CN102579010A - Method for diagnosing obstructive sleep apnea hypopnea syndrome according to snore - Google Patents
Method for diagnosing obstructive sleep apnea hypopnea syndrome according to snore Download PDFInfo
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Abstract
The invention relates to a method for diagnosing obstructive sleep apnea hypopnea syndrome (OSAHS) according to snore. Since snore of a patient with the symptom of the OSAHS has special property that apnea or hypopnea lasting at least ten seconds is reserved between two adjacent times of snore and the amplitude of the snore interval is higher than that of the apnea or hypopnea internal evidently, each snore interval can be detected by means of end-point detection based on short-time amplitude, AHI (apnea hypopnea index) value of the patient can be computed by judging whether the interval between the two adjacent times of snore is longer than ten seconds or not, and finally whether the patient gets the OSAHS or not can be diagnosed. Compared with the conventional PSG (polysomnography) diagnosing method, the method has the series advantages of low cost, high efficiency, convenience in operation without making the patient uncomfortable, and the like.
Description
Technical field
The present invention relates to the method for a kind of definite obstructive sleep apnea low-ventilatory syndrome (Obstructive sleep apnea hypopnea syndrome is called for short OSAHS) apnea hyponea index (Apnea Hypopnea Index is called for short AHI).Be different from traditional (Polysomnography of sleep analysis monitor system; Be called for short PSG); The present invention judges through analyzing the sound of snoring whether the patient asphyxia or low ventilation take place in sleep procedure; Thereby can calculate patient's AHI value,, also new selection is provided simultaneously for the objective evaluation of postoperative effect as a kind of means of the preliminary examination of OSAHS symptom.
Background technology
Snoring is a kind of common sleep phenomenon, the sound of snoring be since the people in when sleep, some position in the upper respiratory tract is caused because of of flaccid muscles or pathological changes and is subsided or total blockage, and the air-flow that is blocked drives the obstructive position vibrations and just produced the sound of snoring.Medically with this when sleep go up air flue subside, block the asphyxia that causes or hypoventilation repeatedly, with degradation symptom under snoring and disorderly frequent generation of Sleep architecture and the blood oxygen saturation, be called OSAHS.
Be PSG to the effective diagnostic method of OSAHS medically, the variation of multichannel sign signal came synthetic determination whether it suffers from this disease when it was slept through the monitoring patient, and can confirm the light and heavy degree of conditions of patients.The signal that PSG write down has EEG signals, eye movement signal, electrocardiogram, electromyogram, oxygen saturation signal, mouth and nose airflow signal, pharyngeal vibration signal.Judge that wherein whether suffering from the topmost reference frame of obstructive sleep apnea low-ventilatory syndrome is the mouth and nose airflow signals, because the mouth and nose airflow signal can reflect directly whether apnea or low ventilation incident have taken place when the patient sleeps.Apnea is meant that the mouth and nose air-flow stops more than 10 seconds fully in the sleep procedure; Low ventilation incident is meant in the sleep procedure that respiratory air flow intensity is than the flat decline of normal water more than 50%; Descend more than 4% than foundation level with blood oxygen saturation simultaneously, and this process continues more than 10 seconds.
PSG monitoring respiration case purpose is in order to calculate the AHI value; Thereby confirm the order of severity of patient's symptom; The computational methods of AHI are the asphyxia that produces in the sleep monitor process the whole night of patient or low ventilation incident divided by the whole night length of one's sleep, in proper order/and hour be unit.Up-to-date medical science standard code can be divided into four types with the OSAHS symptom according to the difference of AHI value: 0 < AHI≤5 belongs to the simple sound of snoring (being that normal condition need not treatment); 5 < AHI≤15 belong to slight OSAHS; 15 < AHI≤30 belong to moderate OSAHS, AHI>30 belong to moderate or severe OSAHS.When PSG monitors; Need many pick offs are connected the different parts of patient body; Pass PSG back behind the good patient's of these sensor acquisition the sign signal; PSG passes to these signals on the PC of diagnostic center again through cable, the professional comes the patient is diagnosed through the variation of these sign signals of software analysis of special use.
