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Kokyu to Junkan Volume 34, Issue 3 （March 1986）

呼吸と循環 34巻3号（1986年3月発行）

Japanese English

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症例

Sleep apnea syndromeを合併した異型狭心症の1例 A case of variant angina with sleep apnea syndrome 塩見利明 ¹ , 小林正 ¹ , 野村博彦 ¹ , 新井太 ¹ , 印牧研吾 ¹ , 伊藤尚雄 ¹ , 奥村一郎 ¹ , 水谷浩也 ¹ , 渡辺務 ¹ , 伊藤朝雄 ² , 佐藤敏子 ² Toshiaki Shiomi ¹ , Tadashi Kobayashi ¹ , Hirohiko Nomura ¹ , Futoshi Arai ¹ , Kengo Kanemaki ¹ , Hisao Ito ¹ , Ichiro Okumura ¹ , Koya Mizutani ¹ , Tsutomu Watanabe ¹ , Asao Ito ² , Toshiko Sato ² ¹愛知医科大学第三内科 ²愛知医科大学中央検査部 ¹The Third Department of Internal Medicine, Aichi Medical University ²The Department of Clinical Pathology, Aichi Medical University pp.333-338

発行日 1986年3月15日 Published Date 1986/3/15

DOI https://doi.org/10.11477/mf.1404204844

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Abstract 文献概要
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　最近，睡眠ポリグラフィ（polysomnography）による睡眠障害の精神生理学的研究^1）の結果，睡眠時無呼吸症候群（sleep apnea syndrome）^2）という新しい臨床的cri—teriaが提起され，注目されている^3）。しかし，sleep ap—nea syndromeが，夜間睡眠中に勃発する各種循環器疾患の病態生理に及ぼす影響については，いまだほとんど知られていない。

　今回著者らは，典型的な異型狭心症（Prinzmetal's　variant form of angina）^4）の患者に，延べ4終夜にわたる睡眠ポリグラフィを施行し，明らかなsleep apnea　syndromeの合併を確認しえた1症例を経験し，異型狭心症と本症との因果関係を文献的考察を含めて検討したので報告する。

A 76-year-old male was admitted because of pre-cordial oppression. The spontaneous attacks with cy-clic ST-elevation in leads V1-6 occured during slee-ping from midnight to early morning. Coronary ci-ne angiography demonstrated organic stenosis of ov-er 90% on the segment No.6 of left anterior des-cending coronary artery. Polysomnography was recorded for 4 nights in total, and the following results were obtained.

1) Fifty attacks with ST-elevation were seen in the first and second nights after withdrawing all dr-ugs, while they were not observed at all in the thi-rd and fourth nights following the administration of calcium antagonists.

2) During the observation for 4 nights (34.5 hours), sleep apnea of more than 10 seconds appe-ared 1136 times in total, and the apnea index was 32.9 in average, the mean apnea time was 22.4 seconds, and the percent apnea time was 20.8 in average. On the type of apnea, the central type was predominant.

3) Following morbid sleep apnea more than 30 seconds, the ST-elevation appeared sometimes. The sleep apnea was also seen during the ST-elevation.

This case was diagnosed as Prinzmetal's variant angina with sleep apnea syndrome from the results of polysomnography. The relation between the sleepapnea and the spontaneous attack of variant angina has not been well clarified yet. However, it has been recognized by other investigators that both ph-enomena frequently appear after the middle age in male and during the REM stage on sleeping. The sleep apnea also induces hypoxemia. Thus, it is assu-med that the sleep apnea may play some role in the spontaneous onset of variant angina.