從同步鼾聲聲學分析和睡眠動態核磁共振成像進行靜態顱面測量和動態上呼吸道塌陷觀察，並探討其與阻塞性睡眠呼吸中止症嚴重程度的關聯。

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方麗娟(Li-Juan Fang) 查詢紙本館藏

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跨領域神經科學博士學位學程

論文名稱

從同步鼾聲聲學分析和睡眠動態核磁共振成像進行靜態顱面測量和動態上呼吸道塌陷觀察，並探討其與阻塞性睡眠呼吸中止症嚴重程度的關聯。
(Statis Craniofacial Measurement and Dynamic Upper Airway Collapse Observed from Synchronized snoring acoustic analysis and Sleep MRI and Its Association with Severity of Obstructive Sleep Apnea)

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摘要(中)

阻塞性睡眠呼吸中止症是一種睡眠呼吸障礙，其特徵是在睡眠期間上呼吸道反覆發生阻塞性塌陷，這會因長期缺氧導致嚴重的心血管和神經認知等相關後遺症。多項生理睡眠檢查是阻塞性睡眠呼吸中止的標準診斷工具，但它不能提供關於上呼吸道塌陷部位和型態的信息。對於接受陽壓呼吸器治療的患者來說，呼吸道塌陷的位置和型態並不重要，因為陽壓呼吸器是對整個塌陷的上呼吸道施加一個壓力支撐呼吸道避免呼吸道阻塞。然而，有一大部分患者面對陽壓呼吸器治療的依從性仍然是一個很大的挑戰，他們經常因為無法適應陽壓呼吸器轉而希望採取外科手術治療。對於外科醫生，識別上呼吸道塌陷部位變得至關重要。更好地理解動態上呼吸道塌陷的位置和型態可以讓外科醫師可以更精準化及個別化的製作符合患者特點及需求的外科手術計畫。目前各種影像學方法和清醒時上呼吸道內視鏡檢查方法已被用於預測氣道塌陷的情形。這些檢查的缺點在於患者在清醒或靜態狀態下並不能完全表現出呼吸道阻塞的位置和型態。因此，若要患者在睡眠時進行成像且不使用藥物鎮靜，那麼動態睡眠核磁共振檢查是一種非常好的動態上呼吸道塌陷研究工具。本研究希望通過動態睡眠核磁共振檢查，並在軸位、矢狀位和冠狀位進行分析，我們透過靜態顱面測量和動態呼吸道塌陷觀察探討其與疾病嚴重程度的相關性。本研究使用睡眠動態核磁共振成像，並同步進行打呼聲錄音以觀察輕度和嚴重阻塞性睡眠呼吸中止症患者的動態呼吸道塌陷的差別。核磁共振中線矢狀影像用於靜態顱面測量。我們從參與睡眠動態核磁共振研究的參與者中選擇了15名男性重度阻塞性睡眠呼吸中止症患者（平均呼吸中止低通氣指數70.3 ± 23次/小時）與15名輕度阻塞性睡眠呼吸中止症患者（平均呼吸中止低通氣指數7.8 ± 1.4次/小時），並與其年齡和身體質量指數進行了配對。靜態顱面測量包括上下頜關係和氣道長度等相關測量。通過盲檢評估軸位、矢狀面和冠狀面觀察軟顎後、舌根後和側咽壁的動態塌陷情形。使用雙變量分析將這些測量與阻塞性睡眠呼吸中止症的疾病嚴重程度（呼吸中止低通氣指數）進行相關分析，統計學上顯著性設置為P < 0.01。結果顯示來自睡眠動態核磁共振成像顯示側咽壁塌陷（b = 51.8，P < 0.001）和來自靜態顱面測量的上呼吸道氣道長度（b = 27.2，P < 0.001）與阻塞性睡眠呼吸中止症的疾病嚴重程度呈顯著正相關。研究結果表明側咽壁塌陷和上呼吸道道長度確實與阻塞性睡眠呼吸中止症嚴重程度有顯著關聯。這些標記可轉化為阻塞性睡眠呼吸中止症患者的常規臨床評估，用於評估個案的嚴重程度及治療的個別化規劃的依據。此研究提供了有關影響阻塞性睡眠呼吸中止症嚴重程度的靜態顱面測量和動態呼吸道塌陷因素的寶貴見解。

摘要(英)

