WO2019117661A1

WO2019117661A1 - Intraoral image-based obstructive sleep apnea diagnosis device and diagnosis method

Info

Publication number: WO2019117661A1
Application number: PCT/KR2018/015901
Authority: WO
Inventors: 김상욱; 김세현
Original assignee: 경상대학교산학협력단
Priority date: 2017-12-14
Filing date: 2018-12-14
Publication date: 2019-06-20

Abstract

The present invention relates to a device and a method for diagnosing obstructive sleep apnea on the basis of an intraoral image. The present invention provides a device for diagnosing obstructive sleep apnea on the basis of an intraoral image, comprising: a photographing module for photographing an intraoral image; a manifestation determining module for determining a manifestation in the intraoral image photographed by a photographing unit on the basis of a predetermined standard, and determining a weight depending on the determined manifestation; and a diagnosing module for calculating the weight determined by the manifestation determining module, and performing a diagnosis of sleep apnea depending on the calculated result. The present invention has the advantage in that it is possible to simply diagnose a sleep apnea symptom early with high reliability by analyzing the intraoral image with a simple configuration.

Description

Oral imaging-based obstructive sleep apnea diagnostic device and diagnostic method

The present invention relates to an apparatus and a method for diagnosing obstructive sleep apnea based on images in the oral cavity.

Obstructive Sleep Apnea (OSA) is one of the symptoms of sleep disturbances, often accompanied by symptoms such as severe snoring during sleep and daytime sleepiness.

When a person breathe, the air passes through flexible structures such as the pharyngeal, throat, tongue, and tongue of the throat, and the surrounding muscles help them to maintain their position during the day, so they do not block the air passage.

However, since the muscles are relaxed and slackened during sleep, the air passage narrows partly, and when the air passes through this part, the soft parts of the surrounding parts are vibrated to make the snoring sound, The OSA occurs.

Some patients with OSA suffer from symptoms that do not cause snoring while they are not snoring, or they suffer from excessive daytime sleepiness.

Patients with OSA develop temporary respiratory arrest during sleep, and resumption of breathing usually occurs with breathless breathing or strong nasal discharge. In this process, awake awakening is often accompanied by sleep disturbances, which can lead to concentration or short-term memory impairment. Severe OSA patients who stop breathing once every two minutes, or more than 30 times an hour, are at risk of complications such as ischemic heart disease, hypertension, stroke, insulin resistance and diabetes.

[0005] As a general method for diagnosing OSA, there is polysomnography (PSG).

PSG is a test to measure the quality and quantity of sleep, and to detect sleep disorders and disorders. It measures physiological and physical signals from the body during sleep and finds various sleep disorders and sleep disorders. EEG, safety, EMG, electrocardiogram, arterial oxygen saturation, abdominal and thoracic respiration, respiratory, snoring, body posture.

Videos are recorded to look for behavior during sleep and occasionally measured for sound pressure or erection in the esophagus. EEG is used as a basic data for understanding the progress and structure of sleep, and safety measures for eye movement are useful for determining sleep stages.

Electromyography should be measured because the muscle tension varies with the sleep phase. In particular, the leg EMG is measured to diagnose sleep disorder, which is called periodic limb movement. Also, tachycardia is necessary for sleep stage judgment and gait diagnosis.

Electrocardiography can measure arrhythmias that occur only during sleep, and measurement of respiratory and respiratory movements is essential for diagnosing OSA. Arterial oxygen saturation is an indirect indicator of OSA severity. Through body posture, we can observe breath, sleep and arousal according to sleep posture.

The results of these PSG tests are summarized as follows: how long to sleep, how long the dream lasts, how much the nose is, how long it takes to get to sleep, the number of breaks, sleep efficiency, Is calculated, and it is judged whether a physiological event occurring during sleep is pathological.

Based on this, the diagnosis and treatment direction of the sleeping problem is set up and specific methods such as weight loss, surgical operation, intraoral device, and sustained positive pressure technique are performed.

