动态心电图初筛阻塞性睡眠呼吸暂停综合征

Clinical value of applying Holter monitoring to preliminarily screen obstructive sleep apnea syndrome

目的探讨应用动态心电图(Holter monitoring,Holter)初筛阻塞性睡眠呼吸暂停综合征(Obstructive Sleep Apnea Syndrome,OSAS)的临床价值。方法对60例患者进行整夜(>7h)多导睡眠仪(Polysomnogram,PSG)及24h动态心电图检测。根据PSG及动态心电图的结果,分别做出OSAS阳性与阴性的诊断。以PSG为金标准,分析评价应用动态心电图初筛OSAS的临床价值。结果 60例患者根据PSG检查结果分为OSAS阳性组44例,OSAS阴性组16例。动态心电图筛查出40例OSAS(真阳性38例,假阳性2例),20例除外OSAS(真阴性14例,假阴性6例)。动态心电图筛查OSAS的灵敏度86.4%,特异度87.5%,误诊率12.5%,漏诊率13.6%,阳性预测价值95%,阴性预测价值70%,总的符合率86.7%,Youden指数73.9%。结论用动态心电图初筛OSAS具有可行性,有望作为临床上诊断OSAS的辅助方法。

Objective To explore the clinical value of applying Holter monitoring to preliminarily screen obstructive sleep apnea syndrome（OSAS）. Methods Sixty patients were detected by overnight（7h）Polysomnogram （PSG）and 24h Holter monitoring（24h Holter）. Two physicians diagnosed whether OSAS positive or OSAS negative according to PSG results and Holter monitoring system. Taking PSG as the gold standard, it will analyze and evaluate the clinical value of applying Holter monitoring to preliminarily screen obstructive sleep apnea syndrome（OSAS）. Results Forty-four of 60 subjects were diagnosed as OSAS positive according to PSG monitoring results,and the other sixteen were diagnosed as OSAS negative. Holter screened 40 OSAS cases（38 of true positive and 2 of false positive）and 20 cases were excluded（14 of true positive and 6 of false positive）. The sensitivity of Holter screening OSAS is 86.4%, 87.5% of specificity, 12.5% of misdiagnosis rate, 13.6% of missed diagnosis rate, 95% of positive predictive value, 70% of negative predictive value, 86.7% of total coincidence rate and 73.9% of Youden index. Conclusion It is feasible to apply Holter to preliminarily screen obstructive sleep apnea syndrome（OSAS）. It can be used as an auxiliary means to diagnose OSAS in clinical practice.