教育入院を必要とする糖尿病患者における閉塞型睡眠時無呼吸症候群の有病率

The Prevalence of Obstructive Sleep Apnea Syndrome in the Diabetes Mellitus Patients who Require Educational Hospitalization

要旨

　本邦における糖尿病(DM)患者集団での閉塞型睡眠無呼吸症候群(OSAS)有病率に関する従来の論文は，パルスオキシメーターの記録や問診による診断結果に基づく報告が多く，検出率や特異性に問題がある．われわれは，OSAS有病率を明らかにするためDM教育入院患者34名(男性20名，女性14名)を対象に，ポリソムノグラフと高い相関を示す睡眠呼吸モニター装置を用いて前向き検討を行った．無呼吸低呼吸指数(AHI)＜5の対象は17名(50.0％)，5≦AHI＜20は10名(29.4％)，20≦AHIは7名(20.6％)でいずれも閉塞型であった．臨床検査値およびDM合併症頻度において3群間で有意差を認めなかった．DM教育入院患者におけるOSAS有病率は50.0％と高率だが，臨床所見のみからその存在を検出することは困難である．DM教育入院患者では適切な感度を有する機器を用いたOSASのスクリーニングが必要である．

Obstructive sleep apnea syndrome (OSAS) frequently complicates cardiovascular diseases like systemic hypertension or metabolic diseases such as diabetes mellitus (DM) which relates insulain resistance. Previous papers have reported on the prevalence of OSAS in Japanese patients with DM. However, as the reported findings are based on only pulse-oxymeter records or on interviews, we suspect that sensitivity and specificity are low. In order to determine the prevalence of OSAS in DM patients, thirty-four DM patients hospitalized for DM study were subjected to a sleep study using a sleep respiratory monitor with a strong correlation with a full polysomnograph. Seventeen patients (50.0％) did not have OSAS, ten patients (29.4％) had mild (5≦AHI＜20) OSAS and seven patients (20.6％) had severe (20≦AHI) OSAS. Laboratory data did not differ significantly among the three groups. Therefore, although the OSAS prevalence ratio of 50.0％ was extremely high, OSAS in DM patients who hospitalized for therapeutic education could not be predicted from laboratory data. We conclude that sleep study should be performed on all DM patients who hospitalized for therapeutic education.