In this way, the standard diagnostic method of OSA can be tested only in a PSG, a sound-proof laboratory and a hospital equipped with various equipment, and the inspection cost is considerable because it is carried out under the observation of a specialized sleeping article.

Therefore, there are many patients who are left without diagnosis. Therefore, it is urgent to develop diagnosis apparatus and diagnosis method specialized for OSA.

Disclosure of Invention Technical Problem [8] The present invention has been made to solve the above-mentioned problems, and it is an object of the present invention to provide a diagnostic apparatus and a diagnosis method capable of early diagnosis of OSA accompaniment based on a captured intraoral image.

According to an aspect of the present invention, there is provided an imaging device including: an imaging module that captures an intraoral image; A determination module for determining a view based on a predetermined reference based on the intraoral image captured by the imaging module and determining a weight based on the determined appearance; And a diagnostic module for calculating weights determined in the above-described finding determination module and for diagnosing sleep apnea according to a result of the calculation. The present invention also provides an intraoral imaging-based obstructive sleep apnea diagnostic apparatus.

(A) taking an intraoral image; (b) determining the appearance of the imaged oral cavity image based on a predetermined reference, and determining a weight according to the determined findings; And (c) calculating a predetermined weight, and diagnosing sleep apnea according to the result of the calculation. The present invention provides an intraoral imaging-based obstructive sleep apnea diagnosis method.

According to the intraoral imaging-based obstructive sleep apnea diagnostic apparatus and diagnostic method according to the present invention, it is possible to easily diagnose by capturing and analyzing intraoral images using a simple apparatus such as a smart phone, The results of this study are summarized as follows: 1.

FIG. 1 schematically shows a configuration of an intraoral imaging-based obstructive sleep apnea diagnostic apparatus according to an embodiment of the present invention.

FIG. 2 is a flowchart illustrating an intraoral imaging-based obstructive sleep apnea diagnosis method according to an embodiment of the present invention.

3 shows each part of the intraoral image and the ROI taken by the imaging module.

Fig. 4 shows an analysis of the capillary sharpness of the study area. Fig. 4 (a) shows the normal study dog with clear capillary without swelling, Fig. 4 Dogs.

Fig. 5 shows an image analysis of the nipple area. Fig. 5 (a) shows the total area of the nipple area and the nipple area where the capillary is not clear. Fig. 5 (b) shows the area of each area separately.

Fig. 6 shows the wrinkles of mucous membranes at the neck region.

Fig. 7 shows the neck part, wherein (a) shows the width and length of the neck part, and (b) shows the state where the tongue is in contact with the umbrella.

8 shows an area portion of the posterior pharyngeal wall.

Fig. 9 shows a state in which the tongue is in contact with the nipple.

Fig. 10 shows the area portions on the right side and the left side of the post portion holding portion.

Figs. 11 and 12 schematically show the shape of the umbrella.

Fig. 13 schematically shows the colors of the umbrella and the puppies.

Fig. 14 is a schematic diagram of a pharyngeal section including a nipple, a one-way strut, and a posterior pharyngeal wall tissue.

These and other objects, features and other advantages of the present invention will become more apparent by describing in detail preferred embodiments of the present invention with reference to the accompanying drawings. In this process, the thicknesses of the lines and the sizes of the components shown in the drawings may be exaggerated for clarity and convenience of explanation. In addition, the terms described below are defined in consideration of the functions of the present invention, which may vary depending on the intention or custom of the user, the operator. Therefore, the definitions of these terms should be described based on the contents throughout this specification.

In addition, the described embodiments are provided for illustrative purposes and do not limit the technical scope of the present invention.

Hereinafter, an apparatus and method for diagnosing obstructive sleep apnea according to a preferred embodiment of the present invention will be described with reference to the accompanying drawings.

First, the configuration of a diagnostic apparatus according to an embodiment of the present invention will be described in detail with reference to FIG. 1 attached hereto.

The diagnostic apparatus according to an embodiment of the present invention includes an imaging module 100, a finding determination module 200, and a diagnostic module 300.

