睡眠時無呼吸症候群（SAS）

• 1日20分の散歩で骨折は予防できる。

• 閉経後でも筋力トレーニングにて骨密度と下肢筋力が改善する。(8-1)

• ダイエット＋有酸素運動は骨密度を低下させる。筋力トレーニングを組み合わせることが必要である。(8-2)

• 転倒予防にはバランス練習が最も効果的である。(8-3)

• SASは大きく体重の影響を受ける。10％体重増加でAHIが32％増加する。逆に10％体重が減るとAHIが26％減少した。食事＋運動による減量プログラムで、CPAPを併用しないでSASは十分完治しうる。(9-2)

• 口腔・下咽頭筋のトレーニング（筋機能療法（Myofunctional Therapy：MT））によって睡眠指数は改善する。(9-3)

【参考文献】

1. 高血圧

   1. Effects of the DASH diet alone and in combination with exercise and weight loss on bloodpressure and cardiovascular biomarkers in men and women with high blood pressure: the
      ENCORE study. Arch Intern Med 2010 Jan 25;170(2):126-135.
       

   2. Appel LJ, Moore TM, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinicaltrial of the effects of dietary patterns on blood pressure. N Engl J Med 1997 Apr17;336(16)1117-24
       

   3. Lonn EM, Bosch J, Lopez-Jaramillo P, Zhu J, Liu L, Pais P, et al. Blood-PressureLowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med2016 May 26;374(21):2009-2020
       

   4. Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al. 
      Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010 Feb 18;362(7):590-599.
       

   5. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects onblood pressure of reduced dietary sodium and the Dietary Approaches to StopHypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med2001 Jan 4;344(1):3-10.
       

2. 脂質異常・肥満症

   1. Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, etal. Does physical activity attenuate, or even eliminate, the detrimental association of sittingtime with mortality? A harmonised meta-analysis of data from more than 1 million men andwomen. Lancet 2016 Sep 24;388(10051):1302-1310.
       

   2. Wen CP, Wai JP, Tsai MK, Yang YC, Cheng TY, Lee MC, et al. Minimum amount of
      physical activity for reduced mortality and extended life expectancy: a prospective cohort
      study. Lancet 2011 Oct 1;378(9798):1244-1253.
       

   3. Arem H, Moore SC, Patel A, Hartge P, Berrington de Gonzalez A, Visvanathan K, et
      al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-
      response relationship. JAMA Intern Med 2015 Jun;175(6):959-967.
       

   4. Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AF, et al. 
      Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med 2010 Nov 25;363(22):2102-2113.
       

   5. Schwarzfuchs D, Golan R, Shai I.
      Four-year follow-up after two-year dietary interventions. N Engl J Med 2012 Oct 4;367(14):1373-1374.
       

3. 糖尿病​

   1. Bibbins-Domingo K, Chertow GM, Coxson PG, Moran AE, Lightwood JM, Pletcher MJ, etal. Reductions in cardiovascular diseasae projected from modest reductions in dietary salt.N Engl J Med 2010 Feb 18;362(7):590-599
       

   2. Salmeron J, Hu FB, Manson JE, Stampfer MJ, Colditz GA, Rimm EB, et al. 
      Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr 2001 Jun;73(6):1019-1026.
       

   3. Yates T, Haffner SM, Schulte PJ, Thomas L, Huffman KM, Bales CW, et al. 
      Association between change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance (NAVIGATOR trial): a cohort analysis. Lancet 2014 Mar 22;383(9922):1059-1066.
       

4. 慢性閉塞性肺疾患（COPD）

   1. Waschki B, Kristen A, Holz O, Muller K, Meyer T, Watz H, Magnussen H.
      Physical activity is the strongest predictor of all-cause mortality in patients with COPD. CHEST 2001 Aug;140(2):331-342.
       

   2. Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. 
      Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax 2006 Sep;61(9):772-778.
      ​​

5. 過敏性腸症候群​

   1. Han MAT, Altayar O, Hamdeh S, Takyar V, Rotman Y, Etzion O, et al. 
      Rates of and Factors Associated With Placebo Response in Trials of Pharmacotherapies for Nonalcoholic Steatohepatitis: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2019 Mar;17(4):616-629.e26.
       

   2. Floch MH, Narayan R. 
      Diet in the irritable bowel syndrome. J Clin Gastroenterol 2002 Jul;35(1 Suppl):S45-52.
       

   3. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. 
      A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014 Jan;146(1):67-75.e5.
       

   4. Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, et al. 
      Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 2011 Mar;106(3):508-14; quiz 515.
       

6. 一過性脳虚血発作

   1. Kivimaki M, Jokela M, Nyberg ST, Singh-Manoux A, Fransson EI, Alfredsson L, et al. 
      Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet 2015 Oct 31;386(10005):1739-1746.
       

   2. Micha R, Penalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. 
      Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States. JAMA 2017 Mar 7;317(9):912-924.
       

   3. Turan TN, Nizam A, Lynn MJ, Egan BM, Le NA, Lopes-Virella MF, et al. 
      Relationship between risk factor control and vascular events in the SAMMPRIS trial. Neurology 2017 Jan 24;88(4):379-385.
       

7. 安定狭心症

   1. Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, et al. 
      Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009 May 30;373(9678):1849-1860.
      ​

   2.  Miller V, Mente A, Dehghan M, Rangarajan S, Zhang X, Swaminathan S, et al. 
      Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet 2017 Nov 4;390(10107):2037-2049.
       

8. 骨粗鬆症

   1. Curtis J.R, Delzell E, Chen L, Black D, Ensrud K, Judd S, et al.
      The relationship between bisphosphonate adherence and fracture: Is it the behavior or the medication? Results from the placebo arm of the fracute intervention trial.J Bone Miner Res. 2011 Apr:26;683-688
      ​

   2. Robertson MC, Gillespie LD. 
      Fall prevention in community-dwelling older adults. JAMA 2013 Apr 3;309(13):1406-1407.
       

   3. Villareal DT, Aguirre L, Gurney AB, Waters DL, Sinacore DR, Colombo E, et al. 
      Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults. N Engl J Med 2017 May 18;376(20):1943-1955.
       

   4. Watson S, Weeks B, Weis L, Harding A, Horan S, Beck B. 
      High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res 2019 Mar;34(3):572.
       

9. 睡眠時無呼吸症候群（SAS）

   1. Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, et al. 
      Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep 2015 May 1;38(5):669-675.
      ​

   2. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. 
      Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000 Dec 20;284(23):3015-3021.