Fumihiko Yasuma

Nagoya University, Nagoya-shi, Aichi-ken, Japan

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Publications (55)144.68 Total impact

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    ABSTRACT: A 75-year-old Japanese woman with acute mitral valve prolapse and regurgitation, that developed one month previously, suffered from intractably progressive congestive heart failure (CHF). However, the emergent surgery was declined, and pharmacological treatment was discontinued due to hypotension and malignant arrhythmia. She was treated with 5-8 cmH2O of continuous positive airway pressure (CPAP) to manage CHF and Cheyne-Stokes respiration during the preoperative period of five weeks, after which plastic surgery of the mitral valve was successfully performed. CPAP can be an effective non-pharmacological treatment for CHF, unloading the left ventricle hydrostatically in order to reduce mitral regurgitation and improve oxygenation.
    Internal Medicine 01/2013; 52(15):1709-13. · 0.97 Impact Factor
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    ABSTRACT: Abstract Conclusion: Persistent obstructive sleep apnoea syndrome (OSAS) occurs in approximately 20% of normal-weight children after adenotonsillectomy (T&A) and, in nearly 70% of them, it is caused by adenoid regrowth. Patients with severe or moderate OSAS showed a high incidence of persistent disease even after T&A. Allergic disease, severity and large adenoid size are associated with adenoid regrowth and persistent disease. Objectives: To investigate factors contributing to persistent OSAS and adenoid regrowth after T&A in normal-weight children. Methods: This was a prospective, observational study at a single institute and involved 49 normal-weight children with severe or moderate OSAS (apnoea-hypopnoea index, AHI, ≥ 5) who underwent T&A. Background information, nasal endoscopic data and pre- and postoperative polysomnographic data were collected. A third polysomnography (PSG) was performed 1.5 year postoperatively in children who subsequently developed symptoms of sleep disturbance. Results: Thirteen children (27%, 13/49) were symptomatic 1.5 years after T&A. Allergic rhinitis (38.5% vs 11.1%, p = 0.03) and allergic disease (69.2% vs 30.6%, p = 0.02) were seen more frequently in these children. A third PSG confirmed persistent disease (AHI ≥ 5) in nine children (18.4%, 9/49). Six children (12.2%, 6/49) were diagnosed as having adenoid regrowth and three (6.1%, 3/49) underwent revision adenoidectomy.
    Acta oto-laryngologica 10/2012; 132(11):1208-14. · 0.98 Impact Factor
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    ABSTRACT: OBJECTIVE: To investigate the contributions of adenoid and tonsil sizes to obstructive sleep apnea syndrome (OSAS) in normal-weight children in two age categories: preschool and schoolchildren. METHODS: Fifty-eight normal-weight (body mass index z-score<2) symptomatic children with OSAS (apnea-hypopnea index≥2) were evaluated. The patients were divided into two age categories: preschool (age<6; n=33) and schoolchildren (age≥6; n=25). Polysomnographic findings and adenoid and tonsil sizes were compared. The relative contributions of body mass index and adenoid and tonsil sizes were also investigated with a regression analysis. RESULTS: Adenoid grade and apnea index correlated significantly in preschool children (r=0.45, p<0.01). On regression analysis, adenoid grade was a significant predictor of the apnea index in preschool children. The influence of adenoid hypertrophy decreased from preschool to schoolchildren. Tonsil size had little influence on the apnea index in either group. CONCLUSION: Adenoid hypertrophy was a major contributor to OSAS in normal-weight preschool children. The upper airway morphology of younger children with OSAS differed from that of older children with OSAS.
