眠れないから「アルコールを飲む」危険信号

　飲酒と睡眠の問題は一般的ですが、プライマリケアにおいて、このことが調査されたことはありませんでした。そこで、「大量の飲酒は、何らかの睡眠障害の自発報告と関連があるだろう」という仮説で、横断的研究cross-sectional surveyがされました。

・1,984名に無記名の質問anonymous postvisit questionnaires
・1,699 (85.6%) が有効回答で、平均年齢は50.4 歳 (SD 17.4 ), 67% が女性で、72.9% が白人。
・22.3% が危険な飲酒をしており、 47.8% が睡眠の質に問題があり、7.3% が睡眠時無呼吸の診断であった。
・多変量解析の結果、飲酒の状態と不眠、睡眠の質全体、レストレスレッグ症候群とは関連がなかった。
・中程度の飲酒が、飲酒をしない人と比べて関連の見込みがあった (OR = 0.61; 95% CI, 0.38-1.00).
・睡眠のための飲酒は、危険な飲酒と強い関連があった (OR = 4.58; 95% CI, 2.97-7.08, compared with moderate drinking)

Alcohol and Sleep Problems in Primary Care Patients: A Report from the AAFP National Research Network
Ann Fam Med. 2010 Nov-Dec;8(6):484-92.

PURPOSE Hazardous and harmful drinking and sleep problems are common, but their associations among patients seen in primary care have not been examined. We hypothesized that greater levels of alcohol consumption would be associated with several self-reported sleep problems.
METHODS In a cross-sectional survey in primary care practices, 94 participating clinicians recruited up to 30 consecutive adult patients, and both clinicians and patients completed anonymous postvisit questionnaires. Patients were asked questions on demographics, alcohol consumption, cardinal symptoms of alcohol use disorders, sleep quality, insomnia, sleep apnea, and symptoms of restless leg syndrome. Multivariate analyses explored the associations of drinking status (none, moderate, or hazardous) and sleep problems, adjusting for demographics and clustering of patients within physician.
RESULTS Of 1,984 patients who responded, 1,699 (85.6%) provided complete data for analysis. Respondents’ mean age was 50.4 years (SD 17.4 years), 67% were women, and 72.9% were white. Of these, 22.3% reported hazardous drinking, 47.8% reported fair or poor overall sleep quality, and 7.3% reported a diagnosis or treatment of sleep apnea. Multivariate analyses showed no associations between drinking status and any measure of insomnia, overall sleep quality, or restless legs syndrome symptoms. Moderate drinking was associated with lower adjusted odds of sleep apnea compared with nondrinkers (OR = 0.61; 95% CI, 0.38?1.00). Using alcohol for sleep was strongly associated with hazardous drinking (OR = 4.58; 95% CI, 2.97?7.08, compared with moderate drinking).
CONCLUSIONS Moderate and hazardous drinking were associated with few sleep problems. Using alcohol for sleep, however, was strongly associated with hazardous drinking relative to moderate drinking and may serve as a prompt for physicians to ask about excessive alcohol use.

「眠れないから、ちょっと一杯」は、さらなる飲酒の習慣を招くリスクかも知れません。

これから）「部分的に正しくても全体的に大きく間違っている判断を執行部がしているから、いまの支持率になっているのではないか」。原口一博前総務相の発言ですが、「部分的に正しくても、病院として間違っている判断をしていないか？」考えはじめました。それぞれのセクションで理にかなっていても、結果が間違っている過ちを正すには、どうなっていればいいのか？