台灣睡眠醫學學會 111年度會員大會暨20th學術研討會

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Welcome Message 邱國樑 (Kuo-Liang Chiu, MD, PhD) President of Taiwan Society of Sleep Medicine

 Director of Sleep Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation  Assistant Professor, College of Medicine, Tzu Chi University

這次年會是闊別兩年以來的第一場實體年會,希望各位會員都能歡喜參加這次的會議。學會也第一次安排 雙軌—實體及線上即時會議,讓一些無法實體與會的會員也能一起參與。疫情雖然仍未完全消除,但我們已 學會與他想處之道,謹祝諸位會員暨家人平安健康,並與我們一起邁向更美好的睡眠醫學進展。

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黃玉書 (Yu-Shu Huang) Chairman of Academic Committee

林口長庚醫院精神科主任及教授

各位與會嘉賓及本會全體會員大家好! 歡迎參加 2022 年台灣睡眠醫學學會年會。由於受到新冠肺炎 COVID-19 的影響,這幾年學會的年會及許 多會議均受到延宕或改為視訊。長達三年的防疫生活,終於在政府及全民努力防疫之下慢慢有一絲曙光。雖 然仍有變種病毒乘機竄出,但在全民努力之下,中央政府防疫政策最新公告,可以恢復實體上課及會議。當 然考量到今年年會實體與線上辦理的優缺點,以及 2~3 年來會員們缺乏年會的實體互動,今年理事長及理 監事們最後決定今年年會暨研討會以實體及線上方式並行,當然大會秘書處也會努力做好會議相關防疫措 施,讓參與的會員放心參加。 此外由於疫情,許多事務及整個世界似乎被停滯,但地球仍在運轉,生命仍需往前進,故此次年會仍大力邀 請多位國內外先進與會,並介紹睡眠醫學相關的新知識。也考慮到疫情對整個世界及科學界的影響,故今年 年會主題訂定為「Beyond Sleep Society」,讓全體會員能接受到更廣大的睡眠相關資訊,提供更寬廣的視 野與素養。 在疫情籠罩下,需因應許多的變動,讓今年的年會變得非常不一樣,但我們終究需突破現狀往前邁進,相信 大家的專業與智慧,定能平安順利度過這些挑戰而成長,也祝福每位會員平安健康,大會成功順利。

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Organizing Committee 台灣睡眠醫學學會 111 年度會員大會暨第二十屆學術研討會 籌備委員 主席 黃玉書:林口長庚醫院精神科主治醫師及主任

委員

(依年會節目表順序)

金韋志:林口長庚紀念醫院兒童心智科主治醫師 林育聖:桃園長庚內科部主任 劉文德:衛生福利部雙和醫院睡眠中心主任及胸腔內科主治醫師 張芳嘉:國立臺灣大學獸醫專業學院院長 林政輝:林口長庚紀念醫院睡眠中心及顱顏中心主治醫生 李佩玲:台大醫院睡眠中心主任 劉勝義:台灣睡眠醫學學會理事 陳濘宏:林口長庚紀念醫院胸腔內科主治醫師 徐崇堯:高雄醫學大學附設中和紀念醫院神經部主任 李立昂:長庚紀念醫院耳鼻喉部主治醫師

論文獎評審委員

(依姓氏筆劃排序)

毛衛中:振興醫院精神醫學部身心治療科及睡眠健康中心主任 李信謙:臺北醫學大學附設醫院精神科主治醫師 李學禹:長庚紀念醫院耳鼻喉部教授級主治醫師 周昆達:臺北榮民總醫院睡眠中心執行長 林政輝:林口長庚紀念醫院睡眠中心及顱顏中心主治醫生 金韋志:林口長庚紀念醫院兒童心智科主治醫師 楊建銘:國立政治大學心理學系教授 楊鈞百:光田綜合醫院神經內科及睡眠中心主任 蘇茂昌:高雄長庚紀念醫院睡眠中心主任

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Program

October 1 (Sat.)

Time / Room

Room 1001

Room 1002

12:00-14:00

Room 1003

Registration

13:50-14:00

[Opening Ceremony] President of TSSM (TSSM 邱國樑理事長致詞) (Room 1001)

14:00-14:50

[Keynote Lecture 1] A Biopsychosocial Approach to Sleep Offers Pathways Beyond Sleep Prof. Fiona H. Barwick PhD (Stanford, USA) Moderator: 楊建銘教授 (Room 1001)

Coffee Break and Poster Viewing

14:50-15:15 15:15-17:30

審查委員:李學禹醫師、楊建銘教授、毛衛中醫師

[Symposium 1] Cardiology and Sleep Medicine

[Symposium 2] Gastroenterology and Sleep Medicine

[Symposium 3] Circadian Clock and Sleep

Organizer: 林育聖醫師

Organizer: 劉文德醫師

Organizer / Moderator:

Moderators:

Moderator: 李學禹醫師

張芳嘉教授

15:15-15:40

15:15-15:35

陳濘宏醫師 / 杭良文醫師 (Sponsored by ResMed)

(1) 15:15-15:40

15:15-15:35

Heart and Sleep from Clinic to Study: A Cardiologist View 林育聖醫師

Sleep Apnea and Gastroesophageal Reflux Disease: Literature Review, Clinical Experience and Community Survey 李信謙醫師

(2) 15:40-16:05

15:35-15:55

15:40-16:05

Central Sleep Apnea in Patients with Heart Failure

The Role of Neurogenic Inflammation in Obstructive Sleep Apnea

莊立邦醫師

劉文德醫師

Circadian Transcription Factor BMAL1 and RNABinding Protein MEX3A Co-Regulate Lgr5+ Stem Cells and Stress Response in the Intestine 黃雯華研究員 15:35-15:55

Family Members Additively Repress the Ectopic Expression of BASIC PENTACYSTEINE3 to Prevent Disorders in Arabidopsis Vegetative Development 蔡皇龍教授

(3) 16:05-16:30

15:55-16:15

Atherosclerosis and Circadian Rhythm 王朝永醫師

16:05-16:30

Sleep Endoscopy 陳美娟醫師

15:55-16:15

Using Two Photon and Endoscope to Observe Light Responsive Cells in the Suprachiasmatic Nucleus in Mouse 陳示國教授

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October 1 (Sat.) Time / Room

Room 1001

Room 1002

(4)

16:15-16:35

16:30-16:55

16:15-16:35

16:30-16:55

Clinical Cardiovascular Disease Applications of Longterm Physiological Data Recorded by Wearables

Current Theory and Literature Review of Gastroesophageal Reflux and Dysphagia in Sleep Disorders

Deciphering UbiquitinMediated Regulation in Plant Circadian Clock

林澂教授

盧柏文醫師

(5)

16:35-17:00

16:55-17:10

16:35-16:55

16:55-17:10

Streamline the Diagnosis and Integrated Care for CVD Patients with OSA – Singapore Experiences

Q and A

Transcriptional Repression by Cryptochrome in the Absence of Period

Prof. LEE Chi-Hang, Ronald 17:00-17:20

Q and A

Room 1003

李金美教授

邱奕穎教授 16:55-17:15

Coordinated Timing among Multiple Circadian Clocks 明智煥教授

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October 2 (Sun.) Time / Room

Room 1001

Room 1002

08:00-09:00

Room 1003

Registration (Poster Viewing) 審查委員:李學禹醫師、楊建銘教授、毛衛中醫師

09:00-10:00

[Keynote Lecture 2] Management of Cardiovascular Disease in Patients with Sleep Apnea: A Case-Based Review of Personalized Treatment Prof. Michael D. Faulx (CCLCM, USA) Moderator: 陳濘宏醫師 (Room 1001)

10:00-10:20 10:20-12:10

Coffee Break and Poster Viewing [Symposium 4] Maxillomandibular Advancement (MMA) for Obstructive Sleep Apnea (OSA) Organizer / Moderator:

[Symposium 5] Sleep-Heart Interaction: Phenotyping and Personalized Treatment in OSA Patients with Cardiovascular Diseases

林政輝醫師

Organize: 李佩玲醫師

[Technologist Training] 技師教育訓練 Organizer:劉勝義理事 Moderator:林嘉謨醫師

Moderators: 侯嘉殷理事長 (TSOC) / 王鶴健理事長 (TSPCCM)

(1) 10:20-10:45

10:20-10:55

10:20-10:40

10:20-10:45

Maxillomandibular Advancement for OSA: Felonies and Misdemeanors

Obstructive Sleep Apnea Phenotype and Cardiovascular Disease: Example of Atrial Fibrillation

The AASM Troubleshooting Guidelines

Kasey Li, DDS, MD

劉勝義技師

李佩玲醫師 (TSSM)

(2) 10:45-11:10

10:55-11:30

10:40-11:00

10:45-11:10

Surgical-Orthodontic Treatment of Obstructive Sleep Apnea Using Surgery-First Approach

The Prevalence, Screen, Diagnosis and Treatment of Obstructive Sleep Apnea in Hypertension Population

睡眠圖譜呼吸事件判讀

廖郁芳醫師

林文貴技師

黃群耀醫師 (TSOC)

(3) 11:10-11-35

11:30-12-05

11:00-11-20

11:10-11-35

MMA for OSA: An Orthodontic-First Approach

Sleep-Heart Interaction: Heart Failure

高山睡眠

曾于娟醫師

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吳彥雯醫師 (TSOC)

曾俊賢技師


October 2 (Sun.) Time / Room

Room 1001

(4) 11:35-12:00

Room 1002

Room 1003

12:05-12:10

11:20-11:40

Q and A

Obstructive Sleep Apnea and Pulmonary Hypertension

11:35-12:00

Manual PAP Titration in Sleep Lab: Focus on the Aspect of BIPAP and ASV Titration

劉景隆醫師 (TSPCCM)

林煜傑技師

11:40-12:10

12:00-12:10

Panel Discussion

Q and A

(5) 12:00-12:10

會員大會

12:10-12:30

(Room 1001)

12:35-13:35

[Keynote Lecture 3] ECG and Heart Rate Use in the Diagnosis of Sleep and Sleep Disorders Prof. Thomas Penzel (Charite University Hospital, Germany) Moderator:邱國樑理事長 (Room 1001)

[Lunch Symposium] Lemborexant, Novel DORA for Insomnia Treatment and RealWorld Experience Sharing 陳田育醫師 Moderator: 李信謙醫師 (Sponsored by Eisai)

13:40-15:20

[Symposium 6] Neurology and Sleep

[Symposium 7] Microbiota and Sleep

Organizer / Moderator:

Organizer: 李立昂醫師

徐崇堯醫師

Moderators: 郭博昭教授 / 康焜泰醫師

(1) 13:40-14:05 (2) 14:05-14:30 (3) 14:30-14:55

Restless Legs Syndrome: An Update

New Era in Microbiota Technology

李穎昇醫師

周士軒博士

Epilepsy and Sleep

Gut Microbiota and Sleep Disorder

葉威志醫師

李立昂醫師

Obstructive Sleep Apnea and Stroke

Tonsil Microbiome among Obstructive Sleep Apnea Children across Intermittent Hypoxemia and Body Weight Status

林煥然醫師

莊海華醫師

(4) 14:55-15:20 15:20-15:35

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REM Sleep Behavior Disorder (RBD)

Probiotics and Insomnia

詹博棋醫師

楊靜修教授

Coffee Break


October 2 (Sun.) Time / Room

Room 1001

Room 1002

15:35-17:00

[Oral Presentation A]

[Oral Presentation B]

Moderator: 周昆達醫師

Moderator: 楊鈞百醫師

審查委員:周昆達醫師、

審查委員:楊鈞百醫師、

林政輝醫師、蘇茂昌醫師

金韋志醫師、李信謙醫師

Respiratory Arousal in Patients with Very Severe Obstructive Sleep Apnea and How It Changes after a NonFramework Surgery

The Impact of Unexpected SleepDisordered Breathing on Patients with Newly Diagnosis Generalized Anxiety Disorder: A CaseControl Study in Taiwan

(1) 15:35-15:50

黃怡舜

陳田育

(2) 15:50-16:05

Diagnosis of Obstructive Sleep Apnea in Dysphonia Patients: Role of Laryngopharyngeal Reflux

腹側海馬迴之恐懼記憶影響 小鼠睡眠 蕭逸澤

張智惠

(3) 16:05-16:20

The Impact of Continuous Positive Airway Pressure on Blood Pressure in Patients with Ischemic Stroke and Obstructive Sleep Apnea

實施睡眠衛生教育與學童睡 眠品質、情緒管理相關研究 彭志業

趙中豪

(4) 16:20-16:35

Possible Treatment to Epiglottic Collapse in OSA Patients: What Did Drug Induced Sleep Endoscopy Tell Us?

