睡眠期別生理變化與檢驗數據剖析於中風人與正常人之差異

How physiological changes of sleep period and inspection data are different from the stroke patients and normal health person

沈易劼(Yi-Jie Shen)

指導教授 ： 黃仁景

中山醫學大學/醫學科技學院/醫學影像暨放射科學系/碩士(2021年)

https://doi.org/10.6834/csmu202100078

摘要

研究目的:本項研究旨在探討中年男性之中風病患與男性正常人，於整夜睡眠過程中，其HRV分析(ECG)，腦波頻段(EEG)與血液檢查結果兩者之間變化差異。睡眠期別分別有：睡前清醒期、第二期非快速動眼期、慢波睡眠、進入快速動眼期睡眠和結束前之快速動眼期。

材料與方法:本研究採用回溯性實驗設計，對照組與正常組兩組年齡相符並分別收集72名中年男性中風病患，以及74名公車司機和台鐵駕駛員作為正常組，進行一整夜睡眠多項生理檢查，並排除任何遺失資料或心律不整中風病患，利用獨立樣本t檢定與單一樣本t檢定對各睡眠期別5分鐘之間心率變異度指標、心電圖ECG訊號、腦波頻段變化與血液檢查數據進行分析比較與其變化趨勢。
結果:所有受試者皆經過獨立樣本t與單一樣本t分析，中風組較難以進入REM睡眠中，且較短之REM期與SWS時段，透過標準誤差圖觀察到θ波能量百分比、脈衝訊號傳遞時間中風組於慢波睡眠時顯著較正常組低，及體溫變化於清醒時段進入到睡眠時中風組於體溫變化量較低相較於正常組之差異存在。

結論:本研究發現中風組SDNN顯示整體偏低，未隨著深睡期下降。中風組清醒波α波能量百分比降幅沒有像正常組來的高， 慢波比重睡著後沒有大幅拉升。中風組在深睡期PTT明顯下降於REM1, REM2有明顯下降，顯示血壓上升或血管收縮。

關鍵字

中風 ； 心率變異度指標 ； 心電圖 ； 腦電圖 ； 血液檢查

並列摘要

Objective：This study observes stroke middle age male patients by using a 12 channel polysomnography. We aim to investigate whether autonomic nervous system, heart rate variability, EEG, ECG signal and hematology test in each stage to aware of what is the difference between stroke patients and normal persons. Sleep stages contain AWK1, N2, SWS, REM1, REM2.

Material and method：We use the retrospective study, recruiting 72 stroke middle age male patients, with 72 age-matched bus and train drivers as normal controls. In the polysomnography analysis, we exclude any missing and stroke patients with atrial fibrillation, analyzing heart rate variability, EEG, ECG signal and hematology test, pulse transit time and detrended fluctuation analysis slope ALPHA in 5 minutes sleep stage.

Results：The Independent Samples t Test and one sample t-test compares the means of stroke patients and normal persons. It can be known that the sleep structure and change trend of the stroke group are different. The standard error line graph observed the difference between theta wave energy percentage and pulse transit time in the stroke patients during slow wave sleep compared with the normal persons, and the body temperature change in the stroke group during the waking period when entering sleep compared with the normal persons.

Conclusion：Our results reveal that, in normal persons SDNN decreased when slow wave sleep and increased during dreaming. The stroke patients has been shown to decrease overall leavels which was significantly lower during all stage. The percentage decrease in the alpha wave in the stroke patient was not as high as that in the normal person, and the proportion of slow wave did not increase significantly after falling asleep. This study showed that PTT in the stroke patients was significantly lower in REM1and REM2 stages. Meaning when PTT increase, blood pressure elevated and constricted of the blood vessels.

並列關鍵字

stroke ； heart rate variability ； electrocardiography ； electroencephalography ； hematology test

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