臺灣博碩士論文加值系統

一般人在睡眠之後，肌肉的張力就會降低，導致呼吸道的狹窄，當氣流經過狹窄的呼吸道就會產生氣音，進而導致鼾聲的產生。近年來減少鼾聲且直接的方法就是以醫師診斷進行手術切除部位，但其中醫師所考量的是手術切除相關部位是否正確，及術後鼾聲聲壓是否有所明顯改善亦或頻率高低，都是在手術前必須詳加探討的。因此本研究將針對國內人口BMI值與鼾聲聲壓和發聲頻率及發聲部位間的相關性，及鼾聲聲壓經過頭影效應影響睡眠拍檔的睡眠感受之關連性探討。研究結果發現，軟顎之鼾聲平均聲壓級音強為36.58 dBSPL，會厭之鼾聲平均聲壓級音強為23.49 dBSPL，舌根之鼾聲平均聲壓級音強為16.3 dBSPL。個案BMI值與軟顎、會厭、舌根部位鼾聲聲壓之關聯性分析分別為P=0.49、0.29、0.84，由此結果可知鼾聲聲壓與BMI值並無顯著關聯。測量睡眠位置之頭影效應結果後發現鼾聲源於90度位置時差異最大頭影效應為3.67 dBSPL。近耳耳廓遮蔽效應部分，發現音源於105度時，音強差異為3.43 dBSPL。遠耳耳廓遮蔽效應差異最大之角度為105度，音強差異為2.78 dBSPL。將聲壓級鼾聲強度轉換為聽力級鼾聲強度，其結果軟顎鼾聲強度成為16.63 dBHL；會厭部位鼾聲強度為16.24 dBHL；舌根部位之鼾聲強度為10.79 dBHL。

When people fall asleep, the airway would become narrow due to the reduction of muscle tension, and then the snoring would occur when the air passed through the narrow airway. In recent years, the uvulapalatopharyngoplasty was the most common treatment for reducing snoring. However, the accurate part for surgery and the improvement in snoring for patients after surgery should be considered at pre-op. Thus, the correlation between the BMI value and the snoring sound frequency of snoring part would be discussed in this study. The sleep partner’s perception of sleep affected by snoring sound pressure level with head shadow effect would also be discussed. Based on the results, the mean sound pressure level of snoring was 36.58 dBSPL by palate, 23.49 dBSPL by epiglottic and 16.3 dBSPL by tongue, respectively. Based on the correlation analysis for the BMI value and the snoring sound frequency of snoring part, the p-value was 0.49 for palate, 0.29 for epiglottic and 0.84 for tongue, respectively. There was no significant correlation between the BMI value and the sound pressure level of snoring. Based on the results of head shadow effect for sleeping place measurement, the significant difference of sound pressure level was 3.67 dB at 90 degrees of snoring sound source. As for the pinna shadow effect for the near ear, the difference of sound pressure level was 3.43 dB at 105 degrees of sound source. The difference of sound pressure level was 2.78 dB at 105 degrees of sound source for the far ear. After transferring the sound pressure level of snoring to the hearing level of snoring, the snoring sound pressure level was 16.63 dBHL for palate, 16.24 dBHL for epiglottic and 10.79 dBHL for tongue, respectively.

