Efficacy and safety of adjunctive modafinil treatment on residual excessive daytime sleepiness among nasal continuous positive airway pressure-treated japanese patients with obstructive sleep apnea syndrome: a double-blind placebo-controlled study.

STUDY OBJECTIVES: This double-blind study evaluated the efficacy and safety of modafinil for treating excessive daytime sleepiness in Japanese patients with obstructive sleep apnea syndrome (OSAS). METHODS: Patients with residual excessive sleepiness (Epworth Sleepiness Scale [ESS] ≥ 11) on optimal nasal continuous positive airway pressure (nCPAP) therapy (apnea-hypopnea index ≤ 10) were randomized to either 200 mg modafinil (n = 52) or placebo (n = 62) once daily for 4 weeks. Outcomes included baseline-week 4 changes in ESS total score, sleep latency on maintenance of wakefulness test (SL-MWT), nocturnal polysomnography, Pittsburgh Sleep Quality Index (PSQI), and safety. RESULTS: All 114 randomized patients completed the study. Mean change in ESS total score (-6.6 vs -2.4, p < 0.001) and SL-MWT (+2.8 vs -0.4 minutes, p = 0.009) were significantly greater with modafinil than with placebo. ESS total score decreased from > 11 to < 11 at the final assessment in 69.2% of modafinil-treated patients and 30.6% of placebo-treated patients (p < 0.001). Corresponding rates at week 1 were 57.7% and 33.9% (p = 0.014). Changes in nocturnal polysomnography, PSQI, and apnea-hypopnea index from baseline to the final assessment were similar in both groups. Adverse drug reactions occurred in 36.5% and 22.6% of patients in the modafinil and placebo groups, respectively (p = 0.146). CONCLUSIONS: Once-daily modafinil was effective and well tolerated for managing residual daytime sleepiness in Japanese OSAS patients with residual excessive daytime sleepiness on optimal nCPAP therapy.

[Prader-Willi syndrome associated with obesity hypoventilation syndrome].

Prader-Willi syndrome (PWS) is a genetic disorder, characterized by shorter height, severe obesity and muscular hypotonicity. In particular, sleep disordered breathing (SDB) is a well-known complication in PWS. We encountered one case of PWS, complicated by typical obesity hypoventilation syndrome. A 23-year-old woman had been given a diagnosis of PWS as age 1, therefore she was treated with growth hormone replacement therapy, and with uvulopalatopharyngoplasty (UPPP) for her narrow throat. Her weight increased greatly to 96kg, body mass index (BMI) 51 kg/m2, resulting in hypersomnolence, cyanosis, heavy snoring, and nocturnal awakening. Eventually, she was admitted because of urinary incontinuence and loss of consciousness. On admission, she had severe hypoxia plus substantial hypercapnia, and her chest X-ray film showed severe cardiomegaly with massive pleural and pericardial effusion. On polysomnography (PSG) one week later, her apnea hypopnea index (AHI) was 16 with a mean nocturnal arterial saturation of 74%, mean percutaneous PCO2 59 Torr, which rose to 73 Torr during REM sleep. Non-invasive positive pressure ventilation (NPPV) was initiated, and improved her condition greatly. She was discharged, but continued to recieve NPPV, and her condition has stayed improved.

[Overlap syndrome involving obstructive sleep apnea syndrome associated with chronic obstructive pulmonary disease].

We reported a case of overlap syndrome involving severe obstructive sleep apnea syndrome (OSAS) associated with chronic obstructive lung disease (COPD). This patient was a 52-year-old heavy smoking man, who had suffered from snoring and apnea for five years, and was admitted to our hospital because of worsening dyspnea. His BMI was 25 Kg/M2, His jaw was very small and he had a narrow upper airway. Chest X-ray showed hyperlucency throughout both lung fields with a markedly dilatation pulmonary arteries. His PaO2 was 62Torr, PaCO2 was 47Torr, FEV(1.0%) was 59%, mean pulmonary artery pressure was 27 mmHg, PSG showed that AHI was 70, were most pronounced during rapid eye movement sleep. He was given a diagnosis of overlap syndrome of OSAS associated with COPD. Generally, Overlap syndrome was believed that chronic bronchitis type (blue bloater) was more frequent than emphysema type. This case was a very rare case, with no obesity, moderate COPD, associated with pulmonary hypertension and hypercapnea, and then to be severe OSAS. However we should be more careful about the OSAS associated with overlap syndrome of the Japanese patients, because to be one factor of exacerbation of respiratory failure.

A flow-through capnometer for obstructive sleep apnea.

