Polysomnography(PSG)多頻道生理紀錄法

--------在睡眠呼吸中止癥(SleepApnea)的應(yīng)用梁麗麗2008年11月19日Polysomnography(PSG)梁麗麗Goldstandard:Polysomnography(overnight)

多頻道生理紀錄法Parameter:EEGEOGChinEMGEKGChestmovementAbdomenmovementLegmovementAirflowOxygensaturationBodypositionSnoringLightvideorecordingGoldstandard:PolysomnographyEEG,EOG,chinEMG

電極黏貼位置示意圖-3EEGchannels:C3/A2,C4/A1,O1/A2,GND,REFC4/A1-2EOGchannels:ROC(1cmabove)/A1,LOC(1cmbelow)/A2LOCROCROC/A1-1EMGchannel:beneaththechin(4cmbetween2electrodes)EMG1EMG2EMGGRDEEG,EOG,chinEMG

電極黏貼位置示意圖-Whatissleepapnea?Apnea:completecessationofairflow(atleast<90%ofbaseline)foratleast10sec>10secWhatissleepapnea?Apnea:comWhatissleephypopnea?Hypopnea:airflow<50%ofbaseline,ordesaturationofatleast4%,orarousalfromsleepWhatissleephypopnea?HypopneThreetypesofSleepapneasyndromeCentraltypeObstructivetypeMixedtypeThreetypesofSleepapneasynCentraltypesleepapnea(睡眠呼吸中止中樞型)定義：1.呼吸波減至10%以下2.每次至少10秒3.無胸腹部的呼吸動作

15seconds不會過胖咽喉通道不狹窄抱怨晚上失眠但白天想睡覺打鼾不嚴重<10%有睡眠呼吸癥狀者顯著---CNSorneuromusculardisorder.Centraltypesleepapnea(睡眠呼吸中Obstructivesleepapnea(睡眠呼吸中止阻塞型)*定義：呼吸波減至10%以下每次至少10秒喉咽氣道阻塞胸腹部呼吸動作持續(xù)，但無氣流交換75seconds較常見>90%臺灣約有11%中老年人口罹患中度或重度阻塞型睡眠呼吸中止癥Obstructivesleepapnea(睡眠呼吸中Mixedtypeapnea睡眠呼吸中止混合型定義：1.呼吸波減至10%以下2.每次至少10秒3.先中樞型再接阻塞型4.>25%的中樞型30secondsMixedtypeapnea睡眠呼吸中止混合型定義：3Hypopnea定義：每次至少有90%的呼吸波減至50%以下每次至少10秒血氧飽和度下降至少3%32secondsHypopnea定義：32seconds阻塞型睡眠呼吸中止癥臨床癥狀打鼾白天嗜睡無法熟睡注意力不集中

晨醒頭痛夜間頻尿性情改變阻塞型睡眠呼吸中止癥臨床癥狀打鼾白天嗜睡無法熟睡注意力不集中sleepapnea的影響sleepapnea的影響sleepapnea相關(guān)危險因素年紀男性>女性肥胖頸圍過粗(男>43公分，女>38公分)

酒精或鎮(zhèn)靜劑、安眠藥顱面結(jié)構(gòu)異常如后縮顎、下顎狹小、鼻中膈彎曲、舌頭過大、暴牙、舌頭過大、扁桃腺肥大、懸壅垂肥大咽顎帆區(qū)狹小、口鼻咽軟組織過多甲狀腺功能過低癥、唐氏癥sleepapnea相關(guān)危險因素年紀RDI及AHI的定義AHI:apnea/hypopneaindex(#/hour)Theaverageofepisodesofapneaandhypopneaperhourofsleep

每小時apneaandhypopnea的平均發(fā)生次數(shù)RDI:respiratorydisturbanceindex(#/hour)#:eventsofapnea,hypopnea,snores,snoreresultinginarousalsRDI及AHI的定義AHI:apnea/hypopnTheseverityofsleepapneaDiagnosisNormalMildModerateSevereRDI/AHI(episodes/hour)<552020-40>40DiagnosisMildModerateSevereMeanSaO290%90%<90%MinimumSaO285%70%<70%ICSIhealthguideliine,Diagnosisandtreatmentofobstructivesleepapnea,2003*嚴重度的睡眠呼吸中止癥可領(lǐng)輕度殘障手冊，已有提議修法改為向健保局申領(lǐng)購買陽壓呼吸器補助費。TheseverityofsleepapneaDi如何治療睡眠呼吸中止癥維持理想體重側(cè)睡避免睡前服用鎮(zhèn)靜藥物避免睡眠不足避免睡前喝酒床頭搖高

