

@

}RFߖ̊
@@PFԐ---PSGMSLTs
@@@@@˔CNS hypersomnolence--->hܓ^AAKlein-LevinnjQ--->SDCɑAB֘AnjQ
@@@@@--->z--->SDCiɑBCSleep drunkenness lomger-sleeper njQ--->S
@@QFs𔺂---@s--->}QցBANarcolepsy---PSG MSLTs-->h܁AR܁ASSRI
@@@@BDelayed sleep phase-->chronotherapy
@@RFԐWQ𔺂--PSG,ċz؂lEMGj^[-->@ǐċz-->CɎzBA
@@@@I^-->Benzodiazepine ,Opiates ,Dopaminergic Drug
@@SFԐɔ--@Sga--‚BA_--_ȂցBB̕p--̖ɕς

@

}SFɔƍsQ
@@PFőLȂ---@ԃPC--ӒEEG-->RPC܁BAԋ|--PSG---SAPsychotherapy,
@@@@@Benzodiazepine,R
@@QFőL---@-->SAR܁AMAOjQ܁BA|-->SSRI,3ŒnR
@@@@B}ዅ^AsQ-->hZClonazepam

sߖÄُ^sA\̎Ԃɂ薰ȂȂǂ͏Ǐłffł͂ȂƂ𖾋LB

šʊӕʐffɊ܂܂̂͒ɂ݁A򕨗pAFXȈwA_ȓIA_owIA restless-legs ͎
l movement njQ (RLS-PLMS)AovQȂǂB銳҂͌šsǂ̏ꍇBs̊ԁAꏊ̐AXgX̑݁A򕨂̎gpAPSGeXǧʂȂǂɊւ񂪊ӕʂ̖ɗB ႦΔrIZ̕s͌Ζq@sɂ鐇oQĂBȐ‹ŃXgX̂钷̕s͐_IASIA򕨗pȂǂɂBȐ‹ŃXgX̂Ȃ̕s͉^͒ɂݏQɂB
ߖ̌ʊӕʐff (Ԃ̉ߏȖC) OSASAċzAxEካNnjQ, narcolepsyÄwA_ȊwA_owIaCA򕨗pAߏ薰CAߏ萇ȂǂB [} 3].
ُ̈^s̑i [} 4] non-REM parasomnias (oAVA|)␇oڍsQ (rhythmic ȉ^Q, Q)A REM sleep parasomnias (REM sQA)A diffuse parasomniasAԃPCAڍsNQ̉^QȂǂ^킹B҂ɂُ^̋L͈ApjbNA}ዅ^sQƈvB҂sQLłĂȂ,ff͖ԃPC͖ԋ|ł낤B
ӕʐʈȉłƑi銳҂̑SsƂ͌ȂCtׂłB
Kvʂ͌lɂقȂB XgXɂZԂ̐Q͐Qł͂ȂB̒ZԐ҂BVl͐ʂ͏ȂĂ悢ƌ͊ԈႢŁAԂ̉Q̎ԂlׂłB
is̎, ̒Z[\ 9]Ɩa [\ 10]ɂ"\lB
s͐_owA_ȓIAwIAɂ݁A򕨗pȂǂ̏Ǐ󂩂ȂBA RLS, l^Q (PLMS), circadian-rhythm Q [\ 10]̏Ǐ̎B

@\ 10. š


にきびにきびのレーザー治療薬治療
@QG
@@  Idiopathic insomnia   Psychophysiologic insomnia  Sleep-state misperception  Inadequate sleep hygiene
@@  Insufficient sleep syndrome  Restless-legs syndrome  Periodic limb movement disorder
@@  Circadian rhythm disorders  Altitude insomnia  Central sleep apnea-insomnia syndrome
@@ʓIwIaCA_owIQA_ȓIQA򕨃AR[gp
@@
@@iߏȒԂ̖C̏ꍇ,  ӕʐffɕǐċz(OSAS)⑼̏QiႦ narcolepsyȂǁj
@@ [\ 11] [\ 12] [\ 13]lB.

