Presenter: Wen-Kuei Lin

Advisor: Dr. Chun-Ju Hou

Present date: 2012.10.03

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Investigation on the feasibility of respiratory motion measurement in sleep using unconstrained techniques for

patients with obstructive sleep apnea

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

Outline

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

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Problems & Rationale

• Obstructive sleep apnea (OSA)– Repetitive pauses in breathing during sleep, despite the

effort to breathe– Blood oxygen desaturation– Day times sleep

• Anatomy and Physiology

3Source: Tainan hospital sleep center

Problems & Rationale

• The prevalence of sleep apnea disorder

5Source: Chuang LP, et al. Chang Gung Med J, 2008

Source: Li HY, Lee LA. Chang Gung Med J 2009

睡眠呼吸障礙之盛行率

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

50小於 歲 51大於 歲

女性

男性1.4%

2.3%2.8%

5.3%

Problems & Rationale

• Taiwan Sleeping Inspection Status (TSSM, 2011)– 45 sleeping center, 200 inspection unit (0.87

bed/100,000)

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( 內政部 , 2010)

Source: TSSM, 2011Source: 內政部 , 2010

(AHI 5)≧

Taiwan Tainan

Middle-aged(>50 years old)

male: 3,345,598 female: 3,520,386

male: 283,382人female: 294,815人

OSA case estimated male: 133,824 (4%)female: 70,408 (2%)

male: 11,336 (4%)female: 5,897 (2%)

(AHI 5)≧

Problems & Rationale

• 睡眠呼吸中止症候群對健康的威脅– 心臟血管方面的影響

• Hypertension• Coronary artery disease• Stroke• Heart failure

– 精神認知方面的影響• Tired• Sleepiness• Inattention• Grumpy• Dejection

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Problems & Rationale

• Tools for evaluating the quality of sleep – PSG– Actigraphy– Oximeter

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Source: Labsystem Source: myhealthyfeelingSource: Philips

Problems & Rationale

• 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– Others

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10

Problems & Rational• Treatment

• Surgery• Body weight control• Oral appliances• Continuous positive

airway pressure (CPAP)

source: DeVilbiss IntelliPAP CPAP Machine

source: nwsleepdoc.com source: Tainan hospital

Problems & Rationale

• Science and Technology– Unconstrained techniques

• Pressure sensing• Etero-core fiber optic

pressure sensors• Video monitoring

technology

– Constrained techniques• PSG• Actigraphy

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Source: 2011 Biomedical Engineering International Conference, 2011

Source: Swedish School, 2011

Purpose & Specific Aims

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• Purpose– Develop a pressure sensing mattress which will be more convenient and suitable for OSA

inspection than PSG

• Procedures – Design a questionnaire to evaluate OSA cases for this study – Build up a pressure sensing mattress system– Apply it to 3-5 testees to make sure the function– Modify and improve the performance of pressure sensing mattress according to the

preliminary inspection results– 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

•  Expected outcome– Have this mattress system works as good as PSG for OSA inspection– The key factors influence OSA such like body weight, postures, gender will be considered and

analyzed– Provide this to be a home inspection system for OSA

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Background & Literatures Review

• Design of Body Activity in Bed Measurement System Using Pressure Sensing Techniques– 臥床姿勢散佈以及異常呼吸型態之低度呼吸

• 劉尚儒，侯春茹 2011

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• The AASM Manual for the Scoring of Sleep and Associated Events– Rules, Terminology and Technical Specifications

• AASM Manual for Scoring Sleep, 2007 – Apnea- hypopnea index, AHI, calculated by dividing the number of events by the number of

hours of sleep – Typical AHI values categorized

• (a). 5–15/ hr = mild, • (b).15–30/ hr = moderate,• (c). > 30/ hr = severe

– Average breath rate• (a).12-20 = normal adult,• (b).20-25 = children,• (c).25-30 = infant,• (d).30-45 = new born

