CPAP療法
CPAPによる日常生活の変化
持続陽圧呼吸療法（Continuous Positive Airway Pressure : CPAP）は、閉塞性睡眠時無呼吸（OSA）の治療法の一つです。CPAPを使用し続けることで、睡眠の質や日常生活における気分の改善などの効果を感じる可能性があります。 （1）
医師の処方を守り、治療を継続的に行うことで、朝の頭痛（2,3）、大きないびき、悪夢、夜間の窒息感などの閉塞性睡眠時無呼吸（OSA）に起因する症状に効果的であると考えられています。
さらに、運転中の居眠りリスクの抑制（4）、日中の眠気の改善により職場での生産性の向上（5）、うつ病やイライラなどの感情の緩和（6,7）、性的能力の改善なども期待できます。
OSA治療は以下のような健康上のリスクを軽減します。
- 高血圧 (8.9)
- 脳卒中と心臓病(6-9)
- Ⅱ型糖尿病(10-12)
- 肥満症 (13)
CPAPによるOSA治療は、患者様のQOLを改善するだけではなく、寝室を共にするパートナーやご家族も安らいだ睡眠を得ることができます。
日常生活への影響
- いびき、無呼吸が引き起こす覚醒などは、一緒に眠っているパートナーの睡眠を妨げている可能性があります。CPAPは患者様とパートナーの両者が良い睡眠を得ることを可能にするかもしれません。（14）
- CPAPを定期的に使用することで、性的パフォーマンスを改善し、OSAに起因する性問題（勃起不全、性的衝動の喪失など）を軽減させます。（15）
- マスク装着に関してパートナーからどのように思われるが不安に感じる場合は、パートナーや医師に相談しましょう。
- CPAPを使用している患者様の外見が改善されることが明らかになりました。インタビューに参加人たちは、CPAPを行っている患者様はより若々しく、魅力的であると回答しています。（16）
- 日中の慢性的な倦怠感が軽減されてより活動的になることで、家族との過ごし方が改善されます。（17〜20）
- 食事中、家族と過ごしている際や外出時などに感じていた眠気が軽減すると（17-20）、より多くの時間を大切な人たちと過ごすことができるようになる可能性があります。
- 一日を通してより活動的になります。職場の会議や友人との集まりにも変化があるかもしれません。（17-20）
- 運転時などの移動が楽になります。（21）
- 物忘れや、集中力・注意力の欠如などもSASの一般的な症状であり、患者様の社会生活に影響を及ぼします。CPAPを定期的に使用することでこれらの症状を軽減できます。（20）
Reference
1 .National Sleep Foundation, Sleep and CPAP adherence. Consulted 12/10/2020 @ www.sleepfoundation.org/articles/sleep-and-cpap-adherence
2. Campos-Rodriguez F, et al. Effect of Continuous Positive Airway Pressure on Blood Pressure and Metabolic Profile in Women with Sleep Apnoea. Eur Respir J. 2017;50(2);1700257.
3. Cass E, et al. Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women. J Clin Sleep Med. 2015;11(9);1029-38
4. Mahssa K, et al. Sleep apnea-related risk of motor vehicle accidents is reduced by continuous positive airway pressure: Swedish Traffic Accident Registry data. Sleep 2015;38(3);341-9
5.Siccoli M, et al. Effects of Continuous Positive Airway Pressure on Quality of Life in Patients With Moderate to Severe Obstructive Sleep Apnea: Data from a Randomized Control-led Trial. Sleep. 2008;31(11);1551-8
6 .Young T, et al, Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9);1217-39
7 Young T, et al, Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up pf the Wisconsin Sleep Cohort. Sleep. 2008;31(8);1071-8.
8. Campos-Rodriguez F, et al. Effect of Continuous Positive Airway Pressure on Blood Pressure and Metabolic Profile in Women with Sleep Apnoea. Eur Respir J. 2017;50(2):1700257.
9.Gottlieb D, et al. CPAP versus Oxygen in Obstructive Sleep Apnea. N Engl J Med. 2014;370(24):2276-85.
10. Mokhlesi B, et al. Effect of One Week of 8-Hour Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea on Glycemic Control in Type 2 Diabetes: A Proof-of-Concept Study. Am J Respir Crit Care Med. 2016;194(4):516-9.
11 . Martínez-Cerón E, et al. Effect of Continuous Positive Airway Pressure on Glycemic Control in Patients with Obstructive Sleep Apnea and Type 2 Diabetes. The Randomized Clinical Trial. Am J Respir Crit Care Med. 2016;194(4):476-85.
12 . Aronsohn R, et al. Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes. Am J Respir Crit Care Med. 2010;181(5):507-1
13. Sharma S, et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;365(24):2277-86.
14 . Doherty LS. et al. Impact of nasal continuous positive airway pressure therapy on the quality of life of bed partners of patients with obstructive sleep apnea syndrome. Chest. 2003 Dec;124(6):2209-14.
15 . Melehan KL. et al. Randomized Trial of CPAP and Vardenafil on Erectile and Arterial Function in Men With Obstructive Sleep Apnea and Erectile Dysfunction. J Clin Endocrinol Metab. 2018 Apr 1;103(4):1601-1611.
