Diagnosis and Treatment of Sleep-disordered Breathing at Outpatient Clinics

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  • 無床診療所における睡眠時呼吸障害の取り扱い
  • ムショウ シンリョウジョ ニ オケル スイミンジ コキュウ ショウガイ ノ トリアツカイ

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Abstract

The diagnosis and treatment of sleep-disordered breathing (SDB) in adults at outpatient clinics are described. In an outpatient clinic, morphological diagnosis and selection of treatment must be performed. The existence of SDB can be assessed and indication of treatment made based on oral consultation, X-rays, and morphological diagnosis of the nose, pharynx and larynx by fiberscope. By specifying the cause of SDB by morphological diagnosis, a patient's understanding deepens and motivation for treatment also improves. SDB diagnosis and a severity-of-illness judgment are performed using portable monitoring devices; Rather than automatic analysis, inspection analysis is recommended. When necessary, cooperation should be undertaken with hospital which can perform polysomnography. The treatment which can be performed at an outpatient clinic is mainly CPAP (continuous positive airway pressure). It is desirable to prepare two or more CPAP apparatuses. In an otolaryngology clinic which can treat the nose, the CPAP persistence rate is higher. Dryness in the nose caused by ventilation of CPAP should be monitored, and a CPAP humidifier added if needed. The CPAP usage should be checked by data, not only the apnea index and average usage time but also checking usage conditions and sleeping time, and instruction relating to sleeping habits should be added if necessary. If needed, cooperation should be undertaken with a hospital or dental clinic which can perform an operation or supply an oral appliance. Cooperation with a psychiatrist well versed in sleep disorders is also desirable. The role of an otolaryngologist is important in order to rates the accuracy of diagnosis and treatment of SDB.

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