Seminar 第 26 回 日本呼吸ケア・リハビリテーション学会学術集会 スポンサード教育講演 同時通訳あり Sleep Disordered Breathing in COPD: Pathophysiology and Polysomnographic Features 日 時 ： 2016 年 10 月1 1 日（火）13：40 ∼ 14：40 会 場 ： B 会場 パシフィコ 横浜会議センター 5F「503」 〒220-0012 神奈川県横浜市西区みなとらい 1−1−1 座 長： 岸 一馬 先生 （国家公務員共済組合連合会虎の門病院 呼吸器センター内科） 演 者： Hartmut （ Johns Schneider, MD, Ph.D. Hopkins School of Medicine, Baltimore, MD, USA ） 参加方法：会場に直接お越し下さい 定 員：400名 共催 第26回 日本呼吸ケア・リハビリテーション学会学術集会 フィリップス・レスピロニクス合同会社 第 26 回 日本呼吸ケア・リハビリテーション 学会学術集会 スポンサード教育講演 2016 年 10月 1 1 日（火）13:40 ∼ 14:40 B会場 パシフィコ横浜会議センター 5F 「503」 Sleep Disordered Breathing in COPD : Pathophysiology and Polysomnographic Features Hartmut Schneider, MD, Ph.D. Johns Hopkins School of Medicine, Baltimore, MD, USA Abstract Chronic obstructive pulmonary disease ( COPD ) is a major source of morbidity, mortality and health care costs. Recent studies have shown high mortality in patients with both sleep apnea and COPD ( so called overlap syndrome ) , leading some to focus on sleep as an important factor in care of the COPD patient. However, the traditional metrics of sleep disordered breathing such as the apnea-hypopnea index do not generally capture the presence or severity of sustained nocturnal hypoventilation or hypoxemia. We offer a conceptual framework for characterizing sleep related breathing disorders in patients with COPD. COPD is associated with alterations in respiratory mechanics and gas exchange, leading to dynamic hyperinflation and / or hypoventilation. As illustrated in adjacent Figure, during wakefulness, patients compensate for expiratory flow obstruction to minimize hyperinflation and to preserve alveolar ventilation. Sleep is associated with several changes in respiratory control that interfere with compensatory mechanisms during wakefulness. A loss of ventilatory drive leads to significant reductions in tidal volume, and compensatory mechanism to prevent hypoventilation are left to changes in respiratory pattern: An increase in inspiratory time would increase tidal volume but would reduce expiratory time. Similarly, an increase in respiratory rate would maintain minute ventilation but also reduces expiratory time. In either case, respiratory patterns during sleep in COPD can worsen dynamic hyperinflation by shortening expiratory time. Moreover, inspiratory flow limitation ( IFL ) is commonly observed during sleep and even mild degrees of inspiratory flow limitation lengthens inspiration, further comprising expiratory time. Mechanisms to minimize hypoventilation will exacerbate dynamic hyperinflation, whereas lengthening expiratory time could compromise ventilation during sleep. Thus, sleep induces specific alterations in breathing pattern that compromise both ventilation and increase respiratory loads in COPD. Thus, in COPD with abnormalities in respiratory mechanics and gas exchange, sleep is a physiologic challenge rather than a period of rest for the respiratory system. Sleep Disordered Breathing in COPD Wakefulness Respiratory loads Pathophysiology Impaired Compensatory Mechanisms Polysomnographic features in COPD Clinical Outcomes Compensatory Mechanisms Sleep Sleep Disturbances Sleep Disturbances ・ Disturbance in sleep architecture ・ Frequent Arousals ・ Sympathetic/parasympathetic imbalance ・ Alpha intrusion Daytime symptoms Morning Fatigue Daytime Sleepiness Decline in Executive Functions Depression Chronic fatigue syndrome PTSD/pain management problems ・ ・ ・ ・ ・ ・ Abnormal breathing patterns ・ ・ ・ ・ ・ ・ Atypical obstructive apnea/hypopnea Expiratory Flow Limitation Inspiratory flow limitation with Dynamic Hyperinflation REM related hypoxia/hypercapnia Tachypnea (Rapid shallow breathing) Sustained Hypoxia and Hypercapnia (CO2 Retention) Cardio-pulmonary findings Endothelial dysfunction Arterial and pulmonary hypertension Hypercapnia and hypoxia Increase in Morality ・ ・ ・ ・ 〒108-8507 東京都港区港南二丁目13番37号フィリップスビル www.philips.co.jp/healthcare/ © 2016 Philips Respironics GK
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