研究目的 : 阻塞性睡眠呼吸障礙是指發生在睡眠過程中呼吸道塌陷導致呼吸不 順暢的問題。依文獻回顧所知，舌體的厚度增加以及彈性係數降低，可能會影響 患病的機率。而過去對上呼吸道的研究常以醫學影像例如核磁共振影像、電腦斷 層以及側顱影像觀察上呼吸周邊結構特徵為主，但是受限於輻射曝射、攝影成 本、耗時等缺點，限制其在臨床上的廣泛利用。而使用超音波作為影像工具則無 上述缺點。本篇研究目的，將建立可信賴之頦下彈性超音波，以進行上呼吸道結 構的測量，並分析上呼吸道體積及彈性係數與阻塞性睡眠呼吸中止症之對應關係。
研究方法 : 首先先針對本團隊發展的臨床測量方法，進行信賴度測試。以評估 是否可以作為本臨床研究的檢查工具。本實驗納入共頦下超音波的受試者共 69 人，其中健康受試者為 37 人；阻塞性睡眠呼吸中止症患者 32 人。以頦下彈性超 音波測量矢狀面及冠狀面之舌體厚度以及彈性係數，進行分析與評估。
結果 : 阻塞性睡眠呼吸中止症患者上呼吸道的矢狀面舌體厚度、冠狀面舌體厚 度皆顯著大於健康組(矢狀面舌體厚度 65.38±0.93mm VS 60.99±0.99mm, Odds ratio=1.150, p=0.0045；冠狀面舌體厚度 63.70±0.98mm VS 57.72±0.96mm, Odds ratio=1.205, p=0.0005)，而冠狀面彈性係數平均值則是顯著小於健康組(13.24±0.36 kPa VS 15.87±0.63 kPa, Odds ratio=0.701, p=0.0029)。組內比較部分，患病組之上 呼吸道結構及彈性係數與呼吸中止指數(AHI)皆無顯著差別(p>0.05)。
結論 : 頦下彈性超音波可作為觀察上呼吸道結構特性之理想工具。阻塞性睡眠 呼吸中止症患者表現出較健康組別厚的舌體以及彈性係數較低的舌體剛性。但舌體彈性係數以及厚度並無法作為患病組嚴重程度之評估標準。

Purpose: Obstructive Sleep Apnea syndrome (OSAs) is a sleep breathing disorders of upper airway collapsing during sleep. It mostly caused by the upper airway structure abnormality. According to the previously studies, volume enlargement and low elasticity of upper airway structure may correlate to the occurrence of OSAs. The medical imaging tools of evaluating upper airway included computed tomography (CT), Magnetic resonance imaging (MRI) and Cephalometric x-ray. However, their application was limited by the drawback such as radiation exposure, high cost and time consuming. Ultrasound imaging may benefit the observation of upper airway. The aim of this study was to establish a reliable submental ultrasound elastography protocol. And identified the upper airway structure characteristic of OSAs patients.
Methods: We used ultrasound as a tool to verified the reliability of clinical submental in our study. Then total sixty-nine adults, with thirty-seven healthy adults and thirty-two OSAs patients, were included for submental ultrasound elastography. The tongue height and tongue elasticity of both sagittal and coronal view were measured to estimate the upper airway characteristic of OSAs patient.
Results: Both Sagittal Tongue Height and Coronal Tongue Height shows significant increase in OSAs patient (Sagittal Tongue Height : 65.38±0.93mm VS 60.99±0.99mm, Odds ratio=1.150, p=0.0045；Coronal Tongue Height 63.70±0.98mm VS 57.72±0.96mm, Odds ratio=1.205, p=0.0005). And the Coronal Tongue Elasticity was lower compared to the healthy group (13.24±0.36 kPa VS 15.87±0.63 kPa, Odds ratio=0.701, p=0.0029). When compared within the OSAs group, Neither Tongue height or Elasticity were correlated to Apnea-Hypopnea Index (AHI) (p>0.05).
Conclusion: Submental ultrasound elastography could be a reliable tool for upper airway structure evaluation. The OSAs patients showed larger Tongue Height and lower Tongue Elasticity when compared to healthy group. But Tongue height and Tongue elasticity could not be the parameter for severity determination in OSAs patients.

