睡眠時無呼吸症候群合併及び非合併心不全患者に対する呼吸補助療法の確立

2014 Fiscal Year Research-status Report

• Project/Area Number: 25461061
• Research Institution: Fukushima Medical University
• Principal Investigator: 義久 精臣 福島県立医科大学, 医学部, 准教授 (40448642)
• Project Period (FY): 2013-04-01 – 2016-03-31
• Keywords: 心不全 / 睡眠時無呼吸症候群 / 呼吸補助療法 / 陽圧呼吸療法 / 酸素療法 / 血管機能 / 血圧変動 / アディポサイトカイン

Outline of Annual Research Achievements

心臓病に合併する睡眠呼吸障害(SDB)の病態および治療法について研究を行った。SDB合併心臓病患者において、陽圧呼吸療法の有用性が期待されている。特に順応性自動制御換気療法（adaptive servo ventilation: ASV）は持続気道陽圧療法(CPAP)と比して様々なタイプのSDBを確実に改善し、コンプライアンスに優れ、心機能改善効果も高い。我々は閉塞性無呼吸やCheyne-Stokes呼吸に対してCPAP、ASV、酸素療法を積極的に導入し、種々の知見を得た。併せて、SDB合併心臓病における病態解明も行っている。
1)ホルター心電図における心拍変動を用いてSDBをスクリーニング可能であった。2)SDB合併心臓病患者にて副交感神経活動を示唆するHeart rate turbulenceは低値であった。3)肥満度と心不全予後に関する解析を行い、obesity paradoxの病態解明を行った。4)SDB合併心不全患者にASVを一晩使用することでSDBの改善に加え、1日尿中カテコラミンは減少し、心室性期外収縮が減少した。5)心臓再同期療法後心不全患者にて、ASVは心不全による再入院を減少した。6)慢性腎臓病合併心不全患者にて、ASVは腎機能及び予後を改善した。7)SDBを合併した左室収縮の保持された心不全患者にてASVは左室拡張能や血管機能を改善した。8)左室収縮の保持された心不全患者にてCPAPやASVは呼吸機能、運動耐用能、予後を改善した。9)貧血合併SDB患者にて、ASVは炎症及び予後を改善した。
上記結果については、随時公表、論文化を行っている。

Current Status of Research Progress

2: Research has progressed on the whole more than it was originally planned.

