Sleep apnea syndrome (SAS) is a known risk factor for cerebral stroke and other cardiovascular diseases；approximately 50% of patients with cerebral stroke subsequently develop sleep-related breathing disorders. Obstructive SAS (OSAS) is the most common form of SAS. Concomitant SAS is considered a poor prognostic factor in patients who undergo cerebral stroke rehabilitation；however, many patients remain undiagnosed. We report the case of a 69-year-old woman who was admitted to the convalescent rehabilitation ward with a diagnosis of cerebral hemorrhage. Results of the STOP-Bang questionnaire administered upon admission revealed that the patient was at a high risk for SAS, and she was subsequently diagnosed with OSAS based on simple respiratory function tests. Nighttime continuous positive airway pressure (CPAP) therapy led to improvement in the patient's daytime awakening and nocturnal frequency, and her rehabilitation treatment became easier. In addition to obstruction of the upper airway, nocturnal rostral fluid shift is implicated in the pathophysiology of OSAS-induced nocturia (polyuria), and the combination of exercise and CPAP therapy may serve as a useful treatment strategy in such cases.

Introduction：The relationship between the results of a driving simulator test and a paper-based evaluation of higher brain function were examined.Subjects：The subjects of this study were 203 patients with brain injury who received support to resume driving during hospitalization or outpatient treatment at our hospital between April 1, 2014 and December 31, 2018.Methods：The sex, age, and results of various higher brain function tests of the patients were investigated using medical records and the outcomes of the driving resumption support. The performance on a driving simulator test was compared between patients judged able to and those judged unable to resume driving.Results：In the group of 165 patients who passed the paper-based evaluation of higher brain function, 34 were judged unable to resume driving based on a driving simulator test. In the group that did not pass the paper-based evaluation of higher brain function, 4 patients were also judged unable to resume driving based on a driving simulator test. The results of the higher brain function evaluation were significantly better in the group permitted to resume driving compared with the group not permitted to resume driving in all items except for the Visual Reproduction subtest of the Wechsler Memory Scale-Revised.Conclusions：Evaluations of actual automobile driving using driving simulators or other means are important in assessing driving resumption. Driving requires the use of various higher brain functions and the results of this study suggest that a higher level of ability is required for safe driving.