    International journal of pediatric otorhinolaryngology 09/2012; · 0.85 Impact Factor
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    ABSTRACT: Complex sleep apnea syndrome (CompSAS) is diagnosed after an elimination of obstructive events with continuous positive airway pressure (CPAP), when a central apnea index ≥5/h or Cheyne-Stokes respiration pattern emerges in patients with obstructive sleep apnea syndrome (OSAS). However, the pathophysiology of CompSAS remains controversial. Of the 281 patients with suspected OSAS, all of whom underwent polysomnography conducted at Nagoya University Hospital, we enrolled 52 patients with apnea-hypopnea index ≥15/h (age 51.4 ± 13.3 years). The polysomnographic findings, left ventricular ejection fraction (LVEF), and nasal resistance were compared between the CompSAS patients and OSAS patients. Forty-three patients were diagnosed with OSAS and nine patients with central sleep apnea syndrome by natural sleep PSG. Furthermore, 43 OSAS patients were classified into the OSAS patients (OSAS group, n = 38) and the CompSAS patients (CompSAS group, n = 5) by the night on CPAP PSG. The nasal resistance was significantly higher in CompSAS group than in OSAS group (0.30 ± 0.10 vs. 0.19 ± 0.07 Pa/cm(3)/s, P = 0.004). The arousal index, percentage of stage 1 sleep, and oxygen desaturation index were significantly decreased, and the percentage of stage REM sleep was significantly increased in the OSAS group with the initial CPAP treatment, but not in the CompSAS group. In addition, the patients with CompSAS showed normal LVEF. CPAP intolerance secondary to an elevated nasal resistance might relate to frequent arousals, which could presumably contribute to an increase in central sleep apnea. Further evaluation in a large study is needed to clarify the mechanism of CompSAS.
    Sleep And Breathing 08/2011; 16(3):747-52. · 2.26 Impact Factor
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    ABSTRACT: To investigate the pharyngeal morphologic features and its pathogenic role on obstructive sleep apnoea syndrome in the elderly population. Prospective controlled, comparative cohort study. Territory referral centre. We enroled 320 consecutive patients with complaints of snoring who visited Nagoya University Hospital from January 2004 to December 2007. We also collected 26 control subjects aged over 60 years from community-dwelling people. We underwent a morphological evaluation, measurement of nasal resistance, assessment of daytime sleepiness and nocturnal polysomnography. Two hundred and ninety-two patients were analysed. The constitution ratio of men, the body mass index and Epworth sleepiness scale were decreased with ageing. Tonsil size was reduced progressively with ageing. Retroglossal space was wider, and soft palate was lower in ≥ 60 year group than in < 40 year group. Retroglossal space was wide in elderly patients with sleep apnoea compared with control subjects. Tonsil size was not correlated to apnoea/hypopnoea index in ≥ 60 year group unlike the other generations. Modified Mallampati Score and tongue size were significantly but mildly correlated only in ≥ 60 year group. Width of fauces was correlated in all the groups. Multiple regression analysis showed that body mass index, age, gender, tonsil size and width of fauces were independent factors for apnoea/hypopnoea index. Morphologically, the tonsil could play a minor role but the width of fauces could play relatively a major role. Additionally, wide retroglossal space, low positional soft palate and large tongue size may be characteristics for elderly patients of obstructive sleep apnoea syndrome.
    Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 03/2011; 36(2):139-46. · 1.87 Impact Factor
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    ABSTRACT: The role of increased nasal resistance in obstructive sleep apnea syndrome (OSAS) remains controversial. The aim of this study was to examine the pathogenetic role of nasal obstruction in obese patients with OSAS. Patients with OSAS (n = 125) at a university hospital were divided into three groups according to body mass index (BMI): nonobese (BMI < 25 kg/m(2)), mildly obese (25 kg/m(2) < or = BMI < 30 kg/m(2)), and obese (BMI > or = 30 kg/m(2)). The subjects underwent nasopharyngoscopy, measurement of nasal resistance, and polysomnography. We studied 42 nonobese, 47 mildly obese, and 36 obese patients with OSAS. Among the obese, but not the nonobese and mildly obese patients, we found significant correlations between the oxygen desaturation index (ODI) and bilateral nasal resistance (BNR; r = 0.412; p = 0.013), between the ODI and unilateral higher nasal resistance (UHNR; r = 0.413; p = 0.012), and between the apnea index and UHNR (r = 0.334; p = 0.046). Multiple regression analysis incorporating all patients showed that BMI (p < 0.001) and BNR (p = 0.033) were independently related to the ODI. In obese patients with OSAS, increased nasal resistance could play an important pathogenetic role in hypoxemic apnea.
