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Background: There are few reports about sleep disturbances in patients with chronic obstructive pulmonary disease (COPD) in Asian countries. Objectives: To investigate the associations between sleep-disordered breathing (SDB) with hypoxemia and sleep quality, including sleep duration, in patients with COPD, we measured SDB and sleep quality including the objective sleep duration determined by an actigraph and portable monitoring. Methods: A cross-sectional epidemiological health survey of 303 male employees (means ± SD: age 43.9 ± 8.2 years; BMI 24.0 ± 3.1) was conducted. Sleep quality was measured using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A respiratory disturbance index (RDI) ≥5 indicated SDB. Results: Nineteen subjects (6.3%) had COPD. Among these, 11 (3.6%) had COPD with SDB (overlap syndrome). Sleep duration, ESS, and PSQI scores were not significantly different between COPD patients and normal control subjects. However, COPD patients had significantly longer sleep latency (p = 0.019), a lower sleep efficiency (p = 0.017), and a higher sleep fragmentation index (p = 0.041) and average activity (p = 0.0097) during sleep than control subjects. They also had a significantly higher RDI and more severe desaturation during sleep than control subjects (p < 0.01). The differences remained after adjustment for age and BMI but disappeared following adjustment for RDI. Conclusions: COPD patients with even mild-to-moderate airflow limitations had nocturnal desaturation and RDI-related impaired sleep quality without significant symptoms.

Dyslipidemia is often comorbid with obstructive sleep apnea (OSA), but few population-based studies have investigated their relationship. Short sleep duration is associated with hypertension and diabetes; however, its association with dyslipidemia is not well known. We investigated relationships among OSA, sleep duration, and the lipid profile in a community-based study.We measured the respiratory disturbance index (RDI) and sleep duration by a type 3 portable device and actigraph in 275 men in a Japanese company. Fasting blood parameters were obtained from periodic inspection data.According to Japanese criteria, 143 subjects had dyslipidemia. Percent sleep time of oxygen saturation as measured by pulse oximetry (SpO2)lt; 90% and prevalence of severe OSA were greater and sleep duration and mean SpO2 during sleep were lower in subjects with dyslipidemia than in those without. Univariate analysis showed that the RDI was positively correlated with serum triglyceride (TG) levels (ρ = 0.20, Plt; .01), and sleep duration was negatively correlated with serum total cholesterol (TC) levels (γ = -0.13, P = .03) and serum low-density lipoprotein cholesterol levels (γ = -0.12, P = .04). Stepwise multiple regression analysis revealed that TG was correlated with RDI (β = 0.14, P = .02), BMI (β = 0.20, Plt; .01), and alcohol intake (β = 0.20, Plt; .01), and that TC was correlated with sleep duration (β = -0.13, P = .03), age (β = 0.15, P = .02), and waist/hip ratio (β = 0.15, P = .02).Short sleep duration was associated with TC levels and RDI was positively associated with TG levels among working-aged men in an urban Japanese company. Correcting the status of OSA and/or short sleep duration might improve the lipid profile and cardiovascular consequences.

Obstructive sleep apnoea is common in patients with diabetes. Recently, it was reported that short sleep duration and sleepiness had deleterious effects on glucose metabolism. Thereafter, several reports showed relationships between glucose metabolism and obstructive sleep apnoea, sleep duration or sleepiness. But the interrelationships among those factors based on recent epidemiological data have not been examined. We analysed data on 275 male employees (age, 44±8years; body mass index, 23.9±3.1kg m(-2) ) who underwent a cross-sectional health examination in Japan. We measured fasting plasma glucose, sleep duration using a sleep diary and an actigraph for 7days, and respiratory disturbance index with a type 3 portable monitor for two nights. Fifty-four subjects (19.6%) had impaired glucose metabolism, with 21 having diabetes. Of those 21 (body mass index, 25.9±3.8kgm(-2) ), 17 (81.0%) had obstructive sleep apnoea (respiratory disturbance index≥5). Regarding the severity of obstructive sleep apnoea, 10, four and three had mild, moderate and severe obstructive sleep apnoea, respectively. The prevalence of obstructive sleep apnoea was greater in those with than without diabetes (P=0.037). Multiple regression analyses showed that the respiratory disturbance index independently related to fasting plasma glucose only in the diabetic subjects. In patients with diabetes, after adjustment for age, waist circumference, etc. sleep fragmentation had a greater correlation with fasting plasma glucose than sleep duration, but without significance (P=0.10). Because the prevalence of obstructive sleep apnoea is extremely high in patients with diabetes, sufficient sleep duration with treatment for obstructive sleep apnoea, which ameliorates sleep fragmentation, might improve fasting plasma glucose.

