臺灣博碩士論文加值系統

研究目的: 根據近年來的研究顯示，由於脈衝延遲時間(Pulse Transit Time，PTT) 和交感神經與血壓等血管狀態變化具有著良好的相關性，並且還有著數據取得方便與非侵入性等特質，所以經常做為血壓或是判斷呼吸中止現象是否發生的的替代性測量方案。而PTT雖然常作為一項重要指標出現於阻塞性睡眠呼吸中止症（Obstructive Apnea，OSA）相關的研究文獻中，但卻少有研究是直接探討PTT本身與睡眠期別和OSA嚴重程度的關聯性。因此，本研究的目的是探討PTT在各睡眠期別與不同呼吸中止指數(Apnea hypopnea Index，AHI)分組時的變化與差異，用以判斷這些因子對PTT值本身所產生的影響。
材料與方法: 本研究使用了自2007年7月至2010年3月所招募到的610名男性久坐工作者作為受試者的睡眠生理檢查與生化檢查資料，根據結果篩選出睡眠周期較完整的125名受試者作為分析研究的對象。並通過訊號分析程式處理光體積計量儀(Photoplethysmograph，PPG)與心電圖(Electrocardiography，ECG)訊號計算出每人在各睡眠期別下的PTT的數值，再根據AHI的嚴重程度與睡眠期別來進行分組，統計分析出不同分組與各個期別下PTT值所產生的變化與差異，並對所觀察到的結果進行歸納統整。
結果: 在不同的AHI嚴重程度分組下，重度OSA組(AHI ≥30)與無OSA組(AHI<5)的PTT值在REM期時會呈現顯著差異。另外進行了各睡眠期別之間的比較分析後，可以觀察到無論個體還是群體的PTT值都會隨著睡眠期別轉換而產生顯著的變化，大部分期別的PTT值都能明確的區分開來，尤其是沒有受到AHI因素干擾的無OSA組，甚至可以直接用PTT值來簡易的判斷出進入淺睡期或深睡期之間的差別。
結論: 睡眠期別確實對PTT的數值有十分顯著性的影響，這使得PTT會隨睡眠期別的改變而產生變化，並且大部分的期別內數據都能彼此區分開來；整體而言，可以發現PTT值會隨著睡眠期別與時間進程而呈現上升的走向趨勢。但對於AHI對PTT的影響方面，大部分的改變或影響都是集中出現在重度OSA組群體之中；像是在REM期時其PTT會出現跟無OSA組有顯著差異的大幅下降，這種現象也使得其PTT值在經過整夜的睡眠後上升幅度也不太明顯，並且重度OSA組在各睡眠期別下都有相對於其他組別顯得較低的PTT值。

Purpose: Because of the PTT has a high correlation with sympathetic nerve, blood pressure and vascular compliance, and it is also easy to obtain data and non-invasive, so it becomes to be an alternative programs to quantitative those factor of influences which has correlation with those studies in past few years, such as non-invasive continuous blood pressure monitoring and judgment an apnea or an awake stage occurred. PTT has also become one of the common key indicators. But there only few studies are talking about the PTT itself and the correlation of it with sleep stage and rating of OSA. The purpose of this study is to investigate the changes and differences when the PTT is inside the each sleep stage and AHI group, in order to analyze the impact of these factors to the PTT itself.
Materials and Methods: This study has used a sleep examination and biochemical data from 610 (male workers) recruited subjects undergoing the tests during July 2007 to March 2010. According to the results by screening out of 125 subjects who have completed sleep stages to become the validated object of analysis, and used the signal analysis program with PPG and ECG signal data to calculate each person''s PTT in every sleep stage, then according to the severity of AHI and Sleep stage to divide groups. After statistical analysis of the changes and differences in PTT were generated by the different groups and stages, the result can be observed and integrated and summarized.
Results: In the different AHI severity groups, the PTT value between severe OSA group (AHI ≥30) and non-OSA group (AHI <5) show significant differences in REM stage. And after comparative analysis between each sleep stage, we can observe the PTT value changed with the sleep stages, and most of the stage''s PTT value can clearly be distinguished, particularly those person who with no interference by AHI factors . The PTT value can be directly used and easily determine the difference between the light sleep and deep sleep.
Conclusion: Sleep stage does have a very significant impact on PTT, which makes the PTT changed with sleep stage, and most of the data of stage can be distinguished from each other; and most of the data of stage can be distinguished from each other. Overall, PTT value will decrease with the passage of time and sleep stage to show out a rising trend. But talking about the impact for AHI to PTT, most of the change or influences are concentrated in severe OSA group. In general, in the REM stage its PTT will appear a significantly dropped with the non-OSA group, and it also makes the rising trend not obvious after all night''s sleep, and the severe OSA group''s PTT is lower than other groups in every sleep stages.

致謝 II
中文摘要 III
英文摘要 V
目錄 VII
圖目錄 IX
表目錄 X
第一章 緒論 1
1-1 前言 1
1-2 文獻探討 1
1-3 研究動機 3
1-4 研究方法 3
第二章 理論探討 5
2-1 PPG的原理介紹 5
2-2 PTT的生理意義 6
2-3 AHI與睡眠呼吸中止症 9
2-4 睡眠分期介紹 12
第三章 研究方法 15
3-1 受試者來源 15
3-2 統計分析 15
第四章 分析結果 20
4-1受試者基本生理資料 20
4-2 排除的PTT校正因子 22
4-3 AHI嚴重程度對PTT的影響 24
4-3-1 AHI分組下的比較結果 24
4-3-2 可提升AHI分組間差異的校正方式 25
4-4睡眠期別對PTT的影響 27
4-4-1 不同睡眠期別間PTT值的變化與趨勢 27
4-4-2 AHI的嚴重程度對PTT趨勢的影響 29
4-4-3 期別間整體的比較 34
4-5區分淺睡/深睡期的最佳切點 35
4-5-1可提升睡眠期別間差異的校正方式 36
4-5-2 使用ROC曲線找出適合的切割點 38
4-6 PTT在睡眠前期與後期的改變(補充) 42
第五章 結論 49
5-1 結果討論 49
5-2 限制性與未來展望 50
參考文獻 52

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