著者

西尾 佳朋 伊藤 邦弘 加藤 三香子 瀧川 友佳子 篠邉 龍二郎 古橋 明文

出版者

特定非営利活動法人 日本睡眠歯科学会

雑誌

睡眠口腔医学 (ISSN:21886695)

巻号頁・発行日

vol.8, no.1, pp.15-20, 2022 (Released:2021-10-01)

参考文献数

27

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Objective: We present a case of narcolepsy in a patient with obstructive sleep apnea (OSA) who complained of residual sleepiness without improvement in Epworth sleepiness scale (ESS) after oral appliance (OA) therapy, and who underwent the Multiple Sleep Latency Test (MSLT).Method: The patient was a 48-year-old male who had no significant past medical history and family history, and had been experiencing excessive daytime sleepiness. The initial interview at the Department of Sleep Medicine did not reveal any cataplexy, sleep paralysis, and hypnagogic hallucinations. He was diagnosed with mild OSA (apnea hypopnea index: AHI 10.5/h) based on polysomnography (PSG), and was referred to our department for OA therapy. Excessive daytime sleepiness did not improve after the initiation of OA therapy. Thereafter, follow-up sleep study with PSG and the MSLT were performed.Results: The PSG with OA showed an improvement of OSA in AHI from 10.5 to 3.6/h, and sleep-onset REM sleep period (SOREMP) was not observed. MSLT showed that the mean sleep latency was 4min 6s/five naps, and number of SOREMP was two times; therefore, the patient was diagnosed with narcolepsy type 2. Use of Modafinil 100 mg/day decreased the ESS score from 15 to 4 and improved daytime sleepiness.Conclusion: In patients with OSA and narcolepsy, it is not possible to improve excessive daytime sleepiness by providing treatment for OSA only. Patients who complain of residual sleepiness even after OA treatment should be assessed further for other sleep disorders including hypersomnia.

著者

野原 幹司

出版者

特定非営利活動法人 日本睡眠歯科学会

雑誌

睡眠口腔医学 (ISSN:21886695)

巻号頁・発行日

vol.7, no.1, pp.2-7, 2020 (Released:2020-10-01)

参考文献数

9

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Polypharmacy is a problem in the clinical practice of elderly medical care. Symptoms caused by polypharmacy are diverse, including falls and deterioration of cognitive function, as well as dysphagia. Textbooks state that neurodegenerative diseases such as stroke and Parkinson’s disease are common causes of swallowing disorder, but there are unexpectedly many drug-induced swallowing disorders in the field of elderly medical care. Typical medicines that cause drug-induced swallowing disorders are sleep-related drugs such as sleep medication, anxiolytics, and antipsychotic drugs. Dentists working in the field of dental sleep medicine are in a good position to treat such disorders because they have knowledge of which sleep-related drugs are likely to cause swallowing disorders, and which drugs do not affect swallowing disorders while improving sleep disorders. Dentists specializing in sleeping dentistry are important for managing drug-induced swallowing disorders in cooperation with prescription physicians. Dental sleep medicine may have an important role to play in treating polypharmacy.

著者

咲間(笹井) 妙子

出版者

特定非営利活動法人 日本睡眠歯科学会

雑誌

睡眠口腔医学 (ISSN:21886695)

巻号頁・発行日

vol.4, no.2, pp.131-137, 2018 (Released:2019-12-04)

著者

田賀 仁 渡辺 正人 江野 幸子 米永 一理 松尾 朗 髙戸 毅

出版者

特定非営利活動法人 日本睡眠歯科学会

雑誌

睡眠口腔医学 (ISSN:21886695)

巻号頁・発行日

vol.7, no.2, pp.88-93, 2021 (Released:2021-01-25)

参考文献数

8

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Objective: Adverse events due to long-term use of night guards have not been sufficiently elucidated. We herein report a case of occlusal changes in a patient who underwent continuous regular observations for at least 14 years since starting to use a night guard and discuss the precautions in the management of night guard use. Case: A 50-year-old female, with the chief complaints of clenching, tongue ache, abrupt awakening, etc. Results: A night guard for the upper jaw was fabricated, and shrinkage of the interdental space in the maxillary anterior region and occlusal changes (open bite) were observed after 12 years and 6 months of its continuous intermittent use. A new night guard for the lower jaw was also fabricated because the patient wanted to continue using it even after the observation. The patient has been using these night guards without any major worsening. Conclusion: Night guards intended to prevent tooth abrasion, root fracture, or tongue pain from sleep-related bruxism may lead to adverse events. As with oral appliances, the fabrication process requires adequate consideration as well as regular and quantitative management.

