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博碩士論文 etd-0725112-131757 詳細資訊
Title page for etd-0725112-131757
論文名稱
Title
心率變異度與呼吸暫止與淺呼吸指數的關聯度與身體質量指數相關
The correlation between Heart Rate Variability and Apnea-Hypopnea Index is BMI dependent
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
55
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2012-06-29
繳交日期
Date of Submission
2012-07-25
關鍵字
Keywords
修正偏誤加速法、摺刀法、拔靴法、心率變異度、睡眠呼吸暫止症
Bias-Corrected Accelerated method, Jackknife, Bootstrap, heart rate variability, sleep apnea syndrome
統計
Statistics
本論文已被瀏覽 5648 次,被下載 1373
The thesis/dissertation has been browsed 5648 times, has been downloaded 1373 times.
中文摘要
近三十年來,睡眠醫學已有了長足的進步,漸發展為一門醫療專業領域,在睡眠障礙中,以呼吸暫止症最為常見,長期呼吸暫止會導致心臟負擔,容易罹患心血管相關疾病。然而心臟是人體維持生命的重要器官之一,從過去研究中發現心率變異度低落的族群,罹患心血管疾病與死亡率的風險也較一般正常人高出許多。因此本研究期望在考慮患者BMI影響下,探討呼吸暫止症與心率變異度低落是否有關聯。
本研究將量測共1068男性受測者的整夜ECG生理訊號,及所偵測到的RRI序列透過FFT頻譜轉換出LF/HF、LF、HF三個頻域指標,以BMI為分組標準,透過Bootstrap method得到取樣後新樣本的分佈(Bootstrap distribution)與其所衍生的BCa method求出BCa信心區間(BCa Interval),估測出母體的形態,並觀察每組信心區間的變化。分析結果說明當呼吸暫止症患者的BMI≥28時,AHI與LF/HF具有顯著相關性,當隨著BMI分組的呼吸暫止症的嚴重程度增加時,重度肥胖相較於體重過重或體重標準的患者,LF/HF值上升,代表其心率變異度相對低落; 呼呼吸暫止症患者的BMI≥27,AHI與LF有顯著性的相關,其指出重度肥胖者在長時間出現呼吸中止,使得交感神經系統活性增加的生理反應變得明顯。
Abstract
Great progress has been made in sleep medical research in recent years and sleep medicine has thus evolved into a specialized medical field. Sleep apnea syndrome is one of the mostly commonly seen sleep disorders. It is now clear that sleep apnea has adverse effects on the heart and is a risk factor for several cardiovascular diseases. Studies have found that decreased heart rate variability (HRV) is a prognostic factor for cardiovascular disease and it also associated with higher mortality rate. Considering the confounding effect of BMI and sleep apnea severity, this work investigates the correlation between heart rate variability and AHI (apnea-hypopnea index which is used to characterize the severity of sleep apnea) by dividing patients into different BMI subgroups.
This work includes 1068 male subjects with complete overnight ECG recordings. The low-frequency (LF), the high-frequency (HF) component and the LF/HF ratio of HRV are computed for the 10 BMI subgroups. The Bootstrap method and the BCa technique for confidence interval estimation are employed to verify the linear association between the HRV measures and the severity of sleep apnea.
The experimental results show that statically significant correlation exist between LF/HF ratio and AHI for BMI ≧28 patient groups. Statically significant correlation between LF and AHI also exists for BMI ≧27 patient groups. These results demonstrate that the associations between some of the HRV measures and AHI are clearly BMI dependent.
目次 Table of Contents
論文審定書 i
誌謝 ii
目錄 iii
圖目錄 vi
表目錄 viii
摘要 ix
Abstract x
1.1前言 1
1.2研究動機與目的 1
1.3文獻回顧 3
1.4論文架構 5
2.1心電圖 6
2.1.1心電圖QRS波形與RR-Interval 6
2.2睡眠呼吸暫止症 8
2.2.1睡眠檢查 10
2.2.2呼吸暫止與淺呼吸指數 11
2.3心率變異度 12
2.3.1心率變異度之頻域分析 13
第三章 工程統計分析 15
3.1拔靴法The Bootstrap method 15
3.2 摺刀法The Jackknife method 16
3.3 信心區間與信心水準Confident Interval and Confident Level 17
3.4 淨相關係數(Partial Correlation Coefficients)與斯皮爾曼等級相關係數(Spearman Rank Correlation Coefficients) 18
3.5 修正偏誤加速法(BCa method)與其信心區間(BCaInterval) 20
第四章 分析步驟與方法 23
4.1前言 23
4.2資料庫來源 24
4.3消除ECG訊號基線飄移 24
4.4 以小波轉換偵測QRS波與RRI 26
4.5 HRV、 LF、HF頻域分析 26
4.6 BMI分組及其BCa Interval 27
第五章 分析結果 31
5.1 AHI與LF/HF 31
5.2 AHI與LF 32
5.3 AHI與HF 33
第六章 結論與未來展望 34
參考文獻 35
附錄Ⅰ BMI分組後AHI vs LF/HF之結果 39
附錄Ⅱ BMI分組後AHI vs LF之結果 41
附錄Ⅲ BMI分組後AHI vs HF之結果 43
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