王司敏,秦浩,顧偉,

1.上海中醫(yī)藥大學(xué) 中醫(yī)系,上海 201203;2.第二軍醫(yī)大學(xué)附屬長(zhǎng)海醫(yī)院 a.呼吸科;b.中醫(yī)科,上海 200433

睡眠監(jiān)測(cè)手環(huán)在31例睡眠障礙患者中的應(yīng)用研究

王司敏1,秦浩2a,顧偉1,2b

1.上海中醫(yī)藥大學(xué) 中醫(yī)系,上海 201203;2.第二軍醫(yī)大學(xué)附屬長(zhǎng)海醫(yī)院 a.呼吸科;b.中醫(yī)科,上海 200433

目的比較睡眠監(jiān)測(cè)手環(huán)與多導(dǎo)睡眠監(jiān)測(cè)儀器在睡眠障礙患者中應(yīng)用中的異同,為臨床應(yīng)用更簡(jiǎn)易、較準(zhǔn)確、低成本的監(jiān)測(cè)睡眠方法提供參考.方法采用某進(jìn)口的多導(dǎo)睡眠儀和某睡眠監(jiān)測(cè)手環(huán),對(duì)31例睡眠障礙患者同時(shí)進(jìn)行監(jiān)測(cè),比較兩者的睡眠總時(shí)間、淺睡眠時(shí)間、深睡眠時(shí)間、睡眠間清醒時(shí)間、睡眠有效率的差異,評(píng)估睡眠監(jiān)測(cè)手環(huán)在睡眠障礙患者中臨床應(yīng)用價(jià)值.結(jié)果睡眠監(jiān)測(cè)手環(huán)與多導(dǎo)睡眠監(jiān)測(cè)儀器兩者所得的睡眠有效率、清醒睡眠時(shí)間、淺睡眠時(shí)間、深睡眠時(shí)間均無顯著性差異(Pgt;0.05).結(jié)論在這31例睡眠障礙患者中,睡眠監(jiān)測(cè)手環(huán)與多導(dǎo)睡眠監(jiān)測(cè)儀在睡眠有效率、清醒睡眠時(shí)間、淺睡眠時(shí)間、深睡眠時(shí)間結(jié)果上無明顯差異,可作為臨床上長(zhǎng)期監(jiān)測(cè)睡眠的參考依據(jù)之一,但是這類物美價(jià)廉,操作方便的儀器廣泛應(yīng)用于臨床睡眠的研究則需要更進(jìn)一步的探討.

睡眠監(jiān)測(cè)手環(huán);多導(dǎo)睡眠監(jiān)測(cè)儀器;睡眠障礙;睡眠時(shí)間

引言

睡眠占了人生的三分之一時(shí)間,睡眠紊亂會(huì)使人體的免疫力下降、誘發(fā)抑郁癥、導(dǎo)致某些心臟疾病和軀體障礙[1],良好的睡眠對(duì)于人體非常重要,一個(gè)好的睡眠是生活質(zhì)量的基礎(chǔ).現(xiàn)在,臨床上用于監(jiān)測(cè)睡眠的儀器很多,多導(dǎo)睡眠監(jiān)測(cè)儀(Polysomnography,PSG)作為其中之一是監(jiān)測(cè)睡眠的金標(biāo)準(zhǔn),但同時(shí)伴隨著諸多缺點(diǎn),如監(jiān)測(cè)不方便,儀器影響睡眠,價(jià)格昂貴等,便攜式體動(dòng)監(jiān)測(cè)儀正是基于其的諸多不方便而被研發(fā),近幾年來,隨著智能電子設(shè)備的發(fā)展和完善,基于體動(dòng)監(jiān)測(cè)儀原理的睡眠監(jiān)測(cè)手環(huán)(Sleep-Monitoring Bracelets,SMB)被越來越多的人群用于睡眠質(zhì)量的自測(cè).為了評(píng)估睡眠監(jiān)測(cè)手環(huán)在睡眠障礙患者中的臨床應(yīng)用準(zhǔn)確性和可靠性,本試驗(yàn)通過對(duì)31例有睡眠障礙的患者同時(shí)使用PSG及手環(huán)進(jìn)行睡眠監(jiān)測(cè),并對(duì)監(jiān)測(cè)結(jié)果進(jìn)行統(tǒng)計(jì)分析,現(xiàn)報(bào)告如下.

