京都大学 / 新制・課程博士 / 博士(医学) / 甲第23097号 / 医博第4724号 / 新制||医||1050(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 近藤 尚己, 教授 稲垣 暢也, 教授 石見 拓 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

This master‘s thesis deals with a detailed description of sleep apnea and methods of detection of sleep apnea. The first part of the work is focused on the physiology of sleep, sleep apnea itself, its distribution, symptoms, risk factors and treatment. The next part of the work deals with polysomnographic examination and methods for analysis of polysomnographic data. The last part is devoted to the procedure design for detecting sleep apnea by using only one kind of signal and by using more kinds of signals, implementation of these proposals, their testing on real data, evaluating the detection performance and comparing the results with data available in the literature.

This thesis deals with the detection of sleep apnea using polysomnographic data and attempt to find a possible alternative and simpler method of this detection. The thesis consists of three parts: The first part is important for introduction to the lungs anatomy and the physiology of breathing and the sleep phisiology. The second part deals with the ways of testing sleep apnea. The third part then continues with implementation of alternative methods of testing in Matlab software. The final program calculates the breathing curve from ECG data. The curve is important for the final detection of sleep apnea.

Introduction Acromegaly is an endocrine disorder characterized by excessive growth hormone production.The most common cause is a benign pituitary adenoma, which can be an isolated tumor or part of a group of concomitant endocrine neoplasms. We present a case of a middle aged woman with sleep apnea and a newly diagnosed acromegaly secondary to a pituitary macroadenoma. Case presentation A 51-year-old woman was seen in the endocrinology clinic for evaluation of hyperparathyroidism and mild hypercalcemia. She had no symptoms related to hypercalcemia. However, she complained of enlargement of her fingers and toes. She also reported galactorrhea and breast engorgement. There was no hyperhidrosis or frontal bossing present and she denied headaches or vision symptoms. Past medical history was significant for obstructive sleep apnea. Insulin like growth factor level was 630 ng/ml (reference 53 - 190 ng/ml), prolactin level was 109 ng/ml (reference 1.9- 25 ng/ml), and Follicular stimulating hormone was 0.4mIU/ml (reference 1.2 - 21.0 mIU/ml). TSH, free T4, ACTH, and cortisol were normal. The labs were consistent with pituitary macroadenoma secreting growth hormone (GH) and prolactin. MRI pituitary showed a 1.9 cm macroadenoma with no evidence of optic nerve compression. Due to the coexisting diagnoses of hyperparathyroidism and pituitary adenoma, CT abdomen was done to evaluate for neuroendocrine tumor and to rule out Multiple Endocrine Neoplasia (MEN) Type 1. She then underwent transsphenoidal resection of the pituitary, with immunostaining reflecting diffuse prolactin and patchy GH expression. Post-surgery IGF, prolactin, thyroid function tests were normal. She was started on hydrocortisone replacement due to abnormal ACTH and cortisol. Her calcium levels normalized, and further genetic testing for MEN was abandoned. Her repeat sleep study also showed resolution of sleep apnea. She did not suffer from further symptoms of acromegaly and was scheduled for periodic surveillance for thyroid axis dysfunction. Discussion Dysregulated growth hormone production seen in acromegaly leads to increased GH and IGF-1 levels. It has many ramifications including debilitating arthritis from osteoarthropathy, glucose intolerance due to insulin resistance, higher propensity for GI neoplasms, and macroglossia with prognathism causing sleep apnea. Average lifespan is decreased by 30% due to cardiovascular and pulmonary dysfunction. Treatment is aimed at decreasing IGF levels and controlling any mass effect or metabolic abnormalities caused by the tumor. Treatment options include invasive procedures for good surgical candidates and medical therapy via somatostatin analogue for patients who are not. Residual or unresectable tumors can be treated with medical therapy or radiation therapy if there is no response to medication.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18166号 / 医博第3886号 / 新制||医||1003(附属図書館) / 31024 / 京都大学大学院医学研究科医学専攻 / (主査)教授 髙橋 良輔, 教授 三森 経世, 教授 佐藤 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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No description available.

Obstructive sleep apnea (OSA) affects about 15 million adults in the United States, and is an independent risk factor for all-cause mortality. The under-diagnosing of OSA has been linked to the inadequate screening by primary care practitioners (PCPs). Existing screening tools are not widely used by PCPs possibly due to time constraints they experience as providers. This study demonstrates how common high-risk diagnoses (obesity, hypertension, diabetes mellitus type 2, dyslipidemia, arrhythmia, and coronary artery disease) can be used to help PCPs identify adult patients at risk for OSA. Unlike other screening tools, these diagnoses are easy to identify in a routine visit. This study was a retrospective chart review that used a random sample of 220 electronic health records. Seventy percent of the sample was positive for OSA, 69% had obesity, and 33% had two or more high-risk diagnoses. The setting of this study was six sleep centers located in five cities in Central Florida. Logistic regression was used to analyze the data to determine interaction among variables and odds ratios. The variables "obesity" and "two or more high-risk diagnoses" had significant effects on the likelihood of being diagnosed with OSA independently of each other (odds ratio of 4.2 and 4.3 respectively; p

The focus of this thesis was to capture and measure carbon dioxide concentrations upon exhalation to determine if an apnea event is occurring. Research in the fields of respiratory physiology and apnea built the foundation for the design of the standoff infant apnea monitor. The monitor is designed to track infant respiration using carbon dioxide and sound signatures of breath without touching the infant. Each detection system, audio and carbon dioxide, were designed separately and brought together for a final proof-of-concept device. The software was developed using LabView and run on a Netbook. Testing was conducted on healthy adults to fine tune the carbon dioxide sensor and measure its response during simulated apnea events. Overnight testing showed that the combined system detected fewer false alarms than either system alone. Infant testing was conducted to determine if the proof-of-concept standoff monitor could detect infant breath at specified distance. The results showed that both detection systems can detect infant breath consistently at distances less than one foot from the infant and poorly at distances exceeding one foot. Finally, conclusions were drawn and interpreted to aid in the design of future generations of the standoff infant apnea monitor. Other research avenues where this technology may be useful were also discussed.

Infant apnea is a widespread condition in which infants fail to effectively breathe, and can lead to death. Clinical solutions exist for continuous monitoring of respirations in a hospital setting and requiring constant skin contact. This thesis investigates the construction of a proof of concept device that performs in-home monitoring without skin contact and with commonly available off-the-shelf components. The device constructed used a directional microphone to detect breathing sounds, an omnidirectional microphone to detect ambient noise as a baseline to help isolate the breathing sounds, and LabVIEW software deployed on an inexpensive laptop computer to quantify incidents of apparent lapses in breathing meeting the clinical definition of apnea. Testing results indicate that these components are effective in capturing these events in pre-term infants as well as adults, which provides promising evidence that a low-cost system could be manufactured for home detection to assist in infant monitoring.