継続的な陽性気管圧治療のサブ最適使用後の過度の昼間の眠気のある中等から重度の阻害性睡眠時無呼吸患者のアルモダフィニルの有効性: 予見性研究
Jinjuta Ngeyvijit1, Tayard Desudchit2,3, Nattapot Dadphan3
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand.
Sleep & breathing = Schlaf & Atmung
|September 4, 2025
まとめ
アルモダフィニルは,過剰な昼間の眠気と睡眠の質を,非最適のCPAP使用で改善した. 治療はよく耐えており,12週間の間にわたって深刻な副作用は見られませんでした.
科学分野:
- 睡眠医学
- 薬理学について
- 呼吸器医学
背景:
- 阻害性睡眠無呼吸 (OSA) は,しばしば昼間の過剰な眠気 (EDS) と関連しています.
- 継続的な陽性気道圧 (CPAP) は主要な治療法ですが,適切なCPAPの使用にもかかわらず,いくつかの患者が持続的なEDSを経験します.
- CPAPの使用が最適でない患者および残留EDSの患者におけるアルモダフィニルの有効性は十分に確立されていません.
研究 の 目的:
- 中度から重度のOSA患者で,CPAPの使用が最適でない場合,アルモダフィニルの治療効果を評価する.
- 睡眠の質とCPAPの遵守に対するアルモダフィニルの影響を評価する.
- この患者集団におけるアルモダフィニルの安全性と耐性を決定する.
主な方法:
- 12週間の前向きなコホート研究で,中度から重度のOSA患者で,CPAPの使用が最適でない (2~4時間/夜) とEDS患者.
- 参加者はCPAP治療を続ける間,毎日アーモダフィニル (150 mg) を服用しました.
- 効果は,エプワース睡眠スケール (ESS),臨床総合印象 (CGI),ピッツバーグ睡眠品質指数 (PSQI) を用いて測定された. 副作用とCPAPの遵守もモニタリングされた.
主要な成果:
- 12週間後,ESS (p<0. 001),CGIスコア (p<0. 001) およびPSQIスコア (p<0. 001) の有意な低下が観察されました.
- OSLER誤差指数では有意な改善は認められませんでしたが,発症時の精神運動の低下 (p=0. 17) 患者では傾向が見られました.
- CPAPの遵守は改善傾向を示し (p=0. 09),重大な有害事象は報告されなかった.
結論:
- アルモダフィニルは,12週間の間にわたって最適なCPAPを使用したOSA患者の主観的なEDSと睡眠の質を効果的に改善します.
- 薬剤はよく耐受され,副作用は自己緩和し,CPAPの遵守に悪影響を及ぼさない.
- アルモダフィニルは,この特定のOSA患者の残留性睡眠症候群の管理に有効な治療法です.
関連する概念動画
Management of Insomnia
785
The sleep cycle, an integral part of human health, consists of several stages with distinct characteristics and functions. It begins with a transition from wakefulness to sleep, known as the light sleep phase, followed by the restorative deep sleep phase, essential for physical recovery and growth. The cycle concludes with the Rapid Eye Movement (REM) phase, characterized by high brain activity and vivid dreaming. Insomnia, a prevalent sleep disorder, involves difficulty falling asleep, staying...
785
Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure
817
Oxygen therapy has emerged as a significant tool in enhancing the quality of life for patients suffering from pulmonary arterial hypertension (PAH). While this therapy has principally been studied on patients with significant hypoxemia, this therapeutic approach helps prevent potential organ damage and can be administered in the comfort of one's home.
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue,...
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue,...
817
Mechanical Ventilation III: Noninvasive Ventilation
931
Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation...
Noninvasive Positive-Pressure Ventilation...
931
Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response
498
Circadian rhythms are cyclic changes that are crucial in plasma drug concentrations. Various standard circadian parameters, including core body temperature, heart rate, and other cardiovascular factors, directly impact disease states and the therapeutic response to drug therapy.
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
498
Sleep Apnea
914
Sleep apnea is a condition where breathing stops intermittently during sleep, often leading to significant health issues. Each episode can last from 10 to 20 seconds or more and is frequently accompanied by a brief arousal from sleep. This disturbance, largely unnoticed by the individual, can lead to severe daytime fatigue. Commonly, individuals seek help after being informed by their partners about loud snoring and noticeable breathing pauses during sleep.
The condition is more prevalent among...
The condition is more prevalent among...
914
Heart Failure VI: Adjunct Therapies
632
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
632


