Talks：	Home-base sleep disordering breathing detection and monitoring system
Name：	羅友倫
Position：	Associate professor
Affiliation：	Department of Thoracic Medicine, Lin-Kou Medical Center of Chang Gung Memorial Hospital/Chang Gung University
Email：	dr.loyulun@gmail.com
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Research Interests：	Sleep Medicine, Critical Care Medicine, Pulmonary Medicine
Selected Publications：	◆Wang CH, Huang CD, Lin HC, Huang TT, Lee KY, Lo YL, Lin SM, Chung KF, Kuo HP*. Increased activation of fibrocytes in patients with chronic obstructive asthma through an epidermal growth factor receptor-dependent pathway. J Allergy Clin Immunol. 2012 May;129(5):1367-76. ◆Lee KY, Ho SC, Chan YF, Wang CH, Huang CD, Liu WT, Lin SM, Lo YL, Chang YL, Kuo LW, Kuo HP*. Reduced NF-κB repressing factor: a link toward systemic inflammation in COPD. Eur Respir J. 2012 Oct;40(4):863-73. ◆Chou PC, Wang CH, Huang CD, Lo YL, Lee KY, Yu CT, Lin SM, Lin HC, Kuo HP*. Nucleic acid amplification test and bronchoscopy improve the diagnostic accuracy of smear-negative tuberculosis. Int J Tuberc Lung Dis. 2012 Dec;16(12):1674-9. ◆Lee LA, Yu JF, Lo YL, Chen YS, Wang DL, Cho CM, Ni YL, Chen NH, Fang TJ, Huang CG, Li HY. Energy types of snoring sounds in patients with obstructive sleep apnea syndrome: a preliminary observation. PLoS One. 2012 Dec;7(12):e53481. ◆Lin TY＃, Lo YL＃, Hsieh CH, Ni YL, Wang TY, Lin HC, Wang CH, Yu CT, Kuo HP. The potential regimen of target-controlled infusion of propofol in flexible bronchoscopy sedation: a randomized controlled trial. PLoS One. 2013 Apr 24;8(4):e62744. ( ＃Co-first author) ◆Wang TY＃, Lo YL＃, Lee KY, Liu WT, Lin SM, Lin TY, Ni YL, Wang CY, Ho SC, Kuo HP. Nocturnal CPAP improves walking capacity in COPD patients with obstructive sleep apnoea. Respir Res. 2013 Jun 19;14(1):66. ( ＃Co-first author) ◆Wang TY, Lo YL*, Liu WT, Lin SM, Lin TY, Kuo CH, Chung FT, Chou PC, Chang PJ, Ni YL, Ho SC, Lin HC, Wang CH, Yu CT, Kuo HP. Chronic cough and obstructive sleep apnoea in a sleep laboratory-based pulmonary practice. Cough. 2013 Nov 5;9(1):24.(*corresponding author) ◆Kuo CH, Lin SM, Lee KY, Chung FT, Lo YL, Hsiung TC, Liu CY, Kuo HP*. Endobronchial ultrasound-guided transbronchial biopsy and brushing: a comparative evaluation for the diagnosis of peripheral pulmonary lesions. Eur J Cardiothorac Surg. 2014 May;45(5):894-8. ◆Lee LA, Yu JF, Lo YL, Chen NH, Fang TJ, Huang CG, Cheng WN, Li HY*. Comparative effects of snoring sound between two minimally invasive surgeries in the treatment of snoring: a randomized controlled trial. PLoS One. 2014 May 9;9(5):e97186. ◆Kuo CH, Wu CY, Lee KY, Lin SM, Chung FT, Lo YL, Liu CY, Hsiung TC, Yang CT, Wu YC*. Chronic Obstructive Pulmonary Disease in Stage I Non-small Cell Lung Cancer That Underwent Anatomic Resection: The Role of a Recurrence Promoter. COPD. 2014 Aug;11(4):407-13. ◆Kuo CH, Lin SM, Lee KY, Chung FT, Feng PH, Hsiung TC, Lo YL, Liu CY, Kuo HP*. Algorithmic approach by endobronchial ultrasound-guided transbronchial needle aspiration for isolated intrathoracic lymphadenopathy: A study in a tuberculosis-endemic country. J Formos Med Assoc. 