Introduction 2018 Obstructive Sleep Apnea OSA n Partial

Introduction 2018三總學會 Obstructive Sleep Apnea (OSA) n Partial / total occlusion of upper airway n Polysomnography (PSG): gold standard n Pathophysiology: unknown n Site(s) of obstruction: unidentified 2

Background 2018三總學會 Ultrasound Elastography 超音波彈性影像檢查 n Objective measurement of tissue stiffness n Noninvasive “virtual” palpation 虛擬 觸診 n Liver, Breast, Prostate, Thyroid, Neck Mass, Musculoskeletal n Compression elastography n Shear wave elastography (SWE) 3

Compression Elastography 同時記錄組織的形變量 4 https: //anz. medical. canon/technology/ul/elastography/

Compression Elastography Manual Compression Semi-quantitative 5 https: //anz. medical. canon/technology/ul/elastography/

Shear Wave ? (剪向波) Particle motion perpendicular to wave motion Direction of wave motion 6

Shear Wave Elastography (SWE) (剪向波超音波彈性影像) Acoustic Radiation Force Impulse (ARFI) 聲輻 射力脈衝 高速超音波攝影 7 https: //anz. medical. canon/technology/ul/elastography/

Hypothesis SWE 2018三總學會 剪向波超音波彈性影像 Obstructive sleep apnea may be associated with the changes of the stiffness of the tongue. 8

Methods 2018三總學會 n Toshiba Aplio 300 (TUS-A 300) n Toshiba PVT-375 BT 6 -1. 9 MHz curvilinear probe n Supine, neck hyperextended n Submental midline sagittal scan n B-mode, air-mucosa interface n Shear wave elastography (SWE) n Quiet breathing and Mueller Maneuver 9

2018三總學會 Results Characteristic non. OSA (n=22) OSA (n=14) p-Value Age (y) 39. 1± 11. 4 46. 4± 9. 3 0. 041 11/11 3/11 0. 087 Body height (cm) 164. 2± 9. 7 167. 5± 6. 9 0. 342 Weight (kg) 62. 0± 11. 8 76. 9± 11. 8 0. 002 BMI (kg/m 2) 22. 9± 3. 3 27. 5± 4. 5 0. 002 35. 2± 3. 5 40. 1± 5. 0 0. 001 78. 0± 8. 6 90. 0± 13. 5 0. 003 1. 0± 0. 88 44. 1± 23. 1 0. 001 Females/males Neck circumference (cm) Waist circumference (cm) AHI Mann–Whitney U test and Fisher’s exact test 11

2018三總學會 Results (All p < 0. 001) non. OSA p = 0. 005 OSA p < 0. 001 p = 0. 134 p = 0. 256 Mann–Whitney U test 12

2018三總學會 Results (All p < 0. 001) non. OSA p = 0. 005 OSA p < 0. 001 p = 0. 134 p = 0. 256 Mann–Whitney U test 13

Discussion 2018三總學會 Normal breathing / Mueller Maneuver Whole tongue stiffness: OSA > non. OSA Mueller Maneuver (UA negative pressure) 14

Sleep/wake 睡眠/清醒狀態 state Chemorecept 化學感受器 or Mechanorece 機械感受器 ptor Hypoglossa l motor 舌下運動神經核 nucleus Central pattern 延腦呼吸節律中樞 generator Genioglossus muscle tension Inspirato ry motor units 吸氣肌運動單元 15 Complete Anatomy 2019, 3 D 4 MED

OSA Awake 16 Complete Anatomy 2019, 3 D 4 MED

OSA Awake 17 Complete Anatomy 2019, 3 D 4 MED

OSA Sleep 18 Complete Anatomy 2019, 3 D 4 MED

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