睡眠监测设备负荷对阻塞性睡眠呼吸暂停低通气综合征诊断的影响

Effects of sleep monitoring equipment load on the diagnosis of obstructive sleep apnea hypopnea syndrome

目的评价睡眠监测设备负荷变化对监测结果的影响。方法对50例受试者分别进行采用连线较少且允许患者活动度较大的II类便携式睡眠监测(portable monitor,PM)设备及传统多道睡眠图(PSG)监测。对比两者的主观评价及客观监测结果的差异,分析差异产生的原因。结果 50例受试者中,29例为OSAHS患者,21例为对照组,其中无鼾症者14例,单纯鼾症7例。PSG监测的呼吸暂停低通气指数(AHI-PSG)与PM设备的AHI值(AHI-PM)呈正相关(r=0.914,P<0.001)。PM与PSG诊断一致性和分度一致性的κ值分别为0.919和0.658(P均<0.05)。PSG-AHI≥5次/h时,AHI-PM的ROC曲线下面积(AUC)为0.987,相对应的最佳诊断切点为4.26次/h,此时敏感度为96.6%,特异度为95.2%,均表现出良好一致性。在对照组,PM和PSG检测到的AHI值无明显相关性(1.52次/h vs 1.68次/h,P>0.05),在OSAHS组,PM较PSG监测到的AHI偏低(18.6次/h vs26.6次/h,P<0.05)。N3期睡眠时间占总睡眠时间的百分比,PM较PSG更高(21.8%vs 13.5%,t=-5.505,P<0.05),PM较PSG的仰卧位睡眠时间差异无统计学意义(62.5%vs56.3%,P>0.05)。结论与PSG相比,PM的负荷小,舒适度和接受程度较高,OSAHS患者用负荷较低的PM检测到的AHI值更低,可能与睡眠质量提升有关。

OBJECTIVE To evaluate the impact of the changes in the load of sleep monitoring equipment on the monitoring results.METHODS Fifty subjects were monitored by type II portable monitoring equipment(PM),which with less wiring and allowing for greater patient mobility,and the traditional polysomnography(PSG)respectively.The differences between subjective evaluation and objective monitoring of the results were compared and the reasons for the differences were discussed.RESULTS Among the 50 subjects,29 were OSAHS patients,14 were non-snore patients and 7 were simple snore patients.PSG’s apnea hypopnea index(AHI-PSG) was positively correlated with PM’s AHI(AHI-PM)(r=0.914,P<0.001).The Kappa values of the diagnostic consistency and grading consistency between PM and PSG were 0.919 and 0.658(all P<0.05).When the AHI-PSG≥5 events/h,the AUC of the AHI ROC obtained by PM was 0.987,and the corresponding optimal cut off point was 4.26 events/h,with a sensitivity of 96.6%and a specificity of 95.2%,showing good consistency.In the control group(non snore or simple snore subjects),there was no significant correlation in AHI values detected by PM and PSG(1.52 events/h vs 1.68 events/h,P>0.05).In OSAHS group,AHI values detected by PM was lower than that detected by PSG(18.6 events/h vs 26.6 events/h,P<0.05).N3 sleep time(as a percentage of total sleep time) in PM monitoring was higher than that in PSG monitoring(21.8%vs 13.5%,t=-5.505,P<0.05),there was no significant difference in supine sleep time between PM and PSG monitoring(62.5% vs 56.3%,P>0.05).CONCLUSION Compared with PSG,PM has lower load,higher comfort and acceptance,and the AHI value detected with lower load PM in OSAHS patients is lower,which may be related to the improvement of sleep quality.