Investigation on the feasibility of respiratory motion
measurement in sleep using unconstrained techniques
for patients with obstructive sleep apnea
針對睡眠呼吸中止症患者探討非穿戴
式技術測量睡眠呼吸運動之可行性
Presenter: Wen-Kuei Lin
Advisor: Prof. Chun-Ju Hou
Present date: 2013.05.01
Outline
Problems & Rationale
 Purpose & Specific Aims
 Background & Literatures Review
 Materials & Methods
 Preliminary Results and Discussion
 Future works
 References

2
Problems & Rationale

Obstructive sleep apnea, OSA
 obstructive type,

central type, mix type apnea
Apnea & Hypopnea Index = Total number of apneas
and hypopneas  Total Sleep Time
AASM Manual for Scoring Sleep, 2007
AHI(Apnea
5 ≦ AHI < 15
15 ≦ AHI< 30
AHI ≧ 30
moderate
severe
Hypopnea Index)
Typical AHI values mild
categorized
3
Problems & Rationale

Obstructive sleep apnea, OSA
 Obstructive
sleep apnea (OSA) is a common
chronic disorder that often requires lifelong care.
Available practice parameters provide evidencebased recommendations for addressing aspects of
care. (LJ Epstein, D Kristo, PJ Strollo et al Journal
of Clinical Sleep Medicine, Vol.5, No. 3, 2009)
 The
present reference or “gold” standard for
evaluation of OSA is the polysomnogram (PSG)
(Su et al., 2004)
 High
correlation was found between hypertention
and OSA. (Geraldo Lorenzi-Filho, 2011)
4
Problems & Rationale

Obstructive sleep apnea, OSA
 Among
Americans at the age of 30-60 years old,
the estimated prevelence of sleep-disordered
breathing, defined as an apnea-hypopnea score of 5
or higher, was 9% for women and 24% for men
(Terry Young, 1993).
 The
prevalence of OSA in middle-age men is
4.1% to 10.9% (Chest, 2001; Eur Respir J, 1998) .
 Obstructive
sleep apnea (OSA) is independently
associated with death from cardiovascular
diseases, including myocardial infarction and
stroke. (CHEST 2011; 140( 2 ): 534 – 542)
5
Problems & Rationale

The prevalence of sleep apnea disorder
Source: Chuang LP, et al. Chang Gung Med J, 2008
Source: Li HY, Lee LA. Chang Gung Med J 2009
睡眠呼吸障礙之盛行率
6.00%
5.00%
4.00%
5.3%
3.00%
男性
2.00%
1.00%
0.00%
女性
1.4% 2.3%
小於50歲
2.8%
大於51歲
6
Problems & Rationale

Tools for evaluating the quality of sleep
 PSG
 Actigraphy
 Oximeter
Source: Labsystem
Source: Philips
Source: myhealthyfeeling
7
Background & Literatures Review-1

Validation of Unobtrusive Pressure Sensor Array for
Central Sleep Apnea Screening
 Daphne
Townsend, Student Member, IEEE, Rafik Goubran,
Fellow, IEEE, Frank Knoefel, and Judith Leech, JULY
2012
8
9
Background & Literatures Review-2

The Design of a Real-Time Accelerometer-Based Sleeping
Position Monitoring System and its Application on Obstructive
Sleep Apnea Syndrome


Xu Yao and Guangmin Sun Institute of Electronic Information and Control
Engineering Beijing University of Technology Beijing, China
Wen-Yen Lin* and Wen-Cheng Chou Department of Electrical Engineering
Healthy Aging Research Center, Chang Gung University Tao-Yuan, Taiwan
10
Background & Literatures Review-3
AASM Manual for Scoring Sleep, 2007
obstructive type
central type
mix type apnea
hypopnea
12
Materials & Methods
Long-term evaluation in 40 cases in Tainan Hospital (n=40)
OSA severity
Pressure sensing
•PSG
•Apneahypopnea
index (AHI)
• Chest breathing
effort
• Abdominal
breathing effort
•Pressure sensing
(1) Respiration rate
(2) Body posture
(3)
(4)
Questionnaire
assessment
• sleep quality
• Pittsburgh Sleep Quality
Index (PSQI)
• Epworth Sleepiness Scale
(ESS)
• Snore Outcomes Survey
(SOS)
Statistic analysis
Materials & Methods
14
Materials & Methods - PSG
15
Materials & Methods - PSG
16
Materials & Methods - PSG

Polysomnography (PSG)
 Electroencephalogram (EEG)
 mentalis/submentalis electromyogram
 Electrooculogram (EOG)
 Electrocardiogram (ECG)


Nasal and oral airflow
Chest and abdominal breathing effort
 Blood oxygen saturation (SpO2)
 Snoring
 Body position
(M.S EMG)
上圖為呼吸暫止症事件的呼吸氣流訊號；下圖為血氧飽和濃度訊號
18
Materials & Methods - PSG

PSG SCORE
Materials & Methods - Questionnaire

Epworth Sleepiness Scale
 ESSν.2
Authority from Dr. Chen, Ning-Hung
 Published in Quality of Life Research. 2002;11:817-21