Obstructive sleep apnoea (OSA) plays a significant role in increasing blood pressure. Significant decreases were reported in blood pressure of hypertensive OSA patients with sleepiness who underwent continuous positive airway pressure (CPAP) treatment, but not in non-sleepy hypertensive OSA patients. More recently, however, significant decreases in blood pressure in non-sleepy hypertensive OSA patients following CPAP were shown. Effects of sleepiness on hypertension in OSA patients have been investigated, but not the effects of hypertension on sleepiness in OSA patients. We investigated the relationships between hypertension and sleepiness in patients with OSA. We analysed data on 275 middle-aged male subjects from a cross-sectional epidemiological health survey. We measured blood pressure and sleep duration objectively using an actigraph for 7 days and the respiratory disturbance index (RDI) with a type 3 portable device for 2 nights, and assessed sleepiness using the Epworth Sleepiness Scale (ESS). The RDI correlated significantly with ESS scores in the 88 hypertensive subjects (r = 0.33, P = 0.0024), but not in the 187 non-hypertensive subjects (r = -0.01, P = 0.91). Short sleep duration correlated significantly with ESS scores in both groups. Both the RDI and short sleep duration were related independently to sleepiness in only hypertensive subjects. Furthermore, the RDI was related negatively significantly to sleep duration in hypertensive subjects. Although short sleep duration was related significantly to sleepiness in both groups, hypertension may be important for the sleepiness in OSA patients. Detailed mechanisms of the difference in the relationship between sleepiness and the severity of OSA with or without hypertension should be studied further.

SLEEP-RELATED HEALTH PROBLEMS AND THEIR IMPACT ON SOCIETY AND ON INDIVIDUALS ARE A MAJOR SOCIAL ISSUE. PEOPLE WITH SLEEP-DISORDERED breathing (SDB) are at increased risk for hypertension,1,2 cardiovascular diseases,3 and mortality.3,4 However, SDB and obstructive sleep apnea syndrome (OSAS) are prevalent but largely undiagnosed in adults.5 In spite of this wide population of undiagnosed patients, in-laboratory sleep-recording capacity has remained limited. This current situation presents an urgent need to move toward the use of portable monitors in home settings. Epidemiologic studies for SDB and OSAS have been conducted not only in Western countries,1–5 but also in Asian countries.6,7 However, sound estimates of SDB prevalence in Japan are lacking: previous Japanese studies have been limited by use of nonprobability samples, low response rates, small samples, and other methodologic problems. All previous Japanese epidemiologic studies on SDB and OSAS were performed with type 4 portable monitors.8–10 In our current study, a cardiorespiratory monitoring device (also referred to as a type 3 portable monitoring device) was used together with actigraphy at home to analyze SDB. Type 3 portable monitors are defined as devices with a minimum of 4 channels monitored,11 including ventilation or airflow (at least 2 channels of respiratory movement or respiratory movement and airflow), heart rate or electrocardiogram, and oxygen saturation, whereas portable monitors that do not meet these criteria are designated as type 4.11 Attended type 3 sleep studies are thought to be a standard method and an alternative for polysomnography in the diagnosis and follow-up for SDB and OSAS.12 On the other hand, type 4 portable monitors are not recommended for diagnosis because they have a higher percentage of false-positive results and high rates of false negatives or conflicting results.11 Most epidemiologic studies have been performed with polysomnography in laboratory settings. Using in-laboratory polysomnography as the gold standard has limitations in validity, partly because subjects tend to sleep more poorly in the laboratory than at home.11 In this study, participants were asked to follow their usual lifestyles, and sleep recordings were performed at home. Home monitoring that more closely reflects the subjects' usual drinking and sleeping habits may present a different prevalence or different outcomes than those from previous reports in the laboratory settings. Recently, obesity has become a major social problem in Japan. The prevalence of obesity (body mass index: [BMI] ≥ 25) in 1983, 1993, and 2003 was 26.7%, 24.5% and 34.4%, respectively, among the Japanese male general population aged 40 to 49 years.13 Obesity and weight gain are positively associated with SDB.14 Thus, SDB may become more prevalent than has been previously reported in Japanese. The primary goal of this paper was to examine the prevalence of home-monitored SDB and OSAS in a Japanese working population. The secondary goal was to test the hypotheses that home monitoring with a type 3 portable monitor and actigraphy can produce reliable data to analyze SDB in usual lifestyles. Here, we report the first epidemiologic study in Japan with a type 3 portable monitor and actigraphy at home to examine the prevalence and related factors of SDB.

