同: SDB

WordNet

be able to accommodate for sleeping; "This tent sleeps six people"
be asleep (同)kip, slumber, log Z''s, catch some Z''s
a period of time spent sleeping; "he felt better after a little sleep"; "there wasnt time for a nap" (同)nap
a natural and periodic state of rest during which consciousness of the world is suspended; "he didnt get enough sleep last night"; "calm as a child in dreamless slumber" (同)slumber
a torpid state resembling deep sleep (同)sopor
bring disorder to (同)disarray
a physical condition in which there is a disturbance of normal functioning; "the doctor prescribed some medicine for the disorder"; "everyone gets stomach upsets from time to time" (同)upset
a disturbance of the peace or of public order
passing or able to pass air in and out of the lungs normally; sometimes used in combination; "the boy was disappointed to find only skeletons instead of living breathing dinosaurs"; "the heavy-breathing person on the telephone" (同)eupneic, eupnoeic
the bodily process of inhalation and exhalation; the process of taking in oxygen from inhaled air and releasing carbon dioxide by exhalation (同)external_respiration, respiration, ventilation
the suspension of consciousness and decrease in metabolic rate
the state of being asleep
not arranged in order (同)unordered

PrepTutorEJDIC

〈U〉『眠り』,『睡眠』[『状態』] / 〈C〉《a sleep》一眠り[の時間] / 〈U〉永眠,死 / 〈U〉(一時的な手足などの)無感覚,しびれ;冬眠(hibernation) / 〈U〉目やに / 『眠る』 / 『文眠なる』,(死んで)葬られている / 〈人〉‘を'泊める[設備がある] / 《a+形容詞+sleepを目的語にして》…‘を'眠る
〈U〉『無秩序』,混乱,乱雑(confusion) / 《しばしば複数形で》(社会的・政治的な)粉争,騒動 / 〈C〉(肉体的・精神的な)不調,異常,障害 / …‘の'秩序を乱す / 〈心身〉‘に'異常を起こさせる
〈U〉呼吸;一息 / 〈C〉一呼吸の間,瞬時 / 〈C〉休息,休止

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/03/03 16:46:57」(JST)

wiki en

Significant physiologic changes in breathing take place during normal sleep related to alterations in respiratory drive and musculature.

1 Normal sleep and breathing
- 1.1 Sleep onset
- 1.2 Steady NREM (Non-REM) sleep
  - 1.2.1 Ventilation
  - 1.2.2 Rib cage and abdominal muscle contributions
  - 1.2.3 Upper airway resistance
  - 1.2.4 Arterial blood gases
  - 1.2.5 Pulmonary arterial pressure
  - 1.2.6 Effects of arousals
- 1.3 Steady REM Sleep
  - 1.3.1 Ventilation
  - 1.3.2 Rib cage and abdominal muscle contributions
  - 1.3.3 Upper airway function
  - 1.3.4 Arterial blood gases
  - 1.3.5 Pulmonary arterial pressure
  - 1.3.6 Effect of arousals
2 Sleep-disordered breathing (abnormal sleep and breathing or sleep-related breathing disorders)
- 2.1 Primary snoring
- 2.2 Upper airway resistance syndrome
- 2.3 Obstructive sleep apnea (including hypopnea) syndrome
- 2.4 Central sleep apnea syndrome
- 2.5 Complex sleep disordered syndrome
- 2.6 Sleep related hypoventilation syndromes
3 References

Normal sleep and breathing

Sleep onset

Set point of ventilation is different in wakefulness and sleep. pCO2 is higher and ventilation is lower in sleep. Sleep onset in normal subjects is not immediate, but oscillates between arousal, stage I and II sleep before steady NREM sleep is obtained. So falling asleep results in decreased ventilation and a higher pCO2, above the wakefulness set point. On wakefulness, this constitutes an error signal which provokes hyperventilation until the wakefulness set point is reached. When the subject falls asleep, ventilation decreases and pCO2 rises, resulting in hypoventilation or even apnea. These oscillations continue until steady state sleep is obtained. The medulla oblongata controls our respiration.

Steady NREM (Non-REM) sleep

Ventilation

Breathing is remarkably regular, both in amplitude and frequency in steady NREM sleep. Steady NREM sleep has the lowest indices of variability of all sleep stages. Minute ventilation decreases by 13% in steady stage II sleep and by 15% in steady slow wave sleep (Stage III and Stage IV sleep). Mean inspiratory flow is decreased but inspiratory duration and respiratory cycle duration are unchanged, resulting in an overall decreased tidal volume.