全自動大鼠判期程式設計並 應用於分辨 WKY 與 SHR 丁彥

陳玉霖

16:40-17:00

頒獎 Award and Closing Ceremony

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Room 1003


Speaker and Abstract

October 1 (Sat.)

14:00-14:50 Room 1001

Keynote Lecture 1 MODERATOR

楊建銘 (Chien-Ming Yang) Position Professor

Affiliation Department of Psychology, National Chengchi University

Research Interests Clinical Psychology, Health Psychology, Behavioral Sleep Medicine, Insomnia, CBT-I

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October 1 (Sat.)

14:00-14:50 Room 1001

Keynote Lecture 1 SPEAKER

“A Biopsychosocial Approach to Sleep Offers Pathways Beyond Sleep” Fiona Barwick, PhD, DBMS

Position 

Clinical Associate Professor

Associate Division Chief – Behavioral Sleep Medicine

Director – Sleep and Circadian Health Postdoctoral Fellowship Program

Affiliation Department of Psychiatry and Behavioral Sciences – Sleep Division Stanford School of Medicine

Research Interests Cultural adaptation of cognitive behavioral therapy for insomnia (CBT-I) and integration of the biopsychosocial model as a framework for CBT-I when treating sleep problems that co-occur with psychiatric conditions (major depression, bipolar disorder, OCD, PTSD) and medical conditions (POTS, chronic pain or fatigue, TBI, Multiple Sclerosis, Parkinson’s).

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Abstract The biopsychosocial model offers a rich framework from which to address the many factors that can affect sleep, especially when sleep problems occur in the context of psychiatric or medical disorders. Using this framework to guide case conceptualization and treatment decisions can open up new perspectives for both patient and clinician, and can expand successful outcomes beyond the treatment of the sleep disturbance itself. This presentation will explain how behavioral sleep medicine incorporates a biopsychosocial model when treating disorders like insomnia, delayed sleep phase, and sleep apnea. It will provide research studies and case examples to illustrate how this approach to treating sleep problems can lead to unexpected outcomes, including benefits to mental, emotional and physical health, and will suggest mechanistic pathways that might contribute to these outcomes.

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October 1 (Sat.) Cardiology and Sleep Medicine MODERATOR

陳濘宏 (Ning-Hung Chen) Position Professor

Affiliation Chang Gung Memorial Hospital

Research Interests Sleep Medicine

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15:15-17:30 Room 1001


15:15-17:30

October 1 (Sat.)

Room 1001

Cardiology and Sleep Medicine MODERATOR

杭良文 (Liang-Wen Hang) Position 1. 2.

Professor Chief of Sleep Medicine Center

Affiliation 1. 2.

School of Nursing & Graduate Institute of Nursing China Medical University China Medical University Hospital

Research Interests 1. 2.

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Sleep Medicine Airway disease , Respiratory Care、Respiratory Therapy


October 1 (Sat.)

15:15-17:30 Room 1001

Cardiology and Sleep Medicine SPEAKER

“Heart and Sleep from Clinic to Study: A Cardiologist View” 林育聖 (Yu-Sheng Lin)

Position 桃園長庚醫院內科副教授

Affiliation 桃園長庚醫院內科科系主任

Research Interests Clinical and Preventive Cardiology Sleep Medicine

Abstract 睡眠佔據人生 1/3 的時間,而心血管疾病例如高血壓、心肌梗塞、中風…等等則是縮短生命的主要疾病。睡 眠品質的好壞與睡眠疾病與否不僅僅是影響到日常生活作息進一步也會影響到重要的心血管疾病!從過去 20 年來的研究包括 Wisconsin Sleep Cohort study、 Heart Health cohort Study、The Busselton Health study 可以發現睡眠的異常與疾病尤其是睡眠呼吸中止症會導致高血壓、心律不整甚至心肌梗塞、中風等的 重大疾病,而台灣本土的資料也同樣證實了睡眠呼吸中止症的個案容易發生重大心血管事件包括中風、心 房顫動、心臟衰竭等提醒我們不是只有治療清醒的個案更需要重視睡眠異常的病患!

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October 1 (Sat.)

15:15-17:30 Room 1001

Cardiology and Sleep Medicine SPEAKER

“Central Sleep Apnea in Patients with Heart Failure” 莊立邦 (Li-Pang Chuang)

Position Chief1, Attending Physician2, Assistant Professor3

Affiliation 1. Department of Sleep Center, Chang Gung Memorial Hospital, Linkou, Taiwan 2. Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan 3. Department of Medicine, Chang Gung University, Taoyuan, Taiwan

Research Interests Sleep Disordered Breathing Intermittent Hypoxia Cell Model and Animal Model

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Abstract 對比阻塞型睡眠呼吸中止症,中樞型睡眠呼吸中止(CSA)一般較少見;比較為人熟知的原因包括某些藥物引 起,如鴉片類藥物, 心臟衰竭, 以及大腦的疾病或傷害, 例如中風、腦瘤等等。 在 CSA 發生的情況下,呼吸道實際上並沒有阻塞, 但是因為沒有呼吸驅力所以空氣停止流向肺部。這主要 是因為大腦和身體之間的溝通出了問題, 所以呼吸的動作停止了。那些有 CSA 的人並不經常打鼾, 所以這 種情況有時會被忽視。值得注意的是,在心臟衰竭的情況下,CSA 是非常頻繁的, 超過 1/4 的患者會被影 響,特別是左心射出分壓低的心臟衰竭病患。CSA 在心臟衰竭的病人身上有一個特別的呼吸模式,被稱為 陳施氏呼吸(CSR)。這是一個不正常、在加快的呼吸及暫停的呼吸之間形成一個迴圈式的呼吸模式。 本次的演講主要著重在探討心衰竭病患的中樞型呼吸中止症之關連性、致病機轉及可能的治療方法。並且 也深入到其相關的生物指標(bio-makers)及應用。

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October 1 (Sat.)

15:15-17:30 Room 1001

Cardiology and Sleep Medicine SPEAKER

“Circadian Rhythm and Cardiovascular Diseases” 王朝永 (Chao-Yung Wang)

Position 林口長庚心臟科教授

Affiliation 林口長庚心臟科 長庚大學 國家衛生研究院 副研究員

Research Interests Circadian rhythm, Obesity, and Aging Clonal Hematopoiesis of indeterminate potential

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Abstract The day and night cycle is based on the rotation of the Earth on its axis. The circadian rhythm, driven by molecular clocks and external cues, connects the environmental changes to endogenous physiological function, behavior activities, and organ homeostasis, including the cardiovascular system. Disrupting the circadian rhythm due to shift work, long-distance traveling, or genetic variations can lead to obesity, aging, and atherosclerosis. Experimental evidence and clinical trials both suggest that circadian rhythm disruption results in disruption of cardiovascular physiology and malalignment of multiple cellular functions. Genetic deletion of several circadian genes or shift works all result in increased cardiovascular disease incidences, worsening outcomes, and higher mortality. The interactions of circadian rhythm and the cardiovascular system are comprehensive, including atherosclerosis, endothelial function, heart failure, arrhythmia, and blood pressure control. In this talk, we will examine the detailed links between circadian rhythm and cardiovascular diseases.

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October 1 (Sat.)

15:15-17:30 Room 1001

Cardiology and Sleep Medicine SPEAKER

“Clinical Applications of Long-Term Physiological Data Recorded by Wearables in Patients with Cardiovascular Diseases Comorbid with OSA” 林澂 (Chen Lin)

Position Associate Professor

Affiliation Department of Biomedical Sciences and Engineering, National Central University

Research Interests 1.

Physiological Signal Analysis and translational researches

2.

Real-World Applications of portable and wearable medical devices

3.

Sleep Medicine

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Abstract There is growing attention on the interactions between sleep disorders and cardiovascular diseases. Considerable progress has been made regarding the associated risk of adverse events in patients with cardiovascular diseases comorbid with obstructive sleep apnea (OSA) and how OSA treatment can improve the prognosis of cardiovascular diseases. Although the underlying mechanisms or links have not been fully understood, portable home sleep apnea testing devices or wearables made long-term or followup monitoring of the severity of OSA or treatment possible, and important physiological mechanisms linked between cardiovascular diseases and OSA can be explored. This talk will introduce commonly used portable/wearable devices and how to derive meaningful physiological biomarkers in patients with cardiovascular diseases by long-term or continuous recorded data. In addition, potential applications of those biomarkers in those patients comorbid with OSA will be discussed.

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October 1 (Sat.)

15:15-17:30 Room 1001

Cardiology and Sleep Medicine SPEAKER

“Streamline the diagnosis and integrated care for CVD patients with OSA – Singapore Experiences” Prof. LEE Chi-Hang, Ronald

Position Professor of Medicine, National University of Singapore, Singapore Senior Consultant Cardiologist, National University Heart Centre, Singapore

Affiliation MBBS, MD, MRCP (UK), FRCP (Edin), FHKCP, FHKAM (Medicine), FAMS, FACC, FSCAI

Research Interests Sleep health and heart disease

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Abstract Obstructive sleep apnea (OSA) is strongly associated with cardiovascular disease (CVD), including hypertension, stroke, heart failure, coronary artery disease, and atrial fibrillation (AF). Studies have shown a worse prognosis for CVD patients with OSA. During a sleep apnea event, the tongue and the airway's muscles relax and collapse, resulting in obstructed airflow to the lungs. Lapses in breathing typically last between 10 to 20 seconds but can last for 30 seconds or even longer and repeatedly occur during the night. When breathing stops, oxygen levels in the blood drop. Our bodies respond by releasing the stress hormone epinephrine, more commonly known as adrenaline. This "fight or flight" response elevates the heart rate and can lead to high blood pressure. Overall, heart function decreases because it becomes less efficient at pumping blood, and the heart itself is affected because of the pressure changes taking place in the chest. Not only the clinical consequences but also the economic costs of untreated OSA, the CVD patients with OSA are predominantly middle-aged and overweight males, which represents the economically productive middle-aged segment. In this lecture, Prof Ronald will be discussing the clinical approach in Singapore including advocating for more effective screening, evaluation, and management of suspected OSA in patients with CVD.

