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1、PolysomnographyPolysomnography (PSG) (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) 多频道生理纪录法Parameter:Parameter: EEG EEG EOG EOG Chin EMG Chin EMG EKG EKG Chest movement Chest movement Abdomen movement Abdomen movemen
2、t 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 电极黏贴位置示意图- 3 EEG channels: C3/A2, C4/A1, O1/A2, GND, REF- 3 EEG channels: C3/A2, C4/A1, O1/A2, GND, REF- 3 EEG cha
3、nnels: C3/A2, C4/A1, O1/A2, GND, REF- 3 EEG channels: C3/A2, C4/A1, O1/A2, GND, REFC4/A1- 2 EOG channels: ROC( 1 cm above)/A1, LOC(1cm below)/A2- 2 EOG channels: ROC( 1 cm above)/A1, LOC(1cm below)/A2- 2 EOG channels: ROC( 1 cm above)/A1, LOC(1cm below)/A2- 2 EOG channels: ROC( 1 cm above)/A1, LOC(1
4、cm below)/A2LOCROCROC/A1ROC/A1- 1 EMG channel: beneath the chin( 4cm between 2 electrodes)- 1 EMG channel: beneath the chin( 4cm between 2 electrodes)- 1 EMG channel: beneath the chin( 4cm between 2 electrodes)- 1 EMG channel: beneath the chin( 4cm between 2 electrodes)EMG1EMG2EMGEMGGRDGRDWhat is sl
5、eep apnea?Apnea: complete cessation of airflow Apnea: complete cessation of airflow (at least 90% of baseline) for at (at least 10 secWhat is sleep hypopnea?HypopneaHypopnea: airflow 50% of baseline, : airflow 50% of baseline, or or desaturationdesaturation of at least 4%, or of at least 4%, or arou
6、sal from sleeparousal from sleepThree types of Sleep apnea syndromeCentral typeObstructive typeMixed 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.
7、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 secondsHypopnea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 的影响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
8、症RDI 及 AHI 的定义AHI: apnea/hypopnea index (#/hour) The average of episodes of apnea and hypopnea per hour of sleep 每小时apnea and hypopnea 的平均发生次数 RDI: respiratory disturbance index (#/hour) #: events of apnea, hypopnea, snores, snore resulting in arousalsThe severity of sleep apnea DiagnosisNormalMildM
9、oderateSevereRDI/AHI (episodes/hour) 40DiagnosisMildModerateSevereMean SaO2 90% 90%90%Minimum SaO2 85% 70%85%) (Total Sleep Time/ Total Recording Time ) X 1004. Sleep Latecy (入眠时间, 15 分钟) 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
10、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(deep 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 PolysomnographyPolysomnography Report ReportPolysomno
11、graphyPolysomnography Report ReportPolysomnographyPolysomnography Report Report脑波频率DeltaDelta 4 13 13 HzHz 脑脑 波波 形形 状状K ComplexK ComplexK ComplexK Complexsharp negative wave, followed by slower positive component, 0.5 secseen in Stage 2SpindlSpindlSpindlSpindle e e eshort rhythmic waveform clusterso
12、f 12-14 Hz 0.5 secseen in stage2low amplitudesawtooth appearanceseen in REMSawtoothSawtoothSawtoothSawtooth waves waves waves wavessharp positive waves, theta frequency range,occurring latter part of Stage1Vertex wavesVertex wavesVertex wavesVertex wavesRelaxed Wakefulness rapid eye movement, blinks
13、 tonic activity, relatively high, voluntary movementwavewave (8-13 cps), (8-13 cps), predominantly in O1, O2 predominantly in O1, O2 Pattern: Blades of grass Pattern: Blades of grass low voltage, mixed frequency, (4 to7 cps), Vertex sharp waves may be present. NON-REM Stage 1 ( 5% of Total Sleep Tim
14、e)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 complex: K complex: 0.5 sec, 13/min0.5 sec, 13/min negative-positive negative-positive Low level tonic activitySlow
15、 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 stages 1 & 2( 1 epoch= 30 seconds)vertex sharp wave, 75uv, 75 uVStage 3 : 20%50% slow waveSleep spind
16、les 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 1015 % of total sleep Slow wave sleep 1015 % of total sleep timetimeREM stage
17、 ( 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 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)