Pittsburgh Sleep Quality Index
DJ, Reynolds Ⅲ CF, Monk TH, Berman SR,
Kupfer DJ: The Pittsburgh Sleep Quality Index: A New
Instrument for Psychiatric Practice and Research.
Psychiatric Research 1989; 28:192-=213.
 Buysse

Snore Outcomes Survey
 2000
R. Gliklich and Outcomes Sciences, Inc. All rights
reserved
Materials & Methods - Pressure
sensing
Preliminary Results and Discussion
Long-term evaluation in 40 cases in
Tainan Hospital from 2013/01/01 to
2013/11/30
 Analyze the data and compare the results
with PSG system
 Complete this pressure sensing mattress
system and have a final report

Preliminary Results and Discussion
Table 1. Demographic data of this study patients. (n=30) (5F, 25M)
Variable
Mean (SD)
Normal range
Age (years)
41.2 (13.9)
Height (cm)
169.3 (7.4)
BW (kg)
77.5 (15.1)
BMI (kg/㎡)
26.9 (4.4)
Neck circumference (cm)
38.1 (3.4)
Waist circumference (cm)
91.1 (12.5)
Hip circumference (cm)
100.3 (6.5)
Waist - Hip ratio
0.9 (0.08)
M: ≦0.9; F: ≦0.8
BP_systolic (mmHg)
124.2 (13.3)
90-140
BP_diastolic (mmHg)
74.8 (11.0)
60-90
Heart rate (times/min)
69.5 (7.7)
60-100
Normal:18.5-24; Obese: ≧30
Table 2. Polysomnography (PSG) and questionnaire in
patients (n=30)
Variable
Mean (SD)
Normal range
PSG_AHI (/hr)
39.2 (25.6)
<5
PSG_average O2 (%)
90.9 (5.8)
94-98
PSG_lowest O2 (%)
73.7 (13.2)
90-98
PSG_snore index (snores/hr of sleep)
218.4 (123.8)
Non: <50; Heavy: >400
PSG_AI (/hr)
23.1(23.0)
PSG_HI (/hr)
16.1 (10.0)
ESS score (0-24)
9.8 (4.3)
<12
SOS score (0-100)
40.6 (13.2)
>55
PSQI score (0-21)
7.0 (4.2)
<5
Sleep quality
6.5 (1.5)
Preliminary Results and Discussion
PSG Graphic summary
Baseline
12AM
Time
Hrs
Epoch
Hypnogram
1AM
2AM
3AM
4AM
5AM
6AM
0
1
2
3
4
5
6
1
下午 11:09:40
121
241
361
481
601
721
7
841
上午 06:09:40
R
W
N1
N2
N3
R
B
L
F
U
Body Position
Pressure sensing
12AM
Time
Hrs
Epoch
0
1
1
121
下午 11:09:40
1AM
↑
2
241
2AM
↑
3
361
↑
3AM
4AM
4
5
481
601
↑
5AM
6AM
↑
7
6
721
841
上午 06:09:40
PSG
Pressure sensing
Future works
Case collection
 Data analysis

 Parameter
extraction
 Statistical analysis

The system compared with PSG tools must be
further studied and investigated the benefits of
our system in sleep evaluation
27
References
【1】Chediak AD. 2008. Why CMS approved home sleep testing for CPAP
coverage. J Clin Sleep Med. 4: 16-18.
【2】劉尚儒、侯春茹，2012.Design of Body Activity in Bed Measurement
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究所碩士論文。
【3】Young T, Peppard PE, Gottlieb DJ. 2002. Epidemiology of Obstructive
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【4】侯春茹、陳彥廷，2012. Measurement of Body Activities Lying in Bed
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吸中止症。行政院國家科學委員會專題研究計畫成果報告。
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【8】Friedlander AH, Walker LA, Friedlander IK, Felsenfeld AL. 2000.
Diagnosing and comanaging patients with obstructive sleep apnea
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28
References
【9】Lin WY, Chou WC. 2012. The design of a real-time accelerometer-based sleeping
position monitoring system and its application on obstructive sleep apnea syndrome.
International Conference on Systems and Informatics, Taiwan.
【10】Nishyama M, Miyamoto M, Watanabe K. 2011. Respiration and body movement
analysis during sleep in bed using hetero-core fiber optic pressure sensors without
constraint to human activity. J Biomed Opt. 16: 17-20.
【11】Aronsohn RS, Whitmore H, Cauter EV, Tasali E. 2010. Impact of untreated
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【12】Howell Jones M, Arcelus A, Goubran R, Knoefel F. 2006. A Pressure Sensitive
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【13】Holtzman M, Townsend D, Goubran R, Knoefel F. 2010. Validation of Pressure
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【14】Townsend DI, Goubran R, Frize M, Knoefel F. 2010. Measuring Chest Movement
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【15】Daphne Townsend, Student Member, Rafik Goubran, Fellow, Frank Knoefel, and
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29
Thank you for your attention!