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October 1 (Sat.)

15:15-17:30 Room 1002

Gastroenterology and Sleep Medicine MODERATOR

李學禹 (Hsueh-Yu Li) Position Professor

Affiliation Departments of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital

Research Interests Sleep surgery, Obstructive Sleep Apnea

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October 1 (Sat.)

15:15-17:30 Room 1002

Gastroenterology and Sleep Medicine SPEAKER

“Sleep Apnea and Gastroesophageal Reflux Disease: Literature Review, Clinical Experience and Community Survey” 李信謙 (Hsin-Chien Lee)

Position Visiting Staff & Chair

Affiliation Department of Psychiatry & Sleep Center, Taipei Medical University Hospital

Research Interests Psychiatry, Sleep Medicine, Public Health

Abstract Lines of evidence indicate a significant association between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD). This talk will briefly introduce current understandings about the relationship between OSA and GERD. Data from a clinical database and community survey will also be presented.

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October 1 (Sat.)

15:15-17:30 Room 1002

Gastroenterology and Sleep Medicine SPEAKER

“The Role of Neurogenic Inflammation in Obstructive Sleep Apnea” 劉文德 (Wen-Te Liu)

Position 1.

Director, Sleep Center of Shuang Ho Hospital, Taipei Medical University

2.

Associate Professor, School of Respiratory Therapy, College of Medicine, Taipei Medical University

3.

Director, Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University

4.

Attending Physician, Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University

Affiliation 1.

School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 11052, Taiwan

2.

Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan

Research Interests Sleep medicine, Obstructive sleep apnea, Artificial intelligence in medicine, pulmonary medicine

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Abstract As we know, craniofacial abnormality and obesity, the kind of anatomical factors, are essential to cause obstructive sleep apnea (OSA). However, studies have also found that chronic rhinitis, sinusitis, and gastroesophageal reflux, are also prone to inflammation of the upper airway leading to congestion and swelling to deteriorate the severity of OSA. In recent years, research on gastroesophageal reflux disease (GERD) and non-allergic rhinitis found associations between some cellular receptors and these disorders. Activating one of the cellular receptors, transient receptor potential cation channel, subfamily V, member 1 (TRPV1) will cause an inflammatory response of the upper airway and esophagus, which is a phenomenon of neurogenic inflammation. The patients will develop symptoms such as runny nose, cough, and acid regurgitation that also cause the deterioration of OSA. Some evidence suggests that patients with erosive esophagitis had increased mRNA performance of TRPV1 on their esophageal mucosa. Besides, the severity of related respiratory inflammation and gastroesophageal reflux will improve if treated with an antagonist against TRPV1. Therefore, these clinical features of GERD, rhinitis and the associated upper airway inflammation are neurogenic inflammation, which is an essential factor leading to OSA. We need further research to approach the role of neurogenic inflammation in the upper airway to figure out the pathogenesis and other treatment strategies.

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October 1 (Sat.)

15:15-17:30 Room 1002

Gastroenterology and Sleep Medicine SPEAKER

“Sleep Endoscopy” 陳美娟 (Mei-Chuan Chen)

Position 胸腔內科主治醫師

Affiliation 臺北醫學大學附設醫院

Research Interests Airway disease, allergic disease

Abstract Sleep-related breathing disorders are complex problems. OSA is one of the major sleep problems not only in elderly but also in the younger patients. It is associated with marked comorbidity and mortality. Till now, mainstay of treatment for OSA is CPAP which is noted for poor compliance in most of the patients. Sleep endoscopy is one of the studies to know the obstruction site in the OSA patients. With precise site, the treatment of the OSA can be individualized and personalized.

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October 1 (Sat.)

15:15-17:30 Room 1002

Gastroenterology and Sleep Medicine SPEAKER

“Current Theory and Literature Review of Gastroesophageal Reflux and Dysphagia in Sleep Disorders” 盧柏文 (Po-Wen Lu)

Position Attending Physician of Gastroenterology Department of Shuanghe Hospital

Affiliation 1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taiwan. No.291, Zhongzheng Rd., Zhonghe, Taipei 23561, Taiwan, ROC 2. Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei 11052, Taiwan, ROC

Research Interests 1. Gastrointestinal motility and functional diseases. 2. Development of endoscopic hemostatic devices and materials. 3. Research on the diagnosis and treatment of pylori.

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Abstract Gastroesophageal reflux (GERD) is associated with ENT disorders and symptoms and is another risk factor for obstructive sleep apnea syndrome (OSAS). Gastric emptying during sleep was delayed, esophageal clearance was significantly delayed, and upper esophageal sphincter pressure was significantly reduced. Studies have linked OSAS with a high frequency of GERD, resulting from increased intrathoracic pressure, further contributing to acid reflux episodes. Severe progression of OSAS also promotes acid reflux, leading to inflammation and even obstruction of the upper airways. In numerous studies over the past decade, continuous positive airway pressure (CPAP) therapy has been found to improve sleep quality in patients with OSAHS and has been shown to improve reflux. And a recent meta-analysis evaluating the evidence for the relationship between hydrogen ion pump inhibitor (PPI) therapy (GERD) and improvement in obstructive sleep apnea (OSA) found that this approach may improve nighttime sleep quality. In addition, more studies are using polysomnography to record apnea index and 24-hour pH monitoring to record the frequency of acid reflux and GERD in OSAS patients; additionally, GERD symptoms are also associated with worsening sleep quality.

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October 1 (Sat.)

15:15-17:30 Room 1003

Circadian Clock and Sleep MODERATOR

張芳嘉 (Fang-Chia Chang) Position Dean / Professor

Affiliation School of Veterinary Medicine, National Taiwan University

Research Interests Sleep Physiology, Sleep Medicine, Neurophysiology, Neuropharmacology

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October 1 (Sat.)

15:15-17:30 Room 1003

Circadian Clock and Sleep SPEAKER

“Circadian Transcription Factor BMAL1 and RNA-Binding Protein MEX3A CoRegulate Lgr5+ Stem Cells and Stress Response in the Intestine” 黃雯華 (Wendy W. Hwang-Verslues)

Position Assistant Research Fellow

Affiliation Genomics Research Center, Academia Sinica

Research Interests Wendy Hwang-Verslues is using cell-based and mouse models to investigate the interplay between cancer and circadian rhythms/core clock genes. She aims to understand how disruption of circadian rhythm or dysregulation of core clock genes influences cancer initiation and progression. She wants to mechanistically link circadian regulation to cancer development to provide new strategies or targets for disease prevention and treatment.

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Abstract Rapidly dividing intestinal stem cells (ISCs) are sensitive to chemotherapeutic agents, such as 5-fluorouracil (5-FU). Drug delivery at different times of day can change 5-FU toxicity; however, the underlying mechanism is unclear. We found that fast proliferating LGR5+ crypt base columnar (CBC) cells required for intestinal homeostasis are controlled by the circadian clock transcription factor BMAL1 and the BMAL1regulated RNA-binding protein MEX3A. BMAL1 directly activates Lgr5 transcription and MEX3A posttranscriptionally controls Lgr5 mRNA stability. Timing of 5-FU delivery when crypt cells had high BMAL1 and low Lgr5 protected ISCs from apoptosis. BMAL1 is critical for intestinal homeostasis and stress response as Bmal1 knockout in LGR5+ CBCs reduced MEX3A expression, decreased CBC numbers, and made ISCs more sensitive to 5-FU-induced apoptosis. Together, these findings demonstrate the central role of BMAL1 in ISC homeostasis and provide a biological explanation for chronotherapeutic chemoprotection.

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October 1 (Sat.)

15:15-17:30 Room 1003

Circadian Clock and Sleep SPEAKER

“BASIC PENTACYSTIENEs, PlantSpecific GAGA-Binding Factors, Constitute a Regulatory Gene Network for Tuning Plant Circadian Clock” 蔡皇龍 (Huang-Lung Tsai)

Position Assistant Professor

Affiliation Institute of Molecular and Cellular Biology, National Taiwan University

Research Interests Most of organisms on the earth evolve circadian clocks to control the oscillations of multiple physiological pathways in sync with the ~24-h period, upon the day-night cycles resulted from the earth rotation, such oscillations are called “circadian rhythms. Besides the predictable day-night and seasonal cycles, plants are sessile in circumstances with numerous unpredictable transient changes during their growth and development. The rhythmicity of the “circadian clock” profoundly keeps plants on the track without over reacting to the random cues, therefore sustains propagating on an optimal season time. The circadian clock comprises genes tightly interlocked in regulatory feedback loops, in other words, clock related genes are directly or indirectly regulated by their downstream genes. Such regulatory feedback loops make genes peak at a specific time of the day and oscillate according to the external cues like light and temperature

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through the day-night cycles. In the model plant, Arabidopsis, LIGHT-REGULATED WD1 (LWD1) plays a role in the morning activation of circadian clock. The five WD repeats of LWD1 form a propeller structure and serve as a protein-protein interaction platform. In our previous study, we have revealed that LWDs form co-activator protein complexes with specific TCP members to directly activate the expression of morning gene CCA1, thus, secure the normal operation of the circadian clock at dawn. However, expressions of several clock genes in the lwd1 lwd2 double mutant don't obey the interlocking gene circuits, e.g. genes and their repressors are down regulated simultaneously when lacking LWDs. This indicates that our knowledge of the circadian clock is not thorough. To investigate the regulatory mechanism of circadian clock, we will use LWD1 as bait to identify transcription factors with similar transcription trends through a plenty of transcriptomes. We will reveal the molecular mechanism of the circadian clock operation via the study of the LWD1 co-expressed transcription factors. Our study would unravel multifaceted connections between circadian clock and plant developmental processes.

Abstract BASIC PENTACYSTEINE (BPC) family members are plant-specific GAGA-motif binding factors (GAFs) controlling multiple developmental processes of growth and propagation. BPCs recruit histone remodeling factors of repressive complexes involving in the transcriptional repression of downstream targets. Under day-night cycles, we found multiple BPC members are transcriptionally co-expressed with LIGHTREGULATED WD1 (LWD1), which encodes a co-activator for the activation of central clock gene, CIRCADIAN CLOCK ASSOCIATED1 (CCA1). The co-expression between BPCs and LWDs prompted us to investigate the role of BPCs in the circadian regulation. We revealed that BPC3, a member antagonized by the functional overlap of other BPCs in vegetative tissues aboveground, is ectopically expressed in the quadruple mutant of bpc1-1 bpc2 bpc4 bpc6. The ectopic BPC3 suppresses multiple clock genes including CCA1 in the mutant and the clock oscillation is therefore phase-delayed. Consequently, the expression peak of CONSTANS (CO) is delayed and the day-time CO level is insufficient to activate the expression of FLOWERING LOCUS T (FT). Intriguingly, even FT expression is obliterated, the mutant is still early-flowered due to that the ectopic BPC3 simultaneously suppresses the main floral repressor FLOWERING LOCUS C (FLC) of the autonomous pathway through direct binding to the FLC promoter. Taken together, our study reveals plant-specific GAFs tune the photoperiodic and autonomous floral promotion pathways concurrently to control the vegetative-to-reproductive transition.

