1、Polysomnography(PSG)Polysomnography(PSG)多频道生理纪录法多频道生理纪录法 -在睡眠呼吸中止症在睡眠呼吸中止症(Sleep(Sleep Apnea)Apnea)的应用的应用梁丽丽 2008年11月19日Gold standard:Polysomnography(over night)Gold standard:Polysomnography(over night)多频道生理纪录法多频道生理纪录法Parameter:Parameter:EEG EEG EOG EOG Chin EMG Chin EMG EKG EKG Chest movement Chest
2、 movement Abdomen movement Abdomen movement Leg movement Leg movement Airflow Airflow Oxygen saturation Oxygen saturation Body position Body position Snoring Snoring Light Light video recording video recordingEEG,EOG,chin EMG EEG,EOG,chin EMG 电极黏贴位置示意图电极黏贴位置示意图C4/A1LOCROCROC/A1ROC/A1EMG1EMG2EMGEMGGR
3、DGRDWhat is sleep apnea?What is sleep apnea?10 secWhat is sleep hypopnea?What is sleep hypopnea?Three types of Sleep apnea syndromeThree types of Sleep apnea syndromep Central typep Obstructive typep Mixed typeCentral 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 15seconds1.不会过胖2.咽喉
4、通道不狭窄3.抱怨晚上失眠但白天想睡觉4.打鼾不严重5.90%2.台湾约有 11%中老年人口3.罹患中度或重度阻塞型4.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 secondsHypopneaHypopnea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 sleep apnea 的影响的影
5、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 RDI 及及 AHI AHI 的定义的定义p AHI:apnea/hypopnea index(#/hour)p The average of episodes of apnea and hypopnea per hour of sleepp 每小时apnea and hypopnea 的平均发生次数 p RDI:respirator
6、y disturbance index(#/hour)p#:events of apnea,hypopnea,snores,snore resulting in arousalsThe severity of sleep apnea DiagnosisNormalMildModerateSevereRDI/AHI(episodes/hour)40DiagnosisMildModerateSevereMean SaO2 90%90%90%Minimum SaO2 85%70%85%)p (Total Sleep Time/Total Recording Time)X 100p 4.Sleep L
7、atecy(入眠时间,15 分钟)p 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Non-REMNon-REMREMREM呼吸速率呼吸速率规则规则较快且有变异性较快且有变异性 血压血压规则规则较高且有变异性较高且有变异性 心跳心跳规则规则 较快且有变异性较快且有变异性 大脑血流速率大脑血流速率 规则规则增加增加体温体温稳定稳定变异变异肌肉张力肌肉张力放松放松消失消失作梦作梦很少很少时常时常阴茎或阴蒂勃起阴茎或阴蒂勃起较少较少时常时常N-REM and REM stage 在功能上的比较Non-REMNon-REM(dee
8、p sleep)(deep sleep)REMREM生长激素的分泌生长激素的分泌脑部生长脑部生长脑部发育脑部发育与智力及记忆有关与智力及记忆有关 Polysomnography ReportPolysomnography ReportPatient name Patient ID:827350 Test date:2007/05/04Sex:MAge:66Height:167Weight:121Sleep Staging Data Lights offPM 11:04:38Sleep OnsetPM 11:44:08Light OnAM 06:30:38Stage shifts 115Time
9、 in Bed(TIB)446Sleep Period Time(SPT)406.5Total sleep time(TST)370Sleep Efficiency83Sleep StagingDuration(min)SPT(%)Latency(min)MVT 00Awake42.5REM33.58.2255Stage 1136.525.36Stage 2227.55639.5 Stage 361.547Stage 400Respiratory Data#of EventsMean Duration(sec.)Max.Duration(sec)Central121.521.5Obstruct
10、ive33431.464.5Mixed000Hypopnea723.636.5Total34231.364.5REM+NREMREMNREMRDI(#/hour)55.557.355.3Polysomnography ReportPolysomnography ReportOximetry Data(min)50607075808590 0.5 secseen in Stage 2short rhythmic waveform clustersof 12-14 Hz 0.5 secseen in stage2low amplitudesawtooth appearanceseen in REM
11、sharp positive waves,theta frequency range,occurring latter part of Stage1Relaxed Wakefulness Relaxed Wakefulness rapid eye movement,blinks tonic activity,relatively high,voluntary movementwave(8-13 cps),wave(8-13 cps),predominantly in O1,O2 predominantly in O1,O2 Pattern:Blades of grass Pattern:Bla
12、des of grass low voltage,mixed frequency,(4 to7 cps),Vertex sharp waves may be present.NON-REM Stage 1(5%of Total Sleep Time)NON-REM Stage 1(5%of Total Sleep Time)slow rolling eye movementtonic activity lower than awakeSleep spindle:0.5 Sleep spindle:0.5 sec,sec,11-16cps,11-16cps,3-8/min 3-8/min K c
13、omplex:K complex:0.5 sec,13/min0.5 sec,13/min negative-positive negative-positive Low level tonic activitySlow eye movementNon-REM Stage 2 (50%of total Non-REM Stage 2 (50%of total sleep)sleep)Stage 1 with vertex sharp wave Stage 2 with sleep spindle&k complex(1 epoch=30 seconds)Comparison between s
14、tages 1&2(1 epoch=30 seconds)vertex sharp wave,75uv,75 uVStage 3:20%50%slow waveSleep spindles may be presentNREM Stage 3(slow wave sleep)(1 epoch=30 seconds)EOG similar to EEGEMG:low level tonicEEG:slow wave 75 uVStage 4:50%slow waveNREM Stage 4(slow wave sleep)(1 epoch=30 seconds)Slow wave sleep 1
15、015%of total sleep Slow wave sleep 1015%of total sleep timetimeREM stage(rapid eye movement,2025 of total REM stage(rapid eye movement,2025 of total sleep time)sleep time)EEG:Saw tooth,2-6 cps,preceding a burst of REMs EOG:Rapid eye movementEOG:Rapid eye movementEMG:Tonic suppressionEEG:Theta waves
16、3-7 cps,low voltage,mixed frequency,Alpha waves may be present REM stage without rapid eye movementREM stage with rapid eye movement(1 epoch=30 seconds)动作期动作期 (MT)(MT)*模糊记录模糊记录 1515秒钟秒钟,放大器阻断讯号放大器阻断讯号,前后页必须入前后页必须入睡睡*过度的肌电波活动过度的肌电波活动:如改变体位或身体移动如改变体位或身体移动(1 epoch=30 seconds)后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用主要经营：网络软件设计、图文设计制作、发布广告等公司秉着以优质的服务对待每一位客户，做到让客户满意！致力于数据挖掘，合同简历、论文写作、PPT设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求The user can demonstrate on a projector or computer,or print the presentation and make it into a film to be used in a wider field