2014 Aug;113(8):527-34. ◆Chen WD, Wen MS, Shie SS, Lo YL, Wo HT, Wang CC, Hsieh IC, Lee TH, Wang CY*. The circadian rhythm controls telomeres and telomerase activity. Biochem Biophys Res Commun. 2014 Aug 29;451(3):408-14. ◆Wang TY, Lo YL, Chou PC, Chung FT, Lin SM, Lin TY, Lin HC, Wang CH, Yu CT, Kuo HP*. Associated bone mineral density and obstructive sleep apnea in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015 Jan 29;10:231-7. ◆Li HY*, L A L, Yu JF, Lo YL, Chen NH, Fang TJ, Hsin LJ, Lin WN, Huang CG, Cheng WN. Changes of snoring sound after relocation pharyngoplasty for obstructive sleepapnoea: the surgery reduces mean intensity in snoring which correlates well to apnoea-hypopnoea index. Clin Otolaryngol. 2015 Apr;40(2):98-105. ◆Wu HT, Talmon R, Lo YL*. Assess Sleep Stage by Modern Signal Processing Techniques. IEEE Trans Biomed Eng. 2015 Apr;62(4):1159-68. (*corresponding author) ◆Lin CW, Lin TY, Lo YL*. Pulmonary Alveolar Proteinosis Treated with Multiple Selective Lobar Lavage by Fiberoptic Bronchoscopy with Non-InvasiveVentilation under Procedural Sedation: A Case Report. Thorac Med. 2015 Apr;30(2):111-117.(*corresponding author) ◆Kuo SC, Hsu PC, Chen CH, Yu CT, Wang CL, Chung FT, Lin SM, Lo YL, Chen TC, Liu CY, Yang CT*. Overall Response to First-Line Tyrosine Kinase Inhibitor and Second-Line Chemotherapy Is Predictive of Survival Outcome in Epidermal Growth Factor Receptor-Mutated Adenocarcinoma. Chemotherapy. 2015 Apr 2;60(3):201-210.[Epub ahead of print]. ◆Lin SM, Chung FT, Kuo CH, Chou PC, Wang TY, Chang PJ, Lo YL, Huang CD, Lin HC, Wang CH, Kuo HP*. Circulating angiopopietin-1 correlates with the clinical course of multiple organ dysfunction syndrome and mortality in patients with severe sepsis. Medicine (Baltimore). 2015 May;94(20):e878. doi: 10.1097/MD.0000000000000878. ◆R. R. Lederman, R. Talmon, H.-T. Wu, Y.-L.Lo, R. R. Coifman. Alternating diffusion for common manifold learning with application to sleep stage assessment. ICASSP, IEEE International Conference on Acoustics, Speech and Signal Processing. 2015 Aug. 5758-5762. doi: 10.1109/ICASSP.2015.7179075. ◆Lo YL, Ni YL, Wang TY, Lin TY, Li HY, White DP, Lin JR, Kuo HP*. Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy. J Clin Sleep Med. 2015 Sep 15; 11(9): 1011–1020. Published online 2015 Sep 15. doi: 10.5664/jcsm.5016. ◆Scott Chih-Hsi Kuo＃, Yu-Lun Lo＃, Chun-Liang Chou, Fu-Tsai Chung, Shu-Min Lin, Chien-Ying Liu, Han-Pin Kuo. Bronchoscopic debulking for endobronchial malignancy: Predictors of recanalization and recurrence. Thoracic Cancer. 2015 Nov;6(6):722-30. doi: 10.1111/1759-7714.12248. Epub 2015 Mar 16. ( ＃Co-first author) ◆Huang SY, Chou PC, Wang TY, Lo YL, Joa WC, Chen LF, Sheng TF, Chung KF, Wang CH, Kuo HP. Exercise-Induced Changes in Exhaled NO Differentiates Asthma With or Without Fixed Airway Obstruction From COPD With Dynamic Hyperinflation. Medicine (Baltimore). 2016 Apr;95(15):e3400. doi: 10.1097/MD.0000000000003400. ◆Wang TY, Hung CY, Shie SS, Chou PC, Kuo CH, Chung FT, Lo YL, Lin SM. The clinical outcomes and predictive factors for in-hospital mortality in non-neutropenic patients with candidemia. Medicine (Baltimore). 