微动敏感床垫睡眠监测系统在儿童阻塞性睡眠呼吸暂停综合征诊断中的应用

Application of micro movement sensitive mattress sleep monitoring system in diagnosis of children with obstructive sleep apnea syndrome

目的评估微动敏感床垫睡眠监测系统（micro movement sensitive mattress sleep monitoring system，MSMSMS）在诊断儿童阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）中的临床应用价值。方法收集2013年6月至2015年6月因睡眠打鼾在首都医科大学附属北京儿童医院睡眠中心进行监测的儿童129例，年龄3～14岁。排除标准：有急性呼吸道感染、颅面畸形、慢性肺疾病、神经肌肉病的患儿。按照诊断标准，OSAS患儿36例；年龄（7．3±2．5）岁；男28例，女8例。非OSAS儿童93例；年龄（6．3±2．3）岁；男61例，女32例。对观察对象进行同步MSMSMS和多导睡眠监测（polysomnography，PSG）。以呼吸暂停／低通气指数（AHI）〉5或阻塞性呼吸暂停指数（OAI）〉1为异常，判断患儿是否存在OSAS，比较MSMSMS和PSG在诊断OSAS和判断睡眠效率上的一致性。结果MSMSMS和PSG诊断OSAS的Kappa系数为0．70（95％ CI：0．57—0．84），Z=7．99，P〈0．0001，表明2种监测方法具有较好的一致性。比较MSMSMS和PSG在睡眠效率判断的一致性，Bland-Ahman法分析显示，有3％（5／129例）的点在95％一致性界限以外，其组内相关系数（ICC）值为0．69，表明2种监测方法在睡眠效率判断上具有较好的一致性，且MSMSMS能够发现不伴脑电觉醒和血氧减低但有皮质下觉醒的呼吸事件。结论MSMSMS在诊断儿童OSAS及判断睡眠效率上与标准PSG具有较好的一致性，并且MSMSMS在检测皮质下觉醒和呼吸事件方面可能更有优势。

Objective To evaluate the application value of the micro movement sensitive mattress sleep moni- toring system（MSMSMS） in the diagnosis of children with obstructive sleep apnea syndrome （OSAS）. Methods One hundred and twenty - nine children aged from 3 to 14 years who visited the sleep center of Beijing Children＇s Hospital Affiliated to Capital Medical University from June 2013 to June 2015 due to sleep snoring were enrolled. Children with acute respiratory infection, cranial facial abnormalities, chronic lung diseases and neuromuscular diseases were excluded. According to the criteria ,36 children were diagnosed as OSAS with average age of （ 7.3 ± 2.5 ） years, including 28 males and 8 females. Ninety - three non - OSAS children were recruited with average age of （6.3 ± 2.3 ） years, inclu- ding 61 males and 32 females. Subjects were monitored with polysomnography（PSG） and MSMSMS simultaneously. Apnea/hypopnea index （AHI） 〉 5 or obstructive apnea index （OAI） 〉 1 were used to define whether OSAS existed. The consistency between MSMSMS and PSG in the diagnosis of OSAS and the determination of sleep efficiency were compared. Results The Kappa consistency coefficient of MSMSMS and PSG in the diagnosis of OSAS was 0. 70 （95% CI： 0.57 -0.84） ,Z =7.99 ,P 〈0. 000 1 ,which indicated the consistency between PSG and MSMSMS was good. The consis- tency of sleep efficiency of MSMSMS and PSG were compared. Bland- Altman results showed that there were 3% （5/129 cases）points out of 95% consistency bound and the interclass correlation coefficient （ICC） was 0. 69 which indicated the consistency of 2 methods was good in determination of sleep efficiency. MSMSMS was able to detect respiratory event that was associated with sub -cortical arousals with no electroencephalogram arousal or blood oxygen reduction. Conclusions There is an adequate consistency between MSMSMS and PSG in the diagnosis of children with OSAS and determination of sleep efficiency. The MSMSMS has an advantage in detection of sub - cortical arousals and respiratory event.