Ⅳ型便携式睡眠监测设备在心内科的应用

Application of TypeⅣPortable Sleep Monitoring in Department of Cardiology

目的:比较Ⅳ型便携式睡眠监测设备(portable monitoring,PM)和Ⅲ型PM,并评估Ⅳ型PM在心内科住院患者中诊断阻塞性睡眠呼吸暂停的价值。方法:入选2016年3月到2018年7月于广东省人民医院心内科住院的患者275例,同时佩戴Ⅲ型PM和Ⅳ型PM进行监测,获得两种设备测得的睡眠呼吸参数。将两种设备所测得参数进行相关性分析,绘制Bland-Altman图反映两种设备测得值之间的一致性。根据Ⅲ型PM呼吸事件指数(respiratory event index,REI)的不同临床诊断阈值计算Ⅳ型PM REI的符合率、Kappa值,制作ROC曲线并计算AUC。结果:共275例患者(男性206例,女性69例)纳入分析,平均年龄(57.5±11.4)岁,体重指数(26.6±3.6)kg/m^(2)。Ⅲ型PM-REI和Ⅳ型PM-REI呈强相关关系(r=0.913,P<0.001),Bland-Altman散点图提示两种设备测得值具有良好一致性。当Ⅲ型PM-REI≥5次/h为参照标准时,Ⅳ型PM-REI诊断的符合率为84.0%,Kappa值为0.520,P<0.001,AUC为0.936,P<0.001;当Ⅲ型PM-REI≥15次/h为参照标准时,Ⅳ型PM-REI诊断的符合率为87.3%,Kappa值为0.744,P<0.001,AUC为0.955,P<0.001;当Ⅲ型PM-REI≥30次/h为参照标准时,Ⅳ型PM-REI诊断的符合率为90.9%,Kappa值为0.742,P<0.001,AUC为0.972,P<0.001。结论:Ⅳ型PM对心内科可疑阻塞性睡眠呼吸暂停患者具有较好的诊断价值,与Ⅲ型PM具有良好的一致性。

Objectives:To evaluate the value of typeⅣportable monitoring(PM)in the diagnosis of obstructive sleep apnea(OSA)among inpatients in the department of cardiology by comparing with that of typeⅢPM.Methods:Patients in Guangdong Provincial People’s Hospital were enrolled from March 2016 to July 2018.The patients underwent typeⅢPM and typeⅣPM in the same night.The sleep parameters were obtained.Correlation analysis was performed between the parameters obtained from the two devices.Bland-Altman plots were used to further illustrate the performances of these two devices.A positive diagnosis of OSA was defined by comparing the typeⅢPM derived respiratory event index(REI)against clinical thresholds of 5,15 and 30 events/h.The typeⅣPM derived REI(Ⅳ-REI)performance metrics were assessed for coincidence rate,Cohen’sκcoefficient and the area under the receiver operator curve(ROC)by comparing with typeⅢPM derived REI(Ⅲ-REI).Results:Valid results were available for 275 subjects.There were 206 male patients(74.9%),the mean age was(57.5±11.4)years,and the body mass index was(26.6±3.6)kg/m^(2).Positive correlation was found betweenⅢ-REI andⅣ-REI(r=0.913,P<0.001).The Bland-Altman plot showed good agreement betweenⅢ-REI andⅣ-REI,with most estimates falling within 2 standard deviations of the mean.ForⅢ-REI≥5 events/h,the coincidence rate ofⅣ-REI was 84.0%,κcoefficient was 0.520,P<0.001.ForⅢ-REI≥15 events/h,the coincidence rate ofⅣ-REI was 87.3%,κcoefficient was 0.744,P<0.001.ForⅢ-REI≥30 events/h,the coincidence rate of IV-REI was 90.9%,κcoefficient was 0.742,P<0.001.The corresponding areas under the ROC were 0.936,0.955 and 0.972,respectively.Conclusions:The typeⅣPM has good diagnostic value for patients with suspected OSA hospitalized in the department of cardiology,and has good consistency with the typeⅢPM.