| 摘要: | 近年來睡眠障礙愈來愈受重視，許多醫院設立睡眠中心專門處理睡眠障礙的問題，由此可見睡眠障礙儼然已經成為現代人生活所需面對的課題，睡眠障礙包含失眠、呼吸中止、夢魘、夢遊症等等。
本研究資料來源取自新光醫院睡眠中心，利用睡眠多項生理檢查(Polysomnography；PSG)記錄，得到XML以及EDF檔案。研究的對象分為正常者(51±13歲)、失眠者(39±13歲)與呼吸中止患者(51±11歲)各30名，共90名受測者，並利用晨間問卷將此三類的受測者再細分為主觀睡得好與主觀睡不好，本研究將呼吸中止患者定義為呼吸中止指數(Apnea Hypopnea Index；AHI 或 Respiratory Disturbance Index；RDI)高於15以上的患者，屬於中度或是重度呼吸中止病患，將失眠定義為睡眠效率(sleep efficiency)低於80%患者。所有受測者以心律變異性、腦波以及睡眠分期轉換為主要觀察的重點，心律變異性方面，得到頻域及時域分析結果；腦波方面則利用頻譜分析得到每個頻段的強度；睡眠分期轉換則是著重於次數的變換，最後比較正常者、呼吸中止與失眠者是否有顯著差異，以及主觀認知失眠與否是否有顯著的差異。
本研究發現，在腦波部分，失眠者與呼吸中止患者的beta波強度皆會較正常者強；在睡眠分期分析部分，失眠者與呼吸中止症患者在睡眠中覺醒的次數都顯著多於正常者；在心律變異性方面，不論是失眠者或是呼吸中止患者，在心律變異中HFnu這個項目數值都顯著低於正常者，證實這三個族群在睡眠中的確有不同的地方值得討論，本研究建議可以從心律變異性中HFnu的差異區分正常者、呼吸中止與失眠者此三類族群。
In recent years, people attach more and more importance to sleep disorder. Hence many hospitals in Taiwan set up sleep center to deal with problems of sleep disorder, modern people have to face this issue. Sleep disorder include insomnia, apnea, nightmare, noctambulation. Generally, sleep disorder can be detected in polysomnography (PSG).
Some studies show insomnia is relative with electroencephalogram (EEG) and autonomic nerve system (ANS). Insomnias’ beta power is more active than normal cases, and delta power is less activity than normal cases. Heart rate in insomnia and apnea groups is faster than normal cases. Low frequency (LF) in REM (rapid eye movements) is more activity in NREM (non-rapid eye movements), and delta power is negative relation with LF and LF/HF (low to high frequency ratio).
In order to find the differences in characteristics of HRV (Heart Rate Variability), EEG and sleep stage changing between normal, apnea and insomnia cases. We obtained PSG data of 30 normal (51±13 years), 30 insomnia (39±13 years) and 30 apnea (51±11 years) cases from the sleep center in Shin Kong Wu Ho-Su Memorial Hospital. According to the morning questionnaire all subjects are divided into subjective sleep good and poor groups. The definition of apnea is AHI (Apnea Hypopnea Index) or RDI (Respiratory Disturbance Index) over 15. The definition of insomnia is sleep efficiency lower than 80%. This study is focus on HRV, EEG and changing sleep stage. In HRV analysis, the average heart rate, standard deviation of RR interval, high frequency (HF), low frequency, normalized LF (LFnu), normalized HF (HFnu) and LF/HF were used. Sleep stage is according to Rechtschanffen and Kales (R&K standard criteria). In EEG analysis, alpha, beta, theta and delta band of EEG power were extracted by spectral analysis. All sleep stages are divided into REM and NREM. The changing sleep stage is focus on number of changing times which is REM, NREM and wake stage.
This study found that insomnia and apnea groups have more beta power and less delta power. In changing stage analysis, insomnia and apnea groups’ waking times are more than normal cases. HFnu value of insomnia and apnea is lower than normal subjects. This study shows a lowering of vagal activity and a raise of EEG beta activity are core problems in insomnia and apnea sleep disorder.
Keyword：Heart Rate Variability, Electroencephalogram, Insomnia, Apnea, Polysomnography |