In a study of 19 healthy adults, the minute ventilation in NREM sleep was 7.18 +/- 0.39(SEM) liters/minute compared to 7.66 +/- 0.34 liters/minute when awake.^[1]

Rib cage and abdominal muscle contributions

Rib cage contribution to ventilation increases during NREM sleep, mostly by lateral movement, and is detected by an increase in EMG amplitude during breathing. Diaphragm activity is little increased or unchanged and abdominal muscle activity is slightly increased during these sleep stages.

Upper airway resistance

Airway resistance increases by about 230% during NREM sleep. Elastic and flow resistive properties of the lung do not change during NREM sleep. The increase in resistance comes primarily from the upper airway in the retroepiglottic region. Tonic activity of the pharyngeal dilator muscles of the upper airway decreases during the NREM sleep, contributing to the increased resistance, which is reflected in increased esophageal pressure swings during sleep. The other ventilatory muscles compensate for the increased resistance, and so the airflow decreases much less than the increase in resistance.

Arterial blood gases

The Arterial blood gasses pCO2 increases by 3-7mmHg, pO2 drops by 3-9mmHg and SaO2 drops by 2% or less. These changes occur despite a reduced metabolic rate, reflected by a 10-20% decrease in O2 consumption, suggesting overall hypoventilation instead of decreased production/metabolism.

Pulmonary arterial pressure

Periodic oscillations of the pulmonary arterial pressure occur with respiration. Pulmonary arterial systolic and diastolic pressure and PAD increase by 4-5mm in NREM sleep

Effects of arousals

Induced transient arousal from NREM sleep cause the following: Increase EMG activity of the diaphragm 150%, increased activity of upper airway dilating muscles 250%, increased airflow and tidal volume 160% and decreased upper airway resistance.

Steady REM Sleep

Ventilation

Irregular breathing with sudden changes in both amplitude and frequency at times interrupted by central apneas lasting 10–30 seconds are noted in Rapid Eye Movement (REM) sleep. (These are physiologic changes and are different from abnormal breathing patterns noted in sleep disordered breathing). These breathing irregularities are not random, but correspond to bursts of eye movements. This breathing pattern is not controlled by the chemoreceptors, but is due to the activation of behavioral respiratory control system by REM sleep processes. Quantitative measure of airflow is quite variable in this sleep stage and has been shown to be increased, decreased or unchanged. Tidal volume has also been shown to be increased, decreased or unchanged by quantitative measures in REM sleep. So breathing during REM sleep is somewhat discordant.

In a study of 19 healthy adults, the minute ventilation in REM sleep was 6.46 +/- 0.29(SEM) liters/minute compared to 7.66 +/- 0.34 liters/minute when awake.^[1]

Rib cage and abdominal muscle contributions

Intercostal muscle activity decreases in REM sleep and contribution of rib cage to respiration decreases during REM sleep. This is due to REM related supraspinal inhibition of alpha motoneuron drive and specific depression of fusimotor function. Diaphraghmatic activity correspondingly increases during REM sleep. Although paradoxical thoracoabdominal movements are not observed, the thoracic and abdominal displacements are not exactly in phase. This decrease in intercostal muscle activity is primarily responsible for hypoventilation that occurs in patients with borderline pulmonary function.

Upper airway function

Upper airway resistance is expected to be highest during REM sleep because of atonia of the pharyngeal dilator muscles and partial airway collapse. Many studies have shown this, but not all. Some have shown unchanged airway resistance during REM sleep, others have shown it to increase to NREM levels.

Arterial blood gases

Hypoxemia due to hypoventilation is noted in REM sleep but this is less well studied than NREM sleep. These changes are equal to or greater than NREM sleep

Pulmonary arterial pressure

Pulmonary arterial pressure fluctuates with respiration and rises during REM sleep.

Effect of arousals

Arousals cause return of airway resistance and airflow to near awake values. Refer arousals in NREM sleep.

Sleep-disordered breathing (abnormal sleep and breathing or sleep-related breathing disorders)

A sleep apnea patient exhibiting a 32s pause in breathing and snoring.

Primary snoring

Snoring is a condition characterized by noisy breathing during sleep. Usually, any medical condition where the normal airway is blocked during sleeping, like obstructive sleep apnea, gives rise to snoring. Snoring, when not associated with any such Obstructive phenomenon is known as Primary Snoring.^[2] Apart from the specific condition of obstructive sleep apnea, other causes of snoring include alcohol intake prior to sleeping, stuffy nose, sinusitis, obesity, long tongue or uvula, large tonsil or adenoid, smaller lower jaw, deviated nasal septum, asthma, smoking and sleeping on one's back. Primary Snoring is also known as Simple Snoring or Benign Snoring, and is not associated with sleep apnea, i.e. temporary cessation of breathing.

