針對睡眠呼吸中止症患者探討非穿戴 式技術測量睡眠呼吸運動之可行性 Investigation on the feasibility of respiratory motion measurement in sleep using unconstrained techniques for patients with obstructive sleep apnea Presenter: Wen-Kuei Lin Advisor: Prof. Chun-Ju Hou Advisor: Prof. Chun-Ju Hou Present date:

Outline Problems & Rationale Purpose & Specific Aims Background & Literatures Review Materials & Methods Preliminary Results and Discussion Future works References 2

Problems & Rationale Obstructive sleep apnea, OSA  obstructive type, central type, mix type apnea Apnea & Hypopnea Index = Total number of apneas and hypopneas  Total Sleep Time AHI(Apnea Hypopnea Index) 5 ≦ AHI < 1515 ≦ AHI< 30AHI ≧ 30 Typical AHI values categorized mildmoderatesevere AASM Manual for Scoring Sleep,

Problems & Rationale Obstructive sleep apnea, OSA  Obstructive sleep apnea (OSA) is a common chronic disorder that often requires lifelong care. Available practice parameters provide evidence- based recommendations for addressing aspects of care. (LJ Epstein, D Kristo, PJ Strollo et al Journal of Clinical Sleep Medicine, Vol.5, No. 3, 2009)  The present reference or “gold” standard for evaluation of OSA is the polysomnogram (PSG) (Su et al., 2004)  High correlation was found between hypertention and OSA. (Geraldo Lorenzi-Filho, 2011) 4

Problems & Rationale Obstructive sleep apnea, OSA  Among Americans at the age of years old, the estimated prevelence of sleep-disordered breathing, defined as an apnea-hypopnea score of 5 or higher, was 9% for women and 24% for men (Terry Young, 1993).  The prevalence of OSA in middle-age men is 4.1% to 10.9% (Chest, 2001; Eur Respir J, 1998).  Obstructive sleep apnea (OSA) is independently associated with death from cardiovascular diseases, including myocardial infarction and stroke. (CHEST 2011; 140( 2 ): 534 – 542) 5

Problems & Rationale The prevalence of sleep apnea disorder Source: Chuang LP, et al. Chang Gung Med J, 2008 Source: Li HY, Lee LA. Chang Gung Med J %2.3% 2.8% 5.3% 6

Problems & Rationale Tools for evaluating the quality of sleep  PSG  Actigraphy  Oximeter Source: Labsystem Source: Philips Source: myhealthyfeeling 7

Background & Literatures Review-1 Validation of Unobtrusive Pressure Sensor Array for Central Sleep Apnea Screening  Daphne Townsend, Student Member, IEEE, Rafik Goubran, Fellow, IEEE, Frank Knoefel, and Judith Leech, JULY

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Background & Literatures Review-2 The Design of a Real-Time Accelerometer-Based Sleeping Position Monitoring System and its Application on Obstructive Sleep Apnea Syndrome  Xu Yao and Guangmin Sun Institute of Electronic Information and Control Engineering Beijing University of Technology Beijing, China  Wen-Yen Lin* and Wen-Cheng Chou Department of Electrical Engineering Healthy Aging Research Center, Chang Gung University Tao-Yuan, Taiwan 10

obstructive type central type mix type apnea hypopnea Background & Literatures Review-3 AASM Manual for Scoring Sleep,

Materials & Methods Long-term evaluation in 40 cases in Tainan Hospital (n=40) OSA severity Pressure sensing Questionnaire assessment PSG Apnea- hypopnea index (AHI) Chest breathing effort Abdominal breathing effort Pressure sensing (1) Respiration rate (2) Body posture (3) (4) sleep quality Pittsburgh Sleep Quality Index (PSQI) Epworth Sleepiness Scale (ESS) Snore Outcomes Survey (SOS) Statistic analysis

Materials & Methods 14

Materials & Methods - PSG 15

Materials & Methods - PSG 16

Materials & Methods - PSG Polysomnography (PSG)  Electroencephalogram ( EEG)  mentalis/submentalis electromyogram (M.S EMG)  Electrooculogram ( EOG)  Electrocardiogram ( ECG)  Nasal and oral airflow  Chest and abdominal breathing effort  Blood oxygen saturation ( SpO2)  Snoring  Body position

上圖為呼吸暫止症事件的呼吸氣流訊號；下圖為血氧飽和濃度訊號 18

Materials & Methods - PSG PSG SCORE

Materials & Methods - Materials & Methods - Questionnaire Epworth Sleepiness Scale  ESSν.2 Authority from Dr. Chen, Ning-Hung  Published in Quality of Life Research. 2002;11: Pittsburgh Sleep Quality Index  Buysse DJ, Reynolds Ⅲ CF, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatric Research 1989; 28:192-=213. Snore Outcomes Survey  2000 R. Gliklich and Outcomes Sciences, Inc. All rights reserved

