以心率變異度辨識睡眠呼吸中止症之軟體分析系統研發

Development of Software Analysis System Using Heart Rate Variability to Identify Sleep Apnea

10.6840/cycu201600915

蔡朋哲

睡眠 ； 睡眠呼吸中止症 ； 心率變異度 ； Sleep ； Sleep apnea ； Heart Rate Variability (HRV)

中原大學生物醫學工程學系學位論文

2016年

碩士

婁世亮;葛宗融

繁體中文

睡眠呼吸中止症發生時會導致心跳加快、血氧濃度下降以及呼吸暫停等症狀，造成睡眠中斷，進而影響睡眠品質。一般診斷睡眠呼吸中止症的方式較繁瑣，故本研究目的為開發一套以心率變異度辨識睡眠呼吸中止症軟體分析系統，初步判斷是否患有睡眠呼吸中止症。使用網路上現有的UCD Sleep Apnea Database ，藉此開發本分析軟體的功能，其功能包含計算心跳速率、重新取樣、快速傅立葉轉換、計算頻譜功率以及開發辨識睡眠呼吸中止症之演算法。本研究開發的軟體與Kubios分析軟體所產生的心率變異度結果具有相當高的相關性，相關係數皆大於0.96，證明本研究開發的軟體功能是可靠的。在演算法的部分，使用線性回歸的方式進行偵測，線性回歸結果與真實發生次數的相關係數為0.4727，此結果的相關係數並不高，準確性結果只有55%。為了改善此結果，進行類神經網路的訓練，類神經網路辨識睡眠呼吸事件結果的準確性為71%。綜合以上論述，本研究已初步開發出使用心率變異度辨識睡眠呼吸中止症之分析軟體，未來將持續改善本分析軟體的演算法，提高辨識睡眠呼吸中止症之準確性及可信度。

When sleep apnea occurs, it will increase heart rate, decrease pulse oximetry (SPO2) and cause sleep disturbances thereby affecting the quality of sleep. Diagnosis of sleep apnea is generally complicated. The purpose of this study is to develop an analysis software system based on heart rate variability to identify sleep apnea and to facilitate an early diagnosis of the symptom. We use the UCD Sleep Apnea Database to develop algorithms of identifying sleep apnea by analysis software. The function includes heart rate calculation, resampling, Fast Fourier Transform and power spectral density. The analysis software in this study has very high correlation with the Kubios analysis software (correlation coefficients >0.96). It shows highly reliability of analysis software. In part of algorithm, linear regression approach is used to determine sleep apnea syndrome. The linear regression correlation coefficient which is 0.4727 and the accuracy is 55%. In order to improve the accuracy, neural network training was carried out and it increased the accuracy of sleep apnea events to 71%. In conclusion, the present study developed an analysis software system based on heart rate variability to identify sleep apnea. The improvement of the analysis software algorithms will be continued to level up the accuracy and reliability of sleep apnea recognition.

