epworth sleepiness scale

  1. 問診において、日中の眠気を評価するためのもの。
  1. 12点以上で病的な過眠症の可能性が高くなるため精査必要となる。ただし、感度については十分ではない場合もあるので、低い（8点未満）からといって否定しきれるかは事前確率次第。
  1. カットオフ値については、さまざまな意見があり、女性では10点以上とすることを提案している報告もある（Correlates of daytime sleepiness in 4578 elderly persons: the Cardiovascular Health Study. PMID: 9485530）。
出典
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1: A new method for measuring daytime sleepiness: the Epworth sleepiness scale.
著者: M W Johns
雑誌名: Sleep. 1991 Dec;14(6):540-5.
Abstract/Text: The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.
Sleep. 1991 Dec;14(6):540-5.

過眠を引き起こす薬剤

副交感神経優位にする薬剤あるいは鎮静作用のある薬剤は、基本的には過眠の有害事象を伴う。
出典
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1: Excessive sleepiness.
著者: Sheila C Tsai
雑誌名: Clin Chest Med. 2010 Jun;31(2):341-51. doi: 10.1016/j.ccm.2010.02.007.
Abstract/Text: Sleepiness is a commonly experienced symptom affecting up to one-fifth of the population chronically. Sleepiness contributes to systemic health effects, and has been shown to contribute to mood disorders and cardiovascular risks. Sleepiness also presents a significant public health risk: it has been associated with major catastrophes, motor vehicle accidents, and medical errors by health care workers. This article reviews the implications of sleepiness on public health, the evaluation of sleepiness, disorders that result in sleepiness, and the management of these disorders.

Copyright 2010. Published by Elsevier Inc.
Clin Chest Med. 2010 Jun;31(2):341-51. doi: 10.1016/j.ccm.2010.02.007....

頭蓋計測点

出典
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1: Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men.
著者: K K Li, C Kushida, N B Powell, R W Riley, C Guilleminault
雑誌名: Laryngoscope. 2000 Oct;110(10 Pt 1):1689-93. doi: 10.1097/00005537-200010000-00022.
Abstract/Text: OBJECTIVES: To investigate the possible differences between Far-East Asian men and white men in obstructive sleep apnea syndrome (OSAS).
STUDY DESIGN: Prospective nonrandomized controlled study.
METHODS: This study compared consecutive Far-East Asian men with OSAS (n = 50) with two selected groups of White men with OSAS (n = 50 in each group). One group of white men was controlled for age, respiratory disturbance index (RDI), and minimum oxygenation saturation (LSAT). Another group was controlled for age and body mass index (BMI). Cephalometric analysis was performed on all subjects.
RESULTS: The majority of the Far-East Asian men were found to be nonobese (mean BMI, 26.7 +/- 3.8) but had severe OSAS (mean RDI, 55.1 +/- 35.1). When controlled for age, RDI, and LSAT, the white men were substantially more obese (mean BMI, 29.7 +/- 5.8, P = .0055). When controlled for age and BMI, the white men had less severe illness (RDI, 34.1 +/- 17.9, P = .0001). Although the posterior airway space and the distance from the mandibular plane to hyoid bone were less abnormal in the Far-East Asian men, the cranial base dimensions were significantly decreased.
CONCLUSIONS: The majority of the Far-East Asian men in this study were found to be nonobese, despite the presence of severe OSAS. When compared with white men, Far-East Asian men were less obese but had greater severity of OSAS. There may be differences in obesity and craniofacial anatomy as risk factors in these two groups.
Laryngoscope. 2000 Oct;110(10 Pt 1):1689-93. doi: 10.1097/00005537-200...

過眠症の鑑別アルゴリズム

出典
imgimg
1: Excessive sleepiness.
著者: Sheila C Tsai
雑誌名: Clin Chest Med. 2010 Jun;31(2):341-51. doi: 10.1016/j.ccm.2010.02.007.
Abstract/Text: Sleepiness is a commonly experienced symptom affecting up to one-fifth of the population chronically. Sleepiness contributes to systemic health effects, and has been shown to contribute to mood disorders and cardiovascular risks. Sleepiness also presents a significant public health risk: it has been associated with major catastrophes, motor vehicle accidents, and medical errors by health care workers. This article reviews the implications of sleepiness on public health, the evaluation of sleepiness, disorders that result in sleepiness, and the management of these disorders.

Copyright 2010. Published by Elsevier Inc.
Clin Chest Med. 2010 Jun;31(2):341-51. doi: 10.1016/j.ccm.2010.02.007....