多频道生理纪录法在睡眠呼吸中止症的应用

多频道生理纪录法在睡眠呼吸中止症的应用第1页/共39页EEG,EOG,chinEMG

电极黏贴位置示意图-3EEGchannels:C3/A2,C4/A1,O1/A2,GND,REFC4/A1-2EOGchannels:ROC(1cmabove)/A1,LOC(1cmbelow)/A2LOCROCROC/A1-1EMGchannel:beneaththechin(4cmbetween2electrodes)EMG1EMG2EMGGRD第2页/共39页Whatissleepapnea?Apnea:completecessationofairflow(atleast<90%ofbaseline)foratleast10sec>10sec第3页/共39页Whatissleephypopnea?Hypopnea:airflow<50%ofbaseline,ordesaturationofatleast4%,orarousalfromsleep第4页/共39页ThreetypesofSleepapneasyndromeCentraltypeObstructivetypeMixedtype第5页/共39页Centraltypesleepapnea(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---CNSorneuromusculardisorder.第6页/共39页Obstructivesleepapnea(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75seconds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第7页/共39页Mixedtypeapnea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30seconds第8页/共39页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%32seconds第9页/共39页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第10页/共39页sleepapnea的影响第11页/共39页sleepapnea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、唐氏症第12页/共39页RDI及AHI的定义AHI:apnea/hypopneaindex(#/hour)Theaverageofepisodesofapneaandhypopneaperhourofsleep

每小时apneaandhypopnea的平均发生次数RDI:respiratorydisturbanceindex(#/hour)#:eventsofapnea,hypopnea,snores,snoreresultinginarousals第13页/共39页TheseverityofsleepapneaDiagnosisNormalMildModerateSevereRDI/AHI(episodes/hour)<552020-40>40DiagnosisMildModerateSevereMeanSaO290%90%<90%MinimumSaO285%70%<70%ICSIhealthguideliine,Diagnosisandtreatmentofobstructivesleepapnea,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。第14页/共39页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.行为治疗第15页/共39页如何治疗睡眠呼吸中止症Fujita(1981),UvulopalatopharygoplastyMostcommonprocedure----removeexcesstissueoftonsils,uvulaandpartofthesoftpalate.1stlinetreatmentforretropalatalcollapse10-50%success2.UPPP(悬壅颚咽成形术)(侵袭性治疗)第16页/共39页3.DentalAppliances齿科装置(非侵袭性治疗)NearlyaseffectiveasCPAPinmildtomoderateOSARepositionthemandible

如何治疗睡眠呼吸中止症第17页/共39页4.NasalCPAP鼻腔阳压呼吸器(非侵袭性治疗)

NasalContinuousPositiveAirwayPressure

(APAP):AutoPositiveAirwayPressure

10cmH2Otoovercomeupperairwaynarrowing,notover20-25cmH20)

如何治疗睡眠呼吸中止症第18页/共39页R&K,1968(Rechtschaffen&Kales)AwakeNon-REMsleep(非快速动眼期)stage1stage2stage3stage4REMsleep(快速动眼期Rapid-Eye-Movement)正常睡眠的分期AmericanAcademySleepMedicine美国睡眠医学会,2007StageWStageN1StageN2StageN3(deepsleep)StageR

第19页/共39页正常睡眠分期的周期关系第20页/共39页睡眠记录常用名词1.TotalRecordingTime(记录总分钟数)TimeinBed(躺在床上的总分钟数)2.TotalSleepTime(睡眠总分钟数)(stage1+stage2+stage3+stage4+REM)3.SleepEfficiency(睡眠效率,>85%)(TotalSleepTime/TotalRecordingTime)X1004.SleepLatecy(入眠时间,<15分钟)5.REMlatency(入快速动眼期时间,80-120分钟)第21页/共39页

N-REMandREMstage在生理上的比较

Non-REMREM呼吸速率规则较快且有变异性血压规则较高且有变异性心跳规则较快且有变异性大脑血流速率规则增加体温稳定变异肌肉张力放松消失作梦很少时常阴茎或阴蒂勃起较少时常第22页/共39页

N-REMandREMstage在功能上的比较

Non-REM(deepsleep)REM生长激素的分泌脑部生长脑部发育与智力及记忆有关第23页/共39页PolysomnographyReport第24页/共39页PolysomnographyReport第25页/共39页PolysomnographyReport第26页/共39页脑波频率Delta<4HzHerzTheta4-7HzAlpha8-13HzBeta>13Hz第27页/共39页

脑波形状KComplexsharpnegativewave,followedbyslowerpositivecomponent,>0.5secseeninStage2Spindleshortrhythmicwaveformclustersof12-14Hz>0.5secseeninstage2lowamplitudesawtoothappearanceseeninREMSawtoothwavessharppositivewaves,thetafrequencyrange,occurringlatterpartofStage1Vertexwaves第28页/共39页RelaxedWakefulnessrapideyemovement,blinkstonicactivity,relativelyhigh,voluntarymovementαwave(8-13cps),predominantlyinO1,O2Pattern:Bladesofgrass第29页/共39页

lowvoltage,mixedfrequency,θ(4to7cps),Vertexsharpwavesmaybepresent.NON-REMStage1(5%ofTotalSleepTime)slowrollingeyemovementtonicactivitylowerthanawake第30页/共39页Sleepspindle:>0.5sec,11-16cps,3-8/minKcomplex:＞0.5sec,1~3/minnegative-positiveLowleveltonicactivitySloweyemovementNon-REMStage2(50%oftotalsleep)第31页/共39页Stage1withvertexsharpwaveStage2withsleepspindle&kcomplex(1epoch=30seconds)Comparisonbetweenstages1&2(1epoch=30seconds)vertexsharpwave,>75uv,<0.5sec,upwardsleepspindlekcomplex(3minute-rule)第32页/共39页EMG:lowleveltonicEEG:0.5~2cps,highvoltage>75uVStage3:20%~50%slowwaveSleepspindlesmaybepresentNREMStage3(slowwavesleep)(1epoch=30seconds)EOGsimilartoEEG第33页/共39页EMG:lowleveltonicEEG:slowwave<2cps,highvoltage>75uVStage4:>50%slowwaveNREMStage