Reason

本年度9編の論文が受理され、その後の研究も順調に推移している。

Strategy for Future Research Activity

引き続き症例の蓄積を行い、長期経過観察（心機能、予後など）を行う。
検体測定、集約したデータについても解析を進めていく。

Causes of Carryover

検体測定はまとめて行った方が廉価であり、随時ではなく集約して測定することとした。

Expenditure Plan for Carryover Budget

今年度に集約して検体測定を実施する予定である。

Research Products

• [Journal Article] Impact of peripheral artery disease on prognosis in hospitalized heart failure patients. (2015)
  • Author(s): Nakamura Y, Kunii H, Yoshihisa A, Takiguchi M, Shimizu T, Nakamura Y, Yamauchi H, Iwaya S, Owada T, Sato T, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Sugimoto K, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Journal Title: Circ J Volume: 79 Pages: 785-93
  • DOI: 10.1253
  • Peer Reviewed / Open Access
• [Journal Article] Cyclic variation in heart rate score by holter electrocardiogram as screening for sleep-disordered breathing in subjects with heart failure. (2015)
  • Author(s): Shimizu T, Yoshihisa A, Iwaya S, Abe S, Sato S, Suzuki S, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Journal Title: Respir Care Volume: 60 Pages: 72-80
  • DOI: 10.4187
  • Peer Reviewed
• [Journal Article] Suppressive effects of adaptive servo-ventilation on ventricular premature complexes with attenuation of sympathetic nervous activity in heart failure patients with sleep-disordered breathing. (2014)
  • Author(s): Iwaya S, Yoshihisa A, Nodera M, Owada T, Yamada S, Sato T, Suzuki S, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Journal Title: Heart Vessels Volume: 29 Pages: 470-477
  • DOI: 10.1007
  • Peer Reviewed
• [Journal Article] Liver dysfunction assessed by model for end-stage liver disease excluding INR (MELD-XI) scoring system predicts adverse prognosis in heart failure. (2014)
  • Author(s): Abe S, Yoshihisa A, Takiguchi M, Shimizu T, Nakamura Y, Yamauchi H, Iwaya S, Owada T, Miyata M, Sato T, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Journal Title: PLoS One Volume: 9 Pages: e100618
  • DOI: 10.1371
  • Peer Reviewed
• [Journal Article] Impact of sleep-disordered breathing on heart rate turbulence in heart failure patients. (2014)
  • Author(s): Yoshihisa A, Suzuki S, Takiguchi M, Shimizu T, Abe S, Sato T, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Journal Title: PLoS One Volume: 9 Pages: e101307
  • DOI: 10.1371
  • Peer Reviewed
• [Journal Article] Impact of body mass index on mortality in heart failure patients. (2014)
  • Author(s): Takiguchi M, Yoshihisa A, Miura S, Shimizu T, Nakamura Y, Yamauchi H, Iwaya S, Owada T, Miyata M, Abe S, Sato T, Suzuki S, Suzuki H, Saitoh S, Takeishi Y
  • Journal Title: Eur J Clin Invest Volume: 44 Pages: 1197-1205
  • DOI: 10.1111
  • Peer Reviewed
• [Journal Article] High-sensitivity cardiac troponin T predicts non-cardiac mortality in heart failure. (2014)
  • Author(s): Nakamura Y, Yoshihisa A, Takiguchi M, Shimizu T, Yamauchi H, Iwaya S, Owada T, Miyata M, Abe S, Sato T, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Journal Title: Circ J Volume: 78 Pages: 890-895
  • DOI: 10.1253
  • Peer Reviewed
• [Journal Article] Cardiovascular function and prognosis of patients with heart failure coexistent with chronic obstructive pulmonary disease. (2014)
  • Author(s): Yoshihisa A, Takiguchi M, Shimizu T, Nakamura Y, Yamauchi H, Iwaya S, Owada T, Abe S, Sato T, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Journal Title: J Cardiol Volume: 64 Pages: 256-264
  • DOI: 10.1016
  • Peer Reviewed
• [Journal Article] Adaptive servo-ventilation therapy improves prognosis in heart failure patients with anemia and sleep-disordered breathing. (2014)
  • Author(s): Suzuki S, Yoshihisa A, Miyata M, Sato T, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Journal Title: Int Heart J Volume: 55 Pages: 342-349
  • DOI: 10.1536
  • Peer Reviewed
• [Presentation] Impact of serum calcium levels on mortality of patients with heart failure and chronic kidney disease. (2014)
  • Author(s): Miura S, Yoshihisa A, Nodera M, Sato A, Takiguchi M, Shimizu T, Nakamura Y, Yamauchi H, Owada T, Abe S, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y:
  • Organizer: Scientific Sessions of American Heart Association
  • Place of Presentation: Chicago, USA
  • Year and Date: 2014-11-15 – 2014-11-19
• [Presentation] Impact of peripheral artery disease on prognosis in heart failure patients. (2014)
  • Author(s): Nakamura Y, Yoshihisa A, Kunii H, Takiguchi M, Shimizu T, Yamauchi H, Owada T, Abe S, Suzuki S, Sugimoto K, Yamaki T, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Organizer: Scientific Sessions of American Heart Association
  • Place of Presentation: Chicago, USA
  • Year and Date: 2014-11-15 – 2014-11-19
• [Presentation] Impact of chronic obstructive pulmonary disease on cardiovascular function and prognosis in heart failure patients. (2014)
  • Author(s): Shimizu T, Yoshihisa A, Takiguchi M, Nodera M, Miura S, Nakamura Y, Yamauchi H, Owada T, Abe S, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Organizer: Scientific Sessions of American Heart Association
  • Place of Presentation: Chicago, USA