– OSA:• obstructive type,• central type,• mix type apnea

– Feet twitching rate• periodic limb movements disorder, PLMD

Background & Literatures Review

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• Michiko Nishyama , Mitsuo Miyamoto, and Kazuhiro Watanabe

• Respiration and body movement analysis during sleep in bed using etero-core fiber optic pressure sensors without constraint to human activity– Journal of Biomedical Optics 16(1), 017002 (January

2011)

Background & Literatures Review

Materials & Methods

• Research structure

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Pressure sensing compare the PSG

(A)Experiment

design

(B)Pressure sensing compare the PSG

(C)Parameters

analysis

(D)Statistical analysis

(E)Results

Materials & Methods

• Experiment Design– Experiment condition

• PSG• Pressure sensing

17s

Materials & Methods

• Experiment design– Tool

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Materials & Methods

• Experiment design– procedures

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說明研究目的

解釋和填寫同意書

配戴睡眠檢查儀

同步啟動和生理校正( 壓力感測系統、 PSG)

全程監測及紀錄( 睡眠 )

結束監測與儲存數據( 起床 )

睡眠品質自我感受問卷

Preliminary Results and Discussion

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Preliminary Results and Discussion

• Pressure sensing and PSG

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Pressure sensing

PSG: Chest and abdominal breathing effort

Preliminary Results and Discussion

• Pressure sensing and OSA

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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

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References

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【 1】 Chediak AD. 2008. Why CMS approved home sleep testing for CPAP coverage. J Clin Sleep Med. 4: 16-18.

【 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. 2002. Epidemiology of Obstructive Sleep Apnea. Am J Respir Crit Care Med. 165: 1217-1239.

【 4 】侯春茹、陳彥廷， 2012. Measurement of Body Activities Lying in Bed Using Pressure Sensing Techniques, CVGIP Reference, Taiwan.

【 5 】嚴成文、杭良文， 2006. 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， 2007. 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， 2005. 阻塞型睡眠呼吸中止症。 Formosan J Med. 9: 124-129.

【 8 】 Friedlander AH, Walker LA, Friedlander IK, Felsenfeld AL. 2000. Diagnosing and comanaging patients with obstructive sleep apnea syndrome. J Am Dent Assoc. 131: 1178-1184.

References

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【 9】 Lin WY, Chou WC. 2012. 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. 2011. 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: 17-20.

【 11】 Aronsohn RS, Whitmore H, Cauter EV, Tasali E. 2010. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 181: 507-513.

【 12】 Howell Jones M, Arcelus A, Goubran R, Knoefel F. 2006. A Pressure Sensitive Home Environment in Haptic Audio Visual Environments and their Applications. IEEE International Workshop. pp. 10-14.

【 13】 Holtzman M, Townsend D, Goubran R, Knoefel F. 2010. Validation of Pressure Sensors for Physiological Monitoring in Home Environments in Medical Measurements and Applications Proceedings (MeMeA). IEEE International Workshop. pp. 38-42.

【 14】 Townsend DI, Goubran R, Frize M, Knoefel F. 2010. Measuring Chest Movement Using an Array of Unobstusive Pressure Sensors. Instrumentation and Measurement Technology Conference. pp.1053-1056.

Thank you for your attention!

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• 基本必備、重要的三大睡眠偵測指標： 口鼻部氣流、胸腹部呼吸動作、手指血氧濃度 • 睡眠檢查儀，依診斷準確度高低，依序分成四級 第一級：多頻道睡眠生理檢查，而且有人在旁邊監測 ( 例：醫院級 PSG ， 12 頻道 ) 第二級：多頻道睡眠生理檢查，但是無人在旁邊監測 ( 例：居家型 PSG ， 9 頻道 ) 第三級：簡單型睡眠監測 ( 例：睡眠呼吸中止篩檢儀， 4 頻道 ) 第四級：血氧濃度監測

美國睡眠醫學會 2007 年製定 「居家型睡眠檢測」臨床指引