Materials & Methods - Materials & Methods - Pressure sensing

Preliminary Results and Discussion Long-term evaluation in 40 cases in Tainan Hospital from 2013/01/01 to 2013/11/30 Analyze the data and compare the results with PSG system Complete this pressure sensing mattress system and have a final report

(n=30) (5F, 25M) Table 1. Demographic data of this study patients. (n=30) (5F, 25M) VariableMean (SD)Normal range Age (years)41.2 (13.9) Height (cm)169.3 (7.4) BW (kg)77.5 (15.1) BMI (kg/ ㎡ ) 26.9 (4.4) Normal: ; Obese: ≧ 30 Neck circumference (cm)38.1 (3.4) Waist circumference (cm)91.1 (12.5) Hip circumference (cm)100.3 (6.5) Waist - Hip ratio0.9 (0.08) M: ≦ 0.9; F: ≦ 0.8 BP_systolic (mmHg)124.2 (13.3) BP_diastolic (mmHg)74.8 (11.0)60-90 Heart rate (times/min)69.5 (7.7) Preliminary Results and Discussion

Table 2. Polysomnography (PSG) and questionnaire in patients (n=30) Variable Mean (SD) Normal range PSG_AHI (/hr)39.2 (25.6)<5 PSG_average O2 (%)90.9 (5.8)94-98 PSG_lowest O2 (%)73.7 (13.2)90-98 PSG_snore index (snores/hr of sleep)218.4 (123.8)Non: 400 PSG_AI (/hr)23.1(23.0) PSG_HI (/hr)16.1 (10.0) ESS score (0-24)9.8 (4.3)<12 SOS score (0-100)40.6 (13.2)>55 PSQI score (0-21)7.0 (4.2)<5 Sleep quality6.5 (1.5)

Preliminary Results and Discussion Body Position Baseline Hypnogram PSG Graphic summary Pressure sensing ↑↑↑↑↑

PSG Pressure sensing

Future works Case collection Data analysis  Parameter extraction  Statistical analysis The system compared with PSG tools must be further studied and investigated the benefits of our system in sleep evaluation 27

References 【 1 】 Chediak AD Why CMS approved home sleep testing for CPAP coverage. J Clin Sleep Med. 4: 【 2 】劉尚儒、侯春茹， 2012.Design of Body Activity in Bed Measurement System Using Pressure Sensing Techniques ，南台科技大學電機工程研 究所碩士論文。 【 3 】 Young T, Peppard PE, Gottlieb DJ Epidemiology of Obstructive Sleep Apnea. Am J Respir Crit Care Med. 165: 【 4 】侯春茹、陳彥廷， Measurement of Body Activities Lying in Bed Using Pressure Sensing Techniques, CVGIP Reference, Taiwan. 【 5 】嚴成文、杭良文， 使用整夜睡眠血氧資料偵測阻塞性睡眠呼 吸中止症。行政院國家科學委員會專題研究計畫成果報告。 【 6 】張慶宏， 台灣某工廠睡眠品質與呼吸障礙盛行率調查。輔仁 醫學期刊 (6) 。 【 7 】陳濘宏， 阻塞型睡眠呼吸中止症。 Formosan J Med. 9: 【 8 】 Friedlander AH, Walker LA, Friedlander IK, Felsenfeld AL Diagnosing and comanaging patients with obstructive sleep apnea syndrome. J Am Dent Assoc. 131:

References 【 9 】 Lin WY, Chou WC The design of a real-time accelerometer-based sleeping position monitoring system and its application on obstructive sleep apnea syndrome. International Conference on Systems and Informatics, Taiwan. 【 10 】 Nishyama M, Miyamoto M, Watanabe K Respiration and body movement analysis during sleep in bed using hetero-core fiber optic pressure sensors without constraint to human activity. J Biomed Opt. 16: 【 11 】 Aronsohn RS, Whitmore H, Cauter EV, Tasali E Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 181: 【 12 】 Howell Jones M, Arcelus A, Goubran R, Knoefel F A Pressure Sensitive Home Environment in Haptic Audio Visual Environments and their Applications. IEEE International Workshop. pp 【 13 】 Holtzman M, Townsend D, Goubran R, Knoefel F Validation of Pressure Sensors for Physiological Monitoring in Home Environments in Medical Measurements and Applications Proceedings (MeMeA). IEEE International Workshop. pp 【 14 】 Townsend DI, Goubran R, Frize M, Knoefel F Measuring Chest Movement Using an Array of Unobstusive Pressure Sensors. Instrumentation and Measurement Technology Conference. pp 【 15 】 Daphne Townsend, Student Member, Rafik Goubran, Fellow, Frank Knoefel, and Judith Leech Validation of Unobtrusive Pressure Sensor Array for Central Sleep Apnea Screening. IEEE TRANSACTIONS ON INSTRUMENTATION AND MEASUREMENT, VOL. 61, NO. 7, pp

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