本研究の目的は、「まちの保健室」を訪れる地域住民の睡眠の実態を調査するとともに、睡眠相談の活動方法を検討することである。研究協力者はH大学「まちの保健室」に来訪した男女102名(平均年齢55.9歳)で、質問紙調査を行った。また、個別睡眠相談を利用した女性17名(平均年齢60.9歳)には、アクチウォッチを用いた個別相談と介入を行いその反応について分析した。得られた結果は以下のとおりである。1)質問紙調査の判定で睡眠が良好だった人は49.0%、要注意の人は21.6%、不眠の疑いがある人は29.4%で、「まちの保健室」に来訪した人の約5割は、睡眠に関して何らかの問題や不満を抱えていた。2)個別睡眠相談来訪者の主な相談内容は、寝つきが悪い、中途覚醒がある、いびき、ほてり、自己の睡眠の測定などで、「不眠の悩みを相談しやすい状況をつくる」、「介入のきっかけの一つとしてアクチウォッチのデータを用いる」、「来訪者と共に生活の仕方を振り返る」、「眠れていることや良い生活習慣等できていることを認める」、「睡眠に関する知識・情報を提供する」などの介入を行った。3)個別睡眠相談を利用した17名のうち7名に、1ヶ月後以降の睡眠や生活の様子について聞き取り調査を行ったところ、「自分の睡眠を知ることによる安心感」、「自分の行動を認める」、「睡眠に対する関心の高まり」などの、視点や考え方の変化がみられた。また、7名中3名には睡眠が改善したという発言があった。睡眠相談は相談に来る人を待つスタイルであるが、今後は集団を対象とした睡眠衛生教育など、より積極的な介入も必要であると考える。「まちの保健室」睡眠相談で、アクチウォッチを用いながら個別の生活に合わせた介入を行うことにより、来訪者の睡眠に対する考え方や生活行動に変化が現れ、睡眠が改善する効果があることが示唆された。, The purpose of this study was to investigate the sleep status of the local residents who visited the "Neighborhood Health Station" and to examine the action method used for sleep consultations. The study volunteers consisted of 102 persons (average age: 55.9 years) who visited the "Neighborhood Health Station" established by H University. The investigation was carried out using questionnaires. Seventeen females (average age: 60.9 years) received individual sleep consultations using an Actiwatch and interventions were made. The results were then analyzed. Results 1) According to the questionnaire data, 49.0% were classified as good sleepers; 21.6% as marginal; and 29.4% were suspected of being insomniacs. About 50% of those who visited the "Neighborhood Health Station" had some issues or dissatisfaction with their sleep. 2) The main topics raised by individuals during sleep consultations were their difficulty in falling asleep, waking up in the middle of the night, snoring, hot flashes and also how to get advice on how to monitor their own sleep patterns. We conducted interventions such as a) creating an environment where visitors can freely discuss their insomnia problems, b) making use of the Actigraph's data as one way of initiating intervention, c) examining clients' lifestyles and having them reflect on this with the support of the counselor, d) acknowledging that a good sleep and good life habits are being achieved, and e) providing knowledge and information about sleep". 3) Of 17 visitors who had individual sleep consultations, seven were chosen for further interviews regarding their sleep status and lives at more than one month after the initial consultation. We witnessed changes in the visitors' viewpoints and thinking, such as a) feeling assured by understanding their own sleep, b) acknowledging their own actions, and c) increased interest in sleep. Moreover, three out of the seven claimed that their sleep had improved. These sleep consultations were relied on waiting for clients to simply come in; however, in the future, we think that more active intervention will be necessary, such as conducting sleep health classes for groups. Intervening, in accordance with individual lifestyles by using the Actiwatch at the "Neighborhood Health Station" consultations, suggests that the clients' ideas about sleep and lifestyle were modified and such interventions were effective in improving sleep.