16 . Chervin RD. et al. The face of sleepiness: improvement in appearance after treatment of sleep apnea. J Clin Sleep Med. 2013 Sep 15;9(9):845-52.
17.No DD et al. Can continuous positive airway pressure therapy improve the general health status of patients with obstructive sleep apnea?: a clinical effectiveness study. Chest. 2002 Nov;122(5):1679-85.
18 . Sforza E. et al. Daytime sleepiness and nasal continuous positive airway pressure therapy in obstructive sleep apnea syndrome patients: effects of chronic treatment and 1-night therapy withdrawal. Sleep. 1995 Apr;18(3):195-201.
19. Bolitschek J. et al. Impact of nasal continuous positive airway pressure treatment on quality of life in patients with obstructive sleep apnoea. Eur Respir J. 1998 Apr;11(4):890-4.
20. Antique NA. et al. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011 Jan 1;34(1):111-9.
21 . Mazza S. et al. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J. 2006 Nov;28(5):1020-8.
22 . Deering S. et al. CPAP Adherence is Associated With Attentional Improvements in a Group of Primarily Male Patients With Moderate to Severe OSA. J Clin Sleep Med. 2017 Dec 15;13(12):1423-1428.
23 . American Academy of Sleep Medicine (AASM). CPAP - Benefits Health Risk Prevention. Aug 2015. http://sleepeducation.org/essentials-in-sleep/cpap/benefits .
2. Campos-Rodriguez F, et al. Effect of Continuous Positive Airway Pressure on Blood Pressure and Metabolic Profile in Women with Sleep Apnoea. Eur Respir J. 2017;50(2);1700257.
3. Cass E, et al. Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women. J Clin Sleep Med. 2015;11(9);1029-38
4. Mahssa K, et al. Sleep apnea-related risk of motor vehicle accidents is reduced by continuous positive airway pressure: Swedish Traffic Accident Registry data. Sleep 2015;38(3);341-9
5.Siccoli M, et al. Effects of Continuous Positive Airway Pressure on Quality of Life in Patients With Moderate to Severe Obstructive Sleep Apnea: Data from a Randomized Control-led Trial. Sleep. 2008;31(11);1551-8
6 .Young T, et al, Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9);1217-39
7 Young T, et al, Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up pf the Wisconsin Sleep Cohort. Sleep. 2008;31(8);1071-8.
8. Campos-Rodriguez F, et al. Effect of Continuous Positive Airway Pressure on Blood Pressure and Metabolic Profile in Women with Sleep Apnoea. Eur Respir J. 2017;50(2):1700257.
9.Gottlieb D, et al. CPAP versus Oxygen in Obstructive Sleep Apnea. N Engl J Med. 2014;370(24):2276-85.
10. Mokhlesi B, et al. Effect of One Week of 8-Hour Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea on Glycemic Control in Type 2 Diabetes: A Proof-of-Concept Study. Am J Respir Crit Care Med. 2016;194(4):516-9.
11 . Martínez-Cerón E, et al. Effect of Continuous Positive Airway Pressure on Glycemic Control in Patients with Obstructive Sleep Apnea and Type 2 Diabetes. The Randomized Clinical Trial. Am J Respir Crit Care Med. 2016;194(4):476-85.
12 . Aronsohn R, et al. Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes. Am J Respir Crit Care Med. 2010;181(5):507-1
13. Sharma S, et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;365(24):2277-86.
14 . Doherty LS. et al. Impact of nasal continuous positive airway pressure therapy on the quality of life of bed partners of patients with obstructive sleep apnea syndrome. Chest. 2003 Dec;124(6):2209-14.
15 . Melehan KL. et al. Randomized Trial of CPAP and Vardenafil on Erectile and Arterial Function in Men With Obstructive Sleep Apnea and Erectile Dysfunction. J Clin Endocrinol Metab. 2018 Apr 1;103(4):1601-1611.
16 . Chervin RD. et al. The face of sleepiness: improvement in appearance after treatment of sleep apnea. J Clin Sleep Med. 2013 Sep 15;9(9):845-52.
17.No DD et al. Can continuous positive airway pressure therapy improve the general health status of patients with obstructive sleep apnea?: a clinical effectiveness study. Chest. 2002 Nov;122(5):1679-85.
18 . Sforza E. et al. Daytime sleepiness and nasal continuous positive airway pressure therapy in obstructive sleep apnea syndrome patients: effects of chronic treatment and 1-night therapy withdrawal. Sleep. 1995 Apr;18(3):195-201.
19. Bolitschek J. et al. Impact of nasal continuous positive airway pressure treatment on quality of life in patients with obstructive sleep apnoea. Eur Respir J. 1998 Apr;11(4):890-4.
20. Antique NA. et al. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011 Jan 1;34(1):111-9.
21 . Mazza S. et al. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J. 2006 Nov;28(5):1020-8.
22 . Deering S. et al. CPAP Adherence is Associated With Attentional Improvements in a Group of Primarily Male Patients With Moderate to Severe OSA. J Clin Sleep Med. 2017 Dec 15;13(12):1423-1428.
23 . American Academy of Sleep Medicine (AASM). CPAP - Benefits Health Risk Prevention. Aug 2015. http://sleepeducation.org/essentials-in-sleep/cpap/benefits .