Upper airway resistance syndrome

Obstructive sleep apnea (including hypopnea) syndrome

Obstructive sleep apnea is apnea either as the result of obstruction of the air passages or inadequate respiratory muscle activity.

Central sleep apnea syndrome

Sleep apnea (or sleep apnoea in British English; /æpˈniːə/) is a sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep. Each pause in breathing, called an apnea, can last for several seconds to several minutes, and may occur 5 to 30 times or more in an hour.^[3]

Complex sleep disordered syndrome

Sleep related hypoventilation syndromes

References

^ ^a ^b Douglas, NJ; White, DP; Pickett, CK; Weil, JV; Zwillich, CW (1982). "Respiration during sleep in normal man". Thorax 37 (11): 840–844. doi:10.1136/thx.37.11.840. PMC 459437. PMID 7164002. Retrieved 2014-07-09.
^ http://stopsnoring-remedies.com/
^ http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html

UpToDate Contents

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1. 成人における睡眠関連呼吸障害：定義 sleep related breathing disorders in adults definitions
2. 心不全における睡眠時呼吸障害 sleep disordered breathing in heart failure
3. 睡眠関連呼吸障害と脳卒中 sleep related breathing disorders and stroke
4. 小児における睡眠が関係する呼吸障害の機序および素因 mechanisms and predisposing factors for sleep related breathing disorders in children
5. 慢性閉塞性肺疾患（COPD）における睡眠呼吸障害 sleep disordered breathing in copd

English Journal

The interaction between sleep-disordered breathing and apolipoprotein E genotype on cerebrospinal fluid biomarkers for Alzheimer's disease in cognitively normal elderly individuals.

Osorio RS1, Ayappa I2, Mantua J2, Gumb T3, Varga A2, Mooney AM2, Burschtin OE2, Taxin Z2, During E3, Spector N3, Biagioni M3, Pirraglia E3, Lau H3, Zetterberg H4, Blennow K4, Lu SE5, Mosconi L3, Glodzik L3, Rapoport DM2, de Leon MJ3.Author information 1Center for Brain Health, NYU School of Medicine, New York, NY, USA; Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain. Electronic address: Ricardo.Osorio@nyumc.org.2Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU School of Medicine, New York, NY, USA.3Center for Brain Health, NYU School of Medicine, New York, NY, USA.4Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.5Department of Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA.AbstractPrevious studies have suggested a link between sleep disordered breathing (SDB) and dementia risk. In the present study, we analyzed the relationship between SDB severity, cerebrospinal fluid (CSF) Alzheimer's disease-biomarkers, and the ApoE alleles. A total of 95 cognitively normal elderly participants were analyzed for SDB severity, CSF measures of phosphorylated-tau (p-tau), total-tau (t-tau), and amyloid beta 42 (Aβ-42), as well as ApoE allele status. In ApoE3+ subjects, significant differences were found between sleep groups for p-tau (F[df2] = 4.3, p = 0.017), and t-tau (F[df2] = 3.3, p = 0.043). Additionally, among ApoE3+ subjects, the apnea and/or hypopnea with 4% O2-desaturation index was positively correlated with p-tau (r = 0.30, p = 0.023), t-tau (r = 0.31, p = 0.021), and Aβ-42 (r = 0.31, p = 0.021). In ApoE2+ subjects, the apnea and/or hypopnea with 4% O2-desaturation index was correlated with lower levels of CSF Aβ-42 (r = -0.71, p = 0.004), similarly to ApoE4+ subjects where there was also a trend toward lower CSF Aβ-42 levels. Our observations suggest that there is an association between SDB and CSF Alzheimer's disease-biomarkers in cognitively normal elderly individuals. Existing therapies for SDB such as continuous positive airway pressure could delay the onset to mild cognitive impairment or dementia in normal elderly individuals.
Neurobiology of aging.Neurobiol Aging.2014 Jun;35(6):1318-24. doi: 10.1016/j.neurobiolaging.2013.12.030. Epub 2013 Dec 27.
Previous studies have suggested a link between sleep disordered breathing (SDB) and dementia risk. In the present study, we analyzed the relationship between SDB severity, cerebrospinal fluid (CSF) Alzheimer's disease-biomarkers, and the ApoE alleles. A total of 95 cognitively normal elderly partici
PMID 24439479

Sleep and aging: examining the effect of psychological symptoms and risk of sleep-disordered breathing.