目錄
指導教授推薦書…………………………………………………………
口試委員審定書…………………………………………………………
國家圖書館博碩士論文電子檔案上網授權書 III
長庚大學博碩士論文著作授權書 IV
誌 謝 V
中文摘要 VI
ABSTRACT VII
目錄 IX
圖目錄 XIII
表目錄 XV
第一章 簡介 1
1-1 研究背景 1
1-1-1 喉部的構造 1
1-1-2 鼾聲的介紹 1
1-1-3 實驗儀器介紹 2
1-2 研究動機 3
1-3 研究目的 3
第二章 鼾聲聲壓與部位之關聯性探討 12
2-1研究背景與目的 12
2-2材料與方法 13
2-2-1 鼾聲測量系統 13
2-2-2 麥克風校正 13
2-2-3 鼾聲測量 14
2-2-4 鼾聲分析 15
2-3結果 15
2-4討論 20
2-5結論 22
第三章 睡眠拍檔睡眠位置與鼾聲特性之關聯性探討 34
3-1研究背景與目的 34
3-2材料與方法 35
3-2-1 睡眠拍檔之鼾聲量測系統 35
3-2-2 麥克風校正 36
3-2-3 睡眠位置之音場量測 36
3-2-4 睡眠位置之頭影效應與耳廓遮蔽效應測量 37
3-2-5 睡眠位置處的頭影效應之分析 37
3-3結果 37
3-4 討論 38
3-5 結論 39
第四章 睡眠拍檔聽覺感受下之鼾聲特性 46
4-1研究背景與目的 46
4-2材料與方法 48
4-2-1 鼾聲測量系統 48
4-2-2 麥克風校正 48
4-2-3 鼾聲測量 48
4-2-4 鼾聲頻譜分析 49
4-3結果 50
4-4討論 52
4-5結論 54
第五章 結論與未來目標 58
5-1結論 58
5-2未來目標 60
參考文獻 61
附錄 63


圖目錄
圖1-1 喉部硬組織 5
圖1-2 喉部軟組織 6
圖1-3 喉部組織圖 7
圖1-4 NI PXI-1042 8
圖1-5 NI PXI 4461 9
圖1-6 NI PXI 4462 10
圖1-6 G.R.A.S 46AE 麥克風 11
圖2-1 校正流程圖 23
圖2-2 鼾聲測量示意圖，A、B、C為三支麥克風，D為麥克風架子，E為受試者 24
圖2-3 背景噪音頻譜，時間為所測得鼾聲那4秒平均 25
圖2-4 第1秒鼾聲頻譜，SP為軟顎部位，SE為會厭部位 26
圖2-5 第2秒鼾聲頻譜，SP為軟顎部位，SE為會厭部位，ST為舌根部位 27
圖2-6 第3秒鼾聲頻譜，SP為軟顎部位，SE為會厭部位 28
圖2-7 第4秒鼾聲頻譜，SP為軟顎部位，SE為會厭部位 29
圖2-8 鼾聲文獻 30
圖2-9受試者鼾聲軟顎部位、會厭部位、舌根部位平均值比較表 31
圖2-10鼾聲軟顎部位、會厭部位、舌根部位各部位最大值、最小值及平均值比較圖 32
圖3-1睡眠位置之頭影效應測量0度示意圖 40
圖3-2睡眠位置之耳廓遮蔽效應測量0度示意圖 41
圖3-3睡眠位置之頭影效應分析 42
圖4-1 鼾聲測量示意圖(A、B、C為三支麥克風，D為麥克風架子，E為受試者) 55









表目錄
表2-1 受試者BMI值及PALATE、EPIGLOTTIC、TONGUE BASE的頻率及最大聲壓級音強 33
表3-1 鼾聲之頭影效應 43
表3-2 鼾聲之近耳耳廓遮蔽效應 44
表3-3 鼾聲之遠耳耳廓遮蔽效應 45
表4-1 ISO R226規範之各頻率聲壓級與聽力級之轉換 56
表4-2軟顎、會厭、舌根等部位鼾聲之聲壓級音強與聽力級音強 57

