脉搏传导时间在检测呼吸驱动力中的价值

Value of pulse transit time in detecting respiratory drive

目的评价脉搏传导时间（pulse transit time，PTT）在判断呼吸暂停性质方面的准确性，为临床应用该方法提供依据。方法32例阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者被纳入本研究。多道睡眠监测（PSG）共监测得到10305次呼吸暂停事件。应用PTT和食管压分别分析所有呼吸暂停事件，综合比较两次分析结果，探讨PTT的准确性。比较动眼和非动眼睡眠期的PTT准确性，并分析每个患者PTT准确性与临床资料的关系。结果在判断呼吸暂停性质方面，PTT与食管压的总体一致率达到96．7％（9970／10305）。以食管压的判断为金标准，PTT检出中枢性、阻塞性和混合性呼吸暂停的敏感度分别为88．0％、91．3％和97．8％；特异度分别为99．8％、97．8％和92．8％。暂停事件的错判主要集中于阻塞性和混合性呼吸事件间相互错判。动眼和非动眼睡眠期PTT判断的准确性差异无统计学意义。PTT判断呼吸事件的准确率与年龄、BMI、最低血氧饱和度、AHI等无明显相关性。结论PTT与食管压在判断呼吸事件性质方面有很好的一致性，对各类呼吸暂停的检出都具有很高的敏感度和特异度，是无创检出呼吸驱动力的良好方法。

Objective To assess the accuracy of pulse transit time （PTT） in classification of apnea events, and collect data for clinical application reference. Methods Thirty-two obstructive sleep apnea- hypopnea syndrome （OSAHS） patients included in the research had Polysomnography （PSG）, and 10 305 apnea events were recorded. All the events were analyzed by PTT and esophageal pressure （Pes） respectively. The results were analyzed to assess the accuracy of PTT and compare the accuracy of pulse transit time between REM stage and NREM stage, and analyze the correlation between age, body mass index （BMI）, apnea hypopnea index （AHI） and concordance rate in every patient. Results The total concordance rate between PTT and Pes in classification of apnea was 96. 7% （9970/10305）. The sensitivities of PTT in detecting central, mixed and obstructive apnea were 88.0%, 91.3% and 97.8% respectively and the specificities were 99.8% ,97. 8% and 92. 8% respectively. The false determinations of apnea events mainly concentrated on the false determinations between the obstructive and mixed apnea. There was no statistical significant between the accuracy of PTT in different sleep stages. There was a negative relationship between the age, BMI, Lowest SaO2, AHI and the concordance rate. Conclusions There was good concordance between PTT and Pes in classification of apnea. PTT had very high sensitivity and specificity in detecting all kinds of apnea. This study showed that PTT can detect respiratory drive noninvasively with high accuracy.