1 試驗(yàn)材料

1.1 睡眠監(jiān)測(cè)手環(huán)

小米二代智能手環(huán),內(nèi)部的組成大體上是三軸重力加速度傳感器ADXL362,記錄器,藍(lán)牙4.0模塊,處理器,以及電池和振動(dòng)器,夜晚睡眠狀態(tài)是通過重力加速度傳感器來監(jiān)測(cè),實(shí)時(shí)捕捉到的3個(gè)維度的各項(xiàng)數(shù)據(jù),經(jīng)過濾波、峰谷檢測(cè)等過程,使用各種算法和科學(xué)縝密的邏輯運(yùn)算得到睡眠數(shù)據(jù),再通過藍(lán)牙傳送到相連接的手機(jī)APP上面轉(zhuǎn)化為可讀數(shù)字.APP上面記錄有全天睡眠時(shí)間、全天深睡眠時(shí)間、全天淺睡眠時(shí)間、清醒時(shí)間、昨晚入睡時(shí)間、今早醒來時(shí)間.清醒就是肢體有大幅動(dòng)作的時(shí)候,淺睡眠狀態(tài)是小幅動(dòng)作的時(shí)候,而深睡眠狀態(tài)是肢體完全放松不會(huì)動(dòng)的.

1.2 多導(dǎo)睡眠監(jiān)測(cè)儀

多導(dǎo)睡眠監(jiān)測(cè)儀由德國(guó)WEINMANN公司生產(chǎn),型號(hào):REF,WM95233,SOMNOlab 2 PSG;該儀器可以監(jiān)測(cè)患者氣流,鼾聲,心率,氧飽和度,體位,以及治療壓力信號(hào),同時(shí)可以記錄腦電、心電、眼電、肌電、呼吸信號(hào)[2],睡眠技師通過分析上述病人睡眠中的各項(xiàng)生理指標(biāo)的變化,可有效地對(duì)整夜的睡眠進(jìn)行判讀.睡眠監(jiān)測(cè)報(bào)告顯示有睡眠開始時(shí)間、睡眠結(jié)束時(shí)間、覺醒時(shí)間、快速動(dòng)眼期時(shí)間(Rapid Eyes Movement Sleep,REM)、非快速動(dòng)眼期時(shí)間1、2、3、4期時(shí)間(Non-Rapid Eyes Movement Sleep,NREM1、2、3、4)、REM潛伏期時(shí)間、睡眠效率、覺醒反應(yīng)次數(shù).

2 試驗(yàn)方法

2.1 病例來源

收集2016年3～10月長(zhǎng)海醫(yī)院呼吸科門診就診患者總共49例患者,脫落18例,納入研究共31例.患者門診主訴為打鼾、憋醒、嗜睡、記憶力減退,診斷為阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive Sleep Apnea-Hypopnea Syndrome,OSAHS)、鼾癥和其他的患者.

2.2 操作方法

患者晚上8:30準(zhǔn)點(diǎn)到達(dá)專門的睡眠監(jiān)測(cè)室中,平躺于病床上,由專門的睡眠監(jiān)測(cè)技師按照美國(guó)睡眠醫(yī)學(xué)學(xué)會(huì)標(biāo)準(zhǔn)佩戴PSG裝置[2],同時(shí)另一名技師在患者左手腕橫紋上2 cm佩戴手環(huán),要求手環(huán)緊貼皮膚.PSG裝置設(shè)置監(jiān)測(cè)時(shí)間設(shè)定為晚上10:00～次日早上05:59或06:59,共8～9 h.手環(huán)監(jiān)測(cè)時(shí)間與PSG同步.

2.3 統(tǒng)計(jì)學(xué)分析

所有統(tǒng)計(jì)資料均使用SPSS 21軟件進(jìn)行分析.統(tǒng)計(jì)描述用均數(shù)±標(biāo)準(zhǔn)差、95%的可信區(qū)間表示,符合正態(tài)分布的配對(duì)資料采用配對(duì)t檢驗(yàn)方法統(tǒng)計(jì),不符合正態(tài)分布的采用Wilconxon 符號(hào)秩檢驗(yàn),P值設(shè)定為0.05.

3 結(jié)果

3.1 基本資料

病例總數(shù)31例,男26例,女5例;平均年齡47歲,最小24歲,最大72歲:47.1±15.5);主訴為打鼾(25人)、憋醒(9人)、嗜睡(8人)、記憶力減退(7人),診斷為OSAHS(11人)、鼾癥(18人)、其他(2人).

3.2 監(jiān)測(cè)數(shù)據(jù)分析

睡眠監(jiān)測(cè)手環(huán)與PSG監(jiān)測(cè)的數(shù)據(jù)有臥床時(shí)間、睡眠總時(shí)間、清醒總時(shí)間、睡眠效率、覺醒次數(shù)、REM潛伏期、NREM1、2、3、4時(shí)間、深睡眠時(shí)間、淺睡眠時(shí)間,統(tǒng)計(jì)數(shù)據(jù)見表1.