1. [1] 鐘威昇 and 侯承伯, "阻塞性睡眠呼吸中止症候群," 家庭醫學與基層醫療, vol. 28, pp. 161-166, 2013.
   連結：
2. [2] 翁根本, 何慈育, 歐善福, 林竹川, and 謝凱生, "心律變動性分析," 臺灣醫界, vol. 52, pp. 290-293, 2009.
   連結：
3. [3] M. D. L. J. EPSTEIN, The Harvard Medical School Guide to a Good Night's Sleep.
   連結：
4. [4] C. Guilleminault, D. Poyares, A. Rosa, and Y.-S. Huang, "Heart rate variability, sympathetic and vagal balance and EEG arousals in upper airway resistance and mild obstructive sleep apnea syndromes," Sleep medicine, vol. 6, pp. 451-457, 2005.
   連結：
5. [5] T. F. o. t. E. S. o. Cardiology, "Heart rate variability standards of measurement, physiological interpretation, and clinical use," Eur Heart J, vol. 17, pp. 354-381, 1996.
   連結：
6. [6] A. H. Khandoker, J. Gubbi, and M. Palaniswami, "Automated scoring of obstructive sleep apnea and hypopnea events using short-term electrocardiogram recordings," IEEE Transactions on Information Technology in Biomedicine, vol. 13, pp. 1057-1067, 2009.
   連結：
7. [9] S. Akselrod, D. Gordon, F. A. Ubel, D. C. Shannon, A. Berger, and R. J. Cohen, "Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control," science, vol. 213, pp. 220-222, 1981.
   連結：
8. [10] E. Vanoli, P. B. Adamson, G. D. Pinna, R. Lazzara, and W. C. Orr, "Heart rate variability during specific sleep stages a comparison of healthy subjects with patients after myocardial infarction," Circulation, vol. 91, pp. 1918-1922, 1995.
   連結：
9. [11] F. Roche, J.-M. Gaspoz, P. Minini, V. Pichot, D. Duverney, F. Costes, et al., "Screening of obstructive sleep apnea syndrome by heart rate variability analysis," Circulation, vol. 100, pp. 1411-1415, 1999.
   連結：
10. [12] K. Dingli, T. Assimakopoulos, P. Wraith, I. Fietze, C. Witt, and N. Douglas, "Spectral oscillations of RR intervals in sleep apnoea/hypopnoea syndrome patients," European Respiratory Journal, vol. 22, pp. 943-950, 2003.
    連結：
11. [13] I. Szollosi, H. Krum, D. Kaye, and M. T. Naughton, "Sleep apnea in heart failure increases heart rate variability and sympathetic dominance," Sleep, vol. 30, p. 1509, 2007.
    連結：
12. [14] A. Hossen, B. Al Ghunaimi, and M. O. Hassan, "Subband decomposition soft-decision algorithm for heart rate variability analysis in patients with obstructive sleep apnea and normal controls," Signal Processing, vol. 85, pp. 95-106, 2005.
    連結：
13. [15] S. Babaeizadeh, D. P. White, S. D. Pittman, and S. H. Zhou, "Automatic detection and quantification of sleep apnea using heart rate variability," Journal of electrocardiology, vol. 43, pp. 535-541, 2010.
    連結：
14. [18] 陳濘宏, "阻塞型睡眠呼吸中止症," 臺灣醫學, vol. 9, pp. 361-366, 2005.
    連結：
15. [20] P. K. Stein and Y. Pu, "Heart rate variability, sleep and sleep disorders," Sleep medicine reviews, vol. 16, pp. 47-66, 2012.
    連結：
16. [21] S. McKinley and M. Levine, "Cubic spline interpolation," College of the Redwoods, vol. 45, pp. 1049-1060, 1998.
    連結：
17. [22] V. O. Alan, W. S. Ronald, and R. B. John, DISCRETE-TIME SIGNAL PROCESSING, 1989.
    連結：
18. [23] J. W. Cooley and J. W. Tukey, "An algorithm for the machine calculation of complex Fourier series," Mathematics of computation, vol. 19, pp. 297-301, 1965.
    連結：
19. [24] M. P. Tarvainen, J.-P. Niskanen, J. A. Lipponen, P. O. Ranta-Aho, and P. A. Karjalainen, "Kubios HRV–heart rate variability analysis software," Computer methods and programs in biomedicine, vol. 113, pp. 210-220, 2014.
    連結：
20. [26] PhysioBank. Available: https://physionet.org/physiobank/
    連結：
21. [27] K.-P. Lin and W. H. Chang, "A technique for automated arrythmia detection of Holter ECG," in Engineering in Medicine and Biology Society, 1995., IEEE 17th Annual Conference, pp. 183-184, 1995.
    連結：
22. [7] 台北醫學大學附設醫院睡眠中心. (2015.10.02). 認識睡眠呼吸障礙.
23. [8] C. Guilleminault, R. Winkle, S. Connolly, K. Melvin, and A. Tilkian, "Cyclical variation of the heart rate in sleep apnoea syndrome: Mechanisms, and usefulness of 24 h electrocardiography as a screening technique," The Lancet, vol. 323, pp. 126-131, 1984.
24. [16] A. N. Rama, S. C. Cho, and C. A. Kushida, "NREM–. REM sleep," Handbook of Clinical Neurophysiology, vol. 6, pp. 21-29, 2005.
25. [17] T. Young, M. Palta, J. Dempsey, P. E. Peppard, F. J. Nieto, and K. M. Hla, "Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study," WMJ: official publication of the State Medical Society of Wisconsin, vol. 108, p. 246, 2009.
26. [19] 許世昌, 新篇解剖學二版: 永大書局有限公司, 2011.
27. [25] M. P. Tarvainen and J.-P. Niskanen, "Kubios HRV," Finland: Biosignal Analysis and Medical Imaging Group (BSAMIG), Department of Applied Physics, University of Eastern Finland, 2012.