@\ 11. ߏȒԂ̖Ci銳҂̕]
Findings on history and physical Diagnostic evaluation Diagnosis Therapy
얞,т, Polysomnography with respiratory monitoring Obstructive sleep apnea b̎ÁG Cz; p (e.g., uvulopalatopharyngoplasty); dental appliance; 򕨗Ö@ (protriptyline); ̏d
E͔, hypnagogicA o,}q, Ԃ̉Ƒ Polysomnography with multiple sleep-latency test Narcolepsy-cataplexy h, e.g., methylphenidate, dextroamphetamines, pemoline, modafinil; REM-}; R (e.g., imipramine, fluoxetine); `k
Restless-legsnjQ, disturbed sleep, predisposing medical condition (e.g., n͐tsS) Polysomnography with bilateral anterior tibialis; ؓd} restless-legs njQ "\ȂΌԂ̎ÁG dopaminergic agents (e.g., levodopa-carbidopa, pramipexole); benzodiazepines (e.g., clonazepam); opiates; gabapentin
Disturbed sleep, (e.g., asthma), and/or predisposing medical therapies (e.g., theophylline) Sleep-wake diary Insomnias "\ȂΌ̎ÂƎÂ̕ύXG behavioral therapy; ʂ̒Z non-benzodiazepine (e.g., zolpidem, zaleplon)

 E͔ narcolepsy𔺂邪,̕aCɌՂɒӁB

@\12. ǐċzl鎞̊ӕ


"中等度の貧血"
Clinical findings Diagnosis to consider Tests Interpretation
,E͔, hypnagogicȌo, }q, ̕ảƑ Narcolepsy Polysomnography with multiple sleep-latency test RłȂԂ̐Ɖ^}q
Ԃ̖C, exercise intolerance, Q, depression SsS xɂ鐇f
Jn, Ԋo, stage shifts and arousals ǐx Blood gases, x@\, Ԓ_fǂƍY_KX. ̕aCÂ鑽̖򂪐WQs𗈂B
JnQ, Ԋo, Ă; ͖Ԛb鎖 GERD (ݐHt) H pH̎Ď Ăɂ݂WQ
֘As, |, I^, bruxism, leg cramps, ,A, o,̑̏Q Parasomnias [\R] Polysomnography ̍D܂ȂۂɋNB
o𔺂s,‹CǴA^]Aւ̋̑r •a Mini-mental status exam, Hamilton depression score ͋CQɂ鐇Ɗ֌WCsω
Ԃ̉ߏȖC, ُ̈^ł̏oɋLȂ PC ]g 炩ȐWQPC

@\13. Narcolepsy ^Ƃ̊ӕ
,E͔, hypnagogicȌo, }q, ̕ảƑ Narcolepsy PSG with MSLT IRłȂԂ̐Ɖ^}q
ߏ肢т,Ԃ̖C,얞, Q,Ǐ, Obstructive sleep apnea PSG Cǂ _fs JԂf𗈂
ΖAs@̗sɂsl Circadian rhythm Q, D Actigraphy  circadian rhythm ̌͂QQ
Ԃ̖C,J,‹C,m\ Hypothyroidism TSH bBzs
Sleepiness, insomnia, Jn Alcohol ƒÍ܂ɂ hypersomnolence Ȃ Antihistamines, narcotics, ACE inhibitors, beta-blockers, anorectics, hypnotics, neuroleptics, Â𗈂ǂ̖, overstimulation, s, or REM suppression
ߏȒԂ̖CALɂȂُ̈^ Seizure disorder EEG ÂȐWPC
sA炢AW͌@AؓɁAߓx̌ƉƋł̂Š s\njQ Ȃ D, s̍ł
tbVłȂԐɔߏȒԂ̖C Idiopathic hypersomnia PSG, MSLT  narcolepsyɎ钋Ԃ̉non-REM
ꂢȐꏊł̖siĎO̎l^𔺂j I^ PSG Interference with non-REM

E͔͕G⏬A͔AꗎA _.
ɊԈ₷B

ff

@\QA\RA\SA\TQƁI

ÁG}A@

s𗈂wI͐_Iɑ΂ē@ɕKvB
@KvƂȂaC̗ COPD b̋}Gs⋕SԋSǂ₤SsSȂǂ
SGbB@\iyђቺǁG̕sSGtsSƓ͂Ɋ֌W鐇QGWÎɌϑzG@KvȐQ𗈂_iNaAdǂ•aAdNjA}__oa

ÁGԓx

KxȌNȐ𐄏 [\ 14] ƎЉƂ̌AdAN[VKxɁB
PGƖڊoߎԂŒ肷B
@QGQ⒋QBR[q[ނ͔BỎߏȃ`R[gA^oRAAR[ B; @
@RGQO4`6ԑO܂łɋKIȉ^͂B
@SGdXgXƊ֌W痣ĐQꏊB
@TGxbh͖邽߂ZbNẌׂɎgpB
@UG1ԔȏxbhŖȂ,NオǏȂǂ̃XgX̊|ȂB
@@ԓxH̕ω͐ċzAnarcolepsy, ⑽̂ق̐Q̉ɂ͂ȂȂƂɒӁB.

