症例は68歳，男性．主訴は睡眠中の大きな寝言や異常行動．神経学的異常は認められず，特発性睡眠行動障害（RBD）と診断した．RBDは，近年シヌクレイノパチーの発症に先行する症状として注目されている．本症例は，嗅覚障害とMIBG心筋シンチグラフィー集積低下の両者を合併しており，シヌクレイノパチーの中でもParkinson病またはLewy小体型認知症へ進展する可能性が高いと考えられた．

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  Objective  The effect of a small amount of alcohol on the sleep structure in relation to alcohol sensitivity was examined using polysomnography (PSG).
  Methods  Alcohol sensitivity was evaluated using alcohol patch test for all subjects. PSGs were performed on three nights after one night for acclimation, and subjects consumed no alcohol, 0.28 or 0.69 g ethanol/kg body weight, respectively, before going to bed. The percentages of sleep time in each sleep stage of 1, 2, 3+4 and rapid eye movement (), latency, and cycle were calculated.
  Subjects  Thirteen healthy female students (age 21.1±0.7 years) were enrolled in this study.
  Results  In all subjects, there were no significant differences in any of the sleep parameters between baseline night and alcohol nights. Six of the 13 subjects were sensitive to alcohol, in whom %stage was significantly decreased by alcohol consumption (baseline night: 18.3±6.2%, alcohol night I: 9.8±5.1% and alcohol night II: 11.0±2.8%), and the latency was significantly prolonged. The standard deviation of cycle was significantly greater on alcohol nights I and II than baseline night. There were no significant differences in other sleep parameters. In the other seven subjects who were insensitive to alcohol, none of the sleep parameters were significantly affected by alcohol consumption.
  Conclusion   sleep was adversely affected by a small amount of alcohol in alcohol-sensitive healthy young women. Alcohol sensitivity might play some important role in impaired sleep by an ingestion of a small amount of alcohol.

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Magnetometries of costal and abdominal wall movements during and NON- sleep were made in sixty normal children under two years of age to study the compensatoy costal respiration. It was confirmed that in the newborn infants their respirations are entirely abdominal in type and adult-type respiratory movements of rib cage and abdominal wall first develop at about four to five months of age. These physiological evidences imply that the newborn infant with unilateral phrenic nerve paralysis may need a respirator support for four to five months. However, such a long-term respirator care carries a considerable potential risk. The authors recommed a early operative plication of the paralytic diaphragm when nerve paralysis did not recover after a few weeks of respirator care.

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Atonia during rapid eye movement () sleep is absent in patients with sleep behavior disorder (RBD), a phenomenon called sleep without atonia (RWA). RBD patients have symptoms in common with neurodegenerative diseases, and data from follow-up studies on idiopathic RBD patient indicate that RBD predicts development of neurodegenerative diseases, particularly Parkinson's disease (PD). Therefore, early diagnosis of RWA can help identify and possibly prevent neurodegenerative diseases. Currently, RWA assessment by visual analysis of polysomnogram (PSG) is only moderately reliable and extremely time-consuming, making it difficult to obtain objective, quantifiable results. We developed an algorithm to automatically quantify tonic and phasic electromyographic (EMG) activities of the musculus mentalis during sleep using the scoring manual proposed by the American Academy of Sleep Medicine. Hilbert transform and average rectification were used to calculate the amplitudes of phasic and tonic muscular activities, respectively. Parameter values in the algorithm were optimized by cross-referencing the classification result obtained from the algorithm with the result from epoch-by-epoch visual inspection by a neurologist. A total of 2315 epochs from 24 PD patients were analyzed. We calculated the optimal parameter set, at which the sum of sensitivity and specificity was the highest, as well as the area under the receiver operating characteristic (ROC) curve (AUC). Verification tests showed good detection accuracy (phasic: sensitivity = 88%, specificity = 82%, AUC = 0.92; tonic: sensitivity = 88%, specificity = 85%, AUC = 0.93). Thus, this automated RWA detection algorithm is potentially useful for rapid and accurate diagnosis of RBD.