統(tǒng)計(jì)結(jié)果顯示:PSG與SMB兩種監(jiān)測(cè)睡眠設(shè)備的睡眠有效率、總睡眠時(shí)間、清醒時(shí)間的Pgt;0.05,說明兩者監(jiān)測(cè)的結(jié)果差異無統(tǒng)計(jì)學(xué)意義,還不能認(rèn)為兩種監(jiān)測(cè)睡眠儀器的結(jié)果不同,表示睡眠監(jiān)測(cè)手環(huán)和多導(dǎo)睡眠監(jiān)測(cè)儀監(jiān)測(cè)結(jié)果有可比性,并無顯著差異.

深睡眠時(shí)間、淺睡眠時(shí)間、清醒時(shí)間的比較.大量睡眠相關(guān)研究定義深睡眠時(shí)間為PSG結(jié)果中NREM3、NREM4和REM的時(shí)間之和[3],定義淺睡眠時(shí)間為NREM1和NREM2時(shí)間之和[4-6],通過對(duì)表1的校正后計(jì)算出PSG監(jiān)測(cè)結(jié)果相對(duì)應(yīng)的深睡眠和淺睡眠時(shí)間,具體見表2.

表1 PSG與SMB睡眠監(jiān)測(cè)統(tǒng)計(jì)結(jié)果 (min)

表2 PSG與SMB配對(duì)t檢驗(yàn)結(jié)果(min)

PSG與SMB監(jiān)測(cè)患者深睡眠時(shí)間、淺睡眠時(shí)間進(jìn)行統(tǒng)計(jì)學(xué)分析,發(fā)現(xiàn)Pgt;0.05,差異無統(tǒng)計(jì)學(xué)意義,不能認(rèn)為兩者監(jiān)測(cè)數(shù)據(jù)不同,智能手環(huán)監(jiān)測(cè)的結(jié)果于多導(dǎo)睡眠監(jiān)測(cè)儀相比并無顯著差異.

4 討論

多導(dǎo)睡眠監(jiān)測(cè)儀是睡眠研究中評(píng)判睡眠好壞的金標(biāo)準(zhǔn),然而,它有諸多不足,比如價(jià)格昂貴,佩戴后影響睡眠,耗費(fèi)個(gè)人和睡眠技師的時(shí)間,不能在家中并且不能長(zhǎng)期記錄睡眠情況等.諸多不足導(dǎo)致了其他客觀監(jiān)測(cè)睡眠技術(shù)的發(fā)展.

體動(dòng)監(jiān)測(cè)儀器作為一種可攜帶的儀器,常常用于監(jiān)測(cè)睡眠.體動(dòng)監(jiān)測(cè)儀通過手腕的運(yùn)動(dòng)幅度來區(qū)分睡眠深度,活動(dòng)度小的計(jì)算為淺睡眠,活動(dòng)度大的歸于深睡眠[7].相對(duì)于PSG,體動(dòng)檢測(cè)儀價(jià)格較便宜,操作簡(jiǎn)單,對(duì)監(jiān)測(cè)地點(diǎn)沒有要求,并且可監(jiān)測(cè)一段時(shí)間內(nèi)的睡眠情況,最后不需要花費(fèi)過多的人力也可生成詳細(xì)的睡眠覺醒圖表.臨床試驗(yàn)研究后通過統(tǒng)計(jì)學(xué)分析發(fā)現(xiàn)各類體動(dòng)監(jiān)測(cè)儀監(jiān)測(cè)的結(jié)果和PSG有不同級(jí)別的相似[8].盡管體動(dòng)監(jiān)測(cè)儀器不能監(jiān)測(cè)動(dòng)眼睡眠潛伏期,但是能很好的監(jiān)測(cè)成人的睡眠狀態(tài)[9-11].臨床上,對(duì)于一些伴隨慢性疼痛的患者,普遍存在入睡困難和睡眠時(shí)間減少問題的人群,體動(dòng)儀就可以用來長(zhǎng)期監(jiān)測(cè)他們的睡眠情況從來調(diào)整用藥[12].

