使用多参数压敏式便携睡眠监测系统检测阻塞型睡眠呼吸暂停伴低通气综合征

Detecting of obstructive sleep apnea hypopnea syndrome using a multi-parameter pressure sensitive sleep monitor

目的:评价一种基于压电驻极体薄膜(electro-mechanical film,EMFi)的多参数压敏式便携睡眠监测系统对阻塞型睡眠呼吸暂停伴低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的筛查价值和研究意义。方法:回顾性分析58例于北京大学第三医院因打鼾就诊患者使用多参数压敏式便携睡眠监测系统和多导睡眠仪(polysomnography,PSG)进行同步整夜监测的检测结果,以PSG检测结果为金标准,计算多参数压敏式便携睡眠监测系统进行OSAHS诊断的敏感度与特异度,比较两种方法判定睡眠呼吸事件、总呼吸暂停时间的一致性。结果:58例患者中男48例,女10例,平均年龄(40.6±12.2)岁,其中PSG诊断为OSAHS患者39例。使用多参数压敏式便携睡眠监测系统进行OSAHS诊断性判读的敏感度为92.3%,95%置信区间为79.1%~98.4%,特异度为100%,95%置信区间为82.3%~100%,两种监测诊断结果间行Kappa检验,k=0.887(P<0.001)。使用多参数压敏式便携睡眠监测系统与PSG同步测定的呼吸暂停低通气指数(apnea hypopnea index,AHI)分别为12.0(2.6~32.2)次/h、13.4(3.1~38.8)次/h,总呼吸暂停时间分别为37.9(9.9~80.5)min、32.3(8.6~93.0)min,两组数据间差异无统计学意义(P>0.05)。两种方法监测的AHI(ρ=0.939,P<0.001)、总呼吸暂停时间(ρ=0.924,P<0.001)均呈高度正相关,Bland-Altman分析显示两者检测结果间一致性非常高。结论:多参数压敏式便携睡眠监测系统作为一种轻便、微干扰、非接触式全自动监测设备,具有较高的OSAHS筛查价值和潜在的病理诊断价值,值得进一步推广应用,对于中枢型呼吸睡眠暂停综合征的分型以及对睡眠分期的判定尚需进一步完善。

Objective:To evaluate the efficacy of an electro-mechanical film-based(EMFi)multi-parameter pressure sensitive sleep monitor(MPSSM)on clinical diagnosis and research significance of obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:Retrospective analysis was made of 58 test subjects at Peking University Third Hospital with suspected OSAHS who were simultaneously monitored by MPSSM and polysomnography(PSG).The PSG test results were used as the gold standard in evaluating the sensitivity and specificity of OSAHS diagnosis of MPSSM.The test result consistency of sleep apnea and hypopnea index(AHI)and total apnea time of the two methods was evaluated.Real-time waveform comparison of sleep respiratory events of a randomly selected patient diagnosed with OSAHS was performed.Results:For 58 test subjects,48 were male,10 were female,with an average age of(40.6±12.2)years.Thirty-nine out of the 58 test subjects were diagnosed with OSHAS by PSG.The sensitivity of MPSSM for OSAHS diagnosis was 92.3%,with 95%confidence interval of 79.1%-98.4%,and the specificity of MPSSM for OSAHS diagnosis was 100%,with 95%confidence interval of 82.3%-100%.Kappa test k=0.887(P<0.001)showed OSAHS diagnosis results of the two methods were almost identical.The AHI measured by MPSSM[12.0(2.6-32.2)times/h]and PSG[13.4(3.1-38.8)times/h]were highly correlated(ρ=0.939,P<0.001).The total apnea time measured by MPSSM[37.9(9.9-80.5)min]and PSG[32.3(8.6-93.0)min]were highly correlated(ρ=0.924,P<0.001).Bland-Altman plot showed that the consistency between the test results of the two methods was very high.Conclusion:As a portable,non-contact,fully automatic monitoring device,MPSSM is reliable in the screening of OSAHS compared with PSG.It is suitable to be promoted and applied in primary medical institutions,nursing homes and domestic usage.However,further research is required in improving the analysis of different sleep phase and the differentiation of central sleep apnea syndrome respiratory events in order to effectively assist medical personnel in making an accurate sleep apnea diagnosis.