ÁG򕨗Ö@

@ffm肵Âv悳ꂽ玡Ân߂B΂ΐQƂɂkBK؂Ȑff̊m̑OɎÂ
@n߂鎖͊bɂasmɂÂx点B
@PȖs̊҂NIAAbNXPAFm[sÖ@ȂǂŎÂBʂɖs
@͖򕨎Â󂯂ׂł͂ȂBCognitive-behavioral treatment (CBT)@͂܂KςAɊւ
@lƑԓxςAǂN𑝐iBTOȏ̎͂̕ł(҂2000lȏ)s҂
@VO`WOɍsÂǂ鎖ĂB CBT temazepamŎÂ󂯂s̘Vl̒ł
@ZԂɐԂ͗ǂȂB̎Â󂯂lPƎÂʂ͗ǂB CBTPƂPێ
@ɂ͍łʂB
@ߐs̊҂͂Q`RTԂ򕨎Â݂ĂǂB [\ 15] [\ 16].
@ǐċz҂͐Ƃnasal continuous positive airway pressure (NCPAP)@ɏ]ƗǂB
@ł NCPAP̎gp͉ߏȒԂ̖CCƐ_ʂł̌NƈʓIȑ̒ǍD𗈂ƌB
@ŝȂs Benzodiazepines Temazepam (Restoril) Intermediate acting ,pɖ肠銳҂ɗL
@sɔs Benzodiazepines Triazolam (nVI) Shorter acting; ϐ┽̊댯
@Flurazepam (_[g) Longer acting; ԕsL銳҂ɗL
@Clonazepam (hZ) Longer acting
@Non-benzodiazepines Zolpidem (Ambien) Short acting
@Buspirone (Buspar) Anti-anxiety effect takes 4 or more weeks
@Sedative antidepressants Nortriptyline (mgAventyl) ;sǂɗL
@Doxepine (Sinequan) Sedating
@Trazodone (XADesyrel) pG daytime sedation, Nጌ, possible priapism

Temazepam (Restoril) 7.5 to 30 mg q.h.s. Intermediate acting; may be useful for problems with sleep continuity
Triazolam (Halcion) 0.125 to 0.250 mg q.h.s. Shorter acting; carries increased risk for tolerance and rebound insomnia
Flurazepam (Dalmane) 15 to 30 mg q.h.s. Long acting; may be useful for patients with daytime anxiety
Clonazepam (Klonipin) 0.5 mg q.h.s. Long acting; may be useful for patients with daytime anxiety
Zolpidem (Ambien) 5 to 10 mg q.h.s. Short-acting non-benzodiazepine
Buspirone (Buspar) 10 to 30 mg q.h.s. Anti-anxiety effect takes four or more weeks
Nortriptyline (Aventyl) 10 to 25 mg q.h.s. Sedating; sǂɗL
Doxepine (Sinequan) 10 to 25 mg q.h.s. Sedating
Trazodone (Desyrel) 25 to 50 mg q.h.s. Side effects include daytime sedation, orthostatic hypotension, and possible priapism

d circadian-rhythmQ҂KȎԂ bright-light Â鎖悢B҂ bright-lightÂ̎gp@
ʂ̐p^[ɖ߂a̒߂B jet lag Ζ̖̂l zolpidemŎÂǂB circadian Q
̎ÂMelatoninKǂݒłB

ÁGNPI@

銳҂͎pKvłB
continuous positive airway pressure (CPAP)ɔȂOSAS̊҂ uvulopalatopharyngoplasty (W laser-⏕),
nasal septoplasty (@uό`̊), Cǐ؊JȂǂKvȎB.


