CPAPアドヒランスの予測因子としてのCPAP装着下覚醒時の呼吸不規則性

BACKGROUND AND OBJECTIVE: The standard therapy for obstructive sleep apnoea (OSA) is continuous positive airway pressure (CPAP) therapy. However, long-term adherence remains at ~50% despite improvements in behavioural and educational interventions. Based on prior work, we explored whether regularity of breathing during wakefulness might be a physiologic predictor of CPAP adherence. METHODS: Of the 117 consecutive patients who were diagnosed with OSA and prescribed CPAP, 79 CPAP naïve patients were enrolled in this prospective study. During CPAP initiation, respiratory signals were collected using respiratory inductance plethysmography while wearing CPAP during wakefulness in a seated position. Breathing regularity was assessed by the coefficient of variation (CV) for breath-by-breath estimated tidal volume (VT ) and total duration of respiratory cycle (Ttot). In a derivation group (n = 36), we determined the cut-off CV value which predicted poor CPAP adherence at the first month of therapy, and verified the validity of this predetermined cut-off value in the remaining participants (validation group; n = 43). RESULTS: In the derivation group, the CV for estimated VT was significantly higher in patients with poor adherence than with good adherence (median (interquartile range): 44.2 (33.4-57.4) vs 26.0 (20.4-33.2), P 34.0 confirmed to be predicting poor CPAP adherence (sensitivity, 0.78; specificity, 0.83). CONCLUSION: At the initiation of therapy, breathing regularity during wakefulness while wearing CPAP is an objective predictor of short-term CPAP adherence.博士（医学）・乙第1391号・平成29年3月15日© 2016 Asian Pacific Society of RespirologyThis is the peer reviewed version of the following article: Respirology Vol.22 No.2 p.386-393 (2017 Feb), which has been published in final form at http://dx.doi.org/10.1111/resp.12900. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving

Effect of Laughter Yoga on Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease.

Objective: To evaluate the clinical usefulness of laughter yoga for patients with chronic obstructive pulmonary disease (COPD) in a pulmonary rehabilitation setting. Design: Pilot study, with randomization of participants. Setting: This study was conducted by the Yoshino-cho National Health Insurance Yoshino Hospital Department of Internal Medicine. Participants: Stable outpatients with COPD (7 men and 1 woman, age 64 to 84 years) participated in the pulmonary rehabilitation program during a 2-week period. Intervention : The patients were divided into two groups based on a sealed envelope randomization method. The laughter yoga group had a 10-min laughter yoga session before exercise training. Patients in both groups had exercise training, educational programs, lung physiotherapy, and nutrition counseling. Outcome Measures: Health-related quality of life using the St. George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) Health Survey Short Form 36-item (SF-36), depression scores using the Self-rating Depression Scale (SDS), anxiety scores using State-Trait Anxiety Inventory (STAI), and spirometry, the 6-minute walk test and mMRC dyspnea scale results were evaluated before and at 2 weeks after the program in both groups. Results: There were significant improvements in the SGRQ impacts domain and the SF-36 general health domain in the laughter yoga group, while the SF-36 physical functioning domain significantly improved in the control group. SDS and STAI result did not significantly change in either group. Spirometry, the 6-minute walk test, and MRC dyspnea scale results did not significantly change in either group. Conclusion: Laughter yoga may improve the psychological quality of life in patients with COPD

Direct Imaging Explorations for Companions around Mid-Late M Stars from the Subaru/IRD Strategic Program

The Subaru telescope is currently performing a strategic program (SSP) using the high-precision near-infrared (NIR) spectrometer IRD to search for exoplanets around nearby mid/late-M~dwarfs via radial velocity (RV) monitoring. As part of the observing strategy for the exoplanet survey, signatures of massive companions such as RV trends are used to reduce the priority of those stars. However, this RV information remains useful for studying the stellar multiplicity of nearby M~dwarfs. To search for companions around such ``deprioritized" M~dwarfs, we observed 14 IRD-SSP targets using Keck/NIRC2 observations with pyramid wavefront sensing at NIR wavelengths, leading to high sensitivity to substellar-mass companions within a few arcseconds. We detected two new companions (LSPM~J1002+1459~B and LSPM~J2204+1505~B) and two new candidates that are likely companions (LSPM~J0825+6902~B and LSPM~J1645+0444~B) as well as one known companion. Including two known companions resolved by the IRD fiber injection module camera, we detected seven (four new) companions at projected separations between $\sim2-20$~au in total. A comparison of the colors with the spectral library suggests that LSPM~J2204+1505~B and LSPM~J0825+6902~B are located at the boundary between late-M and early-L spectral types. Our deep high-contrast imaging for targets where no bright companions were resolved did not reveal any additional companion candidates. The NIRC2 detection limits could constrain potential substellar-mass companions ($\sim10-75\ M_{\rm Jup}$) at 10~au or further. The failure with Keck/NIRC2 around the IRD-SSP stars having significant RV trends makes these objects promising targets for further RV monitoring or deeper imaging with JWST to search for smaller-mass companions below the NIRC2 detection limits.Comment: 16 pages, 8 figures, accepted for publication in A

High-Contrast Imaging of Intermediate-Mass Giants with Long-Term Radial Velocity Trends

A radial velocity (RV) survey for intermediate-mass giants has been operated for over a decade at Okayama Astrophysical Observatory (OAO). The OAO survey has revealed that some giants show long-term linear RV accelerations (RV trends), indicating the presence of outer companions. Direct imaging observations can help clarify what objects generate these RV trends. We present the results of high-contrast imaging observations of six intermediate-mass giants with long-term RV trends using the Subaru Telescope and HiCIAO camera. We detected co-moving companions to gamma Hya B (0.61+0.12 0.14 Stellar Mass), HD 5608 B (0.10 +/- 0.01 Stellar Mass), and HD 109272 B (0.28 +/- 0.06 Stellar Mass). For the remaining targets( Dra, 18 Del, and HD 14067) we exclude companions more massive than 30-60 M(sub Jup) at projected separations of 1-7. We examine whether these directly imaged companions or unidentified long-period companions can account for the RV trends observed around the six giants. We find that the Kozai mechanism can explain the high eccentricity of the inner planets Dra b, HD 5608 b, and HD 14067 b

The effects of heated humidification to nasopharynx on nasal resistance and breathing pattern.

BACKGROUND:Mouth breathing could induce not only dry throat and eventually upper respiratory tract infection, but also snoring and obstructive sleep apnea, while nasal breathing is protective against those problems. Thus, one may want to explore an approach to modify habitual mouth breathing as preferable to nasal breathing. The aim of this study was to investigate the physiological effects of our newly developed mask on facilitation of nasal breathing. METHODS:Thirty seven healthy male volunteers were enrolled in a double blind, randomized, placebo-controlled crossover trial. Participants wore a newly developed heated humidification mask or non-heated-humidification mask (placebo) for 10-min each. Subjective feelings including dry nose, dry throat, nasal obstruction, ease to breathe, relaxation, calmness, and good feeling were asked before and after wearing each mask. In addition, the effects of masks on nasal resistance, breathing pattern, and heart rate variability were assessed. RESULTS:Compared with the placebo mask, the heated humidification mask improved all components of subjective feelings except for ease to breathe; moreover, decreased nasal resistance and respiratory frequency accompanied a simultaneous increase in a surrogate maker for tidal volume. However, use of the heated humidification mask did not affect heart rate variability. CONCLUSION:Adding heated humidification to the nasopharynx could modulate breathing patterns with improvement of subjective experience and objective nasal resistance