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ナルコレプシーの検査方法

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ナルコレプシーとは、「居眠り病」とも呼ばれている慢性疾患の病気です。日中に突然、耐えることができない激しい眠気に襲われ眠ってしまうことが繰り返される病気です。思春期の頃に発症することが多い病気ですが、30歳や40歳という年齢で発症することもあります。

日本人における頻度は、およそ600人に1人ほどと推定されていて、日本国内におよそ20万人の潜在患者がいる計算になります。しかし実際に専門医によってナルコレプシーと診断され治療を受けているのは数千人です。本人も周りの人間もこれが病気とは思わず、本人の性格や夜更かしなどが原因と思われがちなのが、この病気の特徴と言えるでしょう。今回はこの病気の原因と検査方法について詳しく調べていきましょう。

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ナルコレプシーの症状とは

猫

ナルコレプシーは、いきなり眠くなるだけではなく、下記の症状が出る場合があります。

*日中の耐え難い過剰な眠気や居眠り
*笑ったり、得意になったりしたときなどに、体の力が抜ける情動脱力発作(カタプレキシ—)
*寝入りばなに幻覚をみる(入眠時幻覚)
*寝入りばなに金縛りにあう(睡眠麻痺)
*夜中に熟睡できず、何度も目が覚める(夜間熟眠障害)
*眠ったという自覚がないが、後で自分の行動を覚えていない(自動症)

このような症状に加え、ナルコレプシーは、どんなに睡眠を取ったとしても、関係なく昼間眠くなります。そのため、運転業務の人は事故をおこしかねません。同じ睡眠障害の1つである睡眠時無呼吸症候群を併発する可能性も高いと言われています。このような症状が3ヶ月以上続いた場合は専門病院で診察してもらった方が良いでしょう。

ナルコレプシーの検査方法とは

この病気の検査には3つの療法を使って行います。1つづつ説明していきましょう。

終夜睡眠ポリグラフ検査

睡眠障害では必ず行う精密検査です。睡眠中のさまざまな生体情報を同時に記録することができます。実際に測定しているものは、脳波、眼電図、筋電図(頤、下肢)、口・鼻からの気流、胸腹部の運動、心電図、血液の酸素飽和度などが細かく調べられます。その他、食道内圧を測定したり、寝ている状態をビデオ記録することがあります。 静かな防音対策が整った部屋で行われ、通常、医療施設に一泊して検査を受けることになります。この検査により、睡眠の質、睡眠呼吸障害の程度(睡眠時無呼吸症候群の重症度判定)、下肢の動き、脈の乱れなど多くのことを一度に検査することができます。

終夜睡眠ポリグラフ検査を受ける際には、検査技師が夜間にモニターを介して監視している病院がおすすめです。終夜監視を行うには検査技師の労力が必要となりますが、正確な診断を得るためには重要なことです。アメリカでは、検査技師が終夜監視を行っている終夜睡眠ポリグラフ検査は最も確かな検査となります。監視する検査技師がいない場合は検査のレベルが落ちる事があります。

睡眠潜時反復検査(MSLT)

ナルコレプシーの診断に欠かせない検査で、2008年の4月から保険適用となりました。2時間ごとに眠りやすさを調べます。ナルコレプシーの患者さんは眠るまでの時間が8分未満(典型的には5分以内)で、眠るとすぐにレム睡眠になることが2回以上みられます。通常、終夜睡眠ポリグラフ検査を施行した翌日に行います。

この検査の目的は、日中の眠気の程度、レム睡眠の出現の有無を評価することです。いくつかの終夜睡眠ポリグラフ検査の測定項目を省略して、1日に4~5回の睡眠検査を行います。

呼吸ホルター検査

睡眠呼吸モニター、アプノモニターなどさまざまな名称がありますが、簡単に言えば、自宅で検査が可能となるように終夜睡眠ポリグラフ検査の測定項目を省略したものです。主として測定するものは、血液の酸素飽和度です。その他、鼻の気流、いびき音、胸郭の動き、心電図を測定することがあります。ナルコレプシー以外の睡眠障害でも似た様な症状がでるので、病気の分別する時に行われる検査です。

この病気と診断された場合には、薬剤による治療が必要になり、一部の薬剤は認定を受けた医師しか処方できないことになっています。なお、この検査は保険適応になっており3割負担で2万円程度になります。一泊入院しなければならないので、検査する前に会社や学校に事前に連絡をしておくと良いでしょう。

2007年春から、ナルコレプシーの眠気に対する治療薬モディオダールR錠 (一般名:モダフィニル)が、使えるようになりました。この薬は、欧米を中心に世界30カ国以上で承認されていて、ナルコレプシー治療の第1選択薬となっています。副作用が少なく、非常に効果の高い薬です。

2011年に閉塞性睡眠時無呼吸症候群に対する効能も認められ、睡眠障害治療では大変有名な薬です。不静脈やうつ病、高血圧の方には使えないので、必ず医師の診察が必要です。

ナルコレプシーの研究―知られざる睡眠障害の謎 (Hot‐nonfiction)
本多 裕
悠飛社
売り上げランキング: 429,552

まとめ

ナルコレプシーは思春期の子供に多くみられるため、病気と判断されにくい特徴があります。日本では人口の0.16~0.59%、欧米では0.02~0.04%がこの病気にかかっています。規則正しい生活と投薬治療を行う事でかなり症状を抑える事ができます。もし3ヶ月以上日中の眠気が続いた場合は、専門の病院で診察を受けた方がよいでしょう。遺伝の可能性もあるので、親兄弟もよく調べてみて下さい。

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