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Hiroyuki Hirai
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睡眠時無呼吸症候群(Osas)についての患者さん向け説明資料です。
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睡眠時無呼吸症候群(Osas)について
1.
2017/09/21作成 名古屋糖尿病内科クリニック 睡眠時無呼吸症候群(OSAS) について
2.
こんな症状がありませんか? ●いびきをかく ●いびきが止まると言われる ●睡眠中の窒息感 ●日中の強い眠気 ●疲労感が続く
3.
このような人に多い ●寝る前にお酒をよく飲む ●太り気味 ●高血圧、糖尿病、脂質異常症をもつ ●首が短い ●顎が小さい
4.
OSASの問題点 それぞれ未治療の重症OSAS患者では ●心血管イベント 2.87倍 ●脳血管障害 1.66倍 ●交通事故が多い
2.88倍 何より日中の眠気によるQOLの低下
5.
検査と診断の流れ 1.問診 2.簡易検査 a. AHI <
5 :経過観察あるいは1年後に簡易検査再検 b. 5 ≦ AHI < 40 :PSGで精査あるいはCPAP以外の治療 c.40 ≦ AHI :PSGを省略してCPAP導入も考慮 上記はあくまでも目安です AHI(無呼吸低呼吸指数)= 1時間あたりの無呼吸と低呼吸の回数を合計したもの 無呼吸:10秒以上呼吸ができない状態 低呼吸:10秒以上換気が50%以下になった状態
6.
問診 ESS 状況 点数
0~3の4段階評価 座って読書中 0 1 2 3 テレビを見ているとき 0 1 2 3 人の大勢いる場所(会議や劇場など)で座っているとき 0 1 2 3 他の人の運転する車に、休憩無しで1時間以上乗っているとき 0 1 2 3 午後に、横になって休憩しているとき 0 1 2 3 座って人と話をしているとき 0 1 2 3 飲酒せずに昼食後、静かに座っているとき 0 1 2 3 自分で車を運転中に、渋滞や信号で数分間止まっているとき 0 1 2 3 5点未満 日中の眠気少ない 5~10点 日中の軽度の眠気あり 11点以上 日中の強い眠気あり
7.
在宅簡易検査 〜まずは自宅で〜 ●帝人在宅医療(株)から検査機器が発送されます ●手順書に従い測定してください ●測定後に機器を着払い伝票で返却してください ●帝人在宅医療(株)から結果レポートが当院に届きます ●当院で結果を説明いたします
8.
OSASの治療 ●生活習慣の改善 減量、飲酒の制限、睡眠中の体位を工夫する ●内科的治療 CPAP療法:マスクをつけて圧力をかけることで気道の閉塞を防ぐ治療です 毎月1回の受診が必要です ●歯科的治療 マウスピースをつけて、下顎を前方にだすことで気道を広げます ●外科的治療 喉の部分にある過剰な粘膜などを除去することにより、外科的に気道を拡大させます。
9.
いびきを減らすエクササイズ ● 舌の先を硬口蓋に当てて前後に動かす (20回) ●
口蓋を舌で押しながら、上に向けた舌を吸い込む (20回) ● 下の前歯に舌を当てたまま、舌後面を口腔下面に押し付ける (20回) ● 間欠的に「エー(A)」と言いながら、軟口蓋・口蓋垂を挙上する。慣れたら 声を出さずに行う (20回) ● 指を使って口腔内から頬筋を外に向かって押す (20回) ● 左右の奥歯で噛んで嚥下する。(食べながらでも可) Vanessa leto et al., Chest. 2015 Sep;148(3):683-691.
10.
当院は在宅簡易検査に対応しております 医院名 名古屋糖尿病内科クリニック ホームページ https://dm-nagoya.com/ TEL
052-485-7203 FAX 052-308-3648 住所 〒450-0002 名古屋市中村区名駅3丁目22番8号 大東海ビル3階308号
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