2016 Jun;95(23):e3834. doi: 10.1097/MD.0000000000003834. ◆Lee LA, Lo YL, Yu JF, Lee GS, Ni YL, Chen NH, Fang TJ, Huang CG, Cheng WN, Li HY. Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome. Sci Rep. 2016 Jul 29;6:30629. doi: 10.1038/srep30629. ◆Li HY, Lo YL, Wang CJ, Hsin LJ, Lin WN, Fang TJ, Lee LA. Dynamic Drug-Induced Sleep Computed Tomography in Adults With Obstructive Sleep Apnea. Sci Rep. 2016 Oct 20;6:35849. doi: 10.1038/srep35849. ◆Hsieh CH, Lin TY, Wang TY, Kuo CH, Lin SM, Kuo HP, Lo YL. The safety and efficacy of alfentanil-based induction in bronchoscopy sedation A randomized, double-blind, controlled trial. Medicine (Baltimore).2016 Oct;95(43):e5101. ◆Lin YY, Wu HT, Hsu CA, Huang PC, Huang YH, Lo YL. Sleep Apnea Detection Based on Thoracic and Abdominal Movement Signals of Wearable Piezo-Electric Bands. IEEE J Biomed Health Inform. 2016 Dec 7. doi: 10.1109/JBHI.2016.2636778. [Epub ahead of print]
Abstract：	With the aging, obesity and psychiatric stress from civilization, the prevalence of sleep breathing disorders (SBD) are dramatic increasing in recent decades. According to the epidemiological data, there are 890,000 middle-aged men and 400,000 middle-aged women suffering moderate to severe sleep breathing disorders in Taiwan. It will take dozen years to have those patients been examination with Taiwan existing medical institutions. According to the suggestion from AASM (2015), the quality care measurement for adult OSA patients has to meet the following three criteria: 1. Improve disease detection and categorization: OSA symptoms and severity assessment and initial diagnosis within two months. 2. Improve quality of life: Effective treatment, assessment adherence of treatment, sleepiness and the possibility of traffic accidents. 3. Reduce cardiovascular risk: assessment weight, blood pressure, cardiovascular disease racking. Therefore, the development of portable home-based detection and monitoring system is urgency. The development of home-base SDB detection and monitoring system must fulfill the 2012 AASM recommended SCOPER concept including sleep, cardiovascular, oximetry, position, effort, and respiratory. In which, the detection of sleep depth, breathing effort and sleep events are the most challenging. With the advantage of wireless, easy to wear, and information diversity from triaxial accelerometer combining with the algorithm development from the concept of Support Vector Machine and State Machine, we can distinguish central events from obstructive events. With the detection of oxygen level, we can identify the differences between apnea and hypopnea. Therefore, we can detect disease pattern and severity by using triaxial accelerometer with pulse oximetry. Through the application from the modern signal analysis method, such as instantaneous frequency, synchros-squeezing, intrinsic empirical geometry and graph Laplacian and diffusion maps, we can use only simple airflow signal to predict the sleep cycle and stage. This concept can also be possibly applied to the respiratory signal from the three-axis accelerometer that may help to identify the sleep cycle and depth.