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EEG activities in the higher frequency range rather than the conventionally used was hypothesized to be more directly related to neurogenic activities which are expected to construct EEG activities. According to this hypothesis, EEG activities up to 90 Hz were measured and analyzed during sleep. sleep is considered to be only a physiological state which allows one to measure the high frequency EEG activities without contamination of EMG due to muscle atonia except for twitches. The study found that the rhythmic activities with different frequencies randomly appeared one after another in the frequency range up to at least 90 Hz. This result suggests that the rivalry among small neural assemblies activated synchronously is realized during sleep, which might be understood within our hypothesized framework of disinhibition and activation associated with sleep. In addition, the extremely wide bandwidth of 500 Hz analyzed here disclosed the phasic potentials related to the rapid eye movements which had the consistent topographic pattern, i.e., frontal positive and occipital negative, which suggests the dipole located deep in the brain. This phasic event may be related to a neurogenic potential generating ponto-geniculo-occipital (PGO) wave observed in cats during sleep. Therefore, our finding potentially discloses novel aspects of human neurophysiology.

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睡眠行動異常症 (RBD) は, 睡眠中に起こる睡眠随伴症のひとつである。確定診断は, 臨床症状と終夜睡眠ポリグラフ検査において筋活動抑制を伴わない睡眠 ( sleep without atonia, RWA) が確認されることで行われるが, RWAの判定が確立しているとはいえない。今回我々のセンターでのRWA解析について従来法とAASM manual for scoring sleep 2007等を受けて現在行っている解析方法を呈示し, RBDと診断された13例を対象として, 従来法と現解析方法による%, %RWAを比較したが有意差はなかった。現解析方法にてtonic activity typeのRWAが睡眠にしめる割合を算出した。RWAの出現様式やカットオフ値の報告がなされ, 神経変性疾患へ進展する群ではtonic activity typeのRWA値が高いといわれている。既報告例と比較し当センターの%RWA, tonic activity typeのRWA値が低かった。今後解析方法の解釈に統一が必要であり, 詳細な解析が疾患分類や薬剤選択につながる可能性がある。

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The replay of behaviorally induced multi-neuronal activity patterns during subsequent sleep or quiet waking is conjectured to play an important role in the consolidation process of certain types of memory. During the early stages of memory consolidation, the hippocampus appears to be critical; however, over time the involvement of the hippocampus decreases as the memories become gradually consolidated in the neocortex. In this article, we review how temporal spike patterns are replayed during sleep and the possible interactions of the hippocampus and neocortex through these patterns.

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As an example of "automatic algorithms" imitating human discrimination by persons with specialized knowledge and skills based on their sensory information in accordance with the empirical rule not clearly written, we developed algorithms imitating visual assessments to evaluate

sleep not accompanied by a decrease in muscle activity.

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We simultaneously recorded hippocampal and amygdaloid field activity during sleep in rats. In the amygdala, intermittent rhythmic activity, whose frequency was about 8 Hz, was recorded during sleep. This activity was found to be synchronized with hippocampal theta activity. We also recorded pontine phasic potential, which is called P wave. This potential is known to relate to the cholinergic neuronal activity in the brainstem. We found that i) the frequency of theta wave in both the amygdala and hippocampus increased associated with increase in the P wave density, ii) duration of theta in the amygdala increased as P wave density increases iii) synchronization between theta wave in the amygdala and hippocampus became stronger with the increase in the P wave density. Because cholinergic neurons in the brainstem send projections to the amygdala and hippocampus, these results suggest that the brainstem cholinergic neurons activate theta activity both in the amygdala and hippocampus. [J Physiol Sci. 2007;57 Suppl:S137]

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Twenty-four hour polygraphs were performed to obtain distributions of and stage 4 sleep during 2-hour sleep periods in eight different time zones. The time zones differed on the basis of time when sleep onset occurred and the length of preceding awakeness. Eight healthy males, averaging 23. 3 years old, were studied. The experiments ran after the end of a usual night's sleep (00:00-07:00). The eight periods were divided into 4 advanced and 4 delayed shifts based on time of retiring-i. e., A₄-10:00, A₃-15:00, A₂-20:00, A₁-22:00, D₁-02:00, D₂-04:00, D₃-06:00, D₄-10:00.
1) Total sleep time was shorter for the advanced, and longer for the delayed shifts.
2) latency was longest for A₂, and shorter in A₄, A₃ and D_1-4. It became more significant for the periods farther away from A₂ in either direction, with an inverse tendency observed for initial duration.
3) at onset (SOREMp) was observed only for early morning periods, A₄, D₃ and D₄.
4) The amount of sleep was greatest in A₄ and considerably less in the order of A₃ and A₂. It then increased in the following order, A₁, D₁, D₂, D₃ and D₄. Mean rectal temperature during sleep was found to be in an inverse order.
5) Stage 4 sleep increased as follows: A₄<A₃<A₂<A₁<D₁<D₂<D₃<D₄, with significant differences between each two periods.
The above findings indicate the presence of a conspicuous circadian rhythm in sleep, and the dependence of stage 4 sleep on the length of the preceding period of wakefulness.