The photographing module 100 is a device for photographing an intraoral image, and is an apparatus capable of photographing an image and a photograph, and is composed of, for example, a camera.

An intraoral image of the pimple terminal is photographed through the photographing module 100.

The determination module 200 analyzes and judges the intraoral image photographed by the photographing unit according to a preset reference to determine a finding, and determines a predetermined weight.

The determination module 200 may be configured through an image analysis device capable of analyzing information including the size, color, and contrast of the photographed image.

The image determination module 200 analyzes the image and details of the predetermined criteria for determining the weight will be described later.

The diagnostic module 300 calculates a weight determined by the feature determination module 200, and diagnoses sleep apnea based on the calculated result.

The diagnostic module 300 may comprise a calculation / arithmetic unit operable to calculate the output weights.

The diagnostic module 300 may further include an output module 400 for outputting diagnosis results of the diagnosed sleep apnea.

The photographing module 100, the finding determination module 200, the diagnosis module 300 and the output module 400 may be a computer including a photographing device (cam, camera, etc.), a CPU (analysis and calculation device) , A camera included in a device such as a smart phone, an analysis and calculation device, and a display.

Hereinafter, a diagnostic method according to an embodiment of the present invention will be described in detail with reference to FIGS. 2 to 14 attached hereto.

First, an intraoral image is imaged (S10).

And takes an intraoral image of the pivot terminal through the photographing module 100.

The range (region of interest) of the intraoral image of the pimple terminal photographed by the imaging module 100 is not limited, but preferably, as shown in Fig. 3, the uvula 2 of the pimple terminal is positioned at the center (1), posterior pharyngeal wall (3), tongue (4), posterior pillars (5, 6) Anterior pillar (7, 8) is included in the captured image.

Next, the observed intraoral image is determined based on the predetermined criteria, and the weight is determined according to the determined findings (S20).

As described above, the finding determination module 200 determines the appearance of the image photographed by the photographing module 100 through a criterion described later and determines a weight according to the determination.

In addition, the finding determination module 200 may determine a weight according to the findings determined through the image of each designated region of the taken intraoral image.

(2), the posterior pharyngeal wall (3), the tongue (4), and the posterior segment (5, 6) of the region of interest The image of at least one site is analyzed and the weight is determined according to the determined result, and the details will be described below.

Referring to the circular part shown by the broken line in Fig. 4 (a) and Fig. 4 (b), in the study dog 1 region, It is the area where the blood vessel passes.

In OSA patients, mucosal edema of the dog's mouth was frequently observed due to repetitive trauma caused by the snoring-induced friction of the dog's tissues by sucking the dog's tissues downward by the above sound pressure during sleep, And is known to be associated with hyperglycemia.

When edema is present in the study dog (1) area, the sharpness of the capillary blood vessels in the image is lowered and it can be judged.

For example, as shown in Fig. 4 (a), it is judged that there is no edema if there is a difference in sharpness difference over the region of the study dog 1 by more than the predetermined sharpness.

On the other hand, as shown in Fig. 4 (b), it can be judged that there is edema if there is a region in which the difference in sharpness difference is less than a predetermined sharpness in the study dog (1) region.

The weight determination module 200 determines weights according to the results thus determined, and the weights at the regions of the study dog 1 are not limited, but for example, weights of 0 for normal and 2 for abnormal are determined .

Referring to Fig. 5, in the region of the umbilical cord 2, a portion that stands out clearly as compared with the surrounding mucous membrane is a region where capillary vessels of the umbilical cord 2 pass through, similar to the above-mentioned study dog 1 (a)).

As described above, in OSA patients, mucosal edema is frequently caused by the above-mentioned sound pressure during sleep, vibration caused by snoring, hypoxia caused by lowering of arterial oxygen saturation, and mucosal edema is more prominent in the nipple area than in other study dogs.

As shown in Fig. 5 (b), the ratio of the area of the captured image (outer dashed line portion) to the area of the capillary not identified (gray portion surrounded by the inner dashed line) is analyzed Accordingly, weights are set.