PSG is as the golden standard of diagnosis OSAHS, though can diagnose patient's disease accurately, itself also has deficiency, such as medical expense is expensive, uses complicacy, brings discomfort to the patient easily, and Diagnostic Time is long, and the time of making a definite diagnosis is long etc.And the object of the invention is exactly to hope to propose a kind of method easily and effectively to replace PSG; The present invention has considered that the sound of snoring is as the most tangible clinical manifestation of OSAHS patient; And OSAHS patient's the sound of snoring has unique rhythm and pace of moving things; Therefore can come to catch indirectly asphyxia or low ventilation incident through the rhythm and pace of moving things of analyzing the variety classes sound of snoring, thereby calculate the AHI value, confirm whether the patient suffers from OSAHS.This method has a cost than PSG low, and efficient is high, and interval between diagnosis is short, to the painless series of advantages of waiting bitterly for of patient.
Summary of the invention
The objective of the invention is to the deficiency that monitoring exists to PSG, a kind of method of confirming obstructive sleep apnea and hypoventilation syndrome according to the sound of snoring is provided.
Ultimate principle: subside or block because OSAHS patient's upper respiratory tract physiological structure has at some position than the normal person, and the difference of this physiological structure can show through the sound of snoring accordingly.The amplitude of the simple sound of snoring is less; And the difference between the different sound of snoring sections is also less, and the persistent period of a sound of snoring section is basically about two seconds, and the interval between the adjacent sound of snoring section is also more even; Remain on about three seconds, asphyxia or low ventilation do not occur greater than ten seconds; And the magnitude of the OSAHS sound of snoring is bigger, and the persistent period of sound of snoring section is also longer relatively, and its most important characteristic is asphyxia or the low ventilation that between two adjacent sound of snoring sections, exists greater than ten seconds.Therefore can utilize the difference of the simple sound of snoring and the OSAHS sound of snoring that the two is made a distinction, thereby confirm the OSAHS symptom.
Design of the present invention is: make full use of this characteristic of respiration case that exists between the adjacent sound of snoring of OSAHS greater than ten seconds; At first attempt to capture accurately each sound of snoring section; Then through judging that whether the interval between the adjacent sound of snoring section determined whether to have taken place asphyxia or low ventilation incident greater than ten seconds, just can obtain the sum of the respiration case that counts on patient's AHI value at last divided by monitoring time the whole night.From the amplitude of the time domain waveform of sound of snoring signal, the amplitude of sound of snoring section is wanted obviously therefore can to utilize the end-point detection algorithm based on short time amplitude to capture sound of snoring section accurately greater than the amplitude of asphyxia or low ventilation section.When the utilization end-point detecting method; Choosing of threshold value is that influence detects the effect important factors; When carrying out the monitoring of the sound of snoring, the situation of ideal threshold setting is only to be higher than asphyxia and low ventilation section little by little, thereby in case can sharp monitoring can guarantee the sound of snoring time.But because the unstability of monitoring of environmental can not satisfy system requirements if sound of snoring signal is the whole night only set a constant threshold value.Therefore the present invention has designed a kind of computational methods of dynamic threshold; This method was that unit is divided into the experimental process fragment with it with sound of snoring signal the whole night with 30 minutes; In each sub-fragment, be that unit should sub-fragment be divided into several analytical cycles with 100 frames again; Calculate the average and the variance of 100 frame amplitudes in each analytical cycle then, the minimum pairing amplitude average of that analytical cycle of variance multiply by certain proportionality coefficient more just as the segmental dynamic threshold of this sound of snoring.After the method for utilization dynamic threshold end-point detection detects each sound of snoring section; Again through whether judging interval between adjacent two sound of snoring sections, and add some screening conditions and just can calculate the asphyxia that this section sound of snoring signal produced or hang down the event number of ventilating greater than 10 seconds.Sound of snoring signal to the whole night carries out the AHI value that same method just can calculate the patient, thereby realizes the diagnosis of OSAHS.
According to the foregoing invention design, the present invention adopts following technical proposals:
A kind ofly confirm the method for obstructive sleep apnea and hypoventilation syndrome according to the sound of snoring, the concrete operations step is:
(1) puts up suitable playback environ-ment, record patient sound of snoring signal the whole night;
(2) sound of snoring signal of being gathered is carried out pretreatment;
(3) sound of snoring signal of handling well is carried out the dynamic threshold end-point detection, capture each sound of snoring section, unique character is done corresponding processing to combine asphyxia or low ventilation incident then, calculates apnea hyponea index;
(4) display result;
Method of the present invention compared with prior art, have following conspicuous advantage: cost is low, and is easy and simple to handle, and diagnosis speed is fast, do not influence the comfort level of patient sleep etc.