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October 1 (Sat.)

15:15-17:30 Room 1003

Circadian Clock and Sleep SPEAKER

“Using Two Photon and Endoscope to Observe Light Responsive Cells in the Suprachiasmatic Nucleus in Mouse” 陳示國 (Shih-Kuo Chen)

Position Professor

Affiliation Department of Life Science, National Taiwan University

Research Interests Intrinsic photosensitive retinal ganglion cells Circadian photoentrainment In vivo calcium image in mice

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Abstract For circadian clock, one of the major criteria is that this clock can be entrained by external cycle. In mammal, the strongest external environmental cue to entrain the central clock at the suprachiasmatic nucleus (SCN) is light dark cycle. To convey light information for photoentrainment, a specific group of intrinsically photosensitive retinal ganglion cells (ipRGCs) which express photopigment melanopsin, is essential. After light exposure, ipRGC could release glutamate and PACAP directly through their axonal terminal in the SCN to advance or delay the clock depends on the circadian time of the animal. Since the SCN is located at the bottom of the hypothalamus, how does light input trigger the neuronal response in individual SCN neuron remain unclear. Here, using two photon microscope with GRIN lens, we could record activity of SCN neurons using GCaMP reporter. By analyze the calcium response of SCN neurons, we found that SCN neurons have distinct light response. In addition, the activity correlation analysis suggests that the connection circuit is different at distinct ZT time point. Together, our results suggest that the SCN is composed of a dynamic functional circuit. SCN neurons may not form a strong and stable connection throughout the day. Therefore, a flexible populational coding may be utilized for circadian time keeping.

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October 1 (Sat.)

15:15-17:30 Room 1003

Circadian Clock and Sleep SPEAKER

“Deciphering Ubiquitin-Mediated Regulation in Plant Circadian Clock” 李金美 (Chin-Mei Lee)

Position Assistant Professor

Affiliation Institute of Plant Biology Global Agriculture Technology and Genomic Science Master Program National Taiwan University

Research Interests Plant circadian clock, protein ubiquitination, plant temperature responses, alternative splicing

37


Abstract The circadian clock regulates approximately 24-hour rhythmicity of biological pathways to optimize organisms’ responses to the environment and thus increase their fitness. In plants, the clock governs growth, development, and stress resilience, and therefore biomass and quality of crops. The central theme driving the rhythms of the circadian clock across all kingdoms is transcription-translation feedback regulation accompanied by post-translational modifications. Protein ubiquitination mediated by E3 ubiquitin ligase (E3) and degradation by 26S proteasome has emerged as a conserved regulatory pathway in clock progression. However, due to the instabilities of the complex of E3 and its substrates, it remains largely unrevealed. We have developed an E3 ubiquitin ligase decoy strategy to stabilize the E3-substrate complex and overcome the challenge. This strategy was applied to co-immunoprecipitation to uncover the interactors and molecular mechanism of ZEITLUPE E3 ubiquitin ligases in regulating light inputs into the central circadian clock. We also utilized the E3 decoy strategy to establish an Arabidopsis E3 decoy library, which consists of around 25% of E3 in the Arabidopsis genome. We further set up a high-throughput yeast twohybrid yeast screen platform to study the E3-clock regulators’ interacting network to gain a systematical view of the circadian clock and clock-regulated pathways in plants.

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October 1 (Sat.)

15:15-17:30 Room 1003

Circadian Clock and Sleep SPEAKER

“Transcriptional Repression by Cryptochrome in the Absence of Period” 邱奕穎 (Yi-Ying Chiou)

Position Assistant Professor

Affiliation Graduate Institute of Biochemistry, National Chung Hsing University, Taichung City, Taiwan

Research Interests Molecular mechanisms of the mammalian circadian clock Regulation and functional characterization of Photolyase/Cryptochrome families Transactional regulation with other biological events (DNA damage, Repair, Circadian Rhythm)

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Abstract Circadian rhythm is a physiological mechanism with daily periodicity to adapt to the daily environmental changes. Regulation of circadian rhythm affect behavior (sleep-wake cycle) and other physiological functions. The molecular mechanism of circadian regulation is through the transcription-translation feedback loop. Cryptochrome protein (CRY) and Period protein (PER) play a negative feedback function in the mammalian system. CRY and PER could interact with each other. Thus, they were considered to regulate circadian rhythm as a heterodimer. However, the ratio of CRY and PER proteins are different at different times of the day, suggesting the existence of their independent functions. This talk will focus on introducing the mammalian transcription-translation feedback loop and discuss the independent function of CRY in transcriptional repression based on the research results from in celluo biochemical system in the lab.

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October 1 (Sat.)

15:15-17:30 Room 1003

Circadian Clock and Sleep SPEAKER

“Coordinated Timing among Multiple Circadian Clocks” 明智煥 (Jihwan Myung)

Position Assistant Professor

Affiliation Graduate Institute of Mind, Brain and Consciousness (GIMBC), Taipei Medical University

Research Interests Circadian biology

Abstract A spontaneous organization of clock network emerges via communication among cellular circadian oscillators. The organization of clock phases is comparable to network memory in the sense that the pattern is retained and is plastic subject to the photoperiodic light condition and the developmental stage. This pattern of coordinated timing, which we call the phase organization, can be understood as encoded memory of a daylength. Both the mechanism and function of the phase organization remain unknown, but a simple and elegant mathematical description of its formation can be achieved if we allow “negative” coupling among phase oscillators.

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October 2 (Sun.)

09:00-10:00 Room 1001

Keynote Lecture 2 MODERATOR

陳濘宏 (Ning-Hung Chen) Position Director, Department Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital Director, Sleep Center, Chang Gung Memorial Hospital

Affiliation Chang Gung Memorial Hospital

Email ninghung@yahoo.com.tw

Research Interests Sleep Medicine Pulmonary Medicine Tuberculosis: diagnosis, immunology and vaccination

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October 2 (Sun.)

9:00-10:00 Room 1001

Keynote Lecture 2 SPEAKER

“Management of Cardiovascular Disease in Patients with Sleep Apnea: A Case-Based Review of Personalized Treatment” Prof. Michael D. Faulx

Position Associate Professor of Medicine1 Staff Clinical Cardiologist2

Affiliation 1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University 2. Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland, Ohio, USA

Research Interests 

Sleep apnea and cardiovascular disease

Stress-induced (Takotsubo) cardiomyopathy

Medical education

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Abstract Since the time of my cardiology fellowship I have had an interest in the interaction between sleep apnea and cardiovascular disease. I believe that all cardiologists need to have a better awareness of the impact of unrecognized sleep apnea on the patients they see because sleep apnea is endemic in all areas of cardiovascular medicine. Although a clear consensus regarding the best way to integrate the diagnosis and treatment of sleep apnea into cardiovascular practice is lacking, I believe that current data support routine screening for sleep apnea in patients with cardiovascular disease and provide the basis for practical treatment and management recommendations. I am optimistic that future well-designed prospective trials of sleep apnea management and diagnosis in cardiovascular disease are just around the corner and should provide a stronger evidence-base to base treatment recommendations on. My presentation covers my approach to the diagnosis and management of sleep apnea in patients with different cardiovascular conditions.

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October 2 (Sun.)

10:20-12:10

Maxillomandibular Advancement (MMA) for Obstructive Sleep Apnea (OSA) MODERATOR

林政輝 (Cheng-Hui Lin) Position Associate Professor & Director, Craniofacial Center

Affiliation Chang Gung Memorial Hospital, Toayuan, Taiwan

Email Clementlin0614@yahoo.com

Research Interests Craniofaicial Development, OSA surgery

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Room 1001


October 2 (Sun.)

10:20-12:10 Room 1001

Maxillomandibular Advancement (MMA) for Obstructive Sleep Apnea (OSA) SPEAKER

“Maxillomandibular Advancement for OSA: Felonies and Misdemeanors” Kasey Li, DDS, MD

Position Director

Affiliation Sleep Apnea Surgery Center

Research Interests Surgical treatment of OSA

Abstract Maxillomandibular advancement has become a widely performed operation for the treatment of OSA. The indication, rationale, technical considerations and outcomes are well-described in the literature. However, severe complications and failures are encountered too frequently. This lecture will discuss the speaker’s 25 year MMA experience as well as considerations to minimize complications and improve outcomes.

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October 2 (Sun.)

10:20-12:10 Room 1001

Maxillomandibular Advancement (MMA) for Obstructive Sleep Apnea (OSA) SPEAKER

“Surgical-Orthodontic Treatment of Obstructive Sleep Apnea Using Surgery-First Approach” 廖郁芳 (Yu-Fang Liao)

Position Professor

Affiliation Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan Department of Craniofacial Orthodontics, Change Gung Memorial Hospital, Taoyuan, Taiwan

Research Interests 齒顎矯正、正顎手術、唇腭裂、顎骨顏面畸形、睡眠呼吸中止症

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Abstract 近年來手術優先的正顎矯正治療越來越受歡迎,特別是對於骨性三級異常的患者,因為它具有手術排程靈 活、顏面美觀及早改善、總治療時間縮短和牙齒移動更容易等優點,使患者對治療滿意度產生正面的影響。 然而、因為正顎手術後才進行牙齒對齊、平整、去代償及上下牙弓協調,手術優先方法面臨的最大挑戰是手 術咬合的設置。因此,早期長庚醫院顱顏中心只將手術優先方法使用在不需要廣泛術前矯正的典型病例,包 括(1)良好或輕度擁擠的前牙排列、(2)平坦或輕度的 Spee 曲線、及(3)正常或輕度前傾/後傾的門牙傾角。 近年來,隨著 3D 成像技術、3D 虛擬手術模擬的發展及對正顎手術後生物反應的了解,長庚醫院顱顏中心 早已擴大了手術優先方法的典型適應症,將其應用在更複雜的顎骨顏面畸形(例如骨性二級異常、顏面不對 稱、唇腭裂、半邊小臉等相關畸形) 。本次報告我將介紹長庚醫院顱顏中心現今使用手術優先正顎矯正治療 阻塞性睡眠呼吸中止症的臨床考量、指引及療效。

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October 2 (Sun.)

10:20-12:10 Room 1001

Maxillomandibular Advancement (MMA) for Obstructive Sleep Apnea (OSA) SPEAKER

“MMA for OSA: an Orthodontic-first Approach” 曾于娟 (Yu-Chuan Tseng)

Position Director1 Associate Professor2

Affiliation 1. Department of orthodontics, Dental clinics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2. School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Research Interests The major research interest relies on subjects of cephalometric analysis, temporary anchorage devices (TADs), soft and hard tissue change after orthognathic surgery and CBCT study.

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Abstract In recent years, it has become more and more common for patients to seek medical attention due to snoring or sleep apnea. The most significant impact is not only on sleep but also on health-related symptoms such as headache, daytime sleepiness, inability to concentrate, etc. The negative impact is beyond imagination. In dental clinics, the treatment of sleep apnea can be divided into invasive and non-invasive. If the arch width is insufficient, it is recommended to expand the maxillary width to obtain a functional and esthetically stable bite. Growing children need to perform maxillary expansion; adult patients can use surgical-assisted or miniscrew-assisted maxillary expansion or even maxillomandibular advancement surgery (MMA) to improve airway problems and clinically related symptoms. This report will share the treatment experience of the Orthodontic department, Kaohsiung Medical University Hospital. When facing different skeletal relations with OSA, how to carry out preoperative orthodontic treatment planning so that sleep surgeons can get the maximum amount of MMA to improve the respiratory symptoms.