Mellor A1, Waters F, Olaithe M, McGowan H, Bucks RS.Author information 1a School of Psychiatry and Clinical Neurosciences University of Western Australia , Perth , Australia.AbstractControversy exists as to whether self-reported sleep quality declines with age, despite changes in sleep being accepted as part of normal aging. This study sought to investigate age-related differences in self-reported sleep quality, after controlling for conditions that are common with age, such as psychological symptoms and increased risk of sleep-disordered breathing (SDB). The Pittsburgh Sleep Quality Index (PSQI) was administered to a sample of 582 community adults (aged 18-89 years), and the association between age and 3 factors of the PSQI (sleep efficiency, perceived sleep quality, and daily disturbance), and global scores, was examined controlling for depression, anxiety, stress, gender, and SDB risk. Results indicate that (a) before controlling for covariates, there was no significant relation between age and all indexes of self-reported sleep quality, with the exception of sleep efficiency. However, once depression, gender, and SDB risk were controlled for, a significant, yet small, relation was revealed between older age and poorer global sleep quality; (b) there was no association between age and perceived sleep quality or daily disturbances before or after controlling for relevant covariates; and (c) depression, gender, and SDB risk were significant predictors of poorer sleep quality across the indexes but, in general, did not have a marked impact on the relation between age and sleep quality. In conclusion, results suggest that sleep problems are common across the lifespan, and that there were modest age-related differences in self-reported sleep quality, which were not due to depressed mood, gender, or risk of SDB.
Behavioral sleep medicine.Behav Sleep Med.2014 May 4;12(3):222-34. doi: 10.1080/15402002.2013.801343. Epub 2013 Jun 9.
Controversy exists as to whether self-reported sleep quality declines with age, despite changes in sleep being accepted as part of normal aging. This study sought to investigate age-related differences in self-reported sleep quality, after controlling for conditions that are common with age, such as
PMID 23746072

Drug-induced sleep endoscopy changes snoring management plan very significantly compared to standard clinical evaluation.

Pilaete K1, De Medts J, Delsupehe KG.Author information 1ENT Department, University Hospitals of Leuven, Leuven, Belgium.AbstractDrug-induced sleep endoscopy (DISE) is a new tool in the work-up of patients with sleep-disordered breathing (SDB). We assessed the impact of DISE on the treatment plan of snoring patients. This is a single institution prospective longitudinal clinical trial. The setting is a private teaching hospital. A consecutive series of 100 snoring patients prospectively underwent a standardised questionnaire, clinical examination, rhinomanometry, allergy skin prick testing, DISE and polysomnography. Management plan before and after DISE evaluation was compared. In 61 patients (excluding 16 patients sent for continuous positive airway pressure, three patients refused sleep endoscopy and 20 were lost to follow-up), we compared the treatment plans. DISE showed single level airway collapse in 13 and multilevel collapse in 48 patients. The site of flutter did not add additional information as compared to the pattern and the location of the collapse. After DISE, the initial management plan changed in 41 % of patients irrespective of the type of initial management plan. The only somewhat accurate initial treatment plan was uvulopalatopharyngoplasty (unchanged in 11/13 patients). Excluding moderate to severe obstructive sleep apnea patients DISE is an indispensable tool in treatment decision in all SDB patients. We suggest to simplify the protocol for DISE reporting.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery.Eur Arch Otorhinolaryngol.2014 May;271(5):1311-9. doi: 10.1007/s00405-013-2795-3. Epub 2013 Nov 7.
Drug-induced sleep endoscopy (DISE) is a new tool in the work-up of patients with sleep-disordered breathing (SDB). We assessed the impact of DISE on the treatment plan of snoring patients. This is a single institution prospective longitudinal clinical trial. The setting is a private teaching hospit
PMID 24196346

Japanese Journal

慢性腎臓病と睡眠呼吸障害の相互作用

小山崇,渡邊博之,伊藤宏,佐藤一洋,寺田豊,村上学,尾野恭一,渡邊博之,伊藤宏,Kiso Hironori,Ohba Takayoshi,Iino Kenji,Sato Kazuhiro,Terata Yutaka,Murakami Manabu,Ono Kyoichi,Watanabe Hiroyuki,Ito Hiroshi
循環器内科 74(5), 514-518, 2013-11
NAID 120005357472