Description of drawings
Fig. 1 confirms the flow chart of OSAHS symptom according to the sound of snoring.
The specific embodiment
The preferred embodiments of the present invention combine detailed description of the drawings following:
Embodiment one: referring to Fig. 1, confirm that according to the sound of snoring concrete operations step of obstructive sleep apnea low-ventilatory syndrome method is:
(1) puts up suitable playback environ-ment, record patient sound of snoring signal the whole night;
(2) sound of snoring signal to the patient carries out pretreatment, noise reduction and manually delete the recording of patient when sleeping;
(3) sound of snoring signal of handling well is carried out the dynamic threshold end-point detection, capture each sound of snoring incident, add some judgment condition again, thus the indirect AHI value that calculates;
(4) demonstration is based on the OSAHS diagnostic result of the sound of snoring rhythm and pace of moving things.
Embodiment two: present embodiment is introduced the detailed process of embodiment one in more detail:
(1) scheme of recording is set at the patient is adopted non-contact microphone, and mike is suspended on apart from about patient 15cm, and the format setting of recording is WAV, adopts the 8KHz sampling, and 16bit quantizes, and the sound of snoring signal after the recording is kept in the computer;
(2) when playback environ-ment is not good, too big such as environment noise, need carry out pretreatment to sound of snoring signal, thereby guarantee that end-point detection can have higher precision.The method of noise reduction adopts spectrum-subtraction, and the effect behind the noise reduction is as shown in Figure 7, and the amplitude that need satisfy quiet section is below 0.02, and the amplitude of sound of snoring section is more than 0.1.
(3) sound of snoring signal is carried out the dynamic threshold end-point detection; Consider practical situation; Need differentiate the each sound of snoring incident that monitors, such as the persistent period of sound of snoring incident should be too not short, perhaps too short is patient's cough sound or the knock in the environment; Simultaneously should be not oversize yet, perhaps oversize is voice.This method stipulates that effective sound of snoring incident duration should be between 0.56 second to 60 seconds.After capturing sound of snoring incident; Need judge whether to have taken place respiration case through judging the interval between adjacent twice sound of snoring incident, the condition that respiration case need satisfy is to be greater than 10 seconds, but considers practical situation; Can not be oversize, oversize might be dormant change.This method stipulates that effective respiration case should be between 10 seconds to 90 seconds.When carrying out the calculating of AHI, the judgment condition of sound of snoring incident and respiration case all need satisfy.
(4) through the software interface of writing final AHI result is exported.
Present embodiment has designed a analysis software that utilizes the sound of snoring to confirm the OSAHS symptom; This software not only can be realized the real-time analysis of the sound of snoring but also can realize post analysis; The method of analyzing all is to carry out the dynamic threshold end-point detection through the sound of snoring signal to the patient to calculate the AHI value, and last result shows on software interface.Below the simple function of this software down of introducing:
(1) imports the sound of snoring: be used for importing the sound of snoring signal that has recorded, thereby it is carried out sound of snoring analysis.
(2) begin recording, finish recording: be used for the patient is carried out real-time recording, the sound of snoring signal that records is kept under the specified file automatically.
(3) playback: be used for playing sound of snoring file, the sound of snoring that can play importing also can be play the sound of snoring of real-time recording.
(4) display waveform: show the time domain waveform of sound of snoring signal at the assigned address at interface, the waveform that both can show the sound of snoring that the later stage imports also can show the waveform of the sound of snoring signal of real-time recording.
(5) display result: the AHI value that will draw after will analyzing sound of snoring signal is presented at the appointed area at interface.
In order to verify accuracy of the present invention, 34 patients that carry out the PSG diagnosis have been carried out analytical method of the present invention, wherein the severe patient is 15; With S.1 ~ S.15 expression, 8 of moderate patients are with M.1 ~ M.8 expression; 7 of patients with mild; With L.1 ~ L.7 expression, 4 of simple sound of snoring patients are with N.1 ~ N.4 expression.Comparing result is as shown in table 1; AHI by PSG representes on one hurdle the diagnostic result of PSG in the table 1; AHI by SRM representes on one hurdle to use method (the Snore Sound Analysis of sound of snoring analysis; SSA) diagnostic result, contrast can find that analysis result of the present invention can keep concordance preferably with the diagnostic result of PSG.