SAS患者は日中の眠気や倦怠感などの疾患に起因する症状を紛らわすために睡眠にとって悪い習慣を取ってしまっている可能性が指摘されている。しかしSAS患者の生活実態は明らかになっていない。そこで本研究はSAS患者の生活習慣の実態を明らかにし、Apnea Hypopnea Index (AHI)、Epworth Sleepiness Scale (ESS)、Pittsburgh Sleep Quality Index (PSQI)、Body Mass Index(BMI)との関連を検討することを目的として行った。方法は質問紙およびAHIのデータをカルテより転載し、分析を行った。対象者は睡眠時無呼吸症候群と診断され治療前の方、56名を対象として行い、回収率は86%であった。AHI、ESS、PSQI、BMIと喫煙、飲酒、カフェインの摂取、睡眠時間などとの関連をみたところ、飲酒とBMIとの間に有意な関連がみられた。また喫煙とPSQIに有意な関連がみられ、睡眠の質が低いと評価している人ほど喫煙本数が多かった。睡眠時間とESSおよび希望睡眠時間と睡眠時間の差とESSの間に相関がみられ、SASによる睡眠障害だけでなく、睡眠時間の不足も問題である可能性があると考えられた。ベッドパートナーの有無が睡眠を阻害する因子になりうる可能性が示唆された。今回の対象者では治療開始前であったが、SASの治療の第一選択であるCPAP療法には家族のサポートも重要である。そのため今後ベッドパートナーの有無がCPAP療法にどのような影響を及ぼすのかについても検討していくことが重要であると考える。, It has been pointed out that Sleep Apnea Syndrome (SAS) patients may have adopted life-styles which are poor for their sleep in order to alleviate symptoms that originate in disorders such as sleepiness and fatigue during the day. However, there is no clear evidence of what kind of maladaptive life-styles have been adopted by SAS patients. This research was therefore conducted with the aim of revealing the life-styles of SAS patients, and exploring the relationships between those life-styles and their correlation with the Apnea Hypopnea Index (AHI) data, the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and the Body Mass Index (BMI). It was conducted on 56 pre-treated patients diagnosed with SAS via analysis of questionnaires and AHI data from their medical records. The response-rate was 86%. An analysis of the relationships between the data derived from AHI, ESS, PSQI, and BMI to smoking, alcohol consumption, caffeine intake and sleeping hours showed a significant relationship between alcohol consumption and BMI data. Furthermore, a significant relationship was evident between smoking and PSQI data, with those who evaluated their sleep quality as poor smoking the most. A correlation could also be seen between sleeping time and the ESS data, and the difference between desired hours of sleep and actual sleeping time and the ESS data, indicating that not only sleep disturbance was caused by SAS, but also the lack of sleep time could be a problem. In addition, it was also suggested that the existence of a bed partner could be one factor disturbing sleep. While the subjects of this research had not yet been treated, family support is important to CPAP treatment. For this reason, it will also be essential to study the effect of a bed partner on CPAP treatment in the future.

Obstructive sleep apnoea is common in patients with diabetes. Recently, it was reported that short sleep duration and sleepiness had deleterious effects on glucose metabolism. Thereafter, several reports showed relationships between glucose metabolism and obstructive sleep apnoea, sleep duration or sleepiness. But the interrelationships among those factors based on recent epidemiological data have not been examined. We analysed data on 275 male employees (age, 44±8years; body mass index, 23.9±3.1kg m(-2) ) who underwent a cross-sectional health examination in Japan. We measured fasting plasma glucose, sleep duration using a sleep diary and an actigraph for 7days, and respiratory disturbance index with a type 3 portable monitor for two nights. Fifty-four subjects (19.6%) had impaired glucose metabolism, with 21 having diabetes. Of those 21 (body mass index, 25.9±3.8kgm(-2) ), 17 (81.0%) had obstructive sleep apnoea (respiratory disturbance index≥5). Regarding the severity of obstructive sleep apnoea, 10, four and three had mild, moderate and severe obstructive sleep apnoea, respectively. The prevalence of obstructive sleep apnoea was greater in those with than without diabetes (P=0.037). Multiple regression analyses showed that the respiratory disturbance index independently related to fasting plasma glucose only in the diabetic subjects. In patients with diabetes, after adjustment for age, waist circumference, etc. sleep fragmentation had a greater correlation with fasting plasma glucose than sleep duration, but without significance (P=0.10). Because the prevalence of obstructive sleep apnoea is extremely high in patients with diabetes, sufficient sleep duration with treatment for obstructive sleep apnoea, which ameliorates sleep fragmentation, might improve fasting plasma glucose.

