山梨医科大学紀要　第7巻，035-040(1990)

閉塞性睡眠時無呼吸症候群と「いびき」

村上嘉彦

　睡眠時無呼吸症候群は、睡眠時に呼吸が周期的、反復性に停止する病的状態であり、一般に閉塞（末梢）性、中枢性、混合性の３種に分類されるが、睡眠時に上気道のある部位に狭窄や閉塞が起こり出現する閉塞性睡眠時無呼吸がその多数を占める。1970年代に導入された歴史の浅い疾患概念ながらも重症患者では生命に脅威を及ばすような心肺機能不全を来すことも知られ、多くの医療分野で注目され活発な論議を呼んできている。
　この閉塞性睡眠時呼吸障害では、その必発症状として極端に大きな「いびき」があって、しかも上気道の狭窄・閉塞所見の確認が不可欠であるところから、その診断と治療に耳鼻咽喉科医の果たすべき臨床的役割は大きい。本稿ではこの閉塞性睡眠時呼吸障害の症候学と診断法について述べ、さらに治療対策のうちとくにいびきと無呼吸に有効な外科的治療を中心に記述した。

キーワード：睡眠時呼吸障害、いびき、上気道の狭窄・閉塞、睡眠障害



Obstructive Sleep Apnea and Snoring

Yoshihiko MURAKAMI, M. D.

Sleep apnea syndrome is characterized by the periodic cessation of breathing during sleep. These apneic episodes may result from upper airway collapse, termed obstructive or peripheral apnea; lack of thoracic and diaphragmatic activities, termed central apnea; or from a combination of the two, i. e., mixed apnea. The majority of patients, however, falls into the obstructive category, specifically within the anatomic region of the pharynx. Obstructive sleep apnea has been studied intensively since it was introduced in the 1970's and is now recongnized a common and potentially devastating disorder that can occur at any age.
Snoring is a sure sign of a restricted airway, the hallmark of obstructive sleep apnea and typically defined as the sound created by rhythmic oscillation of the soft palate in the inspiratory air stream during sleep.
Heavy, snorers associated with apneic episodes during sleep should first be evaluated by otolaryngologists whether or not there is evidence of discrete airway obstruction in the upper aerodigestive tract. Then, polysomnographic recordings are necessary to confirm the diagnosis of obstructive sleep apnea syndrome.
In this paper, the signs and symptoms that suggest this sleep-related breathing disorder are described and several currently available treatment modalities are briefly reviewed.



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