近幾年來,隨著智能電子設(shè)備的發(fā)展和完善,人們對(duì)生活質(zhì)量的高要求,智能手環(huán)越來越受到人們的關(guān)注(比如 Fitbit Flex,Nike+FuelBand,Jawbone UP band).智能手環(huán)的基本原理類似體動(dòng)記錄儀器.它可以記錄存儲(chǔ)佩戴者日常生活中的鍛煉、睡眠等實(shí)時(shí)數(shù)據(jù),并將這些數(shù)據(jù)與手機(jī)、平板等電子設(shè)備同步.盡管智能手環(huán)記錄睡眠技術(shù)越來越廣泛,但是這些設(shè)備記錄睡眠及清醒的精確度仍未得到臨床的證實(shí)[13-18].在這些商業(yè)化智能手環(huán)中,臨床研究發(fā)現(xiàn)Fitbit Flex,通過與PSG和體動(dòng)儀器對(duì)比,結(jié)果證明其具有一定的可靠性和可信性[19].該試驗(yàn)收集了24位健康成年人,在睡眠監(jiān)護(hù)室中對(duì)同一個(gè)人同時(shí)佩戴3種睡眠監(jiān)測(cè)儀,即Fitbit Flex、PSG、體動(dòng)儀,監(jiān)測(cè)夜晚睡眠數(shù)據(jù)并進(jìn)行統(tǒng)計(jì)分析,結(jié)論是Fitbit Flex可以被用來監(jiān)測(cè)健康成年人的睡眠.隨后Zambotti博士等[20]收集了65例青少年,通過與PSG對(duì)比,發(fā)現(xiàn)在總睡眠時(shí)間和清醒時(shí)間上Jawbone UP與其有很好的一致性.

智能手環(huán)僅僅通過重力加速度和光學(xué)傳感器得到的體動(dòng)和心跳數(shù)據(jù)將睡眠自動(dòng)分為3類:清醒、淺睡眠、深睡眠,簡(jiǎn)單明了,而手環(huán)傳感器和處理算法的應(yīng)用讓監(jiān)測(cè)睡眠更加方便,為追蹤患者的長(zhǎng)期睡眠狀況提供了可能性.但是目前對(duì)手環(huán)的判讀睡眠分期沒有詳細(xì)的準(zhǔn)確的標(biāo)準(zhǔn),不同類型的手環(huán)也因內(nèi)置的傳感器和軟件算法不同導(dǎo)致不同的分析結(jié)果,與多導(dǎo)睡眠監(jiān)測(cè)相比,智能手環(huán)不能細(xì)致的監(jiān)測(cè)睡眠,只能分辨淺睡眠、深睡眠、清醒時(shí)間,不能分辨REM、NREM1、2、3、4時(shí)間,不能監(jiān)測(cè)睡眠潛伏期.另外,在患者心情平靜、無大幅度動(dòng)作的情況下,手環(huán)已經(jīng)判定其為睡眠狀態(tài),而實(shí)際上患者仍舊是清醒的.

本試驗(yàn)還存在諸多不足,首先試驗(yàn)數(shù)據(jù)建立在單獨(dú)一晚的時(shí)間,PSG預(yù)先設(shè)定了工作時(shí)間,并不能監(jiān)測(cè)工作時(shí)間之外的睡眠.其次試驗(yàn)樣本量較少,病人來源受限,未設(shè)立健康人群組.同時(shí),智能手環(huán)采用的廠家較單一局限,更多的智能手環(huán)的對(duì)比試驗(yàn)是很有必要的.然而本實(shí)驗(yàn)證明和傳統(tǒng)的PSG相比,手環(huán)監(jiān)測(cè)睡眠有效率、清醒睡眠時(shí)間、淺睡眠時(shí)間、深睡眠時(shí)間無明顯差異,同時(shí)對(duì)患者睡眠幾乎沒有影響,成本較低,使用方便,可作為臨床上長(zhǎng)期監(jiān)測(cè)睡眠的參考依據(jù)之一.

[1] Lin Y,Liu Z,Ma W,et al.Hazards of insomnia and the effects of acupuncture treatment on insomnia[J].J Integr Med,2016,14(3):174-186.

[2] Grigg-Damberger MM.The AASM scoring manual four years later[J].J clin Sleep Med,2012,8(3):323.

[3] Shambroom JR,Fábregas SE,Johnstone J.Validation of an automated wireless system to monitor sleep in healthy adults[J].J Sleep Res,2012,21(2):221-230.

[4] Genzel L,Kroes MCW,Dresler M,et al.Light sleep versus slow wave sleep in memory consolidation: a question of global versus local processes[J].Trends Neurosci,2014,37(1):10-19.

[5] Fietze I,Penzel T,Partinen M,et al.Actigraphy combined with EEG compared to polysomnography in sleep apnea patients[J].Physiol Meas,2015,36(3):385-396.