    American Journal of Rhinology and Allergy 01/2010; 24(1):51-4.
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    ABSTRACT: The objective was to evaluate the significance of a portable sleep-monitoring device (Apnomonitor 5, Chest Co., Tokyo, Japan) to diagnose sleep apnea syndrome (SAS). The Apnomonitor 5 comprised an oronasal thermistor, a pulse oximeter, chest and abdominal belts to monitor the circumferences of the chest and abdomen, a microphone to monitor tracheal sound, a position detector, and an integrative unit. This screening device was commercially available and it had been used to diagnose SAS in our country. Twenty-two consecutive adults who attended Inazawa City Hospital who were suspected for SAS were prospectively enrolled and they undertook the standard polysomnography (PSG) and Apnomonitor 5 simultaneously. The designated polysomnographers analyzed the records of the PSG and Apnomonitor 5. These sleep and respiratory parameters of the devices were compared, the results of which were double-checked by the designated sleep specialist. The apnea-hypopnea index (AHI), apnea index, total number of apnea, and oxygen desaturation index obtained by the PSG and Apnomonitor 5 correlated significantly, whereas the averaged sleep time, total number of hypopnea, hypopnea index, and nadir oxygen saturation differed between the devices. The sensitivity of the Apnomonitor 5 versus PSG was 95% in the SAS patients with the AHI> or =15. The Apnomonitor 5 can be a sensitive and useful screening device for SAS especially in patients with the AHI> or =15.
    Auris, nasus, larynx 04/2009; 36(2):176-80. · 0.58 Impact Factor
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    ABSTRACT: To estimate the effectiveness of nasal surgery on the occurrence of sleep apnea, and to analyze the pharyngeal morphology of apnea patients whose sleep-disordered breathing was ameliorated postoperatively. Prospective study. Thirty-five consecutive patients with apnea and nasal obstruction underwent polysomnography and a morphological examination of the upper airway before and after nasal surgery, which included septoplasty, inferior turbinectomy, and/or functional endoscopic sinus surgery. Sleep apnea was significantly ameliorated in only eight patients. The postoperative reduction in the apnea-hypopnea index tended to be lower in those with a low-positioned soft palate, reflected in an elevated modified Mallampati score, and a narrow retroglossal space. Neither swollen tonsils nor narrow fauces affected the surgical outcome. Regression analysis showed that the modified Mallampati score (P < .05) and the retroglossal space (P < .05) were significant predictors of postoperative improvement in the apnea-hypopnea index. Among sleep apnea patients suffering from nasal obstruction, nasal surgery is effective in those with a high-positioned soft palate and/or a wide retroglossal space.
    The Laryngoscope 03/2009; 119(5):1011-6. · 1.98 Impact Factor
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    ABSTRACT: An aim of this study was to assess the predictive power of an otorhinolaryngological examination of the upper airway to identify risk factors of obstructive sleep apnea syndrome (OSAS) in the patients. We examined 141 consecutive patients with OSAS. The morphological features were assessed by the designated otorhinolaryngologist while the subjects were sitting relaxedly with tidal breathing. The bilateral nasal resistance was measured using the active anterior rhinomanometry during daytime wakefulness. The body mass index (BMI), fauces's narrowness, neck circumference, lowest oxygen saturation, tonsil size and modified Mallampati grade (MMP) showed the statistically significant correlations with the apnea-hypopnea index (AHI) of an index of apnoeseverity, however, the age, Epworth sleepiness scale (ESS), nasal resistance and retroglossal space were not significantly associated with the AHI. The upper airway morphology significantly associated with AHI are fauces's narrowness, tonsil size, and MMP, but not nasal resistance and retroglossal space.
