STOP-Bang问卷及Epworth嗜睡评分预测OSAHS及与睡眠相关性研究

目的探讨STOP-Bang问卷(SBQ)和Epworth嗜睡评分(ESS)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)诊断和评估睡眠质量中的价值。方法以51名鼾症患者为研究对象,行整夜多导睡眠监测前接受SBQ和ESS评估。结果 (1)单纯鼾症组与OSAHS组SBQ、ESS,非快动眼睡眠(Ⅰ期、Ⅱ期、Ⅲ+Ⅳ期)及快动眼睡眠(REM)、觉醒次数和微觉醒指数比较差异显著(P0.05)。(2)SBQ≥3分筛查OSAHS灵敏度、特异度分别为89.50%、30.80%;ESS≥9分筛查OSAHS灵敏度、特异度分别为78.90%、69.20%;SBQ≥3与ESS≥9筛查OSAHS的差异有统计学意义(χ~2=7.513,P=0.006)。(3)SBQ与呼吸暂停/低通气指数(AHI)、Ⅱ期睡眠、觉醒次数、微觉醒指数正相关(P0.05),与Ⅲ+Ⅳ期睡眠(%)和REM睡眠(%)负相关(P0.05)。ESS与AHI、Ⅰ期睡眠、Ⅱ期睡眠、觉醒次数、微觉醒指数正相关(P0.05),与Ⅲ+Ⅳ期睡眠(%)和REM睡眠(%)负相关(P0.05)。结论 SBQ与ESS均能预测OSAHS、评估OSAHS睡眠质量,两者联合使用优于单一量表。     

阻塞性睡眠呼吸暂停三种常用量表的比较分析

目的探讨阻塞性睡眠呼吸暂停(OSA)患者三种常用的量表及可能的预测界值。方法选取49例患者,对所有患者同时完善Epworth嗜睡量表(ESS)、STOP-Bang问卷、柏林问卷以及多导睡眠监测,比较三种量表的敏感度和特异度。结果 STOP-Bang问卷的灵敏度为100%,特异度为50%;ESS量表的灵敏度为46.51%,特异度为83.33%;柏林问卷的灵敏度为81.4%,特异度为50%。STOP-Bang问卷和柏林问卷的灵敏度相比差异有统计学意义(P0.05),柏林问卷和ESS量表的灵敏度相比差异有统计学意义(P0.01)。三种量表特异度之间的比较差异均无统计学意义。STOP-Bang问卷预测OSA(AHI≥5)的最佳界值为3分,预测中重度OSA(AHI≥15)的最佳界值为5分。结论 STOP-Bang问卷判断OSA的灵敏度最高,优于ESS量表和柏林问卷。STOP-Bang问卷可以预测OSA的严重程度。     

Ⅲ级睡眠呼吸监测设备在住院心血管疾病患者中监测的准确性评价

目的:评价Ⅲ级便携式睡眠呼吸监测设备(PM)在住院心血管疾病(CVD)患者中对睡眠呼吸暂停(SA)监测的准确性及应用价值。方法:入选101例住院CVD患者,分别应用Ⅱ级多导睡眠呼吸监测设备(PSG)与Ⅲ级PM进行睡眠呼吸监测,比较两种监测设备的睡眠呼吸暂停低通气指数(AHI)结果。将AHI(单位:次/h)分为正常(AHI5)、轻度(5≤AHI15)、中度(15≤AHI30)、重度(AHI≥30)4等级,计算Kendall相关系数、Kappa值,进行配对卡方检验。结果:Ⅱ级PSG的AHI为(18.0±16.6)次/h,Ⅲ级PM的AHI为(18.6±17.4)次/h,差异无统计学意义(P0.05)。AHI正常、轻度、中度、重度4等级,Kendall相关系数为0.701,P0.01,呈强相关关系。一致性检验Kappa值为0.493,P0.01,呈中等强度一致性。Ⅱ级PSG与Ⅲ级PM均以AHI≥15次/h为诊断界值时一致性检验,Kappa值为0.679,P0.05,呈高度一致性。以Ⅱ级PSG为标准作受试者工作特征(ROC)曲线分析,以AHI≥15次/h为诊断界值时,Ⅲ级PM曲线下面积(AUC)为0.918,敏感度为80.4%,特异度为87.3%。Ⅲ级PM最佳诊断点为AHI=15.70次/h,此时约登指数最大,为0.695。结论:对于住院CVD患者监测SA严重程度,Ⅲ级PM与Ⅱ级PSG相比,使用AHI≥15次/h为诊断标准时一致性良好,具有较高的准确性。AHI=15.70次/h为Ⅲ级PM诊断中重度SA的最佳截点。     