INTRODUCTION: Capnogram is often distorted due to aspiration of expired gas when a sidestream capnometer is used for non-intubated, spontaneously breathing condition. The purpose of this study was to make a flow-through capnometer without aspiration and to check if this capnometer precisely detected apnea during obstructive sleep apnea (OSA). METHODS: (1) Flow-through capnometer The capnometer consisted of a flow-through etCO(2) sensor, cap-ONE, and an accompanying capnometer. The size of cap-ONE was small enough to be fitted under the nose where gas expired from the nose and the mouth passed through. Thus, the expired gas to be measured is directly blown into the cap-ONE. (2) The cap-ONE using a spontaneously breathing model Capnograms obtained by the cap-ONE and sidestream capnometers during nasal and oral breathing under normal and reduced ventilation were compared with a reference capnogram. (3) Clinical study with OSA patients With nineteen OSA patients capnograms during apnea events diagnosed as OSA by polysomnography were examined using the cap-ONE. (4) Simulation study with an OSA model Apnea in which inspiratory flow was zero and small expiratory flows repeated was produced. Capnograms and apnea detection were compared between the cap-ONE and sidestream capnometers. RESULTS: In the spontaneouly breathing model capnograms and etCO(2) of the cap-ONE during nasal and oral breathing were almost identical with the reference capnogram but those of sidetream capnometers during oral breathing were significantly reduced. In the clinical study 41% of total OSA events showed capnograms with prolonged and elevated phase with small ripples. In a simulation study reduction of CO(2) tension during no-inspiration was small and apnea was successfully detected with the cap-ONE. However, with sidestream capnometers the reduction of CO(2) tension was large and apnea was not detected. CONCLUSIONS: We concluded that the cap-ONE can record capnograms with minimum distortion and detect apnea reliably during OSA.

Environmental and behavioral conditions of bathing among elderly Japanese.

This study investigated the bathing conditions of elderly Japanese, and sought to find factors relating to regional differences in death rates from bathtub accidents. A questionnaire survey was carried out in 11 areas of Japan. Questionnaires including questions regarding the length of time since houses had been built, types of facilities, and subjects' indoor thermal sensations and behavior while bathing were distributed to detached houses in each area twice, once in summer and once in winter. Completed questionnaires were collected from approximately 160 elderly people over 65 years old. Information regarding thermal sensations of rooms in winter revealed that a prefabricated bath and insulating window glass eased the cold in the bathroom. Unexpectedly, more subjects in the southern region than in the northern region reported being cold or a little cold while bathing in winter. In the present study, thermal sensations and behaviors while bathing seemed to be more affected by facilities and the location of houses than by the sex and age of the subjects.

Serum lipid levels and factors affecting atherogenic index in Japanese children.

An evaluation was made of the serum lipid levels and factors relating to atherogenicity in schoolchildren in Akita, Japan, in order to determine actual conditions and promote awareness of health. The subjects were 2878 boys and 2729 girls aged 9, 12 and 15 years, who lived in cities, towns and villages in the Akita prefecture. Physical and lifestyle data including serum lipids were collected from the subjects in their schools under the direction of the prefectural board of education. Total cholesterol levels were found to be nearly equal to those currently representative for Japanese children, ethnically situated between blacks and whites in the United States of America. Atherogenic indices (AIs) were lower than those in all other countries owing to the elevated high-density lipoprotein (HDL) cholesterol levels observed in this study. According to data obtained from the questionnaires that were part of the study, regularly taking breakfast and exercising in sports clubs seems connected to maintaining lower atherogenicity in childhood.

Ethnic differences in the relationship between bioelectrical impedance and body size.

The present study compared the regression equations of bioelectrical impedance on body size among various groups to investigate potential differences due to ethnicity. Data consisted of 30 Japanese and 28 Caucasoid subjects, and other groups of Aborigines, Danes, Melanesians and Polynesians from literature. The relationship between impedance and body weight fot the groups showed the ethnic difference. In the regression equations for Japanese and Caucasoid, a statistically significant difference was observed between both groups. The regression equation for Japanese was lower in the elevation. This seemed to be attributable to differences in the volume of fat-free mass for the same body build, configuration of the body, and fat-free mass density.

Ideal body shape in young Japanese women and assessment of excessive leanness based on allometry.

The present study is aimed to clarify the degree of leanness desired by contemporary young Japanese women using questionnaires and to use allometry to define the body weight boundary between the excessively lean and the others for a given height. Questionnaires on ideal body shape were distributed to female college students living in Akita and the suburbs of Tokyo. Data for 578 respondents, aged 18 to 21 years-old, were analyzed. The questionnaire asked the subjects to report their current and ideal body shape and to make a qualitative self-assessment of their weight. On average, the perceived ideal weight was 5.2 kg lower than the current weight. The results also revealed that young women have a tendency to misunderstand their body shape and to regard themselves as heavier than they really were. Meanwhile, we defined leanness as a state of insufficient lean body mass (LBM, kg) in relation to height (Ht, cm). Allometric equation of LBM on Ht and the standard error of estimate (SEE) were calculated as LBM=3.87 x 10(-3) x Ht(1.826) and 1.09, respectively. The LBM boundary between the excessively lean and the others was determined using these values according to a statistical procedure comparing normal and abnormal values. The corresponding total body weight was estimated from the boundary LBM in the literature. Subsequently the body weight boundary for each height was tabulated in order to make young women reconsider weight control. The subjects were asked to assess the body weight boundary for their own height. The boundary values were found to be consistent with the sense of the subjects.