Recommendation ISO R 226(1961) Normal-loudness contours for pure tones and normal threshold of hearing under free eld listening conditions. Recommendation ISO R 226
Agrawal S, Stone P, McGuinness K, Morris J and Camilleri AE (2002) Sound frequency analysis and the site of snoring in natural and induced sleep. Clin Otolaryngol Allied Sci 27: 162-6
Briones B, Adams N, Strauss M, Rosenberg C, Whalen C, Carskadon M, Roebuck T, Winters M and Redline S (1996) Relationship between sleepiness and general health status. Sleep 19: 583-8
Cartwright RD and Knight S (1987) Silent partners: the wives of sleep apneic patients. Sleep 10: 244-8
EAG S (1997) Acoustical features of the external ear. Binaural and Spatial Hearing in Real and Virtual Environments: pp 25–47
Fairbanks DNF FS, et al., eds. (1987) Snoring: an overview with historical perspectives. New York, Raven Press: 1-18
Fischer WH and Schafer JW (1991) Direction-dependent amplification of the human outer ear. Br J Audiol 25: 123-30
Fitzpatrick MF, Martin K, Fossey E, Shapiro CM, Elton RA and Douglas NJ (1993) Snoring, asthma and sleep disturbance in Britain: a community-based survey. Eur Respir J 6: 531-5
Haraldsson PO, Carenfelt C, Lysdahl M and Tingvall C (1995) Does uvulopalatopharyngoplasty inhibit automobile accidents? Laryngoscope 105: 657-61
Hill PD, Lee BW, Osborne JE and Osman EZ (1999) Palatal snoring identified by acoustic crest factor analysis. Physiol Meas 20: 167-74
Hoffstein V, Haight J, Cole P and Zamel N (1999) Does snoring contribute to presbycusis? Am J Respir Crit Care Med 159: 1351-4
Hoffstein V, Mateika S and Anderson D (1994) Snoring: is it in the ear of the beholder? Sleep 17: 522-6
Jean-Louis G, Kripke DF, Ancoli-Israel S, Klauber MR and Sepulveda RS (2000) Sleep duration, illumination, and activity patterns in a population sample: effects of gender and ethnicity. Biol Psychiatry 47: 921-7
Jones TM, Swift AC, Calverley PM, Ho MS and Earis JE (2005) Acoustic analysis of snoring before and after palatal surgery. Eur Respir J 25: 1044-9
Kripke DF, Simons RN, Garfinkel L and Hammond EC (1979) Short and long sleep and sleeping pills. Is increased mortality associated? Arch Gen Psychiatry 36: 103-16
LD Victor (1999) Obstructive sleep apnea. Am Fam Physician 60: 2279-2286
Osborne JE, Osman EZ, Hill PD, Lee BV and Sparkes C (1999) A new acoustic method of differentiating palatal from non-palatal snoring. Clin Otolaryngol Allied Sci 24: 130-3
Quinn SJ, Daly N and Ellis PD (1995) Observation of the mechanism of s snoring using sleep nasendoscopy. Clin Otolaryngol Allied Sci 20: 360-4
Quinn SJ, Huang L, Ellis PD and Williams JE (1996) The differentiation of snoring mechanisms using sound analysis. Clin Otolaryngol Allied Sci 21: 119-23
Robertson S, Loughran S and MacKenzie K (2006) Ear protection as a treatment for disruptive snoring: do ear plugs really work? J Laryngol Otol 120: 381-4
Shaw EA (1974) Transformation of sound pressure level from the free field to the eardrum in the horizontal plane. J Acoust Soc Am 56: 1848-61
Victor Hoffstein P, MD (1996) snoring chest 109: 201-222
White JE, Smithson AJ, Close PR, Drinnan MJ, Prichard AJ and Gibson GJ (1994) The use of sound recording and oxygen saturation in screening snorers for obstructive sleep apnoea. Clin Otolaryngol Allied Sci 19: 218-21
White JES SA, Close PR, et al. (1994) The use of sound recording and oxygen saturation in screening snorers for obstructive sleep apnea. Clin Otolaryngol Allied Sci 19:218-21
Wilson K, Stoohs RA, Mulrooney TF, Johnson LJ, Guilleminault C and Huang Z (1999) The snoring spectrum: acoustic assessment of snoring sound intensity in 1,139 individuals undergoing polysomnography. Chest 115: 762-70
林逸昕 (2007) The sound field outside human ear canal with Head Shadow Effect and Pinna Effect.