(肥胖特別是肚子大的人）感冒及過敏一定要治好睡前避免吃太多戒菸手術(shù)一個月后

98公斤手術(shù)前135公斤扁桃腺肥大1.行為治療如何治療睡眠呼吸中止癥維持理想體重手術(shù)一個月后手術(shù)前13如何治療睡眠呼吸中止癥Fujita(1981),UvulopalatopharygoplastyMostcommonprocedure----removeexcesstissueoftonsils,uvulaandpartofthesoftpalate.1stlinetreatmentforretropalatalcollapse10-50%success2.UPPP(懸壅顎咽成形術(shù))(侵襲性治療)如何治療睡眠呼吸中止癥Fujita(1981),Uvul3.DentalAppliances齒科裝置(非侵襲性治療)NearlyaseffectiveasCPAPinmildtomoderateOSARepositionthemandible

如何治療睡眠呼吸中止癥3.DentalAppliances齒科裝置(非侵4.NasalCPAP鼻腔陽壓呼吸器(非侵襲性治療)

NasalContinuousPositiveAirwayPressure

(APAP):AutoPositiveAirwayPressure

10cmH2Otoovercomeupperairwaynarrowing,notover20-25cmH20)

如何治療睡眠呼吸中止癥4.NasalCPAP鼻腔陽壓呼吸器(非侵襲性治療)

R&K,1968(Rechtschaffen&Kales)AwakeNon-REMsleep(非快速動眼期)stage1stage2stage3stage4REMsleep(快速動眼期Rapid-Eye-Movement)正常睡眠的分期AmericanAcademySleepMedicine美國睡眠醫(yī)學會,2007StageWStageN1StageN2StageN3(deepsleep)StageR

R&K,1968(Rechtschaffen&K正常睡眠分期的周期關(guān)系正常睡眠分期的周期關(guān)系睡眠記錄常用名詞1.TotalRecordingTime(記錄總分鐘數(shù))TimeinBed(躺在床上的總分鐘數(shù))2.TotalSleepTime(睡眠總分鐘數(shù))(stage1+stage2+stage3+stage4+REM)3.SleepEfficiency(睡眠效率,>85%)(TotalSleepTime/TotalRecordingTime)X1004.SleepLatecy(入眠時間,<15分鐘)5.REMlatency(入快速動眼期時間,80-120分鐘)睡眠記錄常用名詞1.TotalRecordingTim

N-REMandREMstage在生理上的比較

Non-REMREM呼吸速率規(guī)則較快且有變異性血壓規(guī)則較高且有變異性心跳規(guī)則較快且有變異性大腦血流速率規(guī)則增加體溫穩(wěn)定變異肌肉張力放松消失作夢很少時常陰莖或陰蒂勃起較少時常

N-REMandREMstage在生理上的比較

N-REMandREMstage在功能上的比較

Non-REM(deepsleep)REM生長激素的分泌腦部生長腦部發(fā)育與智力及記憶有關(guān)

N-REMandREMstage在功能上的比較

PolysomnographyReportPolysomnographyReportPolysomnographyReportPolysomnographyReportPolysomnographyReportPolysomnographyReport腦波頻率Delta<4HzHerzTheta4-7HzAlpha8-13HzBeta>13Hz腦波頻率Delta<4HzHerzTheta4-7Hz

