应用动态心电图推导呼吸曲线初筛睡眠呼吸暂停综合征

Screening of sleep apnea syndrome by ECG derived respiration of ambulatory electrocardiogram

目的以多导睡眠仪(PSG)作对照,探讨动态心电图推导的呼吸曲线(EDR)初筛睡眠呼吸暂停低通气综合征(SAHS)的可行性。方法2004年2月—2004年11月对80例就诊于睡眠中心的患者进行整夜(大于7h)多导睡眠仪(PSG)监测,同时同步进行动态心电图检查。双方在互相不沟通的情况下分别计算睡眠呼吸暂停低通气指数(AHI),并做出睡眠呼吸暂停低通气综合征阳性与阴性的诊断,以PSG结果作为金标准评价应用动态心电图EDR技术初筛SAHS的可行性。结果应用软件进行自动分析,分别设定软件灵敏度为75%、87·5%、100%,当灵敏度为75%时,EDR检出SAHS的敏感性26·7%、特异性80%、阳性预测值80%、阴性预测值26·7%、诊断符合率40%;灵敏度为87·5%时,敏感性55%、特异性45%、阳性预测值75%、阴性预测值25%、诊断符合率52·5%;灵敏度为100%时,敏感性88·3%、特异性35%、阳性预测值84·1%、阴性预测值50%、诊断符合率75%。结论应用动态心电图的EDR技术,采用软件自动分析可以对SAHS患者进行初筛,其中采用灵敏度为100%时自动分析的敏感性及符合率较高。

Objective To evaluate the feasibility of screening sleep apnea- hypopnea syndrome （SAHS） by from electrocardiogram_derived respiration （EDR） of ambulatory electrocardiogram （AECG） monitoring. Methods The overnight sleep investigation was administered to 80 subjects by polysonmogram （PSG） and 24 hours AECG monitoring simultaneously during February through November, 2004. The electrocardiogram analyzers did not know the PSG results at all, They were both asked to give the apnea hypopnea index （AHI） by EDR and PSG respectively. The PSG result was considered as the gold standard so as to evaluate the feasibility of screening SAHS by EDR of AECG monitoring. Results The average age, male gender, body mass index, history of hypertension were higher in the SAHS （ ＋ ） patients than those of the SAHS（ - ） patients. Automatic analysis was performed with software in a sensitivity of 75% ,87.5% and 100% respectively. When software sensitivity adjusted to 75% ,the sensitivity of screening SAHS with EDR was 26. 7%, with the specificity of 80%, the positive predictive value of 80% , the negative predictive value of 26. 7%, the diagnose accordance rate of 40%. When software sensitivity was adjusted to 87.5%, the sensitivity of screening SAHS with EDR was 55% ,with the specificity of 45%, the positive predictive value of 75%, the negative predictive value of 25%, and the diagnose accordance rate of 52. 5%. When software sensitivity was adjusted to 100%, the sensitivity of screening SAHS with EDR was 88. 3%, with the specificity of 35%, the positive predictive value of 84. 1%, the negative predictive value of 50%, and the diagnose accordance rate of 75%. Conclusion EDR technique of AECG was useful to screen the suspicious SAHS patients, sensitivity and the diagnosis coincidence rate was higher when the sensitivity of automatic analysis software was adjusted to 100%.