多频道生理纪录法在睡眠呼吸中止症的应用.ppt

Polysomnography (PSG) 多频道生理纪录法 -在睡眠呼吸中止症(Sleep Apnea)的应用,梁丽丽,2008年11月19日,Gold standard: Polysomnography (over night) 多频道生理纪录法,Parameter: EEG EOG Chin EMG EKG Chest movement Abdomen movement Leg movement Airflow Oxygen saturation Body position Snoring Light video recording,EEG, EOG, chin EMG 电极黏贴位置示意图,- 3 EEG channels: C3/A2, C4/A1, O1/A2, GND, REF,- 2 EOG channels: ROC( 1 cm above)/A1, LOC(1cm below)/A2,ROC/A1,- 1 EMG channel: beneath the chin( 4cm between 2 electrodes),EMG,GRD,What is sleep apnea?,Apnea: complete cessation of airflow (at least 90% of baseline) for at least 10 sec,What is sleep hypopnea?,Hypopnea: airflow 50% of baseline, or desaturation of at least 4%, or arousal from sleep,Three types of Sleep apnea syndrome,Central type Obstructive type Mixed type,Central type sleep apnea(睡眠呼吸中止中枢型),定义： 1. 呼吸波减至10%以下 2. 每次至少10秒 3. 无胸腹部的呼吸动作,15seconds,不会过胖 咽喉通道不狭窄 抱怨晚上失眠但白天想睡觉 打鼾不严重 10% 有睡眠呼吸症状者 显着- CNS or neuromuscular disorder.,Obstructive sleep apnea (睡眠呼吸中止阻塞型),*定义： 呼吸波减至10%以下 每次至少10秒 喉咽气道阻塞 胸腹部呼吸动作持续，但无气流交换,75 seconds,较常见90 % 台湾约有 11%中老年人口 罹患中度或重度阻塞型 睡眠呼吸中止症,Mixed type apnea 睡眠呼吸中止混合型,定义： 1. 呼吸波减至10%以下 2. 每次至少10秒 3. 先中枢型再接阻塞型 4. 25% 的中枢型,30 seconds,Hypopnea,定义： 每次至少有90 %的呼吸波减至50%以下 每次至少10秒 血氧饱和度下降至少 3%,32 seconds,阻塞型睡眠呼吸中止症临床症状,打鼾,白天嗜睡,无法熟睡,注意力不集中,晨醒头痛,夜间频尿,性情改变,sleep apnea 的影响,sleep apnea相关危险因素,年纪 男性 女性 肥胖 颈围过粗 (男43公分，女38公分) 酒精或镇静剂、安眠药 颅面结构异常如后缩颚、下颚狭小、鼻中膈弯曲、舌头过大、暴牙、舌头过大、扁桃腺肥大、悬壅垂肥大咽颚帆区狭小、口鼻咽软组织过多 甲状腺功能过低症、唐氏症,RDI 及 AHI 的定义,AHI: apnea/hypopnea index (#/hour) The average of episodes of apnea and hypopnea per hour of sleep 每小时apnea and hypopnea 的平均发生次数 RDI: respiratory disturbance index (#/hour) #: events of apnea, hypopnea, snores, snore resulting in arousals,The severity of sleep apnea,ICSI health guideliine, Diagnosis and treatment of obstructive sleep apnea, 2003,*严重度的睡眠呼吸中止症可领轻度残障手册，已有提议修法改为向健保局申领 购买阳压呼吸器补助费。,如何治疗睡眠呼吸中止症,维持理想体重 侧睡 避免睡前服用镇静药物 避免睡眠不足 避免睡前喝酒 床头摇高 (肥胖特别是肚子大的人） 感冒及过敏一定要治好 睡前避免吃太多 戒菸,手术 一个月后 98公斤,手术前 135公斤 扁桃腺肥大,1. 行为治疗,如何治疗睡眠呼吸中止症,Fujita (1981), Uvulopalatopharygoplasty Most common procedure- remove excess tissue of tonsils, uvula and part of the soft palate. 