腦波形狀KComplexsharpnegativewave,followedbyslowerpositivecomponent,>0.5secseeninStage2Spindleshortrhythmicwaveformclustersof12-14Hz>0.5secseeninstage2lowamplitudesawtoothappearanceseeninREMSawtoothwavessharppositivewaves,thetafrequencyrange,occurringlatterpartofStage1Vertexwaves腦波形狀KComplexsharpnegativRelaxedWakefulnessrapideyemovement,blinkstonicactivity,relativelyhigh,voluntarymovementαwave(8-13cps),predominantlyinO1,O2Pattern:BladesofgrassRelaxedWakefulnessrapideye

lowvoltage,mixedfrequency,θ(4to7cps),Vertexsharpwavesmaybepresent.NON-REMStage1(5%ofTotalSleepTime)slowrollingeyemovementtonicactivitylowerthanawakelowvoltage,mixedfrequency,Sleepspindle:>0.5sec,11-16cps,3-8/minKcomplex:＞0.5sec,1~3/minnegative-positiveLowleveltonicactivitySloweyemovementNon-REMStage2(50%oftotalsleep)Sleepspindle:>0.5sec,KcomStage1withvertexsharpwaveStage2withsleepspindle&kcomplex(1epoch=30seconds)Comparisonbetweenstages1&2(1epoch=30seconds)vertexsharpwave,>75uv,<0.5sec,upwardsleepspindlekcomplex(3minute-rule)Stage1withvertexsharpwaveEMG:lowleveltonicEEG:0.5~2cps,highvoltage>75uVStage3:20%~50%slowwaveSleepspindlesmaybepresentNREMStage3(slowwavesleep)(1epoch=30seconds)EOGsimilartoEEGEMG:lowleveltonicEEG:0.5~EMG:lowleveltonicEEG:slowwave<2cps,highvoltage>75uVStage4:>50%slowwaveNREMStage4(slowwavesleep)(1epoch=30seconds)Slowwavesleep10~15%oftotalsleeptimeEMG:lowleveltonicEEG:slowREMstage(rapideyemovement,20~25oftotalsleeptime)EEG:Sawtooth,2-6cps,precedingaburstofREMsEOG:RapideyemovementEMG:TonicsuppressionEEG:Thetawaves3-7cps,lowvoltage,mixedfrequency,AlphawavesmaybepresentREMstage(rapideyemovementREMstagewithoutrapideyemovementREMstagewithrapideyemovement(1epoch=30seconds)REMstagewithoutrapideyemo動作期(MT)*模糊記錄15秒鐘,放大器阻斷訊號,前后頁必須入睡*過度的肌電波活動:如改變體位或身體移動(1epoch=30seconds)動作期(MT)*模糊記錄15秒鐘,放大器阻斷訊號,多頻道生理紀錄法在睡眠呼吸中止癥的應(yīng)用課件后面內(nèi)容直接刪除就行資料可以編輯修改使用資料可以編輯修改使用后面內(nèi)容直接刪除就行主要經(jīng)營：網(wǎng)絡(luò)軟件設(shè)計、圖文設(shè)計制作、發(fā)布廣告等公司秉著以優(yōu)質(zhì)的服務(wù)對待每一位客戶，做到讓客戶滿意！主要經(jīng)營：網(wǎng)絡(luò)軟件設(shè)計、圖文設(shè)計制作、發(fā)布廣告等致力于數(shù)據(jù)挖掘，合同簡歷、論文寫作、PPT設(shè)計、計劃書、策劃案、學習課件、各類模板等方方面面，打造全網(wǎng)一站式需求致力于數(shù)據(jù)挖掘，合同簡歷、論文寫作、PPT設(shè)計、計劃書、策劃感謝您的觀看和下載Theusercandemonstrateonaprojectororcomputer,orprintthepresentationandmakeitintoafilmtobeusedinawiderfield感謝您的觀看和下載TheusercandemonstrPolysomnography(PSG)多頻道生理紀錄法

--------在睡眠呼吸中止癥(SleepApnea)的應(yīng)用梁麗麗2008年11月19日Polysomnography(PSG)梁麗麗Goldstandard:Polysomnography(overnight)

多頻道生理紀錄法Parameter:EEGEOGChinEMGEKGChestmovementAbdomenmovementLegmovementAirflowOxygensaturationBodypositionSnoringLightvideorecordingGoldstandard:PolysomnographyEEG,EOG,chinEMG

電極黏貼位置示意圖-3EEGchannels:C3/A2,C4/A1,O1/A2,GND,REFC4/A1-2EOGchannels:ROC(1cmabove)/A1,LOC(1cmbelow)/A2LOCROCROC/A1-1EMGchannel:beneaththechin(4cmbetween2electrodes)EMG1EMG2EMGGRDEEG,EOG,chinEMG