Obstructive sleep apnea (OSA), a condition characterized by repeated episodes where the upper airway collapses during sleep. This collapse interrupts normal breathing and is associated with significant health risks, including heart and brain-related issues. The typical method for diagnosing OSA is polysomnography , which effectively identifies sleep disruptions but doesn′t pinpoint where or how the airway collapses. While continuous positive airway pressure therapy for OSA involves using a device that delivers positive pressure to keep the airway open during sleep, many patients find this uncomfortable and do not consistently use it. This noncompliance often leads patients to consider surgical alternatives, which necessitates precise identification of the exact locations of airway collapse to tailor the surgical approach. Traditional imaging techniques performed while the patient is awake or using static images are not very effective because they fail to capture the airway′s behavior during sleep, when OSA actually occurs. As a result, sleep MRI, performed without sedating the patient, emerges as a superior method. It allows researchers to observe the airway dynamically as it behaves naturally during sleep, providing valuable insights into where and how the airway collapses. This study involved analyzing 15 male subjects with severe OSA, who had an average Apnea-Hypopnea Index (AHI) of 70.3 events per hour, and comparing them to 15 males with mild OSA, who had an average AHI of 7.8 events per hour. Both groups were matched by age and body mass index . We used MRI to measure static craniofacial structures and observe the dynamic airway collapse in the retropalatal (RP), retroglossal (RG), and lateral pharyngeal wall (LPW) areas, in various views (axial, sagittal, and coronal). These measurements were then correlated with OSA severity using AHI, and statistical significance was set at P < 0.01. The study′s findings demonstrated that collapse at the lateral pharyngeal wall (b = 51.8, P < 0.001) and the length of the upper airway (b = 27.2, P < 0.001) were significantly associated with severity of OSA. These results suggest that specific features observed through sleep MRI, like the extent of lateral pharyngeal wall collapse and the length of the upper airway, could be crucial markers for assessing the severity of OSA. Incorporating these MRI findings into routine clinical evaluations could help refine the approach to treatment, particularly surgical interventions, leading to more customized and effective care for patients with OSA. The study underscores the importance of understanding both the anatomical and dynamic aspects of the upper airway in managing OSA severity.

關鍵字(中)

★ 動態核磁共振
★ 睡眠呼吸中止

關鍵字(英)

論文目次

目錄
中文摘要 ……..…………………………………………………….. i
英文摘要 . ……..…………………………………………………….. iii
誌謝 ……..…………………………………………………….. v
目錄 ……..…………………………………………………….. vi
表目錄 ……..…………………………………………………….. ix
圖目錄 ……..…………………………………………………….. x
一、緒論……………………………………………………… 1
1-1 阻塞性睡眠呼吸中止症的發生率與流行病學…………… 1
1-2 阻塞性睡眠呼吸中止症的病因與病生理……………… 2
1-3 阻塞性睡眠呼吸中止症的症狀，體徵和共病症………. 4
1-4 阻塞性睡眠呼吸中止症的評估和診斷………………… 6
1-4-1 阻塞性睡眠呼吸中止症的臨床評估…………………… 6
1-4-2 阻塞性睡眠呼吸中止症的診斷………………………… 7
1-4-3 阻塞性睡眠呼吸中止症的上呼吸道影像評估………… 8
1-5 阻塞性睡眠呼吸中止的治療…………………………… 12
1-6 研究動機及目的………………………………………… 15
1. 研究內容與方法………………………………………… 17
2-1 研究母體………………………………………………. 17
2-2 研究設計………………………………………………. 17
2-2-1 多項生理睡眠檢查……………………………………. 18
2-2-2 動態核磁共振掃描…………………………………… 19
2-2-3 判定睡眠的準則……………………………………… 20
2-2-4 同步鼾聲聲學分析和睡眠動態核磁共振成像……… 20
2-3 靜態顱面測量………………………………………… 24
2-4 動態上呼吸道塌陷評估……………………………… 25
2-5 統計分析……………………………………………… 27
2. 結果 …………………………………………………. 28
3. 討論…………………………………………………... 34
4-1 研究重要發現……………………………………….. 34
4-2 研究的強項…………………………………………… 35
4-3 和其他研究比較……………………………………… 35
4-4 臨床應用……………………………………………… 36
4-5 研究的弱點…………………………………………… 38
4. 結論…………………………………………………… 39
參考文獻………………………………………………………………. 40
附錄一………………………………………………………………….. 46

參考文獻

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指導教授

羅孟宗

審核日期

2024-6-21

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