The estimated prevalence of sleep-disordered breathing (SDB) with an apnea-hypopnea index (AHI) of 5 or higher was 24 percent for men, and 4 percent of men in the middle-aged work force meet the minimal diagnostic criteria for the sleep apnea syndrome (SAS) (SDB with daytime hypersomnolence). However, there are few published data about this problem in our country.A random sample of 208 men 30 to 76 years old who were staying overnight for a complete physical examination were the subjects of this study. A portable sleep data acquisition device was used to determine the frequency of episodes of apnea and hypa-pnea in them. The prevalence of SDB was worked out and the clinical significance was discussed.The estimated prevalence of SDB was 76.4 percent and that of SAS was 12.5 percent. Compared with subjects with lower AHI values, those with higher levels of SDB and AHI included a significantly large number of individuals of advanced age and with hypertension, although their body mass index, Epworth sleepiness scale, and values of total cholesterol and triglycerides were not significantly high.These data revealed a remarkable high incidence of SDB in our country and suggested an association of SDB with risk factors of cardio-vascular events. We need a regular screening for sleep disorders by polysomnography or the portable device at least.
percent ; Prevalence aspects ; Sleep Apnea Syndromes ; Male population group ; SAS

To clarify characteristics of home care in rural areas in Japan, we investigated the actual status of home care in a rural area (Asuke town, Asahi town, Inabu town, northern part of Toyota city and Shimoyama village) in Aichi prefecture. The subjects were 149 patients who were under medical care and nursing supervision at home for the last 2 years and a half. Age, sex, ADL, prognosis, principal care-givers of the patients and distance from patients' houses to our hospital were compared with the average data of all the nurse stations in Japan (1996). The percentage of patients over 90 years old was 23.4% in this area as against 13.5% of the national average. Sex and ADL levels were similar to the average. The proportion of females as principal care-givers of patients was 80%, which is about average. However, the proportion ofdaughters-in-law was 51.7%, double of the national average. In 48 cases (32%), the time required to get to the hospital by car was over 31 min. This ratio was 3 times higher than that of the average data, and it took 50 min from farthest patient's house (35km). In prognosis, 66 patients died-44 cases (67%) in hospital and 22 cases (23%) at home.
Our questionnaire survey regarding patients' and care-givers' wishes was responded to by 38 of 47 principal care-givers who utilized our home care and nursing survice program. One half of care-givers were over 60 yearsold and had taken care of a patient for over 5 years. Mental stress, feeding and toileting were major problems most principal care-givers cited. However, they required services at a day-care institution for elderly patients and recovery of used paper diapers. Death at home was wished by 23 (61%) patients and care-givers, if they received enough medial care and welfare services.
These findings revealed that elderly people take care of elderly patients, their houses are far from the hospital and they wish to die at home. More collaboration among all providers of medical care and health and welfare services, and the establishment of an information network are necessary to improve these problems, resulting in safe, acceptable and satisfied home care for patients and care-givers.

To clarify what are contributing factors associated with the place to die (home or hospital) in a rural area, we investigated several background factors of 107 patients who died at home or in hospital after receiving home care service during the period of four years from July 1995 to June 2000. The subjects were divided into two group those who died at home (39 cases, 36%) and those who died in our hospital (68 cases, 64%). The ratio of deaths at home increased every year, and reached a half of those who died after receiving home care service. The average age in those who died at home were 87.1±9.5 years, that was higher than that of those who died in our hospital (82.2±9.8 years). There was no difference betwe two groups about sex, basic diseases and the time required to get to the hospital by car. Death at home was more preferred by patients, whereas death in the hospital was preferred by patients' families. The level of activities of daily living (ADL) in those who died at home was lower compared with that in those who died in the hospital. Those who died at home significantly had lesser complaints (pain, dyspnea and so on) and had more care-givers in the family, than those who died in the hospital. These results revealed that the major factors in death at home are: 1) low level of ADL, 2) preference to death at home expressed by patients, 3) presence of additional care-givers, and 4) no complaint of symptoms from patients.

Purpose: We examined the safety and efficacy of cataract surgery and postoperative management in our hospital and at the homes of the patients who live on medically underserved remote.
Patients and methods: A total of 27 patients (54 eyes), who were followed in our hospital or at their homes were enrolled in this study. Cataract surgery was performed on them between January 2009 and January 2010 and we could follow up six months postoperatively. We divided these patients into two groups:group I (GI) consisted of 13 patients who could come to our hospital regularly during both preoperative and postoperative periods, and group II (GII) consisted of 14 patients who could not come to our hospital regularly during either preoperative or postoperative periods. Cataract surgeries were performed on all the patients in GI and GII in our hospital. The patients in GI were hospitalized for three days and those in GII were for seven days. After cataract surgery, the patients in GI had their eyes checked regularly in our hospital and those in GII were in their homes where the doctor visited. Postoperative ophthalmic clinical tests were conducted to examine visual acuity, intraocular pressure and fundus.
Results: GI comprised three males and 10 females. Their age averaged 79.3. GII comprised four males and 10 females. Their age averaged 82.6. Preoperative ophthalmic examinations found that preoperative average visual acuity (LogMAR and decimal visual acuity in parentheses) and spherical equivalent in GI and GII were 0.69 (0.41), 0.80 (0.33) and -0.43 dioptors, -0.42 dioptors respectively, showing no significant differences between the two groups. Postoperative ophthalmic examinations found that, best corrected visual acuity (LogMAR) was significantly increased to 0.36 (0.66) and 0.44 (0.53) in GI and GII respectively, showing no significant differences either.
Conclusions: We concluded that we could get safe and efficient cataract surgery and postoperative management combined with prolonged hospitalization and house calls on the patients who live in the isolated islands.