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October 2 (Sun.)

10:20-12:10 Room 1002

Sleep-Heart interaction: Phenotyping and Personalized Treatment in OSA Patients with Cardiovascular Diseases MODERATOR

侯嘉殷 (Charles Jia-Yin Hou) Position M.D., FACC, FAPSC, FESC

Affiliation MacKay Memorial Hospital

Research Interests Arrhythmia, Cardiac Electrophysiology, Cardiac Implantable Electronic Devices (CIED)

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October 2 (Sun.)

10:20-12:10

Sleep-Heart interaction: Phenotyping and Personalized Treatment in OSA Patients with Cardiovascular Diseases MODERATOR

王鶴健 (Hao-Chien Wang) Position 臺大醫學院附設癌醫中心醫院 副院長 臺大醫學院內科部 教授 社團法人臺灣胸腔暨重症加護醫學會 理事長

Affiliation 臺大醫學院附設癌醫中心醫院 臺大醫學院 社團法人臺灣胸腔暨重症加護醫學會

Research Interests 胸腔醫學重症醫學、支氣管鏡、胸腔超音波

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Room 1002


October 2 (Sun.)

10:20-12:10 Room 1002

Sleep-Heart interaction: Phenotyping and Personalized Treatment in OSA Patients with Cardiovascular Diseases SPEAKER

“Obstructive Sleep Apnea Phenotype and Cardiovascular Disease: Example of Atrial Fibrillation” 李佩玲 (Pei-Lin Lee)

Position Director Clinical Associate Professor

Affiliation National Taiwan University Hospital Internal Medicine, National Taiwan University, College of Medicine

Research Interests Her research focuses on clinical phenotyping, molecular mechanism, and therapeutic Intervention of obstructive sleep apnea. She is particularly interested in technology and big data in sleep medicine. Her other works include sleep disordered breathing in pediatrics and pregnancy

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Abstract Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airway obstruction that results in cessation of airflow during sleep. Untreated OSA may increase the probability of developing cardiovascular diseases, metabolic disorders, and neurocognitive dysfunctions. Evidences support that OSA is independently associated with atrial fibrillation (AF) and severity of OSA may have a dose relationship with AF incident. The prevalence of OSA in general population is 9-38% which increases to 21-47% in patients with AF. Vice versa, the prevalence of AF in general population is 1% which increases to 4% in patients with OSA. Evidences supporting screening of OSA in patients with AF undergoing catheter ablation are strongly while evidences are weak for other patients with AF. Vice versa, the evidences supporting screening of AF in patients with OSA are weak and no evidence suggests the modality for OSA screening. Though CPAP treatment is the standard treatment for OSA, its impact on AF burden is not clear.

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October 2 (Sun.)

10:20-12:10 Room 1002

Sleep-Heart interaction: Phenotyping and Personalized Treatment in OSA Patients with Cardiovascular Diseases SPEAKER

“The Prevalence, Screen, Diagnosis and Treatment of Obstructive Sleep Apnea in Hypertension Population” 黃群耀 (Chun-Yao Huang)

Position 1. Director, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan 2. Director, Division of Cardiology, Taipei Medical University Hospital, Taiwan

Affiliation 1. Division of Cardiology, Department of Internal Medicine, Taipei Medical University hospital, Taiwan 2. Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan 3. Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

Research Interests Vascular Biology, Lipidology, Cardiac Pharmacology, Big data, Wearable device

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Abstract With the progress of the civilized world, the prevalence of hypertension is increasing day by day, and hypertension in Taiwan is also listed as one of the top ten causes of death of the year. Sleep breathing arrest syndrome is a common disease in the civilized world, but also because of the lack of medical advocacy, knowledge promotion, and simple detection methods, although sleep breathing is a very important disease, it is the most easily ignored risk factor for hypertension. The disease can only be screened out through the patient's disease awareness and the vigilance of the clinician, with appropriate measurement tables and screening tools. At present, the tools for the treatment of respiratory arrest syndrome have gradually matured and have certain clinical efficacy, so it is time to face up to and promote the treatment of sleep apnea syndrome in the hypertensive population.

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October 2 (Sun.)

10:20-12:10 Room 1002

Sleep-Heart interaction: Phenotyping and Personalized Treatment in OSA Patients with Cardiovascular Diseases SPEAKER

“Sleep-Heart Interaction: Heart Failure” 吳彥雯 (Yen-Wen Wu)

Position Director

Affiliation Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan

Research Interests Internal Medicine, Cardiology, Nuclear Medicine, Cardiovascular Functional Imaging, Atherosclerosis, Heart Failure, Biomarkers

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Abstract Sleep-disordered breathing (SDB), including obstructive sleep apnea, central sleep apnea (CSA), and Cheyne-Stokes respiration, is common in patients with heart failure (HF) and associated with lower left ventricular ejection fraction (LVEF), increased arrhythmia burden, and increased mortality. All HF patients should be screened for SDB. Effective treatment of OSA with continuous positive airway pressure (CPAP) therapy improves short-term and long-term outcomes in HF patients. Although adaptive servoventilation (ASV) appears to not reduce CV and all-cause death for HF patients with extremely low LVEF, those with profound CSA associated hypoxemia or less severe HF still benefit from ASV therapy. In this talk, we outline the current understanding of the bidirectional relationship between these disorders and HF. Although limited evidence, some studies have shown that sleep quality and insomnia are associated with cognitive function, and patients with HF that are at high risk for cognitive decline. In this talk, we also explore emerging data on the cost effectiveness and outcome of intervention and recent advances in therapeutics, including ongoing trials.

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October 2 (Sun.)

10:20-12:10

Sleep-Heart interaction: Phenotyping and Personalized Treatment in OSA Patients with Cardiovascular Diseases SPEAKER

“Obstructive Sleep Apnea and Pulmonary Hypertension” 劉景隆 (Ching-Lung Liu)

Position Director (Respiratory Care Center) Attending Physician (Chest Division, Internal Medicine Department) Assistant Professor (Department of Medicine)

Affiliation MacKay Memorial Hospital MacKay Medical College

Research Interests Sleep and sleep-disordered breathing Respiratory physiology and airway disease Respiratory infection and immune response

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Room 1002


Abstract Sleep-related breathing disorders (SBD), including obstructive sleep apnea (OSA), central sleep apnea, and sleep-related hypoventilation, are an under-recognized but highly prevalent group of diseases. These nocturnal respiratory events result in intermittent hypoxia, with the potential to increase pulmonary arterial pressure, have a great impact on cardiovascular health. However, the association between OSA and pulmonary hypertension (PH) is not well understood. This relationship appears to be bi-directional, but our understanding of the mechanisms that drive the process remains very limited. Consequences of OSA combined with PH have been shown to increase mortality in clinical observational studies. Additionally, limited data suggest that treatment with positive airway pressure (PAP), which improves pulmonary hemodynamics and reduces pulmonary atrial pressure, may be clinically beneficial. Finally, through clinical cases, we will demonstrate and discuss the impact of SDB on pulmonary arterial pressure, as well as the changes in pulmonary arterial pressure following PAP therapy.

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October 2 (Sun.)

10:20-12:10 Room 1003

Technologist Training MODERATOR

林嘉謨 (Chia-Mo Lin) Position Director of Chest Department

Affiliation Medical College, FU JEN Catholic University, Taipei, Taiwan, ROC.

Research Interests Sleep medicine, Biochemistry, Pulmonary medicine

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October 2 (Sun.)

10:20-12:10

Technologist Training SPEAKER

“The AASM Troubleshooting Guidelines” 劉勝義 (Sheng-Yi Liu)

Position Polysomnographic Consultant

Affiliation Sleep Center, Taipei Veterans General Hospital

Research Interests Clinical Polysomnography

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Room 1003


Abstract Artifacts are extraneous signals, appearing within any of the recorded parameters of the polysomnogram. These signals may originate from the patient’s body, from recording instruments and devices used on the patient, or from the surrounding environment. Most of artifacts are undesirable and can severely impede the scoring and interpretation. These may include 60Hz powerline frequency, slow frequency artifact, electrode popping artifact, excessive ECG potentials recorded in the EEG and EOG channels and various mixed frequencies unrelated to patient physiology, recorded within any of the channels. The AASM Troubleshooting Guidelines provides a systematic approach to identify and correct artifacts that could interfere with the collection and interpretation of the data. It suggests this word LACES to identify a variety of different artifacts and to correct the cause or source of the artifacts. Each letter stands for a step in the systematic approach. L=Location, A=Application, C=Connection, E=Equipment, S=Settings. By using the LACES method we can fix any problems and produce clean, high quality recordings. To obtain an accurate polysomnogram, the AASM Troubleshooting Guidelines must be very helpful to individuals who are training to become registered sleep technologists and those interested in improving their knowledge and skills in the field of clinical polysomnographic technology.

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October 2 (Sun.)

10:20-12:10 Room 1003

Technologist Training SPEAKER

“睡眠圖譜呼吸事件判讀” 林文貴 (Wen-Kuei Lin)

Position 組長

Affiliation 成大醫院睡眠醫學中心

Abstract 依美國睡眠醫學學會,AASM,2020 年 2.6 版成人呼吸事件為基礎,講解睡眠中各呼吸型態所產生的呼吸事 件作分析判讀。

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October 2 (Sun.)

10:20-12:10 Room 1003

Technologist Training SPEAKER

“高山睡眠” 曾俊賢 (Chun-Hsien Tseng)

Position 睡眠技師

Affiliation 臺北榮民總醫院 睡眠醫學中心 睡眠技師 中華醫事科技大學醫事技術學系 兼任講師

Research Interests 睡眠醫學

Abstract 台灣是屬於一個多高山的島嶼,大家常會利用休假到高山休閒旅遊,而不同環境常常會影響睡眠,利用這 一個機會跟大家分享介紹高山睡眠。

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October 2 (Sun.)

10:20-12:10 Room 1003

Technologist Training SPEAKER

“Manual PAP Titration in Sleep Lab: Focus on the Aspect of BIPAP and ASV Titration” 林煜傑 (Yu-Chieh Lin)

Position Polysomnographic Technologist

Affiliation Sleep Medicine Center, Taichung Tzu Chi Hospital

Research Interests Sleep medicine, Basic science, Pathophysiology of sleep disorders

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Abstract Sleep disordered breathing encompasses a series of sleep-related breathing disorders such as obstructive sleep apnea (OSA), central sleep apnea (CSA) and hypoventilation syndrome. Positive airway pressure (PAP) therapy is an effective and common treatment for patients with sleep disordered breathing. Before the patient start PAP therapy, PAP titration should be executed to determine the optimal setting of PAP. PAP titration can be classified into CPAP, BIPAP and Adaptive-servo ventilation (ASV) titration. CPAP titration is the most common titration in sleep lab for patient with OSA. However, in the patients with congestive heart failure, obesity hypoventilation and neuromuscular diseases. CPAP may not afford to relieve the respiratory events among these patients. Advanced mode of PAP including BIPAP and ASV may be applied to these patients. Due to home-based automated CPAP titration may be applied to patient with OSA universally in the future. The proportion of patients with comorbidities will increase in laboratory titration in the future. In response to this situation, titration techniques of advanced PAP modes are essential for PSG technologists. In this talk, we will demonstrate the experience of BIPAP and ASV titration to increase the efficacy of advanced PAP titration.