    Auris, nasus, larynx 01/2009; 36(4):444-9. · 0.58 Impact Factor
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    ABSTRACT: The aim of this study was to clarify the interaction of lateral and supine sleeping positions with upper airway morphology in patients with obstructive sleep apnea syndrome (OSAS). Thirty-one patients with OSAS, whose apnea/hypopnea index (AHI: number of episodes of apnea or hypopnea per hour) was over 15, were enrolled in this study. Subjects were divided in two groups according to positional effects on their AHI. In six patients, a lateral posture decreased the AHI by 50% and more (responders); in the remaining 25, lateral positioning decreased the AHI by less than 50% or even increased the AHI (nonresponders). AHI and body mass index (BMI) of the responders tended to be lower and their mean age was younger than those of nonresponders, but these differences were not statistically significant. We compared the upper airway morphology between the responders and the nonresponders regarding the tonsil size, tongue position (modified Mallanpati grade, reflecting the space between the tongue and soft palate) and the width of the fauces and retroglossal space. In addition, we compared nasal resistance between the groups using active rhinomanometry. The width of the fauces was significantly greater (P=0.041) among the responders than among the nonresponders. However, the other parameters were not consistently different between the two, and these differences were not statistically significant either. The distance between the fauces was the sole morphological feature to distinguish the responders and the nonresponders to the positional therapy in patients with OSAS. Lateral positioning during sleep might be a recommended sleep hygiene for OSAS patients with wide fauces.
    Auris, nasus, larynx 08/2008; 36(3):305-9. · 0.58 Impact Factor
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    ABSTRACT: To examine if real-world stress affects the restorative function of sleep in daily life, we studied the impact of college examinations on cardiorespiratory resting function during sleep. In healthy college students, at 1 week before, the day before, and the first day of semester-end examinations pulse wave signal during sleep at their own residences was measured continuously with a wristband-shaped wireless transdermal photoelectric sensor. The cardiorespiratory resting function was assessed quantitatively as the power of a high-frequency component of pulse rate variability, a surrogate measure of respiratory sinus arrhythmia. Changes in anxiety were also evaluated with a state anxiety questionnaire. On the day before the examinations, compared with 1 week before, the score of state anxiety increased and the HF component of pulse rate variability decreased. Among college students, anxiety about college examinations may be accompanied by suppression of the cardiorespiratory resting function during sleep.
    Psychophysiology 08/2008; 45(4):667-70. · 3.26 Impact Factor
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    ABSTRACT: Obstructive sleep apnea syndrome (OSAS) is associated with increases in cardiovascular morbidity and mortality. Vascular changes in individuals with OSAS have not been fully elucidated, however. The possible impact of OSAS on the extent of aortic pressure augmentation (AG), an indicator of cardiovascular risk, was investigated. Forty-five consecutive male patients aged 35 to 78 years (56.0+/-9.6 years) who were referred to the sleep clinic of Nagoya University Hospital for screening and treatment of OSAS and 71 age-matched healthy men were enrolled in the study. AG was derived from the pressure waveform measured at the radial artery by applanation tonometry. The number of apnea and hypopnea episodes per hour (apnea-hypopnea index [AHI]) was determined by standard polysomnography. AG was significantly greater in OSAS patients than in controls (9.0+/-4.1 vs. 6.4+/-3.4 mmHg, p<0.001), and it was significantly reduced in 19 OSAS patients treated with continuous positive airway pressure. AG was also significantly correlated with the AHI (r=0.562, p<0.001) and age (r=0.356, p=0.016) but not with the serum concentrations of low and high density lipoprotein-cholesterol, triglyceride, or glycosylated hemoglobin. Stepwise multiple regression analysis revealed that the AHI was the most significant contributing factor to the increased AG in OSAS patients (beta=0.109, r=0.530, p<0.001). OSAS may thus have an adverse effect on vascular function that can be ameliorated by appropriate treatment.