[6] Lechinger J,Heib DP,Grumber W,et al.Heartbeat-related EEG amplitude and phase modulations from wakefulness to deep sleep: Interactions with sleep spindles and slow oscillations[J].Psychophysiology,2015;52(11):1441-50.

[7] Ancoli-Israel S,Cole R,Alessi C,et al.The role of actigraphy inthe study of sleep and circadian rhythms[J].Sleep,2003,26(3):342-392.

[8] Van de Water AT,Holmes A,Hurley DA.Objective measurements of sleep for non-laboratory settings as alternatives to polysomnography-a systematic review[J].J Sleep Res,2011,20(1):183-200.

[9] De Souza L,Benedito-Silva AA,Pires ML,et al.Further validation of actigraphy for sleep studies[J].Sleep,2003;26(1):81-85.

[10] Sadeh A.The role and validity of actigraphy in sleep medicine:an update[J].Sleep Med Rev,2011,15(4):259-267.

[11] Martin JL,Hakim AD.Wrist actigraphy[J].chest,2011,139(6):1514-1527.

[12] Brown CA,Bostick G,Bellmore L,et al.Hand self-shiatsu for sleep problems in persons with chronic pain: a pilot study[J].J Integr Med,2014,12(2):94-101.

[13] Grifantini K.How's my sleep?Personal sleep trackers are gaining in popularity, but their accuracy is still open to debate[J].IEEE Pulse,2014,5(5):14-18.

[14] Fischer S.Sleep on it:sleep might just be the most important part of daily health-and the biggest new target for biomedical engineering[J].IEEE Pulse,2014,5(5):8.

[15] Chen KY,Jr BD.The technology of accelerometry-based activity monitors: current and future[J].Med Sci Sports Exer,2005,37(11 Sl):S490.

[16] Steins D,Dawes H,Esser P,et al.Wearable accelerometrybased technology capable of assessing functional activities in neurological populations in community settings: a systematic review[J].J Neuroeng Rehabil,2014,13(11):36.

[17] Dobkin B.Wearable motion sensors to continuously measure real-world physical activities[J].curr Opin Neurol,2013,26(6):602-608.

[18] Lowe SA,Olaighin G.Monitoring human health behaviour in one's living environment: a technological review[J].Med Eng Phys,2014(36):147-168.

[19] Montgomery-Downs HE,Insana SP,Bond JA.Movement toward a novel activity monitoring device[J].Sleep Breath,2012,16(3):913-917.

[20] de Zambotti M,Baker FC,Colrain IM.Validation of sleeptracking technology compared with polysomnography in adolescents[J].Sleep,2015,38(9):1461-1468.

本文編輯 袁雋玲

Application Study of Sleep Monitoring Bracelet in 31 Patients with Sleep Disorders

WANG Simin1, QIN Hao2a, GU Wei1,2b
1.School of Chinese Medical Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;2.a.Department of Respiration; b.Department of Traditional Chinese Medicine, Changhai University, The Second Military Medical University, Shanghai 200433, China

ObjectiveThis research aimed to provide some more convenient, accurate and more low-cost ways for sleep monitoring in clinical practice by comparing the differences between sleep-monitoring bracelets and polysomnography devices.MethodsThirtyone patients with sleep disorders were monitored at the same time via an imported polysomnography and a sleep monitoring bracelet.The differences of total sleep time, light sleep, sound sleep, total wake time and sleep efficiency in different detection group were compared, so as to evaluate the clinical practicing value of sleep monitoring bracelets for sleep disorder patients.ResultsThere was no significant difference between sleep-monitoring bracelets and polysomnography devices in above mentioned monitoring experiments(Pgt;0.05).ConclusionThere is no obvious difference between the sleep-monitoring bracelets and polysomnography devices in monitoring sleep efficiency, total wake time, light sleep and sound sleep. It can be used to monitor long-term sleep. However, further validation is needed before advocating use of these inexpensive and easy-to-use devices widely in clinical sleep medicine and research.

sleep-monitoring bracelets; polysomnography devices; sleep disorders; sleep time

R197.39

B

10.3969/j.issn.1674-1633.2017.10.022

1674-1633(2017)10-0083-03

2017-01-12

上海市中醫(yī)藥發(fā)展三年行動(dòng)計(jì)劃建設(shè)項(xiàng)目(ZY3-CCCX-3-7002).

顧偉,副教授,副主任醫(yī)師,主要研究方向?yàn)橹形麽t(yī)結(jié)合臨床與基礎(chǔ)研究.

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