For example, if the area ratio of the portion where the capillary is not identified is 0%, 0, if it is more than 0% but less than 10% 1, if more than 10% is less than 25% 1.5 is more than 25% The weight of 3 is determined.

In OSA patients, mucosal edema of the throat tissue becomes wrinkled when the mucosal edema becomes severe, and thus the presence of mucosal wrinkles is an indicator of the severity of OSA - induced mucosal edema.

As shown in Fig. 6, the weights can be determined through the number of wrinkles generated in the mucous membrane at the area of the nape 2. The number of wrinkles of the mucous membrane 2 as described above can be determined by identifying the shape in which the mucous membrane of the mucous membrane 2 is folded in the lateral direction as indicated by a star-shaped mark in Fig.

For example, 0 for wrinkles, 3 for 1 to 3 wrinkles, 1 for 4 to 7, and 3 for wrinkles of 7 or more.

Then, as shown in Fig. 7, the weights can be determined according to the ratio of the length and width of the nipple 2.

In OSA patients, excessive breathing efforts occur in the thorax and abdomen to overcome the closure of the upper airway during inhalation and to inhale air into the bronchus and lungs, thereby creating excessive negative pressure in the airway. Repeated occurrences of such a sound pressure, mucosal edema, as well as long lengthening itself is the effect of the lining.

As shown in Fig. 7 (a), when the value of y / x is less than 1.5, the width of the neck 2 is x and the length is y, and when the value of y / x is less than 1.5, At this time, the weights of the case 2 in which the nipple 2 touches the tongue 4 are determined irrespective of the width and length ratio of the nipple 2, as shown by the broken-line circle in Fig. 7 (b).

As shown in Fig. 8, the weight can be determined according to the area of the rear pharyngoscope wall 3.

Patients with OSA often have an anatomically narrow laryngeal structure compared to healthy persons. In many cases, the posterior pharyngeal wall is not visible when the tongue is covered by the tongue and the tongue is not artificially depressed.

As shown in FIG. 8, when the photographed image is weighted according to the area of A, which is the portion of the posterior pharyngeal wall 3, for example, when the area of the pharyngeal wall 3 exceeds 7 cm ² , 7 cm ² or less 3 cm ² is exceeded, and when it is 3 cm ² or less, weight of 2 is determined.

In addition, the weight can be determined depending on whether the tongue 4 and the umbrella 2 are in contact with each other. It is not the case that the molar is stretched due to the above-mentioned sound pressure, but the weight of the molar can reach the tongue when the mouth is opened because the tongue is relatively larger than the pharyngeal space.

As shown by the broken line in Fig. 9, the weights of 1 (the broken-line circle portion in Fig. 9) when the nipple 2 makes contact with the tongue 4, and 0 when it does not touch are determined.

This weight is independent of the weight according to the ratio of the length and width of the neck 2. That is, for example, even when the length and width ratio of the nipple 2 is 1.5 or more and less than 2.0, if the nipple 2 is in contact with the tongue 4 separately, a weight of 1 is additionally determined.

The weights can also be determined according to the ratio of the area of the right side (5) and the area of the left side (6) of the post. Studies on OSA patients The asymptomatic rhinorrhoeal mucosal edema of dogs, nipples, etc. is asymmetric as the degree of mucosal edema increases. Therefore, this asymmetric mucosal edema causes asymmetry of the shape of the posterior part of both posterior segments, which can be an indicator of OSA severity.

10, the right side 5 and the left side 6 of the posterior platelet are indicated by R and L, respectively, on the basis of the pinched terminal.

When the ratio (R / L) of the right side (5) and the left side (6) of the strut is greater than 0.9 and less than 1.1, the weights are set to 0, 0.9 or less, or 1.1 or more.

Fig. 11 schematically shows the shape of the umbrella.

In OSA patients, the shape of the umbilical cord (2) is in the form of a wine barrel or bell, through which OSA severity can be diagnosed.

As shown in Fig. 11 (a), the nipple 2 generally forms a hill that becomes narrower from the base to the tip.