| Patient's numbering | AHI by PSG | AHI by SSA | Patient's numbering | AHI by PSG | AHI by SSA |
| S.1 | 76 | 73 | M.3 | 32 | 34 |
| S.2 | 71 | 72 | M.4 | 28 | 34 |
| S.3 | 69 | 60 | M.5 | 28 | 30 |
| S.4 | 68 | 66 | M.6 | 26 | 29 |
| S.5 | 66 | 59 | M.7 | 22 | 30 |
| S.6 | 64 | 47 | M.8 | 22 | 25 |
| S.7 | 63 | 70 | L.1 | 14 | 17 |
| S.8 | 61 | 61 | L.2 | 14 | 12 |
| S.9 | 61 | 55 | L.3 | 12 | 13 |
| S.10 | 56 | 56 | L.4 | 12 | 12 |
| S.11 | 51 | 47 | L.5 | 10 | 8 |
| S.12 | 47 | 42 | L.6 | 6 | 15 |
| S.13 | 44 | 53 | L.7 | 5.5 | 6 |
| S.14 | 41 | 44 | N.1 | 3.3 | 4 |
| S.15 | 40 | 40 | N.2 | 2.2 | 2 |
| M.1 | 38 | 34 | N.3 | 1.2 | 6 |
| M.2 | 32 | 35 | N.4 | 1 | 9 |
The contrast of table 1. diagnostic result
This software of the present invention's design is installed on patient's the household PC; The patient is as long as record to the sleep state of oneself when sleep; Click display result behind the End of Tape, software will show patient's AHI value, thereby judges whether it suffers from OSAHS.The doctor also can adopt this software to carry out tele-medicine, and the patient only needs its sound of snoring signal that records is transferred to the doctor through network, and the doctor is the state of an illness of diagnosing patients rapidly just, the realization tele-medicine.
Claims (4)
1. confirm obstructive sleep apnea and the syndromic method of low ventilation according to the sound of snoring for one kind, operating procedure is following:
(1) puts up suitable playback environ-ment, record patient sound of snoring signal the whole night;
(2) sound of snoring signal of being gathered is carried out pretreatment;
(3) sound of snoring signal of handling well is carried out the dynamic threshold end-point detection, capture each sound of snoring section, corresponding processing done in unique sound of snoring rhythm and pace of moving things to combine asphyxia and low ventilation incident then, calculates apnea hyponea index;
(4) display result.
2. according to claim 1ly confirm obstructive sleep apnea and the syndromic method of low ventilation according to the sound of snoring; It is characterized in that said step (1) puts up suitable playback environ-ment, adopt contactless non-directive Electret Condencer Microphone during the whole night sound of snoring signal of record patient, Hz-KHz should be between 50Hz ~ 15000Hz; The open-circuit voltage output level is about-40+3.5dB; Mike is suspended on apart from about patient 15cm, and the format setting of recording is WAV, adopts the 8KHz sampling; 16bit quantizes, and the sound of snoring signal after the recording is kept in the computer.
3. according to claim 1ly confirm obstructive sleep apnea and the syndromic method of low ventilation, it is characterized in that need carrying out noise reduction when said step (2) is carried out pretreatment to the sound of snoring signal of being gathered and manually delete the recording of patient when sleeping according to the sound of snoring:
When playback environ-ment was not good, environment noise was too big, need carry out pretreatment to sound of snoring signal, thereby guaranteed that end-point detection can have higher precision; The method of noise reduction adopts spectrum-subtraction, and the effect behind the noise reduction need satisfy quiet section amplitude below 0.02, and the amplitude of sound of snoring section is more than 0.1.
4. according to claim 1ly confirm obstructive sleep apnea and the syndromic method of low ventilation according to the sound of snoring; Needs calculated the primary energy threshold value in per 30 minutes when it is characterized in that said step (3) is carried out the dynamic threshold end-point detection to the sound of snoring signal of handling well; And after end-point detection is accomplished; Need screen detected sound of snoring incident and respiration case, consider practical situation, sound of snoring incident should satisfy greater than 0.56 second; Less than 60 seconds restrictive condition, respiration case should satisfy greater than 10 seconds restrictive conditions less than 90 seconds; Have only sound of snoring incident and respiration case to satisfy simultaneously under the situation of restrictive condition, just count the calculating of apnea hyponea index.
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