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12:35-13:35

October 2 (Sun.)

Room 1001

Keynote Lecture 3 MODERATOR

邱國樑 (Kuo-Liang Chiu) Position 1.

Director of Sleep Center

2.

Assistant Professor

Affiliation 1.

Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation.

2.

College of Medicine, Tzu Chi University

Research Interests Sleep breathing disorders in cardiovascular diseases

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October 2 (Sun.)

12:35-13:35 Room 1001

Keynote Lecture 3 SPEAKER

“ECG and Heart Rate Use in the Diagnosis of Sleep and Sleep Disorders” Prof. Thomas Penze

Position Scientific Chair of Sleep Medicine Center at Charite University Hospital, Berlin, Germany. President of German Sleep Society.

Affiliation Interdisciplinary Sleep Medicine Center, Charite University Hospital Berlin, Germany

Research Interests Sleep apnea pathophysiology, cardiovascular consequences of Sleep apnea, Biosignal processing in sleep

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Abstract An important parameter of polysomnography is recorded with the ECG and additional heart rate recordings. Often the evaluation is minimal in the summarizing reports. As this parameter adds much information to the sleep signals, such as EEG, EOG, and EMG, the cardiac signals give additional diagnostic information for autonomic nervous activity during sleep. In this overview we present methodological developments in sleep research focusing on heart rate, ECG and cardio-respiratory couplings. I will report on physiological and pathophysiological insights related to sleep medicine obtained by ECG, heart rate and new technical developments. Recorded nocturnal ECG facilitates conventional heart rate variability analysis, studies of cyclical variations of heart rate, and analysis of ECG waveform. In healthy adults, the autonomous nervous system is regulated in different ways during wakefulness, slow-wave sleep, and REM sleep. Analysis of beat-to-beat heart-rate variations with statistical methods allows us to estimate sleep stages based on the differences in autonomic nervous system regulation. Up to some degree, it is possible to track transitions from wakefulness to sleep by analysis of heart-rate variations. ECG and heart rate analysis allow assessment of selected sleep disorders as well. Sleep disordered breathing can be detected reliably by studying cyclical variation of heart rate combined with respiration-modulated changes in ECG morphology. Examples for this detection method are presented.

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October 2 (Sun.)

12:35-13:35 Room 1003

Lunch Symposium MODERATOR

李信謙 (Hsin-Chien Lee) Position Visiting Staff & Chair

Affiliation Department of Psychiatry & Sleep Center, Taipei Medical University Hospital

Research Interests Psychiatry, Sleep Medicine, Public Health

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October 2 (Sun.)

12:35-13:35 Room 1003

Lunch Symposium SPEAKER

“Lemborexant, Novel DORA for Insomnia Treatment and Real-World Experience Sharing” 陳田育 (Tien-Yu Chen)

Position 主治醫師

Affiliation 三軍總醫院

Research Interests 睡眠醫學 精神醫學

Abstract 介紹全新機轉失眠藥物 Dayvigo 機轉、臨床文獻及使用經驗

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October 2 (Sun.)

13:40-15:20 Room 1001

Neurology and Sleep MODERATOR

徐崇堯 (Chung-Yao Hsu) Position Professor, Department of Neurology, Kaohsiung Medical University Chief, Department of Neurology, Kaohsiung Medical University Chief, Department of Neurology, Kaohsiung Medical University Hospital Chief, Sleep Disorders Center, Kaohsiung Medical University Hospital

Affiliation Kaohsiung Medical University and Hospital

Research Interests Neurology (Sleep Disorders and Epilepsy)

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October 2 (Sun.)

13:40-15:20 Room 1001

Neurology and Sleep SPEAKER

“Restless Legs Syndrome: An Update” 李穎昇 (Ying-Sheng Li)

Position 高醫神經部主治醫師

Affiliation 高醫神經部 高醫醫研所碩士班

Research Interests Sleep medicine, Epilepsy

Abstract Restless legs syndrome is a circadian rhythm related and sensorimotor disorder. The diagnostic criteria has been established by IRLSSG as follows: an urge to move, unpleasant sensation when rest, improving sensory symptoms after movement, and deterioration in the evening or night. The current pathogenesis of RLS is presumed as dopaminergic theory, and brain iron deficiency. We will discuss the latest concept of the syndrome especially the pathogenesis, comorbidities and associated diseases burden. Additionally, the relationship of RLS and epilepsy will be emphasized separately.

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October 2 (Sun.) Neurology and Sleep SPEAKER

“Epilepsy and Sleep” 葉威志 (Wei-Chih Yeh)

Position Attending Physician

Affiliation Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital

Research Interests Sleep Medicine, antiseizure medications

Abstract Epilepsy is associated with changes in 1. REM sleep macro- and microstructure 2. Sleep Spindles and Sawtooth wave 3. Dynamics of NREM People with epilepsy had REM sleep disturbance and NREM sleep instability

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13:40-15:20 Room 1001


October 2 (Sun.)

13:40-15:20 Room 1001

Neurology and Sleep SPEAKER

“Obstructive Sleep Apnea and Stroke” 林煥然 (Huan-Jan Lin)

Position Attending Physician

Affiliation Neurology department, E-DA hospital College of medicine, I-Shou University

Research Interests Sleep medicine, epilepsy, clinical neurophysiology

Abstract Obstructive sleep apnea(OSA) is an important but frequently ignored risk factor of ischemic stroke. The devastating disability after stroke result in socioeconomical burden and warrant better preventing strategy. The talk will focus on the epidemiology of OSA and ischemic stroke and discuss about the bidirectional mechanisms of OSA and stroke. We will also provide current evidence of treatment of OSA benefits ischemic stroke prevention. Besides, we will point out the future direction of clinical studies of OSA in stroke patients. In the end, we will share our experience of treating OSA in stroke through a clinical case.

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October 2 (Sun.)

13:40-15:20 Room 1001

Neurology and Sleep SPEAKER

“REM sleep behavior disorder (RBD)” 詹博棋 (Po-Chi Chan)

Position 1. Director 2. Attending Physician

Affiliation 1. Director of Sleep Center of Chang Hua Show-Chwan Memorial Hospital 2. Attending Physician, Department of Neurology, Chang Hua Show-Chwan Memorial Hospital

Research Interests Neurology, Sleep Medicine

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Abstract REM sleep behavior disorder (RBD) is a REM sleep parasomnia manifesting as repeated episodes of sleep related vocalization and/or complex motor behaviors. RBD is categorized as either idiopathic or secondary to other neurologic disorders and medications. A clinical history of dream enactment or complex motor behavior together with the presence of muscle atonia during REM sleep confirmed by video polysomnography are mandatory for RBD diagnosis. Most older adults with idiopathic RBD will eventually develop an overt neurodegenerative disorder (αsynucleinopathies). The primary goal of treatment is to reduce injury to the patient and their bed partner. In the future, studies will likely evaluate neuroprotective therapies in patients with idiopathic RBD to prevent or delay α-synucleinopathy-related motor and cognitive decline.

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October 2 (Sun.)

13:40-15:20 Room 1002

Microbiota and Sleep MODERATOR

郭博昭 (Terry B.J. Kuo) Position Professor of Institute of Brain Science

Affiliation National Yang Ming Chiao Tung University

Research Interests Autonomic Neuroscience, Sleep Physiology, Neuroscience, Pharmacology, Cloud Computing Science, Signal Analysis

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October 2 (Sun.) Microbiota and Sleep MODERATOR

康焜泰 (Kun-Tai Kang) Position 耳鼻喉科主任

Affiliation 衛生福利部臺北醫院

Research Interests Child; Sleep apnea syndrome, meta-analysis

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13:40-15:20 Room 1002


October 2 (Sun.)

13:40-15:20 Room 1002

Microbiota and Sleep SPEAKER

“New Era in Microbiota Technology” 周士軒 (Shih-Hsuan Chou)

Position 領域應用科學家 (Field Application Scientist)

Affiliation 圖爾思生物科技股份有限公司 (BIOTOOLS CO., LTD.)

Research Interests Physiology, pharmacology, molecular biology and microbiology

Abstract The mainstream method to identify and analyze bacterial is the 16S rRNA gene sequencing. The nearly 1500 bp 16S rRNA gene includes nine variable regions as known the highly conserved 16S sequence. BIOTOOLS CO., LTD. provides better taxonomic resolution using full-length 16S gene sequencing compared conventional V3-V4 sequencing. Nevertheless, our bioinformatic pipeline demonstrates taxonomic resolution at species and strain level. BIOTOOLS CO., LTD. also provides untargeted metabolomics for annotating metabolites that correlate with microbes and further accentuates the potential role of gut microbiota and metabolites as biomarkers to predict outcomes of several disease models.

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October 2 (Sun.)

13:40-15:20 Room 1002

Microbiota and Sleep SPEAKER

“Gut Microbiota and Sleep Disorder” 李立昂 (Li-Ang Lee)

Position Professor

Affiliation 1.

Department of Otorhinolaryngology - Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan

2.

Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan

3.

School of Medicine, National Tsing Hua University, Hsinchu, Taiwan

Research Interests Sleep Medicine, Laryngology, Infectious Disease, Brain Sciences, Medical Education

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Abstract Disruptions of normal sleep may disturb the balance of psycho-physical health; therefore, sleep disorders may interfere with the homeostasis of hormone levels, mood, and body weight. Current evidence supported a close relationship between gut microbiota and sleep disorders. The gut microbiota affects its host in many ways; in contrast, sleep disorders can alter microbiota composition and cause dysbiosis. These directional relationships between gut microbiota and sleep disorders may result in metabolic disorders, mood disorders, and other complications. In this talk, we will explore what is present in the literature on the link between gut microbiota and sleep disorders in humans.

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October 2 (Sun.)

13:40-15:20 Room 1002

Microbiota and Sleep SPEAKER

“Tonsil Microbiome among Obstructive Sleep Apnea Children across Intermittent Hypoxemia and Body Weight Status” 莊海華 (Hai-Hua Chuang)

Position 1.

Associate Professor

2.

Department Director

3.

PhD. Candidate

Affiliation 1.

Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan

2.

College of Medicine, Chang Gung University, Taoyuan, Taiwan

3.

School of Medicine, National Tsing Hua University, Hsinchu, Taiwan

4.

Health Promotion Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan

5.

Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan

Research Interests Epidemiology, health impact, and prevention of obesity, suboptimal body composition, and declined physical fitness

84


Abstract The tonsil microbiome is associated with chronic tonsillitis and obstructive sleep apnea (OSA) in children, and the gut microbiome is associated with host weight status. In this study, we hypothesized that weight status may be associated with clinical profiles and the tonsil microbiome in children with OSA. We prospectively enrolled 33 non-healthy-weight (cases) and 33 healthy-weight (controls) pediatric OSA patients matched by the proportion of chronic tonsillitis. Differences in the tonsil microbiome between the non-healthy-weight and healthy-weight subgroups and relation- ships between the tonsil microbiome and clinical variables were investigated. Non-healthy weight was associated with significant intermittent hypoxemia (oxygen desaturation index, mean blood saturation (SpO2), and minimal SpO2) and higher systolic blood pressure percentile, but was not related to the tonsil microbiome. However, chronic tonsillitis was related to Acidobacteria in the non-healthy-weight subgroup, and oxygen desaturation index was associated with Bacteroidetes in the healthy-weight subgroup. In post hoc analysis, the children with mean SpO2 ≤ 97% had reduced α and β diversities and a higher abundance of Bacteroidetes than those with mean SpO2 > 97%. These preliminary findings are novel and provide insights into future research to understand the pathogenesis of the disease and develop personalized treatments for pediatric OSA.

85


October 2 (Sun.) Microbiota and Sleep SPEAKER

“Probiotics and Insomnia” 楊靜修 (Ching-Hsiu Yang)

Position 教授

Affiliation 陽明交通大學腦科學研究所及睡眠研究中心

Research Interests 1.

精神益生菌與睡眠

2.

高血壓與睡眠

3.

環境低溫與睡眠

4.

運動與睡眠

5.

睡眠與心血管疾病研究

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Abstract 已知有些精神益生菌可以增加腦內腺苷受體基因的表達、提升多巴胺、血清素濃度或迷走神經系統活性,而 這些似乎有機會可提升睡眠品質。也因為現今安眠藥的種種副作用讓許多人不敢長期使用,近期我們透過 與生展及益福公司的產學合作,使用來自生展公司的 ProGA28 與益福公司的 PS150 與 PS128 益生菌產品, 這些益生菌皆源於台灣,研究分別採用三種本睡眠研究中心建立的大、小鼠及人體睡眠多功能睡眠紀錄及 分析技術,以大小鼠壓力引發失眠模式及人類自覺失眠者做不同實驗設計,發現益生菌 ProGA28、PS150、 PS128 分別對於特定的睡眠品質不良與焦慮、憂鬱皆有一定程度的改善。 第一部份使用大鼠換籠壓力引發失眠模型測試,餵食 ProGA28 一個月,便可有效改善大鼠因壓力造成睡眠 潛伏期拉長、前期睡眠下降及睡眠深度變少,並同時減少壓力引起的睡眠中交感神經興奮及下降迷走神經 作用,更緩解因壓力造成減少焦慮、憂鬱及社交行為,特別是其抗焦慮作用與睡眠改善與副交感活性增加有 關,因此推測 ProGA28 可調節腸道微生物群並通過腸-腦軸影響大腦功能,產生抗焦慮、抗憂鬱作用和調 節自律神經作用,減輕壓力引起的睡眠障礙。 第二部分使用小鼠換籠壓力引發失眠模式及小鼠多功能睡眠儀紀錄及分析模型。過去已證實 PS150 可以抑 制炎症,减少下丘腦-垂體-腎上腺軸的活化,延長睡眠時間,减少睡眠潜伏期,並防止齧齒動物因咖啡因引 起的失眠。故本研究進一步比較 PS150 與 diphenhydramine(一種常用的睡眠輔助劑)對睡眠改善的效果, 結果證實 PS150 更能有效地改善由換籠造成睡眠潛伏期拉長、並恢復非快速眼動睡眠和快速動眼期的時間。 此外,透過 PS150 組糞便檢驗,發現腸道菌 Erysipelotrichia、Actinobacteria 和 Coriobacteriia 顯著增加, 表明 PS150 可誘導腸道微生物群重塑。 第三部分使用人體研究採隨機雙盲控制設計,評估自覺失眠者在服用 PS128 四周後對睡眠的改善。過去 PS128 已在大小鼠研究中證實可提升腦內多巴胺與血清素的濃度,並改善焦慮與憂鬱行為,本研究進一步 針對自覺失眠者的睡眠品質的改善,研究結果顯示 PS128 可顯著改善失眠者憂鬱情緒和深睡時的睡眠品質 並降低睡眠時皮質激發狀態,且失眠者的憂鬱分數的改善與睡眠各種參數改善有顯著相關。 以上,希望我們近期的益生菌研究可為失眠患者提供一道新的治療曙光。

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October 2 (Sun.)

15:35-17:00 Room 1001

Oral Presentation A MODERATOR

周昆達 (Kun-Ta Chou, MD & Ph.D) Position Head, Division of clinical respiratory physiology, Department of chest medicine1 Chief Executive Officer, Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan2 Associate Professor, School of Medicine, National Yang-Ming Chiao Tung University, Taiwan3

Affiliation Taipei Veterans General Hospital, Taipei, Taiwan1,2 National Yang-Ming Chiao Tung University, Taiwan3

Research Interests Sleep Medicine, Chest Medicine, Epidemiology, Intermittent hypoxemia, animal model

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October 2 (Sun.)

15:35-17:00 Room 1001

Oral Presentation A ABSTRACT

Respiratory Arousal in Patients with Very Severe Obstructive Sleep Apnea and How It Changes after a Non-Framework Surgery 黃怡舜 Objective: Respiratory arousal in patients with obstructive sleep apnea (OSA) has a helpful role to activate upper airway muscles and the resumption of airflow and an opposing role to exacerbate OSA. Patients with very severe OSA (apnea-hypopnea index (AHI) ≥ 60 events/hour) may have specific chemical and mechanical stimuli to initiate a respiratory arousal. Little was reported about how respiratory arousal presents in this distinct subgroup and how a non-framework surgery may change it. Methods: Retrospective cohort study at level-1 sleep laboratory of the authors’ tertiary referral hospital. Results: Scatter plot with correlation and changes after the surgery were reported in 27 patients with very severe OSA. Conclusion: Respiratory arousal index was correlated with each of AHI, mean oxyhemoglobin saturation of pulse oximetry (SpO2), mean desaturation, and desaturation index. Its mean was higher than other reports with less severe OSAs. It can be reduced about half after the surgery. Keywords: palatoplasty; one-stage; retropharynx; polysomnography (PSG); Continuous-Positive-AirwayPressure (CPAP)

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October 2 (Sun.)

15:35-17:00 Room 1001

Oral Presentation A ABSTRACT

Diagnosis of Obstructive Sleep Apnea in Dysphonia Patients: Role of Laryngopharyngeal Reflux (以嗓音障礙來 表現的睡眠呼吸中止症: 咽喉胃酸逆流的角色) 張智惠* 張智恩 毛衛中 振興醫院耳鼻喉部、振興醫院睡眠健康中心、振興醫院嗓音醫學中心 Introduction Dysphonia is the symptoms of altered voice quality, which can be described as hoarse, breathy, strained or weak. In our voice center, we found the etiology for dysphonia other than the structural or functional causes of vocal folds, is intractable laryngopharyngeal reflux. Since obstructive sleep apnea (OSA) is believed to be correlated with laryngopharyngeal reflux (LPR), this study aimed to evaluate the prevalence of OSA in patients with LPR complained with dysphonia. Method Fifty dysphonia patients were enrolled in the study retrospectively. For each patient, flexible fiberscope was examined, patients with vocal fold lesions were excluded. Patients with the diagnosis of LPR was enrolled and assessed with reflux finding score (RFS). For the patients with intractable LPR after 3 months of medication, further personal history was obtained and PSG was performed. Result The main complaints of dysphonia patient is hoarseness, accompanied with lump sensation. Mean duration of dysphonia period is 3 months or more, but not correlate to reflux finding score (RFS). The mean BMI of the OSA group significantly was higher than the non-OSA group (p < 0.05), and the mean reflux finding score (RFS) in OSA patients was higher than non-OSA patients. Most of the patients in the OSA group showed moderate-severe OSA, but not correlate to BMI. Conclusion Dysphonia should be examined with associated risk factors and underlying conditions other than vocal fold lesions alone. A high number of patients with dysphonia suffered from intractable LPR, which could be correlated to OSA. The severity of RFS is related to the possibility of OSA.

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October 2 (Sun.)

15:35-17:00 Room 1001

Oral Presentation A ABSTRACT

The Impact of Continuous Positive Airway Pressure on Blood Pressure in Patients with Ischemic Stroke and Obstructive Sleep Apnea (持續正壓呼吸器對於阻塞性睡眠 呼吸中止症併有腦中風病患的血壓影響) 趙中豪 Chung-Hao Chao*1, 于鍾傑 Chung-Chieh Yu2 基隆長庚醫院

1

神經內科 2 胸腔科睡眠中心 Keelung Chang Gung Memorial Hospital

Background: Continuous positive airway pressure (CPAP) therapy may reduce blood pressure (BP) in patients with obstructive sleep apnea (OSA). However, the benefits of CPAP therapy for the reduction in BP in patients with OSA and ischemic stroke have not previously been proved. Objective: The BP lowering effects of treatment with CPAP in subacute ischemic stroke patients with OSA. Methods: This was a prospective and non-randomized observational study in which ischemic stroke patients with OSA being treated in a rehabilitation ward were enrolled from 2015 to 2018. The participants who tolerated CPAP were classified as the CPAP group, while those who refused or could not tolerate CPAP were classified as the control group. A comparison was made between the measurements of BP in three consecutive days before and after two weeks of CPAP therapy with the control group by MannWhitney U test. Results: A total of 44 participants were enrolled and completed the study (control group: 19; CPAP group: 25; mean age= 59.8 years old; mean apnea hypopnea index= 42.9). The average AHI of the CPAP group was decreased from 43.0 ± 17.3 /hr to 6.5 ± 4.9/hr after CPAP therapy. The average time of CPAP usage was 7.3±1.0 hours per night, and all of participants used it for more than 70% of the days during the study period. Morning and evening blood pressure comparison showed no obvious diurnal change. In the CPAP treatment and control groups, statistical significance was achieved for the differences in systolic/diastolic BP in the morning (-4.9 ± 14.8/-2.9±8.9 mmHg, respectively) and differences in systolic/diastolic BP at the night time ( -11 ± 8.5/-4 ± 8.6, respectively). Conclusion: CPAP treatment is associated with the BP lowering effects among the ischemic stroke patients with OSA.

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October 2 (Sun.)

15:35-17:00 Room 1001

Oral Presentation A ABSTRACT

Possible Treatment to Epiglottic Collapse in OSA Patients: What Did Drug Induced Sleep Endoscopy Tell Us? (以睡眠內視鏡探討阻塞性睡眠呼吸中止症病患會厭塌陷 的可能治療方式) 陳玉霖 Yu-Lin Chen *1, 施驊瑋 Hua-Wei Shih 2, 徐英碩 Ying-Shuo Hsu 2 臺北市立聯合醫院中興院區家醫科 2 新光吳火獅紀念醫院耳鼻喉科 Shin Kong Wu Ho-Su Memorial Hospital 1

Objective: In obstructive sleep apnea (OSA) patients, epiglottic collapse (EC) remains one of the important factor to continuous positive airway pressure (CPAP) failure. This study aims to explore treatments that can improve EC under drug-induced sleep endoscopy with target-controlled infusion (TCI-DISE) in OSA patients. Methods: This retrospective study reviewed 274 patients with polysomnography (PSG) or home sleep test (HST)confirmed OSA, who were intolerable to CPAP treatment and therefore underwent TCI-DISE from 2016 to 2021 at a tertiary referral hospital. 36 patients with anteroposterior EC were included to this study. Upper airway obstruction was observed by TCI-DISE and scored using velum, oropharynx, tongue base and epiglottis (VOTE) classification. EC severity was assessed multiple times with the patients under supine position with or without lateral head rotation and forcefully-closed mouth, application of oral appliance (OA), intermittent negative airway pressure (iNAP) respectively. Results: After applying these procedures to patients, EC severity decreased significantly from total obstruction to partial or no obstruction in 68.8% patients by head rotation, 75.0% patients by forcefully-closed mouth, 60.0% patients under OA. EC severity didn’t decrease significantly in supine iNAP use in TCI-DISE with only 21% improvement. After simultaneously applying head rotation, EC severity decreased more significantly from total obstruction to partial or no obstruction in 95.0% patients by forcefully-closed mouth, 86.2% patients under OA, 89.5% patients under iNAP. Conclusion: In TCI-DISE, we found that EC severity can be reduced most significantly by head rotation with forcefully-closed mouth. Supine iNAP use was not effective in decreasing EC severity in TCI-DISE.