電極黏貼位置示意圖-Whatissleepapnea?Apnea:completecessationofairflow(atleast<90%ofbaseline)foratleast10sec>10secWhatissleepapnea?Apnea:comWhatissleephypopnea?Hypopnea:airflow<50%ofbaseline,ordesaturationofatleast4%,orarousalfromsleepWhatissleephypopnea?HypopneThreetypesofSleepapneasyndromeCentraltypeObstructivetypeMixedtypeThreetypesofSleepapneasynCentraltypesleepapnea(睡眠呼吸中止中樞型)定義：1.呼吸波減至10%以下2.每次至少10秒3.無胸腹部的呼吸動作

15seconds不會過胖咽喉通道不狹窄抱怨晚上失眠但白天想睡覺打鼾不嚴重<10%有睡眠呼吸癥狀者顯著---CNSorneuromusculardisorder.Centraltypesleepapnea(睡眠呼吸中Obstructivesleepapnea(睡眠呼吸中止阻塞型)*定義：呼吸波減至10%以下每次至少10秒喉咽氣道阻塞胸腹部呼吸動作持續(xù)，但無氣流交換75seconds較常見>90%臺灣約有11%中老年人口罹患中度或重度阻塞型睡眠呼吸中止癥Obstructivesleepapnea(睡眠呼吸中Mixedtypeapnea睡眠呼吸中止混合型定義：1.呼吸波減至10%以下2.每次至少10秒3.先中樞型再接阻塞型4.>25%的中樞型30secondsMixedtypeapnea睡眠呼吸中止混合型定義：3Hypopnea定義：每次至少有90%的呼吸波減至50%以下每次至少10秒血氧飽和度下降至少3%32secondsHypopnea定義：32seconds阻塞型睡眠呼吸中止癥臨床癥狀打鼾白天嗜睡無法熟睡注意力不集中

晨醒頭痛夜間頻尿性情改變阻塞型睡眠呼吸中止癥臨床癥狀打鼾白天嗜睡無法熟睡注意力不集中sleepapnea的影響sleepapnea的影響sleepapnea相關(guān)危險因素年紀男性>女性肥胖頸圍過粗(男>43公分，女>38公分)

酒精或鎮(zhèn)靜劑、安眠藥顱面結(jié)構(gòu)異常如后縮顎、下顎狹小、鼻中膈彎曲、舌頭過大、暴牙、舌頭過大、扁桃腺肥大、懸壅垂肥大咽顎帆區(qū)狹小、口鼻咽軟組織過多甲狀腺功能過低癥、唐氏癥sleepapnea相關(guān)危險因素年紀RDI及AHI的定義AHI:apnea/hypopneaindex(#/hour)Theaverageofepisodesofapneaandhypopneaperhourofsleep

每小時apneaandhypopnea的平均發(fā)生次數(shù)RDI:respiratorydisturbanceindex(#/hour)#:eventsofapnea,hypopnea,snores,snoreresultinginarousalsRDI及AHI的定義AHI:apnea/hypopnTheseverityofsleepapneaDiagnosisNormalMildModerateSevereRDI/AHI(episodes/hour)<552020-40>40DiagnosisMildModerateSevereMeanSaO290%90%<90%MinimumSaO285%70%<70%ICSIhealthguideliine,Diagnosisandtreatmentofobstructivesleepapnea,2003*嚴重度的睡眠呼吸中止癥可領(lǐng)輕度殘障手冊，已有提議修法改為向健保局申領(lǐng)購買陽壓呼吸器補助費。TheseverityofsleepapneaDi如何治療睡眠呼吸中止癥維持理想體重側(cè)睡避免睡前服用鎮(zhèn)靜藥物避免睡眠不足避免睡前喝酒床頭搖高