ÁG⊮wiAnȂǁj

̕s҂n[u⑼̖򑐂ɓĂBȊwIɂ͂͌̕ʂSɊւĂ͕słB
[\17].
Valerian, English valerian, allheal(Valeriana officinalis) ÍpƌĂB萇⏕n[u̎gp͂B
Skullcap, blue pimpernel, madweed(Scutellaria lateriflora) Purported herbal remedy for insomnia; ʂ͕s
Passion flower(Passiflora incarnata) Purported herbal remedy for restlessness and insomnia; ʂ͕s
Chamomile(Matricaria chamomilla) Purported remedy for insomnia and other conditions. GWvgŎgp; ʂ͕s
Melatonin ʑ̂őz. Hypnotic and circadian-rhythm effects have been documented. gp̈S͏ؖĂȂB h{⏕܂ƂĎgp邪 ނ݂ɎgpׂłȂB

Complications
̐Qdȍǂ𔺂B [\ 18].
s, OSAS, narcolepsy, circadian-rhythmQ͒Ԃ̖CƐ𔺂BA͒ÍÖܗpAEƏЉIQA傤•ałNBċziǐ⒆jA኷CAċz̍ǂ͓̌xsǂɂʎ̂Ȃǂ̎̂SǕaS (ÂʼnP)ċzsSA cor pulmonale𗈂BAǂ_o؎҂ÍÖ܎gp҂ł͔x𗈂ƂB
InsomniaAOSASANarcolepsyA
Circadian-rhythm disorders		 Ԃ̖CA, sedative hypnoticp, EƏ㖔͎ЉI,•ả"\
Sleep apnea (obstructive and central)
Central hypoventilation
Periodic breathing		 spӂȒÍÖgp ċz}̌xsɂʎ,̊댯
SǎS̑ (ÂʼnP)
ǂ_o؎̊҂Ventilatory failure, cor pulmonale, x

ʂȏ

s̘VlÂ͌ɓٓIɂ܂ŐV̒ӂKvłBÍ܎gp̓]|̊댯ׂ̈ɂ̖͌ʂӂĎgpB•aɂ݁AsNȐ̓K؂ȎÂ͏dvłB
@
Ƃɂ'邩H

Q҂𐇖QƂɑ鎖lBՏ^̂AႦ sleep apnea periodic limb movementsȂǂVlQ (e.g., 傫Ȃт,ߏȒԂ̖C,  restless legs̑i) ՏI PSGŌo߂ώ@BtǂmĂaC痈Q͓]̕Kv͂ȂȂBbɂaCǂȂĂQȂΐƂׂ֑łB
_I̐i͂肵Ȃ⊳҂̍sff⎡Â̖WQɂȂ鎞͐_Ȉ␸_q񋟎҂ɏЉׂłB
銴AsAɎtꂽAĐȉQ͐ffƎÂQ𗈂BႦΐ{̋t󂯂Ă鋫E̖͎Ȉ̐iQ҂͂΂ΐQ鎞𗧂ĂĂ. Ȃ̂Ɋ҂𑕂aȔQ悭B

@\Prognosis

ӂׂ͐Q̗\͐FXł邱ƂłB
International Classification of Sleep DisordersɍڂĂWS̏Q̗\͐FXłB‹̕ωAsȎAЂǂ₩܂ꏊAXgX̂oA}̕aCAhIȖ򕨂̐ێAڂɂߐ̐Q̗\͗ǂBႦΎڂ̕s̉񕜂ƐTCN̍ēɗs鎞͂PPԂ̗ōs͂PDTłB̑̕s͗\オB
ߏȒԂ̖C̕a̗\FXłB Narcolepsy ɉȂς킵aŎƂFlƑ̂҂ɂꂽAASrA•aȂǂɎ邱ƂBċz̊bɂ_oؖ͋ǂ̕aCÂȂ҂͒͏oȂBȉ̌ʓIȎÂȖ̊Cŗ\b̂Ɏ킯鎖oBɎǐ sleep apnea (OSAS) ҂͏Ǐ󂪂ȂȂB

@҂̋GʓI

śANWԐKvłƌԈMSɂ蕡GɂȂBɐQ悤ƂăCCsɂȂB

@҂̋GȊǗ
̖ɂ͌NȐێi\PSjЉƂ̌𗬁AdAN[ṼoXƂ鎖łB
ׂ̈ɋKIɒÍ܂gp̂͂߂B
ċz̗lȒ኷CnjQ΁AÍ܂gpĂ͂Ȃi͌ċz}ɂȂ̂ŁjB

@oߊώ@
҂ƋKIȍĕ]ƃj^[̕KvbBꎞIȃXgXy•aɂs͓퐶ł悭̂ƂĎ󂯓Ă悢BKǂwI͐_ȓIaCȂ̂ɕsȂ͊bɌ̐QB ̒Ögp͑ϐAˑA֒fibenzodiazepines𒆎~ĂR`QOŋNĂj𐶂ށB͐T琔Ōʂ鎖]܂B

@



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