Fumihiko Yasuma

Nagoya University, Nagoya, Aichi, Japan

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Publications (97)208.83 Total impact

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    ABSTRACT: We aimed to conduct a cross-sectional study in order to investigate the effect of periodic limb movements during sleep (PLMS) on daytime sleepiness in patients with sleep disordered breathing especially those with obstructive sleep apnea syndrome (OSAS), diagnosed by polysomnography (PSG). Our subjects included 233 male patients who visited our institute during the 25-month period between June 2012 and June 2013. We scored the number of Periodic Limb Movements per hour as the Periodic Limb Movements Index (PLMI) on standard PSG, and considered that periodic limb movements during sleep was present in the patients with PLMI >15/h. Non-PLMS group included those patients with PLMI ≤15/h. To assess the sleepiness of participants, we used Japanese version of the Epworth Sleepiness Scale (JESS) and Japanese version of the Pittsburgh Sleep Quality Index. We compared the sleep parameters and sleepiness indicators between patients with PLMS and age, apnea–hypopnea index (AHI), and body mass index-matched non-PLMS control groups. JESS scores were higher in patients with PLMS than in non-PLMS in both low AHI (<15/h) and high AHI (≥15/h) strata. However, the difference was statistically significant only in high AHI stratum (P = 0.399 and 0.001, respectively). In conclusion, PLMS was associated with increased JESS especially in patients with moderate-to-severe OSAS. Although the magnitude of the difference in those with AHI <15/h was smaller and statistically insignificant in the present study, this issue warrants further investigation by enrolling more patients with AHI <15/h.
    No preview · Article · Dec 2015 · Sleep and Biological Rhythms
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    ABSTRACT: We presented two obese male patients with sleep apnea syndrome, whose elevated hematocrit was normalized with continuous positive airway pressure. The first case was 28 years of age with the BMI of 48.2, who was diagnosed as sleep apnea syndrome associated with obesity hypoventilation syndrome. The patient had been treated successfully with positive airway pressure for the past 11 years thereafter without cardiovascular morbidity. The second case was 44 years of age with the BMI of 31.5, who was transferred for the transient loss of consciousness and convulsion. The patient was diagnosed as cerebral venous thrombosis with sleep apnea, which was treated successfully with positive airway pressure subsequently. In both cases, the initially elevated hematocrit (>50%) was normalized with continuous positive airway pressure. The increase in hematocrit in sleep apnea syndrome, the mechanisms of which might be complicated, could be a risk not only for the arterial but also venous thromboembolism in apnea patients, and it should be mentioned among the practitioners.
    No preview · Article · Apr 2015 · Kokyu to junkan. Respiration & circulation
  • K Suzuki · S Nakata · M Tagaya · F Yasuma · S Moral · E Miyao · S Tsuiki · T Nakashima
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    ABSTRACT: Predictors of treatment outcome of oral appliances (OAs) in patients with obstructive sleep apnoea syndrome (OSAS) are not known. There is a pressing need for simple, clinically useful tools to predict treatment outcome. This study aimed to identify predictors of successful OA therapy for OSAS, including evaluation of pharyngeal morphology, which can be measured during routine examination by an otorhinolaryngologist. This was a prospective study of 26 OSAS patients treated with OAs. A favourable outcome was obtained in 14 patients (responders) but not in 12 patients (nonresponders). The baseline patient characteristics and polysomnography and rhinopharyngeal findings were analysed. Body mass index (BMI) was significantly lower in responders versus nonresponders (23.6 ± 2.8 vs. 27.9 ± 4.7 kg/m2; p < 0.05). Pharyngeal morphology, age, sex and nasal resistance did not differ between the groups. Multiple regression analysis showed that BMI was a significant predictor of improvement in the apnoea/hypopnoea index after OA treatment (p < 0.05). Here we demonstrated that BMI is a favourable predictor of OA treatment outcome in OSAS patients. Among the OSAS patients, responders had wider retroglossal spaces than nonresponders.
    No preview · Article · Jan 2014 · B-ENT

  • No preview · Article · Oct 2013 · Kokyu to junkan. Respiration & circulation
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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.
    No preview · Article · Aug 2013 · Internal Medicine
  • Fumihiko Yasuma

    No preview · Article · Nov 2012 · Thorax
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    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.
    No preview · Article · Oct 2012 · Acta oto-laryngologica
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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.
    No preview · Article · Sep 2012 · International journal of pediatric otorhinolaryngology

  • No preview · Article · Dec 2011 · Kokyu to junkan. Respiration & circulation
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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.
    No preview · Article · Aug 2011 · Sleep And Breathing
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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.
    No preview · Article · Mar 2011 · Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery

  • No preview · Article · Jan 2011
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    Preview · Article · Aug 2010 · Otolaryngology Head and Neck Surgery
  • M. Naughton · F. Yasuma · T. Murohara

    No preview · Article · Mar 2010 · Kokyu to junkan. Respiration & circulation
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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.
    No preview · Article · Jan 2010 · American Journal of Rhinology and Allergy
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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.
    No preview · Article · Aug 2009 · Auris, nasus, larynx
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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.
    No preview · Article · May 2009 · The Laryngoscope
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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.
    No preview · Article · Apr 2009 · Auris, nasus, larynx
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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.
    No preview · Article · Aug 2008 · Auris, nasus, larynx
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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.
    No preview · Article · Aug 2008 · Psychophysiology