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sleep behavior disorder (RBD) is a sleep-related parasomnia characterized by action of dream content, which is often an aggressive or terrible nightmare. Because of the self-defense movements and behaviors in dreams, sleep-talking (e.g., yelling and screaming) and violent movements of the arms and legs may injure the patient or bed partner. Idiopathic or isolated RBD that develops after middle age may progress to neurodegenerative diseases, such as Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy, in half of the patients after 10 years. The development of a method that can accurately diagnose RBD by polysomnography may help to identify patients at high short-term risk of developing α-synucleinopathies. Such patients may be enrolled in trials of disease-modifying therapy. Several techniques for the early diagnosis of α-synucleinopathies are under development for clinical use and await application in clinical trials of candidate therapies.

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レム睡眠行動異常症 (RBD) は, 「夢内容に一致した異常行動 (DEB) 」を主徴候とする睡眠関連疾患として知られている。しかしDEBはRBD以外のさまざまな病態でもみられ, 必ずしもRBDに特異的なものではない。またRBDの確定診断にはビデオ同時記録による終夜睡眠ポリグラフィ (vPSG) で「筋活動の低下を伴わないレム睡眠 (RWA) 」を証明することが必須であるが, RWAも同じくRBD以外の病態でもみられ, この所見のみで直ちにRBDと診断することはできない。本稿では, DEBおよび類似の現象を呈する病態, ならびに特発性RBD以外でRWAの出現する病態について解説する。またRBD/RWAと神経変性疾患との関連について, 現在の知見を述べる。

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This paper presents two sleep indices related with sleep and; awake and non- sleeps defined from the heart beat and body movement measured by the pneumatic method. The former is defined by the heart rate variability and latter is defined by channel capacity in the measurement of heartbeat, which is the degree of how the pulse wave measurement is corrupted with the body movement. These indices were compared with the occurrence rates of the delta-waves, spindle waves in the electroencephalogram and rapid eye movements measured by a polygraph and show the relationship with these bio-signals. The sleep stages estimated by using the indices were more accurate than those estimated by the conventional method based on the heart rate and body movement.

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人はなぜ眠るのか?　この疑問は何世紀にも渡り問われ続けてきたものの，未だに統一見解に至っていない。ノンレム睡眠が学習・記憶に貢献することが報告され，システムコンソリデーション仮説やシナプス恒常性仮説など，複数の仮説が提案された。しかし，レム睡眠については，未だ議論の余地がある。本項では，視覚学習を中心として，ヒトの学習における睡眠の役割について，これまでに蓄積されてきた知見に加えて，新しい脳機能計測技術を用いて明らかにされてきた研究成果を述べる。特に，MRスペクトロスコピーと睡眠ポリグラフの同時計測により，ヒトの睡眠中の興奮抑制バランスを計測することも可能になった。この技術を用いることで，ノンレム睡眠とレム睡眠中には，視覚システムにおいて脳の変化のしやすさ（脳の可塑性）が変動し，オフラインゲインと干渉に対する頑健さという，学習の異なる側面に，それぞれの睡眠が貢献することが明らかになってきた。

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近年,睡眠/覚醒機能の障害によるQOL低下が取沙汰されるようになり,睡眠の定量的評価が重要視されている。しかし睡眠段階の検出に通常用いられる睡眠ポリグラフには,計測装置が比較的大掛かり,多数の計測用電極や配線により被検者が寝づらい,睡眠段階の判定に経験と長い解析時間を要する,などの問題がある。そこで本研究では,テレメトリ方式のパルスオキシメータを用いて,睡眠中脈拍変動の連続計測データを元に,睡眠期の自動検出を試みた。健常成人男性5名において,睡眠ポリグラムによる睡眠段階判定との照合の結果,敏感度70%,特異度90%,検出精度81%で睡眠期の検出が可能であることが分かった。

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