  • Year and Date: 2014-11-15 – 2014-11-19
• [Presentation] The usefulness of combined assessment of E/e’ ratio and transmitral flow pattern to interpret cardiac condition. (2014)
  • Author(s): Oikawa M, Kobayashi A, Yamauchi H, Suzuki S, Yoshihisa A, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Organizer: Scientific Sessions of American Heart Association
  • Place of Presentation: Chicago, USA
  • Year and Date: 2014-11-15 – 2014-11-19
• [Presentation] Non-invasive positive airway pressure improves mortality in heart failure patients with preserved left ventricular ejection fraction and sleep-disordered breathing. (2014)
  • Author(s): Suzuki S, Yoshihisa A, Miura S, Takiguchi M, Shimizu T, Abe S, Sugimoto K, Yamaki T, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Organizer: Scientific Sessions of American Heart Association
  • Place of Presentation: Chicago, USA
  • Year and Date: 2014-11-15 – 2014-11-19
• [Presentation] The impact of plasma levels of receptor for advanced glycation end-products and high mobility group box 1 in patients with pulmonary hypertension. (2014)
  • Author(s): Suzuki S, Nakazato K, Sugimoto K, Yoshihisa A, Yamaki T, Kunii H, Suzuki H, Saitoh S, Takeishi Y
  • Organizer: Scientific Sessions of American Heart Association
  • Place of Presentation: Chicago, USA
  • Year and Date: 2014-11-15 – 2014-11-19
• [Presentation] Echocardiographic epicardial adipose tissue relates to coronary artery plaque and calcification: comparisons with abdominal visceral adipose tissue. (2014)
  • Author(s): Oikawa M, Owada T, Yamauchi H, Yoshihisa A, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Organizer: Scientific Sessions of American Heart Association
  • Place of Presentation: Chicago, USA
  • Year and Date: 2014-11-15 – 2014-11-19
• [Presentation] 心不全と呼吸管理: Do adaptive servo-ventilation improve prognosis in heart failure patients? （ASVは心不全予後を改善するか？）(symposium). (2014)
  • Author(s): Yoshihisa A, Suzuki S, Takeishi Y
  • Organizer: 第18回 日本心不全学会学術集会
  • Place of Presentation: 大阪
  • Year and Date: 2014-10-10 – 2014-10-12
• [Presentation] HFpEF -基礎研究から—: Impact of adaptive servo-ventilation on cardiovascular function and prognosis in patients with HFpEF and sleep-disordered breathing（HFpEF患者におけるSDB加療の重要性） (symposium). (2014)
  • Author(s): Yoshihisa A, Suzuki S, Takeishi Y
  • Organizer: 第18回 日本心不全学会学術集会
  • Place of Presentation: 大阪
  • Year and Date: 2014-10-10 – 2014-10-12
• [Presentation] 睡眠時呼吸障害に対する持続陽圧呼吸療法の功罪：CRT 患者における適正なSDB 評価時期及び治療に関する検討（シンポジウム）. (2014)
  • Author(s): 義久精臣, 鈴木 聡, 竹石恭知
  • Organizer: 第62回 日本心臓病学会学術集会,
  • Place of Presentation: 仙台
  • Year and Date: 2014-09-26 – 2014-09-28
• [Presentation] 慢性疾患・生活習慣病を合併した心疾患患者の管理：慢性閉塞性肺疾患(COPD) 合併心不全患者における心血管機能・予後及びβ遮断薬の効果に関する検討（シンポジウム）. (2014)
  • Author(s): 義久精臣, 鈴木 聡, 及川雅啓, 竹石恭知
  • Organizer: 第62回 日本心臓病学会学術集会
  • Place of Presentation: 仙台
  • Year and Date: 2014-09-26 – 2014-09-28
• [Presentation] Cardiovascular function and prognosis of patients with heart failure coexistent with chronic obstructive pulmonary disease. (2014)
  • Author(s): Nakamura Y, Yoshihisa A, Shimizu T, Owada T, Yamauchi H, Miyata M, Abe S, Suzuki S, Saitoh S, Takeishi Y
  • Organizer: Congress of the European Society of Cardiology
  • Place of Presentation: Barcelona, Spain
  • Year and Date: 2014-08-30 – 2014-09-03
• [Presentation] Cyclic variation of heart rate score by Holter ECG for screening sleep disordered breathing in heart failure patients. (2014)
  • Author(s): Shimizu T, Yoshihisa A, Suzuki S, Sugimoto K, Yamaki T, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Organizer: Congress of the European Society of Cardiology
  • Place of Presentation: Barcelona, Spain
  • Year and Date: 2014-08-30 – 2014-09-03
• [Presentation] Influence of sleep disordered breathing on heart rate turbulence in heart failure patients. (2014)
  • Author(s): Shimizu T, Yoshihisa A, Suzuki S, Sugimoto K, Yamaki T, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Organizer: Congress of the European Society of Cardiology
  • Place of Presentation: Barcelona, Spain
  • Year and Date: 2014-08-30 – 2014-09-03
• [Presentation] High-sensitivity cardiac troponin T predicts non-cardiac mortality in heart failure. (2014)
  • Author(s): Nakamura Y, Yoshihisa A, Shimizu T, Yamauchi H, Miyata M, Suzuki S, Nakazato K, Suzuki H, Saitoh S, Takeishi Y
  • Organizer: Congress of the European Society of Cardiology
  • Place of Presentation: Barcelona, Spain
  • Year and Date: 2014-08-30 – 2014-09-03
• [Presentation] 睡眠時無呼吸と全身病態の関連と治療法への展開：睡眠呼吸障害と心・腎・血管連関 -心不全に対するSDB 治療の多面的効果-（シンポジウム）. (2014)
  • Author(s): 義久精臣, 鈴木 聡, 竹石恭知
  • Organizer: 日本睡眠学会 第39回定期学術集会
  • Place of Presentation: 徳島
  • Year and Date: 2014-07-03 – 2014-07-04
• [Presentation] 透析患者の心腎連関と睡眠時無呼吸症候群：心不全合併腎臓病患者のASV(Adaptive-Servo Ventilation)療法による心腎機能改善効果（シンポジウム） (2014)
  • Author(s): 義久精臣, 鈴木 聡, 竹石恭知
  • Organizer: 第59回 日本透析医学会学術集会・総会
  • Place of Presentation: 神戸
  • Year and Date: 2014-06-12 – 2014-06-15
• [Remarks] 福島県立医科大学 研究者データベース
  • URL: http://www.fmu.ac.jp/kenkyu/Profiles/15/0001471/profile.html