    Hypertension Research 07/2008; 31(6):1109-14. · 2.79 Impact Factor
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    ABSTRACT: The maxillofacial characteristics of patients with obstructive sleep apnea syndrome (OSAS) have previously been analyzed using standard cephalometric analysis. Malocclusion influences the occurrence of sleep apnea, but the pathology of malocclusion in OSAS has not yet been fully investigated. Therefore, we investigated malocclusion in patients with OSAS using cephalometric and dental analysis. Cephalometric and dental analyses were performed to evaluate malocclusion in 97 male patients with OSAS (49.7+/-11.7 years). The number of apnea and hypopnea episodes per hour (apnea-hypopnea index: AHI) was determined by standard polysomnography. The overall prevalence of severe overjet (the horizontal distance between the upper and lower incisors of >or=6 mm) was 43.3%. AHI was significantly correlated with body mass index (BMI) in obese OSAS patients (r=0.385, p=0.010), whereas it was significantly correlated with overjet in non-obese OSAS patients (BMI<25 kg/m2) (r=0.313, p=0.022). Multiple regression analysis revealed that BMI was the significant factor contributing to increased AHI in all patients, and overjet was in non-obese OSAS patients. There were no significant differences between non-obese and obese OSAS patients in the angle of protrusion of the superior alveolar base (SNA) or in the angle of protrusion between the superior and inferior alveolar bases (ANB). The angle of protrusion of the inferior alveolar base (SNB) was significantly smaller in non-obese than in obese OSAS patients. We have shown that overjet was associated with the severity of OSAS in non-obese patients. Our findings suggest that malocclusion may play an important role in the development of sleep apnea/hypopnea.
    Internal Medicine 02/2008; 47(18):1573-8. · 0.97 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the effects of nasal surgery on nasal resistance, sleep apnea, and sleep quality in adult male patients with obstructive sleep apnea syndrome (OSAS). A prospective study was performed in OSAS patients who underwent isolated nasal surgery in a tertiary referral center. During the 3-year study period, 49 OSAS patients suffering from symptomatic nasal obstruction/impaired nasal breathing underwent the standard polysomnography before and after surgery. Polysomnography along with measures of nasal resistance and daytime sleepiness (the Epworth sleepiness scale [ESS] scores) were reviewed also. Surgery decreased the nasal resistance (0.55 +/- 0.37 Pa/cm(3) per second versus 0.17 +/- 0.19 Pa/cm(3) per second; p < 0.001) and ESS scores (11.7 +/- 4.1 versus 3.3 +/- 1.3; p < 0.001), without changes in the apnea-hypopnea index (AHI; 44.6 +/- 22.5 versus 42.5 +/- 22.0). Surgery increased nadir oxygen saturation (76.2 +/- 10.9% versus 78.8 +/- 8.1%; p < 0.01), shortened apnea-hypopnea duration (averaged/maximum; 33.5 +/- 7.3/61.1 +/- 46.0 versus 28.8 +/- 7.4/47.3 +/- 36.1 second; p < 0.05/p < 0.01), and improved sleep quality. The results suggest that nasal surgery is useful for lowering nasal resistance, ameliorating sleep-disordered breathing, and improving sleep quality and daytime sleepiness in OSAS.
    American Journal of Rhinology 01/2008; 22(1):59-63. · 1.36 Impact Factor
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    ABSTRACT: Individuals with obstructive sleep apnea syndrome (OSAS) are at high risk for cardiovascular morbidity and mortality. The effects of OSAS severity and nocturnal continuous positive airway pressure (CPAP) on daytime baroreflex sensitivity (BRS) and nitric oxide (NO) production were investigated in OSAS patients. Fifty-one consecutive males with OSAS and 29 age-matched healthy men underwent the Valsalva test and standard polysomnography. Patients with an apnea-hypopnea index (AHI) of >or=20 episodes per hour were randomized to receive CPAP treatment for 3 months (n=14) or no such treatment (n=19). The BRS index measured from the overshoot phase (phase IV) of the Valsalva maneuver and plasma NO concentration were significantly lower, whereas the AHI, oxygen desaturation time, arousal index, percentage of sleep stage 1, and systolic blood pressure were significantly greater, in patients with an AHI of >or=20/h than in those with an AHI of <20/h or in controls. The 24-h urinary excretion of norepinephrine was significantly reduced and the plasma NO concentration was significantly increased after one night of CPAP. The BRS index for phase IV and the Valsalva ratio were significantly increased in the CPAP group after the 3-month treatment period but remained unchanged in the non-CPAP group of OSAS patients. The daytime BRS index and NO production were thus inversely related to the severity of OSAS, and successful CPAP treatment improved these parameters in patients with moderate to severe OSAS. CPAP may therefore reduce the risk of cardiovascular complications due to endothelial dysfunction or increased sympathetic activity.