Obstructive sleep apnoea (OSA) plays a significant role in increasing blood pressure. Significant decreases were reported in blood pressure of hypertensive OSA patients with sleepiness who underwent continuous positive airway pressure (CPAP) treatment, but not in non-sleepy hypertensive OSA patients. More recently, however, significant decreases in blood pressure in non-sleepy hypertensive OSA patients following CPAP were shown. Effects of sleepiness on hypertension in OSA patients have been investigated, but not the effects of hypertension on sleepiness in OSA patients. We investigated the relationships between hypertension and sleepiness in patients with OSA. We analysed data on 275 middle-aged male subjects from a cross-sectional epidemiological health survey. We measured blood pressure and sleep duration objectively using an actigraph for 7 days and the respiratory disturbance index (RDI) with a type 3 portable device for 2 nights, and assessed sleepiness using the Epworth Sleepiness Scale (ESS). The RDI correlated significantly with ESS scores in the 88 hypertensive subjects (r = 0.33, P = 0.0024), but not in the 187 non-hypertensive subjects (r = -0.01, P = 0.91). Short sleep duration correlated significantly with ESS scores in both groups. Both the RDI and short sleep duration were related independently to sleepiness in only hypertensive subjects. Furthermore, the RDI was related negatively significantly to sleep duration in hypertensive subjects. Although short sleep duration was related significantly to sleepiness in both groups, hypertension may be important for the sleepiness in OSA patients. Detailed mechanisms of the difference in the relationship between sleepiness and the severity of OSA with or without hypertension should be studied further.

OBSTRUCTIVE SLEEP APNEA (OSA) IS CHARACTERIZED BY REPEATED EPISODES OF APNEA AND HYPOPNEA DURING SLEEP. THERE IS A GROWING BODY OF evidence to support the belief that severe OSA is a risk factor for cardiovascular diseases and death,1 not only in clinical cases2,3 but also in the general population.4,5 The National Cholesterol Education Program (NCEP) Adults Treatment Panel III (2001) proposed a clinically-based approach that establishes a diagnosis of metabolic syndrome (Mets), when an individual has 3 of 5 risk factors for cardiovascular disease.6 There appears to be considerable overlap in the clustering of cardiovascular disease mechanisms involved in Mets and OSA. Indeed, 5 recent studies have shown that OSA was significantly associated with Mets.7–11 However, 4 of the 5 were non-epidemiological studies, while subjects in the one epidemiological study were relatively obese for an Asian population.9 Another study has reported that obesity,12 and not OSA was responsible for metabolic abnormalities. Thus, it has not yet been established whether Mets is primarily determined by obesity or sleep apnea. In addition, although the prevalence of OSA in Mets subjects is not well understood,9 the converse (i.e., the prevalence of Mets in OSA subjects) has been investigated several times.7–11 We hypothesized that OSA would be an independent risk factor for Mets in a normal male population. We investigated the prevalence of sleep apnea in subjects with Mets in a Japanese male working urban city population (n = 275) whose body mass index (BMI) matched that of the general Japanese male population.13 In this study, we also looked at the prevalence of OSA in Mets subjects, as this is an area that has not been investigated extensively. Recently, in addition to obese subjects, it has been reported that Mets subjects have a shortened sleep duration which has a significant association with morbidity and mortality.14–19 In these studies, the sleep duration was measured by a sleep diary, rather than with an actigraph.20 The sleep duration in bed as measured by an actigraph has been shown to be compatible with the duration as measured by polysomnography.21 We also investigated weekly mean sleep duration by means of an actigraph.

Previous neuroimaging studies that examined cerebral blood flow during rapid eye movement (REM) sleep have reported inconsistent findings regarding the activity of the dorsolateral prefrontal cortex (DLPFC). Although most previous positron emission tomography (PET) studies failed to detect DLPFC activation during REM sleep, several studies have observed DLPFC activation, possibly reflecting transient prefrontal activities related to REM. More recently, an event-related functional magnetic resonance imaging (fMRI) study observed REM-locked activation of the DLPFC during REM sleep. The present study investigated hemodynamic changes of the DLPFC throughout the REM sleep period in 25 subjects using near-infrared spectroscopy. Continuous monitoring of changes in the hemoglobin (Hb) concentration and tissue oxygenation index (TOI, proportion of oxygenated-Hb to total-Hb) in the bilateral DLPFC was conducted every 0.5 s, simultaneously with polysomnographic recordings. Eight of the 25 subjects showed REM sleep, and all indicated a clear increase in both the oxygenated-Hb concentration and TOI from baseline at the occurrence of first REM, relative to prior stage 2 sleep. The results indicate that the appearance of the first REM that occurred just after onset of the REM sleep closely coincides with the activation of the DLPFC, which could play a role in cognitive activities during REM sleep in humans.