高级呼吸事件自动探测装置对睡眠呼吸暂停低通气综合征患者的临床应用评价

Validation of the advanced event detection in patients with sleep apnea hypopnea syndrome using auto-CPAP treatment

目的 探讨内置于智能型无创呼吸机内的高级呼吸事件自动探测装置（AED）在睡眠呼吸暂停低通气综合征（SAHS）患者无创正压通气（CPAP）治疗中的应用价值.方法 收集2013年1-8月于北京大学人民医院睡眠中心确诊的SAHS患者28例,其中男26例,女2例;年龄36～79岁,平均（51.9±14.6）岁.分别进行整夜CPAP治疗,同时进行整夜多导睡眠呼吸监测（PSG）,比较PSG得出的呼吸暂停低通气指数（AHI）、呼吸暂停指数（AI）和低通气指数（HI）和AED自动评分得出的AHI、AI和HI,分析AED能否有效评价无创呼吸机治疗过程中AHI、AI和H1的变化.结果 两种方法得到的AHI分别为（6.1±5.6）和（7.1±5.3）次/h（P ＞0.05）,AI分别为（5.4±5.4）和（4.6±4.2）次/h（P＞0.05）,HI分别为（0.77±1.07）和（2.54±1.98）次/h（P ＜0.05）;Spearman相关系数相关分析结果显示AHI相关系数为0.698（P ＜0.01）,AI相关系数为0.767（P ＜0.01）,HI相关系数为0.141（P＞0.05）;Bland-Altman一致性检验结果显示两种方法得到的残余AHI指数具有较高的一致性.结论 高级呼吸事件自动探测装置（AED）对于SAHS患者智能型CPAP治疗中AHI和AI的评估相关性较好,但对于HI的监测准确性不佳,使用AED技术评估家庭智能型CPAP治疗效果具有一定的临床参考价值.

Objective To validate the use of the event detection capabilities in an auto-CPAP system used by patients with sleep apnea hypopnea syndrome（SAHS）.Methods A total of 28 subjects with SAHS were recruited in the study.All the underwent tests of polysomnography（PSG） before and during treatment by an-auto-CPAP system with advanced event detection （AED）in the sleep lab.Apnea-hypopnea index （AHI）,apnea index （AI） and hypopnea index （HI） by PSG and PAP machine were compared.Results The mean AHI derived from PSG and AED was （6.1 ±5.6） and （7.1 ±5.3） times/h（P 〉0.05）,AI was （5.4 ± 5.4） and （4.6 ± 4.2） times/h （P 〉 0.05）,HI was （0.77 ± 1.07） and （2.54 ± 1.98） times/h （P 〈 0.05）.The Spearman correlation coefficient of AHI was 0.698 （P 〈 0.05）,AI was 0.767 （P 〈 0.05）,HI was 0.141 （P 〉 0.05）.Bland-Altman plot also showed a high agreement between AHI derived from PSG and AHI derived from AED.Conclusion AED showed a high agreement with PSG in the detection of AHI and AI,but not in HI.This technique may be helpful to monitor the efficacy of PAP treatment at home for long-term follow-up.