    Hypertension Research 08/2007; 30(8):669-76. · 2.79 Impact Factor
  • Respiration 02/2007; 74(4):475-7. · 2.62 Impact Factor
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    American Journal of Respiratory and Critical Care Medicine 09/2006; 174(4):479; author reply 479-80. · 11.04 Impact Factor
  • Fumihiko Yasuma, Toyoaki Murohara
    Circulation Journal 07/2006; 70(6):802; author reply 803. · 3.58 Impact Factor
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    ABSTRACT: We report two cases of Duchenne muscular dystrophy (DMD) complicated with dilated cardiomyopathy (DCM), who were affected with cerebral infarction. Case 1 suddenly developed dysarthria and right facial weakness at age 21. Cranial CT study disclosed a low density area in the left basal ganglia and internal capsule. Case 2 had a history of transient ischemic attack (TIA) at age 21. Five months after the TIA, he developed right hemiplegia and dysarthria, and a low density area in the corona radiate in left cerebral hemisphere was observed in cranial CT. These two cases showed the radiographic cardiomegaly with cardio thoracic ratio (CTR) of 72.8% and 66.6%, the decreased echocardiographic left ventricular ejection fraction below 20%, and the elevated titer of thrombin-anti-thrombin III complex (TAT) and D-dimer. The autopsy of Case 2 at age 26 disclosed the remarkable degeneration and fibrosis of myocardium and old ischemic lesion in the left cerebral frontal cortex. Despite the negative finding of the emboli in the left heart, cardiogenic cerebral infarction secondary to DCM was strongly suspected in both cases.
    Nō to shinkei = Brain and nerve 04/2006; 58(3):250-5.
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    ABSTRACT: Sleep disturbance and the use of hypnotic medications are common in patients on hemodialysis. Factors that contribute to sleep disturbance and the use of hypnotic medications in hemodialysis patients were investigated. With the use of a questionnaire-based survey, we examined the prevalence of symptoms that reflect sleep disorders such as insomnia, restless legs syndrome (RLS), and snoring and use of hypnotic medications in 252 hemodialysis patients. The overall prevalence of insomnia was 59.1%, with the prevalence of difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), and early morning awakening (EMA) being 47.6, 24.2, and 28.2%, respectively. Daytime sleepiness and habitual snoring were reported by 42.5 and 33.7%, respectively. The prevalence of routine use of hypnotic drugs was 25.8%. Both RLS and age were significantly associated with insomnia [odds ratio (OR), 3.75; p 0.001, OR, 1.03; p < 0.01]. RLS was a significant factor for DIS, DMS, and EMA (OR, 2.26; p < 0.05, OR, 3.44; p < 0.0005, OR, 4.25; p < 0.0005) and age was a significant factor for DMS and EMA (OR, 1.03; p = 0.053, OR, 1.05; p < 0.005). Both insomnia and snoring were associated with the use of hypnotic drugs (OR, 2.97; p < 0.001, 1.59; p=0.13). Both RLS and sleep-disordered breathing may contribute to sleep disturbance in hemodialysis patients. RLS in particular may be an important factor in insomnia, which in turn is likely responsible for the high prevalence of hypnotic drug use in hemodialysis patients.
    Internal Medicine 02/2006; 45(22):1273-8. · 0.97 Impact Factor

Publication Stats

688 Citations
144.68 Total Impact Points

Institutions

  • 1997–2012
    • Nagoya University
      • • Graduate School of Medicine
      • • Division of of Internal Medicine
      • • Department of Medical Technology
      Nagoya-shi, Aichi-ken, Japan
  • 2003–2005
    • Nagoya City University
      • Department of Internal Medicine
      Nagoya, Aichi, Japan