1st line treatment for retropalatal collapse 10-50% success,2. UPPP (悬壅颚咽成形术) ( 侵袭性治疗),3. Dental Appliances 齿科装置 (非侵袭性治疗),Nearly as effective as CPAP in mild to moderate OSA Reposition the mandible,如何治疗睡眠呼吸中止症,4. Nasal CPAP 鼻腔阳压呼吸器(非侵袭性治疗) Nasal Continuous Positive Airway Pressure (APAP): Auto Positive Airway Pressure,10 cmH2O to overcome upper airway narrowing, not over 20-25 cmH20),如何治疗睡眠呼吸中止症,R & K, 1968 (Rechtschaffen & Kales) Awake Non-REM sleep (非快速动眼期) stage 1 stage 2 stage 3 stage 4 REM sleep (快速动眼期 Rapid-Eye-Movement),正常睡眠的分期,American Academy Sleep Medicine 美国睡眠医学会, 2007 Stage W Stage N1 Stage N2 Stage N3 (deep sleep ) Stage R,正常睡眠分期的周期关系,睡眠记录常用名词,1. Total Recording Time (记录总分钟数) Time in Bed (躺在床上的总分钟数) 2. Total Sleep Time (睡眠总分钟数) (stage1+stage2+stage3+stage4+REM) 3. Sleep Efficiency (睡眠效率, 85%) (Total Sleep Time/ Total Recording Time ) X 100 4. Sleep Latecy (入眠时间, 15 分钟) 5. REM latency (入快速动眼期时间, 80-120分钟),N-REM and REM stage 在生理上的比较,阴茎或阴蒂勃起,较少,时常,N-REM and REM stage 在功能上的比较,Polysomnography Report,Polysomnography Report,Polysomnography Report,脑波频率,脑 波 形 状,K Complex,sharp negative wave, followed by slower positive component, 0.5 sec seen in Stage 2,Spindle,short rhythmic waveform clusters of 12-14 Hz 0.5 sec seen in stage2,low amplitude sawtooth appearance seen in REM,Sawtooth waves,sharp positive waves, theta frequency range, occurring latter part of Stage1,Vertex waves,Relaxed Wakefulness,rapid eye movement, blinks,tonic activity, relatively high, voluntary movement,wave (8-13 cps), predominantly in O1, O2 Pattern: Blades of grass,low voltage, mixed frequency, (4 to7 cps), Vertex sharp waves may be present.,NON-REM Stage 1 ( 5% of Total Sleep Time),slow rolling eye movement,tonic activity lower than awake,Sleep spindle: 0.5 sec, 11-16cps, 3-8/min,K complex: 0.5 sec, 13/min negative-positive,Low level tonic activity,Slow eye movement,Non-REM Stage 2 ( 50% of total sleep ),Stage 1 with vertex sharp wave,Stage 2 with sleep spindle & k complex,Comparison between stages 1 & 2,vertex sharp wave, 75uv,0.5sec, upward,sleep spindle,k complex,( 3 minute-rule ),EMG: low level tonic,EEG: 0.5 2cps, high voltage 75 uV Stage 3 : 20%50% slow wave Sleep spindles may be present,NREM Stage 3 ( slow wave sleep),EOG similar to EEG,EMG: low level tonic,EEG: slow wave 75 uV Stage 4: 50% slow wave,NREM Stage 4 ( slow wave sleep ),Slow wave sleep 1015 % of total sleep time,REM stage ( rapid eye movement, 2025 of total sleep time),EEG: Saw tooth,2-6 cps, preceding a burst of REMs,EOG: Rapid eye movement,EMG: Tonic suppression,EEG: Theta waves 3-7 cps, low voltage, mixed frequency, Alpha waves may be present,REM stage without rapid eye movement,REM stage with rapid eye movement,动作期 (MT),* 模糊记录 15秒钟, 放大器阻断讯号, 前后页必须入睡 * 过度的肌电波活动: 如改变体位或身体移动,后面内容直接删除就行 资料可以编辑修改使用 资料可