CPAP 治療中に出現した中枢性無呼吸が心房細動アブレーション治療後に減少した 1 例

In recent years, the prevalence of sleep apnea syndrome (SAS) has increased, alongside that of metabolic syndrome. The Japanese national health insurance system allows the use of continuous positive airway pressure (CPAP) therapy for patients with an apnea hypopnea index (AHI) of ≥40 recorded at home by an apnomonitor, even if polysomnography (PSG) has not been performed. Japanese otorhinolaryngology practitioners often follow-up patients with obstructive sleep apnea (OSA) on CPAP therapy. Intervention by CPAP is associated with a reduced frequency of apnea episodes, improved sleep quality, and also improvements in various associated symptoms. However, there are some reports of increased risk of development of central apnea (CSA), especially with advancing age, in patients receiving CPAP therapy for OSA. According to the International Classification of Sleep Disorders, CSA can be classified into eight categories. We encountered a case in which CSA with Cheyne-Stokes breathing (CSA-CSB) appeared remarkably during CPAP therapy for severe OSA. Closer examination confirmed the presence of underlying atrial fibrillation with decreased heart function in this patient, and ablation therapy for atrial fibrillation performed by an interventional cardiologist resulted in improvement of the CSA-CSB. OSA serves as a risk factor for the development various diseases, especially cardiovascular disease, which is a highly prevalent comorbidity in patients with OSA. The risk of heart failure is increased and the risk of appearance of CSA, as a manifestation of heart failure, tends to increase with advancing age in patients with OSA. Otorhinolaryngologists engaged in the management of AHI and follow-up of patients on CPAP therapy, besides ensuring compliance, prescribing the optimal pressure for CPAP, and detecting any leakage, should grasp the general condition of the patient, especially paying attention to the presence of underlying cardiovascular disease, and should seek to collaborate with a cardiologist early in the clinical course.