(肥胖特別是肚子大的人）感冒及過敏一定要治好睡前避免吃太多戒菸手術(shù)一個月后

98公斤手術(shù)前135公斤扁桃腺肥大1.行為治療如何治療睡眠呼吸中止癥維持理想體重手術(shù)一個月后手術(shù)前13如何治療睡眠呼吸中止癥Fujita(1981),UvulopalatopharygoplastyMostcommonprocedure----removeexcesstissueoftonsils,uvulaandpartofthesoftpalate.1stlinetreatmentforretropalatalcollapse10-50%success2.UPPP(懸壅顎咽成形術(shù))(侵襲性治療)如何治療睡眠呼吸中止癥Fujita(1981),Uvul3.DentalAppliances齒科裝置(非侵襲性治療)NearlyaseffectiveasCPAPinmildtomoderateOSARepositionthemandible

如何治療睡眠呼吸中止癥3.DentalAppliances齒科裝置(非侵4.NasalCPAP鼻腔陽壓呼吸器(非侵襲性治療)

NasalContinuousPositiveAirwayPressure

(APAP):AutoPositiveAirwayPressure

10cmH2Otoovercomeupperairwaynarrowing,notover20-25cmH20)

如何治療睡眠呼吸中止癥4.NasalCPAP鼻腔陽壓呼吸器(非侵襲性治療)

R&K,1968(Rechtschaffen&Kales)AwakeNon-REMsleep(非快速動眼期)stage1stage2stage3stage4REMsleep(快速動眼期Rapid-Eye-Movement)正常睡眠的分期AmericanAcademySleepMedicine美國睡眠醫(yī)學會,2007StageWStageN1StageN2StageN3(deepsleep)StageR

R&K,1968(Rechtschaffen&K正常睡眠分期的周期關(guān)系正常睡眠分期的周期關(guān)系睡眠記錄常用名詞1.TotalRecordingTime(記錄總分鐘數(shù))TimeinBed(躺在床上的總分鐘數(shù))2.TotalSleepTime(睡眠總分鐘數(shù))(stage1+stage2+stage3+stage4+REM)3.SleepEfficiency(睡眠效率,>85%)(TotalSleepTime/TotalRecordingTime)X1004.SleepLatecy(入眠時間,<15分鐘)5.REMlatency(入快速動眼期時間,80-120分鐘)睡眠記錄常用名詞1.TotalRecordingTim

N-REMandREMstage在生理上的比較

Non-REMREM呼吸速率規(guī)則較快且有變異性血壓規(guī)則較高且有變異性心跳規(guī)則較快且有變異性大腦血流速率規(guī)則增加體溫穩(wěn)定變異肌肉張力放松消失作夢很少時常陰莖或陰蒂勃起較少時常

N-REMandREMstage在生理上的比較

N-REMandREMstage在功能上的比較

Non-REM(deepsleep)REM生長激素的分泌腦部生長腦部發(fā)育與智力及記憶有關(guān)

N-REMandREMstage在功能上的比較

PolysomnographyReportPolysomnographyReportPolysomnographyReportPolysomnographyReportPolysomnographyReportPolysomnographyReport腦波頻率Delta<4HzHerzTheta4-7HzAlpha8-13HzBeta>13Hz腦波頻率Delta<4HzHerzTheta4-7Hz

腦波形狀KComplexsharpnegativewave,followedbyslowerpositivecomponent,>0.5secseeninStage2Spindleshortrhythmicwaveformclustersof12-14Hz>0.5secseeninstage2lowamplitudesawtoothappearanceseeninREMSawtoothwavessharppositivewaves,thetafrequencyrange,occurringlatterpartofStage1Vertexwaves腦波形狀KComplexsharpnegativRelaxedWakefulnessrapideyemovement,blinkstonicactivity,relativelyhigh,voluntarymovementαwave(8-13cps),predominantlyinO1,O2Pattern:BladesofgrassRelaxedWakefulnessrapideye

lowvoltage,mixedfrequency,θ(4to7cps),Vertexsharpwavesmaybepresent.NON-REMStage1(5%ofTotalSleepTime)slowrollingeyemovementtonicactivitylowerthanawakelowvoltage,mixedfrequency,Sleepspindle:>0.5sec,11-16cps,3-8/minKcomplex:＞0.5sec,1~3/minnegative-positiveLowleveltonicactivitySloweyemovementNon-REMStage2(50%oftotalsleep)Sleepspindle:>0.5sec,KcomStage1withvertexsharpwaveStage2withsleepspindle&kcomplex(1epoch=30seconds)Comparisonbetweenstages1&2(1epoch=30seconds)v