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CPAP治療の流れと効果~睡眠時無呼吸症候群治療の第一選択~

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CPAP治療(Continuous Positive Airway Pressure:経鼻的持続陽圧呼吸療法)は、睡眠時無呼吸症候群(SAS)の治療の最も重要な治療法となっています。

睡眠時無呼吸症候群は眠っているときに無呼吸状態になる病気で、日中の強い眠気や意欲低下から社会的な生活が困難となったり、高血圧、不整脈、脳血管障害といった合併症をひきおこしたりと、日常生活に深刻な影響が生じます。

このような状況を回避するためには、病気にいちはやく気づき、適切な治療を受けることが大切です。

本記事では、CPAP治療を受けるまでの流れと、CPAP治療の効果をご紹介します。

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睡眠時無呼吸症候群の症状

いびきをかく男

睡眠時無呼吸症候群は、日中の眠気や意欲の低下などにより、日常生活に大きな支障を来す病気です。

日常生活のなかの症状などから、睡眠時無呼吸症候群であることが疑われる場合は、一度病院で検査を受けてみることをお勧めします。

睡眠時無呼吸症候群が疑われる症状は以下のとおりです。
【就寝時】

  • いびきをかく
  • 息がとまる
  • 呼吸が乱れる
  • 息が苦しくて目が覚める
  • 何度も目を覚まし、トイレに行く

【起きているとき】

  • 強い眠気に襲われる
  • イライラして興奮しやすい
  • やる気がなくなる
  • 記憶力や集中力が低下する
  • 性欲がなくなる
  • 身体を動かすと、息切れがする

CPAP治療を受けるまでの流れ

睡眠時無呼吸症候群が疑われる症状がある場合は、呼吸器科や耳鼻咽喉科などを受診します。

病院ではまず、問診が行われます。
【問診の内容】

  • 自覚症状
  • 生活習慣や合併症
  • 交通事故やニアミス経験
  • 服用中の薬
  • 夜寝ているときの様子:自分ではわからないこともあるので、ベッドパートナーに同席してもらうとよいでしょう
  • 眠気についてのアンケート

問診で、睡眠時無呼吸症候群の疑いがあると判断された場合、簡易型検査装置を用いた検査を行います。

簡易型検査装置によるスクリーニング検査の結果、睡眠時無呼吸症候群の可能性が高いと判断された場合、さらに詳しい検査で確定診断を行います。
検査は、無呼吸の状態を正確に測定するために、通常は夜間の入院検査で行います。
この検査は終夜睡眠ポリグラフィ(PSG)というもので、身体に電極やセンサーをつけて行いますが、痛みを伴うものではありません。

検査で睡眠時無呼吸症候群と診断された場合、次に治療法を決定します。
【治療法】

  • 減量
  • 生活習慣の指導
  • CPAP使用
  • マウスピースなどの装置着用
  • 手術

睡眠時無呼吸症候群が軽症の場合は、減量や生活習慣の見直しなどで症状が改善する場合もあります。
しかし症状が重い場合は、眠気や気力の低下などで、減量や生活習慣の見直しに取り込むこと自体が難しくなるため、CPAP治療が多く行われます。

それでは次に、CPAP治療の方法、効果をご紹介します。

CPAP治療の方法

CPAP治療は、CPAPという装置を就寝時に使用し、鼻に装着したマスクから空気を送り込むことによって、一定の圧力を気道にかけて呼吸を確保する方法です。

CPAP治療を行うときには、患者個人に最も適した機器・マスクの選択や、空気を送る圧力の処方など、専門医の指導が必要となります。

CPAP治療には大きく3種類のタイプがあります。

  • 固定タイプ:固定圧を上限として下限圧から徐々に圧を上昇させ、一定の圧を維持する。一度適した圧を設定すればマスクからの漏れなどがなく使用しやすい。体重の変化、アルコールの摂取などの諸条件の変化に対応できず圧が不足することがある
  • オートタイプ:下限圧と上限圧の間で必要に応じて圧力を変動させる。諸条件への対応がしやすい。個人の呼吸パターンによっては相性が合わないこともある。また、マスクからの漏れをうまく制御する必要がある。
  • Bilevelタイプ:呼気、吸気それぞれの圧を固定設定する特殊なタイプ

CPAP治療はスクリーニング検査でAHI(Apnea-Hypoxia-Index:無呼吸・低呼吸指数)40以上、または確定診断でAHI20以上で、保険適用となり、CPAPの機材は月に5000円ほど(3割負担の場合)でレンタルすることができます。

また、CPAP治療は根治療法ではないため、毎日CPAP治療を継続することによって、効果を維持することが必要となります。

CPAP治療の効果

CPAP治療を行うとほとんどの場合、治療を開始した日からいびきをかかなくなり、昼間の眠気も軽くなります。

また、重症の睡眠時無呼吸症候群においては、CPAP治療群と無治療群を比較した場合、CPAP治療群のほうが明らかに予後がよいという報告が多くあり、様々な研究によって睡眠時無呼吸症候群に対するCPAP治療の効果が証明されています。

CPAP治療の効果を以下にあげます。

  • 無呼吸、低呼吸、いびきの消失
  • 睡眠の質の向上
  • 日中の眠気の改善
  • 高血圧や狭心症など合併症の改善
  • 良眠により活動的になり、仕事や趣味、社会生活に意欲が湧き、生活の質(QOL)が向上する
  • 意欲の向上により、減量や禁煙に成功することもある

CPAP治療では、重症であるほど自覚症状が劇的に改善します。
反対に、CPAP治療前から自覚症状が少ない場合は、改善の実感が少ないようです。
ただ、実感が得られなくても多くの場合は、睡眠時無呼吸症候群による脳血管系、心血管系のリスクが除去される等、何等かの変化がみられます。

ネルネル 21回用 (口閉じテープ)
三晴社 (2006-06-05)
売り上げランキング: 115

まとめ:重症の睡眠時無呼吸症候群にはCPAP治療が効果的

睡眠時無呼吸症候群の治療には、減量、生活習慣の改善などが必要となりますが、重症の場合は日中の眠気、気力の低下などによりこれ自体が難しくなります。

このため、CPAP治療は睡眠時の無呼吸の状況を機械の力を借りて改善することのできる、非常に有効な治療方法であるといえます。

CPAP治療で良質な睡眠を確保することにより、意欲の向上から減量、生活習慣の改善につなげることもできます。

睡眠時無呼吸症候群かもしれない、と思うような症状がある方は、ぜひ一度専門医の診察を受けることをおすすめします。

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