以穿戴式隨身裝置引導呼吸訓練作為心血管疾病自主神經調節的輔助治療模式

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研究生：	王晨旭 Chen-Hsu WANG
論文名稱：	以穿戴式隨身裝置引導呼吸訓練作為心血管疾病自主神經調節的輔助治療模式 Wearable Device Guided Breathing Training Exercise as an Auxiliary Management of Autonomic Nervous Modulation in Cardiovascular Disease
指導教授：	羅孟宗 Men-Tzung LO 林澂 Chen LIN
口試委員:
學位類別：	博士 Doctor
系所名稱：	生醫理工學院 - 跨領域轉譯醫學研究所 Institute of Translational and Interdisciplinary Medicine
論文出版年：	2025
畢業學年度：	113
語文別：	英文
論文頁數：	118
中文關鍵詞：	穿戴式隨身裝置、呼吸訓練、心血管疾病、自主神經調節
外文關鍵詞：	Wearable Device, Breathing Training Exercise, Cardiovascular Disease, Autonomic Nervous Modulation
相關次數：	點閱：22 下載：0
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本研究探討了在心血管疾病族群中，其自主神經系統功能、慢性發炎和血管硬化之間的關係，並評估了以穿戴式隨身裝置上的應用程式所引導的呼吸訓練模式作為輔助治療的有效性。透過四個實驗項目，我們納入了130名慢性心血管疾病病人族群和34名健康對照者，使用穿戴式心電圖裝置評估受試者的自主神經功能。蒐集以心率變異度為基本的指標參數加以推演計算，包括生理年齡及其綜合健康指數。
結果顯示，與單純高血壓病人相比，合併高血壓和糖尿病病人的生理年齡指標顯著升高，而綜合健康指數則顯著降低。心臟衰竭病人在接受呼吸訓練輔助治療後，以上兩項參數均顯著改善。三個月的呼吸訓練顯著降低了血壓及腫瘤壞死因子-α (TNF-α) 數值，但壓力反射敏感性的改善並非持久的。綜合健康指數被證明比傳統的心率變異度參數指標測量方法更可靠、更靈敏，可用於短期自主神經評估。
以上結果顯示，穿戴式心電圖監測隨身裝置結合呼吸訓練模式，為慢性心血管疾病的風險管理和治療監測提供了一種非侵入性的持續方向，並為疾病初期之亞健康族群的健康促進提供了可行的未來前景。

This study investigated the relationship between autonomic nervous system function, chronic inflammation, and vascular stiffness in cardiovascular disease (CVD) patients, while evaluating the effectiveness of app-guided breathing training exercise as an auxiliary treatment. Through four experimental projects involving 130 CVD patients and 34 healthy controls, we assessed autonomic function using a wearable electrocardiogram (ECG) device that calculated heart rate variability (HRV) based parameters including physiological age and a comprehensive health index.
Results showed that patients with hypertension and diabetes had significantly higher physiological age and lower comprehensive index compared to hypertension only patients. Heart failure patients demonstrated significant improvement in both parameters following treatment. Three months of breathing training significantly reduced blood pressure and tumor necrosis factor-α levels, though baroreflex sensitivity improvements were not sustained. The comprehensive index proved more reliable and sensitive than traditional HRV measures for short-term autonomic assessment.
These findings suggest that wearable ECG monitoring combined with breathing training offers a promising non-invasive approach for cardiovascular risk management and treatment monitoring. It could be provided a sustained direction for health promotion in subclinical population.

中文摘要..................................................i
Abstract.................................................ii
致謝.....................................................iii
Table of Contents........................................iv
List of Tables..........................................viii
List of Figures..........................................ix
List of Abbreviations....................................xi
Chapter 1: Introduction....................................1
The Global Burden of Hypertension and Cardiovascular Disease....................................................1
Chapter 2: Literature Review...............................3 
1 Autonomic Nervous System Dysfunction in Cardiovascular Disease....................................................3
2 The Inflammatory Paradigm in Cardiovascular Disease....4
3 Hypertension as a Primary Risk Factor for Heart Failure....................................................6
4 Neurohormonal Mechanisms Linking Hypertension and Heart Failure....................................................8
5 Metabolic Dysfunction in the Hypertension-Heart Failure Continuum..................................................9
6 Microvascular Dysfunction and the Hypertension-Heart Failure Transition........................................10
7 The Role of Atrial Dysfunction in Hypertension-Related Heart Failure.............................................11
8 Gender and Ethnic Differences in Hypertension-Heart Failure Progression.......................................11
9 Prevention Strategies: Breaking the Hypertension-Heart Failure Link..............................................12
10 The Neuro-Immune Interface: Autonomic Regulation of Inflammation..............................................13
11 Heart Rate Variability: A Window into Autonomic Function..................................................14
12 Breathing Exercises: From Ancient Practice to Modern Medicine..................................................16
13 The Anti-inflammatory Potential of Breathing Exercises.................................................18
14 Technological Innovation: Wearable Devices in Cardiovascular Health.....................................20
Chapter 3: Study Rationale and Objectives.................22
Chapter 4: Methods........................................24
1 Experimental Guidelines...............................24
2 Experimental Projects.................................24
2.1 Experimental Project 1..............................24
2.2 Experimental Project 2..............................25
2.3 Experimental Project 3..............................25
2.4 Experimental Project 4..............................26
3 Device Guided Slow Breathing (DGSB) Protocol..........26
4 Experimental Methods and Procedures...................27
5 Study Protocol and Data Collection....................28
6 Data Analysis Methods.................................29
6.1 Heart Rate Variability Analysis.....................29
6.2 Statistical Analysis................................30
7 Ethical Considerations................................31
Chapter 5: Results........................................32
1 Experimental Project 1: Cross-sectional Study.........32
1.1 Data of Clinical Patient Group......................32
1.2 Data of Control Group...............................34
1.3 Characteristics of Comprehensive Parameters and Physiological Age.........................................35
1.4 Changes in Comprehensive Parameters and Physiological Age.......................................................36
1.5 Comparison of Comprehensive Index and Physiological Age.......................................................38
2 Experimental Project 2: Newly Diagnosed Heart Failure Follow-up Study...........................................40
3 Experimental Projects 3 & 4: Breathing Training as an Auxiliary Treatment.......................................41
3.1 Clinical Patient Data...............................41
3.2 The Effect of App-guided Breathing Training on Baroreflex................................................43
3.3 Blood Pressure Changes and Evaluation of Arteriosclerosis..........................................45
3.4 Changes in Autonomic Nervous Activity...............47
3.5 Changes in Blood Inflammatory Index.................50
Chapter 6: Discussion.....................................53
1 Comprehensive Analysis of Short-term Autonomic Function Assessment................................................53
2 Autonomic Dysfunction in Cardiovascular Disease.......55
3 Heart Failure and Autonomic Recovery..................57
4 DGSB as a Comprehensive Cardiovascular Intervention...59
5 The Anti-inflammatory Effects of Breathing Training...61
6 Correlations Between Autonomic Function and Inflammation..............................................63
7 Wearable Technology and Real-time Biofeedback.........65
8 Clinical Translation and Future Directions............67
9 Limitations and Methodological Considerations.........69
10 Integrative Perspectives: Toward Precision Cardiovascular Medicine...................................71
11 Implications for Public Health and Healthcare Delivery..................................................72
Chapter 7: Conclusion.....................................75
References................................................79
                                

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