臨牀透析 Vol.18 No.2(1)


特集名 透析療法とsleep apnea syndrome (SAS)
題名 睡眠と呼吸生理
発刊年月 2002年 02月
著者 吉田 稔 福岡大学医学部呼吸器科
【 要旨 】 睡眠は呼吸生理,呼吸機能に対して明らかに影響を及ぼす.睡眠は,(1)脳幹部にある呼吸中枢群,(2)動脈血ガスの変化に対応する中枢性,末梢性化学受容器および肺,気道系の機械的受容器,(3)脊髄経路,呼吸筋の機能,(4)大脳皮質にある行動調節系などの呼吸調節系に対し抑制的に働く.その結果,睡眠中の換気量は,おおむね1回換気量の減少を伴って減少し呼吸パターンも影響を受ける.また睡眠中の重力の影響により仰臥位での横隔膜は挙上し,機能的残気量などの肺気量は減少,また上気道狭窄・上気道筋の緊張低下により気道抵抗は上昇する.さらに低O2,高CO2換気応答は睡眠中明らかに低下する.これらの変化は睡眠中の動脈血O2分圧の低下,動脈血CO2分圧の上昇をもたらす.このような睡眠中の呼吸機能を把握しておくことは,呼吸器臨床上からも重要である.
Theme Sleep Apnea Syndrome in Maintenance Hemodialysis Patients
Title Sleep and respiratory physiology during sleep
Author Minoru Yoshida Respiratory medicine, School of Medicine, Fukuoka University
[ Summary ] Sleep is associated with definite changes in respiratory physiology and function in normal subjects. The functions of the respiratory center of the medulla, central and peripheral chemoreceptors responding to arterial blood gas changes, mechanical receptors in the lung and chest wall and behavioral control systems in the higher cortical center are regulated and suppressed by sleep. It has been reported in many studies that minute ventilation appears to decrease with decreases in tidal volume and patterns of breathing are also altered during sleep. Lung volume, such as functional residual capacity (FRC), decreases due to elevation of the diaphragm and airway resistance increases following compression of the upper airway by the effects of gravity in the supine sleeping position.
Hypoxic ventilatory responses, and hyper capnic ventilatory responses were markedly supressed during sleep, compared to wakefullness in adults. Arterial O2 tension (Pao2) decreased an arterial CO2 tension (Pao2) increased slightly as reflected by changes in respiratory function. Understanding of changes in respiratory function during sleep is very important clinically, particularly in respiratory medicine and conditions associated with sleep disorders and breathing.
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