著者

對木 悟 幸塚 裕也 福田 竜弥 飯島 毅彦

出版者

特定非営利活動法人 日本睡眠歯科学会

雑誌

睡眠口腔医学 (ISSN:21886695)

巻号頁・発行日

vol.9, no.2, pp.25-32, 2023 (Released:2023-03-18)

参考文献数

26

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Some key features including both anatomical (i.e., craniofacial) and non-anatomical factors are involved in the pathogenesis and development of obstructive sleep apnea (OSA). Since craniofacial factors are visible whereas non-anatomical factors routinely require laborious studies and complicated equipment for quantitative evaluation, dentists may be able to detect OSA by understanding the background craniofacial characteristics of OSA. Obese individuals with excessive soft tissue inside the oral cavity do not necessarily develop OSA if the jaw size is large relative to the amount of soft tissue. Conversely, an obese patient is highly likely to have OSA when the jaw size is not sufficiently large relative to the tongue size, a phenomenon called “oropharyngeal crowding.” This review highlights the anatomical balance theory to account for the underlying mechanisms of oropharyngeal crowding in OSA.

著者

鈴木 善貴 大倉 一夫 松香 芳三

出版者

特定非営利活動法人 日本睡眠歯科学会

雑誌

睡眠口腔医学 (ISSN:21886695)

巻号頁・発行日

vol.3, no.1, pp.10-21, 2016 (Released:2019-12-20)

被引用文献数

1

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Sleep Bruxism (SB), which has been thought to have various harmful influences to stomatognathic system, is a disease with jaw movement accompanied by excessive occlusal force during sleep. The physiological masticatory muscle activity, which can be observed several times at night even in healthy people, is recently referred to as rhythmic masticatory muscle activity (RMMA) as a biomarker to diagnose SB. Patients who exhibit RMMA over 4 times per hour are diagnosed with SB. It has been suggested that RMMA might be caused by primary factor (brain activation) and/or secondary factor (e.g. sleep apnea, REM behavioral disorder). During RMMA event, phasic or/and tonic masticatory muscle contractions are performed and jaw movement, such as clenching at eccentric jaw position and grinding exceeding canine edge to edge, are specifically observed by recent studies. These jaw movements may cause various signs (e.g. tooth attrition, masticatory muscle pain). However, these signs can be due to other multiple factors( e.g. tooth, daytime oral habits), so it is hard to establish a causal link between SB and the signs. SB has been diagnosed by electromyography, clinical signs and questionnaire. In order to improve the validity of SB diagnostic methods, grading system is recently applied; polysomnography with audio-video recordings, clinical signs, and questionnaire define “definite,” “probable,” and “possible” SB respectively. Since there is still no definitive treatment for SB, dental clinicians have been performing symptomatic therapy such as splint therapy, pharmacotherapy, and behavioral therapy. Splint therapy is the most commonly used therapy on SB patients, but its potential side effects, e.g. worsening sleep breathing disorder, have been reported. Therefore, behavioral therapy, such as sleep hygiene measure and relaxation, needs to be performed first. Unlink the primary SB, the secondary factor might lead to not only negative effect but also positive influences such as activating secretion or diffusion of saliva in gastroesophageal reflux disease patients and releasing stress. Therefore, for the case caused by the secondary factor, dentists should consult with medical specialists from different fields to review and examine the case.