However, as shown in Fig. 11 (b), the OSA patient does not narrow the width of the neck 2 while attaching the neck 2 to the base, but looks like a cylinder, Apparently.

Alternatively, as shown in Fig. 11 (c), there is a region where the middle width from the base of the nipple 2 is wider than that of the base, and the overall shape shows the shape of the wine reservoir.

Therefore, a weight can be given according to the shape of the nipple 2 described above.

As shown in Figs. 11 (a) and 11 (b), when the width of the base of the nipple 2 is a, the width of the point 3/4 between the base and the attachment is b, If the width is c, the weight is determined as follows.

If c / a> 0.9, the weight is 1; if b = c, the weight is 1; and if c> b, the weight is 2.

Fig. 12 schematically shows the shape of the nipple 2.

Patients with OSA have irregularities in the mucosa of the uvula (2), which can be used to diagnose OSA severity.

Referring to Fig. 12, in the case of normal, the tangent line (broken line) tangent to the surface of the mucous membrane attached from the base to the attached mucous membrane, like the right side of the nipple 2, has a uniform tendency to be smooth without inflection point.

However, in the case of an OSA patient, as in the case of the left side of the nape 2 shown in Fig. 12, the corrugation of the mucous membrane is formed on the side of the nape 2 and concave or convex protruding surfaces And an inflection point at which the directionality of the tangent line slope is changed when the tangent line is drawn along the uneven surface is observed.

Therefore, a weight can be given according to the number of inflection points observed in the umbrella 2.

If the number of inflection points observed in the umbilicus is 1, 2 or 3, 2 or 4 or more, the weight is determined. If the inflection point of the umbellate is lost due to severe mucosal irregularity of the umbilicus The weight of Edo 3 is determined.

Fig. 13 schematically shows the colors of the neck and the dogs.

Color change of the umbrella (2) appears in OSA patients. Specifically, the color of the umbrella (2) shows a distinct redness compared to the color of the study dog (1).

This suggests tissue damage due to repeated trauma and hypoxia caused by snoring, which can be diagnosed through the number of pixels and color information appearing in diagnostic images or photographs.

Specifically, if the average degree of redness in the neck part is higher than the average degree of redness in the study part, it can be judged as fever. For example, if the mean value of the color information corresponding to the red of the pixel corresponding to the neck portion is higher than the average value of the color information corresponding to the red portion of the pixel of the study portion, . In one embodiment, the color information corresponding to the red of the pixel may be represented by a value corresponding to R in the RGB color system.

In addition, when the standard deviation of the redness of the nipple area is large (for example, the edge of the nipple shows translucent color due to submucosal edema, but the central part shows redness) If the redness is high, the redness can be recognized as compared to the entire portion of the study dog (for example, the pixels with the upper 20% color information value corresponding to red).

For example, suppose that the information corresponding to the red color of each pixel in the color system of the image is the R value, the average R value of the pixel of the study part is R _SP , and the average R value of the pixel of the neck part is R _UV And the average R value of the upper 20% pixels of the R value of the _spot is defined as R _UV _-R . If R _UV / R _SP > 2, 2, R _UV If the standard deviation (SD) of the values is large (for example, SD of R _UV > 50) R _UV _-R / R _SP > 2, we can set the weight of 2.

In the normal case, the folding observed at the pharyngeal region shown in FIG. 13 is the folds of the anterior pillar portion and the two folds located at the posterior pillar portion.

However, in some severe OSA patients, the sequela also has vertical wrinkles (including mucosa and submucosal tissue) on the medial side of the strut.

Vertical wrinkles were observed at the vertical position biased to the inner side of the stalk (2) base width (the broken line in FIG. 13) in the inner side of the strut, and when these separate wrinkles were observed, Suggesting the possibility of severe OSA.

If only one side of the vertical wrinkle is observed on the left or right side, weight 1 can be applied if both sides are observed.

Next, a predetermined weight is calculated, and sleep apnea is diagnosed according to the calculation result (S30).

The diagnosis module 300 diagnoses sleep apnea according to the result of summing the weights determined by the determination module 200. The diagnosis module 300 can diagnose the degree of sleep apnea in stages by dividing the summed weights by stages.