誌謝 I
中文摘要 II
ABSTRACT III
目錄 V
表目錄 VII
圖目錄 VIII
第一章 背景 1
第二章 文獻回顧 3
第一節 阻塞性睡眠呼吸中止症之盛行率 3
第二節 阻塞性睡眠呼吸中止症之臨床特徵 4
第三節 阻塞性睡眠呼吸中止症之診斷 5
第四節 與阻塞性睡眠呼吸中止症相關之生理機轉 6
第五節 易發生阻塞性睡眠呼吸中止症之的生理特徵 8
第六節 評估上呼吸道周邊組織結構特性之工具回顧 9
第七節 超音波基本原理 12
第八節 超音波於影像醫學的應用 12
第九節 超音波之彈性成像 13
第十節 利用超音波作為阻塞性睡眠呼吸中止症診斷工具之相關研究方法回顧 14
第十一節 研究目的 15
第二章 實驗材料與方法 16
第一節 前導實驗 : 頦下超音波彈性影像之信賴度研究 16
1.1 實驗對象 16
1.2 實驗流程及所需的儀器與設備 16
1.3 影像數據化與測量 18
1.3 實驗資料處理及分析 19
第二節 主實驗 : 頦下超音波彈性影像分析阻塞性睡眠呼吸中止症患者之上呼吸道結構特性 20
2.1 實驗對象 20
2.2 實驗流程及所需的儀器與設備 21
2.3 影像數據化與測量 22
2.1 實驗資料處理及分析 24
第三章 實驗結果 25
第一節 頦下超音波信賴度測試 25
第二節 實驗對象之基本資料分析 25
第三節 阻塞性睡眠呼吸中止症患者與一般受試者之生理結構差異 26
第四節 健康受試者在不同年齡層之結構差異 26
第五節 阻塞性睡眠呼吸中止症嚴重度相關因子分析 27
第四章 討論 28
第一節 頦下超音波於上呼吸道結構測量之可行性 28
第二節 阻塞性睡眠呼吸中止症患者之生理特質 29
第三節 患病組在頦下超音波影像下的上呼吸道特性 29
第四節 影響呼吸睡眠中止指數嚴重性的因子 30
第五節 超音波作為上呼吸道檢查工具的成效與展望 31
參考文獻 33
附錄一 健康受試者招募文宣 44
附錄二 表格與圖片 45

 
表目錄

表一、有關睡眠呼吸中止症盛行率的研究列表 45
表二、睡眠呼吸障礙對心血管的影響 46
表三、超音波於常見組織中的傳導速度 47
表四、利用超音波進行阻塞性睡眠呼吸中止症之研究列表 48
表五、頦下超音波之施測者間信度(Inter-Rater Reliability) 49
表六、頦下超音波之施測者內信度(Intra-Rater Reliability) 50
表七、患病組與健康組之基本資料比較 51
表七之一、患病受試者基本資料表 52
表七之二、健康受試者基本資料表 53
表八、阻塞性睡眠呼吸中止症之風險因子評估 54
表九、健康受試者在結構上的差異 55
表十、各項測量值之Spearman相關係數 56
 
圖目錄

圖 1 、睡眠時發生呼吸道塌陷的示意圖 57
圖2、多功能睡眠生理監測儀的監測項目和位置 58
圖3-1、本實驗使用之超音波儀器Toshiba Aplio 300 Platinum Platform 59
圖3-2、本實驗使用之環狀探頭PVT-375sc Convex Transducer 60
圖4-1、頦下超音波矢狀面(sagittal view)的測量 61
圖4-2、頦下超音波B mode下的舌體矢狀面測量 62
圖4-3、頦下超音波舌體矢狀面之彈性成像 63
圖4-4、頦下超音波舌體矢狀面之彈性成像取樣 64
圖5-1、頦下超音波冠狀面(coronal view)的測量 65
圖5-2、頦下超音波B mode下的舌體冠狀面 66
圖5-3、頦下超音波舌體冠狀面之彈性成像 67
圖5-4、頦下超音波舌體冠狀面之彈性成像取樣 68
圖6、同受試者彈性超音波矢狀面與冠狀面均質程度的差異 69

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