著者

奥野 健太郎 野原 幹司 尾花 綾 佐々生 康宏 加藤 紀子 阪井 丘芳

出版者

特定非営利活動法人 日本睡眠歯科学会

雑誌

睡眠口腔医学 (ISSN:21886695)

巻号頁・発行日

vol.2, no.2, pp.115-120, 2016

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Objectives: We present a case of severe obstructive sleep apnea(OSA) in which oral appliance(OA) therapy had no significant efficacy and there was poor compliance of continuous positive airway pressure (CPAP) therapy related to pressure intolerance, but in which combination therapy of OA and CPAP reduced optimal pressure and improved compliance.<br>Methods: The patient was a 69-year-old man with no significant past medical history who was diagnosed as having severe obstructive sleep apnea (AHI: 92.5/h, lowest SpO2: 82%) by polysomnography (PSG). We recommended CPAP therapy due to the severe OSA, but the patient refused this therapy and desired OA therapy. First, OA therapy was applied to this patient. After OA insertion for 2 months, the patient reported reduction of snoring and wore the OA comfortably; the efficacy of OA therapy in OSA was evaluated by PSG.<br>Results: PSG under OA showed an improvement of OSA in AI from 81.3/h to 33.1/h, but residual findings in AHI: 73.2/h. Secondly, we adopted CPAP therapy because of inadequacy of the efficacy of OA therapy. In PSG with CPAP titration, optimal pressure is 17cmH2O. After wearing CPAP for 3 months, the patient reported insomnolence because of discomfort of airflow from CPAP. The data of compliance of CPAP therapy were actual days utilized: 54.8%, compliance per day: 3 h 45 min, and % of days utilized ≥ 4 h/d (%): 23.8%. We considered that a cause of the poor compliance of CPAP therapy was that the optimal pressure was too high. Thirdly, we adopted combination therapy of OA and CPAP for the purpose of reducing the optimal pressure of CPAP. The optimal pressure with CPAP titration PSG wearing OA decreased from 17cmH2O to 11cmH2O. The combination therapy showed improvement of compliance in terms of actual days utilized from 54.8% to 96.8%, in terms of compliance per day from 3 h 45 min to 4 h 8 min, and in terms of % of days utilized ≥ 4 h/d from 23.8% to 54.8%.<br>Conclusions: This report suggests that wearing an OA decreased the optimal pressure of CPAP and improved the compliance of CPAP therapy for severe OSA. It is important that, in the selection of treatment for patients with OSA, we adopt not only OA therapy or CPAP therapy, but also combination therapy of OA and CPAP.

著者

駒田 陽子

出版者

特定非営利活動法人 日本睡眠歯科学会

雑誌

睡眠口腔医学 (ISSN:21886695)

巻号頁・発行日

vol.3, no.2, pp.127-132, 2017 (Released:2019-12-20)

著者

水野 一枝

出版者

特定非営利活動法人 日本睡眠歯科学会

雑誌

睡眠口腔医学 (ISSN:21886695)

巻号頁・発行日

vol.2, no.2, pp.89-93, 2016 (Released:2019-12-20)

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Ambient temperature and humidity are important factors that determine sleep quality. In real-life situations where bedding and clothing are used, sleep is affected more by heat than by cold exposure. Effects of thermal environment on sleep are strongly related to thermoregulation. Increased skin temperature(Tsk) and decreased core body temperature at sleep onset period, and stable Tsk and bed climate during sleep are important for maintaining sleep. Heat exposure increases wakefulness and decreases rapid eye movement sleep(REM) and slow wave sleep(SWS). In aged subjects, heat exposure increases wakefulness and decreases REM, while no effect is observed on SWS. Furthermore, heat exposure reduces the core body temperature decrease, and increases Tsk, whole body sweat loss, and bed climate humidity both in young and aged subjects. Humid heat exposure further affects sleep stages and thermoregulation. Although the ambient temperature is cold, effects of using electric blankets on sleep and thermoregulation showed similar result to heat exposure, with subjectively dried mouth sensation in the morning. These results indicate that increased thermal stress by humid heat or heated bed climate affects sleep and thermoregulation and might increase dried mouth sensation in the morning.