心肺耦合分析技术对阻塞性睡眠呼吸暂停的诊断价值

Diagnosis of obstructive sleep apnea using cardiopulmonary coupling analysis

目的探讨心肺耦合分析技术对阻塞性睡眠呼吸暂停（OSA）的诊断价值。方法纳入2016年5月就诊于四川大学华西医院睡眠医学中心并行整夜多导睡眠监测（PSG）的睡眠障碍患者44例。所有受试者同时进行PSG和心肺耦合监测。对心肺耦合与PSG睡眠参数进行比较，并分析心肺耦合呼吸紊乱指数（RDI）与PSG各参数的相关性。以PSG为金标准，计算心肺耦合分析技术对OSA诊断的敏感度、特异度、阳性预测值、阴性预测值及受试者工作特征（ROC）曲线下面积。结果44例患者中男37例，女7例，年龄（46．3±12．5）岁，体质指数（25．6±3．7）kg／m2；其中诊断为OSA者33例。心肺耦合分析的RDI与PSG的呼吸暂停低通气指数（AHI）差异无统计学意义（P〉0．05）。心肺耦合分析的RDI、低频耦合与AHI均呈正相关（r=0．849、0．850，均P〈0．001）；高频耦合与AHI呈负相关（r=-0．767，P〈0．001）。当AHI分别35、10、15、20、30次／h时，心肺耦合诊断敏感度分别为0．82、0．93、0．96、0．96、0．77，特异度分别为0．50、0．75、0．72、0．80、0．86，阳性预测值分别为0．85、0．87、0．83、0．85、0．85，阴性预测值分别为0．55、0．86、0．93、0．94、0．79。ROC曲线下面积分别为0．868、0．892、0．915、0．942、0．921。心肺耦合分析的RDI≥20．4次／h时，OSA可能性增加，其敏感度为0．79，特异度为0．91。结论心肺耦合与PSG诊断OSA具有较好的一致性，具有较高的诊断价值。

Objective To explore the diagnostic value of cardiopulmonary coupling analysis in the screening of obstructive sleep apnea （OSA）. Methods A total of 44 participants with sleep disorders from Sleep Medicine Center of West China Hospital in May 2016 were included in the study. All participants were monitored with cardiopulmonary coupling while undergoing polysomnography （PSG）. The sleep parameters detected by cardiopulmonary coupling and PSG were compared and the correlation between respiratory disturbance index （RDI） of cardiopulmonary coupling and sleep parameters of PSG were analyzed. Using PSG as ＂golden standard＂, the sensitivity, specificity, positive predictive value, negative predictive value and the corresponding areas under the receiver operating characteristic （ROC） curves were calculated for cardiopulmonary coupling. Results There were 44 participants included in the study （37 males and 7 females） with a mean age of （46. 3 ± 12. 5） years old and a mean body mass index of （25. 6±3. 7） kg/m2. And there were 33 subjects diagnosed with OSA. There were no significant difference between respiratory disturbance index （RDI） derived from cardiopulmonary coupling and apnea-hypopnea index （AHI） derived from PSG. Correlation analysis showed that the RDI, low frequency coupling monitored by cardiopulmonary coupling was positively correlated with AHI detected by PSG （r =0. 849, 0. 850, both P 〈0. 001 ） ; and the high frequency coupling was significantly negatively correlated with AHI （ r = - 0. 767, P 〈 0. 001 ）. For AHI ≥5/h,≥10/h, ≥15/h, ≥20/h and ≥30/h respectively according to PSG, sensitivity was 0. 82, 0. 93, 0. 96, 0. 96, 0.77, specificity was 0. 50, 0. 75 0. 72, 0. 80, 0. 86, positive predictive value was 0. 85, 0. 87, 0. 83, 0. 85, 0. 85, negative predictive value was 0. 55, 0. 86, 0.93, 0. 94, 0.79 for cardiopulmonary coupling. The corresponding areas under the ROC curves were 0. 868, 0. 892, 0. 915, 0. 942, 0. 921 respectively. In addition, when the RDI derived from CPC was higher than 20. 4/h, the patients were more likely suffering from OSA, and the sensitivity was 0. 79 and the specificity was 0. 91. Conclusions The results of cardiopulmonary coupling are consistent with simultaneous PSG parameters. Cardiopulmonary coupling has a highly diagnostic value for sleep respiratory disorder.