For example, if the sum of the weights is less than 3, it is mild, and if it is 3 or more, the increase is 8 or more and 13 or less.

An example of the weights determined in the above-described finding determination module 200 is as follows: (1) there is edema of the study dog (1) (+1), the area ratio of the portion where the capillary is not identified (1.5), the wrinkles of the umbilical cord (2) are 2 (+1), the width and height ratio of the umbilical cord (2) is 1.8 (+1), the area of the posterior pharyngeal wall is 4 cm ² (0), the tongue 4 does not come in contact with the umbrella 2 (0), the area ratio of the right and left sides of the posterior stiffener is 1 (0) The sum of the result weights is 5.5, which leads to a moderate diagnosis.

The result of the diagnosis as described above can be output through the output module 400.

In addition, the present invention may be embodied as a program or an application stored in a storage medium such as a computer or a smart phone, and the configuration of which is performed in accordance with the diagnostic method described above, as described above .

According to the intraoral imaging-based obstructive sleep apnea diagnostic apparatus and diagnostic method according to the present invention, it is possible to perform early diagnosis of sleep apnea easily and reliably by analyzing the intraoral image as a simple constitution.

Although the preferred embodiments of the present invention have been described, the present invention is not limited to the specific embodiments described above. It will be apparent to those skilled in the art that numerous modifications and variations can be made in the present invention without departing from the spirit or scope of the appended claims. And equivalents should also be considered to be within the scope of the present invention.

(Description of reference numerals)

100: photographing module

200:

300: diagnostic module

400: Output module

Claims

A photographing module 100 for photographing an intraoral image;

A finding determination module (200) for determining the appearance of the intraoral image photographed by the imaging module (100) on a predetermined basis and determining a weight according to the determined findings; And

And a diagnosis module (300) for calculating weights determined by the above-mentioned finding determination module (200) and diagnosing sleep apnea according to the calculation result.

Oral imaging - based obstructive sleep apnea diagnostic device.
The method according to claim 1,

The finding determination module 200 determines a finding based on a preset reference image of each designated region of the taken intraoral image, sets a weight according to the determined finding,

Each of the designated sites described above comprises at least one of a soft palate, a uvula, a posterior pharyngeal wall, a tongue, and a posterior pillars.

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the predetermined reference is in accordance with a capillary sharpness of the ridge mucosa of the captured image,

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the predetermined criterion is based on a ratio of the total area of the nipples of the image taken and the area of the capillary not identified.

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the preset reference is based on the number of wrinkles of the nape mucosa of the image taken,

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the preset reference is based on a ratio of a length and a width of the nip of the captured image,

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the predetermined criterion is based on an area of the posterior pharyngeal wall of the captured image,

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the preset reference is based on whether or not the tongue of the captured image is in contact with the nipple.

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the preset reference is based on a ratio of left and right side areas of the posture of the captured image,

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the predetermined criterion is based on a ratio of a width of a predetermined point between the base and the base of the nipple and the attachment of the image of the captured image,

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the predetermined reference is based on the number of inflection points of a tangent line which is in contact with the surface of the eye of the captured image,

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the preset reference is based on a difference in color between the nipple of the image captured and the color of the study,

Oral imaging - based obstructive sleep apnea diagnostic device.
3. The method of claim 2,

Wherein the predetermined reference is based on the number of vertical wrinkles located on the inner side of the strut,

Oral imaging - based obstructive sleep apnea diagnostic device.
14. The method according to any one of claims 1 to 13,

The diagnosis module 300 diagnoses sleep apnea according to severity according to the calculation result,

Oral imaging - based obstructive sleep apnea diagnostic device.
(a) a step of taking an intraoral image;

(b) determining the appearance of the imaged oral cavity image based on a predetermined reference, and determining a weight according to the determined findings; And

(c) calculating a predetermined weight, and diagnosing sleep apnea according to the calculation result;

Oral imaging - based obstructive sleep apnea diagnosis.