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October 2 (Sun.) Oral Presentation B MODERATOR

楊鈞百 (Chun-Pai Yang) Position Director, Sleep Medicine Center

Affiliation Kuang Tien General Hospital

Research Interests Sleep Medicine, Headache Medicine

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October 2 (Sun.)

15:35-17:00 Room 1002

Oral Presentation B ABSTRACT

The Impact of Unexpected Sleep-Disordered Breathing on Patients with Newly Diagnosis Generalized Anxiety Disorder: A Case-Control Study in Taiwan (非預期性睡眠 呼吸中止症對於初診斷廣泛性焦慮症患者的影響) 陳田育 Tien-Yu Chen 1,2, 郭博昭 Terry B.J. Kuo 2, 楊靜修 Cheryl C.H. Yang 2 三軍總醫院精神醫學部 Department of Psychiatry, Tri-Service General Hospital 1/ 陽明交通大學 腦科學研究所 Institute of Brain Science, National Yang Ming Chiao Tung University 2 Objective: Generalized anxiety disorder (GAD) and sleep-disordered breathing (SDB) share similar symptoms, such as poor sleep quality, irritability, and poor concentration during daily activities. Some evidence has reported a bidirectional relationship between anxiety disorders and SDB. The aim of this study is to examine the impact of unexpected SDB in patients with newly diagnosed GAD. Methods: This prospective case-control study included patients newly diagnosed with GAD from a psychiatric clinic and healthy controls from the local community. All participants completed questionnaires for sleep and mood symptoms and a resting 5-min heart rate variability (HRV) examination during enrollment. They also used a validated home sleep test device to detect unexpected SDB. An oxygen desaturation index (ODI) ≥5 was considered indicative of SDB. Results: Total 56 controls and 47 newly diagnosed GAD participants (mean age 55.1±12.04 years) were included. There was no significant difference in the proportion of unexpected SDB in the control and GAD groups (46.43% vs 51.06%). Patients with comorbid GAD and SDB had higher Beck Anxiety Index (BAI) scores (23.83±11.54) than those without SDB (16.52±10.61). Patients with GAD had worse Pittsburgh Sleep Quality Index (PSQI) scores than controls, regardless of SDB comorbidity. Both the control and GAD groups with SDB had lower global autonomic function than the control group without SDB, as evidenced by the HRV results. Backward stepwise regression analysis indicated that age and body mass index (BMI) were the two major risk factors for ODI. Conclusion: The study revealed that nearly 50% of participants with average age 55 in both the GAD and control groups had unexpected SDB. Among patients with GAD, those with unexpected SDB had more severe anxiety symptoms than those without. Furthermore, age and BMI were considered risk factors for unexpected SDB.

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October 2 (Sun.)

15:35-17:00 Room 1002

Oral Presentation B ABSTRACT

腹側海馬迴之恐懼記憶影響小鼠睡眠 李婷嫣, 張晉源, 廖彩君, 蕭逸澤* 國立臺灣大學獸醫學系 Objective Traumatic daytime experience may lead to sleep disturbances at night. Sometimes these traumatic experiences replay after falling asleep and subsequently disrupt sleep. In the present study, we hypothesize the activation of neurons that encode fear memory in the hippocampus causes sleep disturbance in animals.

Methods To observe the brain activity, we performed in vivo calcium imaging in the ventral CA1 of the hippocampus (vCA1) and recorded the electrical field for both vCA1 and basal amygdala (BA) in mice during sleep. Then, we compared the neuronal activity before/after the subjects were fear conditioned. In addition, optogenetic, chemogenetic, and activity-dependent neural tagging techniques were used to tag and manipulate neurons that had activated during fear conditioning.

Results The results demonstrated that neurons in vCA1 were robustly activated during sleep when we applied conditioned stimuli. The electrical field was mainly transferred from vCA1 to BA when the subject heard the conditioned stimuli. Moreover, inhibition of the vCA1-BA pathway reduced the sleep disruption following fear conditioning. In addition, stimulation of the neurons that had activated during fear conditioning caused sleep disturbance

Conclusion Our results suggest the reactivation of neurons that keep fear memory in vCA1 contributes to sleep disturbance. The vCA1 to BA is one of the main pathways leading to this type of sleep disturbance.

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October 2 (Sun.)

15:35-17:00 Room 1002

Oral Presentation B ABSTRACT

The Relationship between Implementation of Sleep Hygiene Education and Sleep Quality and Emotional Management of School Aged Children (實施睡眠衛生教育 與學童睡眠品質、情緒管理相關研究) 彭志業 台灣地區國小高年級學生普遍有睡眠不足的問題,睡眠時間遠低於專家對學齡期睡眠時數的建議。學童常 出現白天上學遲到,上課精神不佳,同時週末晚上熬夜,形成假日補眠的現象。更由於入睡前過度使用 3C 設備,造成藍光對於深度睡眠的破壞,不僅遲滯了睡眠時間,更戕害了睡眠品質。依據文獻發現,學童睡眠 的問題,與學生睡眠知識缺乏,和睡眠衛生執行意願與習慣,有密切的關聯。 本研究目的為探討實施學童睡眠衛生教育課程,對於提升學童睡眠衛生知識、改善睡眠品質、調整情緒效果 之成效分析。研究者在桃園市國小實地進行睡眠衛生課程教學,並以學生睡眠日誌紀錄、研究者自編學生睡 眠衛生課程及自編睡眠衛生知識測驗、自陳式情緒測驗及兒童睡眠衛生問卷(CSHQ)為研究工具進行研究。 研究結果發現:本研究參照計畫行為理論,安排實施睡眠衛生教育課程教學,確實能影響國小高年級學童的 睡眠衛教認知表現與執行情況。能有效提升兒童睡眠衛生知識、並減少睡眠問題,且在日常生活中表現較多 的正向情緒,同時藉由學生與家長的配合,進一步培養學童良好的睡眠習慣。

關鍵詞:生理時鐘、睡眠衛生教育、睡眠品質、睏睡度與情緒

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October 2 (Sun.)

15:35-17:00 Room 1002

Oral Presentation B ABSTRACT

全自動大鼠判期程式設計並應用於分辨 WKY 與 SHR 丁彥*, 吳承翰, 陳玠文, 謝達斌, 楊靜修, 郭博昭 國立成功大學醫學系, 國立陽明交通大學腦科學研究所, 國立陽明交通大學睡眠研究中心, 國立成功 大學牙醫學系, 衛生福利部草屯療養院心腦研究中心 Objective: Various automatic algorithms have been developed in recent years to accelerate sleep scoring and to reduce human efforts in rodent models. Nonetheless, even for those showing excellent performance, no algorithm has been validated on different strains of rodent. The applicability of such system in genetic modified animal models was therefore unclear. The aim of this study is to develop an automatic sleep analysis scoring algorithm using supervised and unsupervised approaches to discriminate between normotensive Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR). Methods: Polysomnographic analysis was performed on freely moving WKY and SHR under full day monitoring. Continuous power spectral analysis was applied to the electroencephalogram (EEG) and electromyogram (EMG) signals, from which the mean power frequency (MPF) of the EEG and the power magnitude of the EMG (EMG power) were quantified. Automatic scoring algorithm was developed using rule-based, clustering method and the support vector machine (SVM). Rats consciousness states were discriminated into active waking (AW), paradoxical sleep (PS), and quiet sleep (QS). Hypnograms constructed by each method were compared with manual scoring outcome to assess accuracy. Moreover, SHR are reported to have more fragmented sleep architecture pattern in comparison with WKY. Inter-phasal transitions were quantified upon the two strains to assess the applicability on strain discrimination. Results: MPF and EMG power thresholds for rule-based scoring algorithm determined using different frequency bands of encephalogram and one-dimensional clustering method showed decent performance on the accuracy among the WKY rats and the SHR rats (85%-87%). Two-dimensional clustering (K means) implemented as unsupervised machine learning method presented 85% accuracy for the WKY rats and 70% accuracy for the SHR rats. Notably, Two-dimensional clustering method showed the best sensitivity for paradoxical sleep on both strain (70%-75%). Support vector machine exhibited the best performance with 94% accuracy for the WKY rats and 93% accuracy for the SHR rats. Sleep phase alternation counts quantified by all the above methods showed significant difference among WKY rats and SHR rats (p<0.05). Conclusion: Unsupervised machine learning algorithm using SVM resulted in the best performance among all other approaches. The sleep architectural pattern of the SHR rats revealed to be fragmented and can be easily identified compared to the WKY rats using automatic scoring algorithms.

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Acknowledgment 主辦單位

台灣睡眠醫學學會 Taiwan Society of Sleep Medicine

贊助單位 攤位與廣告

台灣瑞思邁股份有限公司

科林儀器股份有限公司

ResMed Taiwan

Clinico Inc.

紐西蘭商費雪派克醫療器材公司 台灣分公司 Fisher & Paykel Healthcare Asia Limited Taiwan Branch

台灣飛利浦股份有限公司

衛采製藥股份有限公司

杏昌生技股份有限公司

Philips

Eisai

Hi-Clearance Inc.

博兆股份有限公司 BROJAW

萊鎂醫療器材股份有限公司 Somnics, Inc.

大立雲康股份有限公司 Largan Health Technology CO., LTD

信東生技股份有限公司 Taiwan Biotech Co., Ltd

台灣阿斯特捷利康股份有限公司 AstraZeneca

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花禮感謝名單 台灣胸腔及心臟血管外科學會 台灣精神醫學會 蔡長哲理事長暨全體理監事 社團法人台灣小兒神經醫學會 台灣神經學學會理事長胡朝榮秘書長鄔定宇暨全體理監 台灣婦產科醫學會 理事長黃閔照、監事長張基昌、秘書長黃建霈 中華民國放射線醫學會理事長邱宏仁暨全體理監事 臺灣兒科醫學會理事長李宏昌暨全體理監事 社團法人台灣胸腔暨重症加護醫學會 台灣兒童胸腔暨重症醫學會 台灣家庭醫學醫學會理事長黃信彰 中華民國重症醫學會理事長黃瑞仁暨全體理監事 台灣消化系醫學會 理事長吳明賢、秘書長邱瀚模 台灣兒童青少年精神醫學會

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