应用便携式多导睡眠监测仪对边远地区慢性心力衰竭伴睡眠呼吸暂停患者的临床意义

目的:应用便携式多导睡眠监测仪(PSG)监测边远地区慢性心力衰竭患者,分析其中睡眠呼吸暂停特别是中枢性睡眠呼吸暂停的临床意义。方法:选择云南省怒江傈僳族自治州人民医院心血管病内科住院的患者40例,应用PSG监测其中瓣膜性心脏病患者16例,其他病因引起的心脏扩大患者24例。根据呼吸暂停低通气指数(AHI)分为两组,即AHI≥5次/h组20例和AHI5次/h组20例,分析比较两组患者中枢性睡眠呼吸暂停与心功能的关系。结果:(1)AHI≥5次/h组患者美国纽约心脏协会(NYHA)心功能Ⅲ/Ⅳ级比例、左心房内径、左心室舒张末期内径、左心室收缩末期内径、左心室舒张末期容积、左心室收缩末期容积、AHI以及氧减指数均明显大于AHI5次/h组,而左心室射血分数低于AHI5次/h组,差异均有统计学意义(P均0.05)。(2)AHI≥5次/h组20例患者中以中枢性睡眠呼吸暂停为主16例,以阻塞性睡眠呼吸暂停为主4例。(3)多元Logistic向前逐步选择(Wald)回归分析结果表明,AHI≥5次/h与左心室射血分数[优势比(OR)=0.9,95%可信区间(CI):0.8~1.0,P=0.017)]、最低氧饱和度(OR=0.9,95%CI:0.7~1.0,P=0.022)以及左心室后壁厚度(OR=0.3,95%CI:0.1~0.9,P=0.034)相关;中枢性睡眠呼吸暂停与NYHA心功能Ⅲ/Ⅳ级相关(OR=15.0,95%CI:3.2~71.4,P=0.001)。结论:睡眠呼吸暂停尤其中枢性睡眠呼吸暂停是严重慢性心力衰竭的一种表现,PSG应用于边远地区慢性心力衰竭患者的评估及治疗随访,具有现实意义。     

基于鼾声分析技术的手机软件在成人阻塞性睡眠呼吸暂停筛查中的应用价值研究

目的 评价基于鼾声分析技术的智能手机软件“睡好了么”(Sleepok)在成人阻塞性睡眠呼吸暂停(OSA)筛查中的应用价值,并与常用OSA筛查量表进行比较。方法 纳入2022年7月至2023年4月因打鼾就诊于北京大学人民医院呼吸睡眠医学科进行多导睡眠监测(PSG)的成人受试者173例,在行PSG时同步使用Sleepok监测鼾声,受试者于监测当晚在研究者指导下填写纸质问卷(包括基本信息和常用OSA筛查量表)。结果 Sleepok与PSG测得呼吸暂停低通气指数(AHI)差异无统计学意义(P>0.05)。Pearson相关分析结果显示,Sleepok＿AHI与PSG＿AHI具有较好的相关性(r=0.80,P<0.001)。Bland-Altman一致性检验结果显示,Sleepok＿AHI与PSG＿AHI有较高的一致性(P=0.118),两者之间的平均差异仅为-1.82次/h。ROC曲线分析结果显示,Sleepok＿AHI对OSA、中重度OSA和重度OSA均有较好的诊断价值,其最佳截断值分别为16.6次/h、18.9次/h和28.0次/h。单纯鼾症组与OSA组6种量表(No-Apne...     

C+手环对成人睡眠呼吸暂停低通气综合征的初筛价值

目的 探讨C+手环对成人睡眠呼吸暂停低通气综合征(sleep apnea hypopnea syndrome,SAHS)的初筛价值.方法 对145例疑似SAHS患者同时进行多导睡眠图(polysomography,PSG)与C+手环监测,分别统计PSG监测所得睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)、PSG与C+手环监测所得氧减饱和度指数(oxygen desaturation index,ODI4)、平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)以及血氧饱和度＜90％占整个记录时间的百分比(TS90％).结果 C+手环监测所得ODI4与PSG监测所得AHI两者显著相关(r=0.711,P＜0.001).C+手环与PSG监测所得ODI4、LSaO2、MSaO2以及TS90％进行相关性分析(r分别为0.708、0.575、0.486、0.631,P值均＜0.001).分别以PSG-AHI≥5次/h作为诊断SAHS的阳性标准,C+手环监测所得ODI4≥5次/h作为诊断SAHS的初筛标准,配对矿检验显示差异无统计学意义(x2=1.71,P＞0.05,Kappa值=0.524,P＜0.001).以PSG-AHI≥5次/h作为诊断SAHS的阳性标准,以C+手环监测所得ODI4≥11.45次/h作为SAHS初筛标准,灵敏度为77.4％,特异度为83.9％,以ODI4≥15.45次/h作为初筛标准,其对应特异度为90.3％,灵敏度为68.9％.结论 C+手环对SAHS有一定的初筛价值,可作为一种便携式筛查工具.     

Watch-PAT睡眠监测系统与Compumedics多导睡眠监测系统的对比研究

目的 评价一种通过测定外周交感活性来判断呼吸事件的便携式睡眠仪Watch-PAT诊断阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的效率和准确度.方法 对20例疑诊OSAHS的患者在睡眠室由专业的技术人员同时进行多导睡眠仪(Compumedics)和Watch-PAT(型号:WP-200)监测.PSG的数据根据AASM指南由专业技术人员进行分析;Watch-PAT通过记录外周动脉弹性、心率、血氧饱和度和体位来判断呼吸暂停和低通气事件、血氧以及睡眠状态,并自动分析和生成报告.对比PSG和Watch-PAT的数据,比较的指标包括呼吸暂停低通气指数(AHI)、平均血氧饱和度(SpO2 mean)、最低血氧饱和度(SpO2min)、总睡眠时间(TST)和睡眠结构(REM/NREM).结果 受试者的年龄为(47.95±12.43)岁,体质量指数(BMI)为(28.82±4.15)kg/m2.PSG监测的AHI是(37.65±31.34)次/h.Watch-PAT和PSG的AHI、SpO2 min、SpO2 mean、TST和REM/NREM均高度相关(r=0.99,0.97,0.98,0.78,0.69,P值均＜0.001).Watch-PAT和PSG计算的AHI差异无统计学意义[(37.41±28.85)次/h比(37.65±31.34)次/h],P＞0.05).但Watch-PAT的TST和REM/NREM要高于PSG的结果(P ＜0.01);Watch-PAT的SpO2 mean和SpO2 min也高于PSG的结果(P＜0.01).当PSG AHI≥5次/h为诊断界值时,Watch-PAT AHI的ROC曲线下面积为1.0,其诊断的灵敏度和特异度分别是100％和100％(Watch-PAT AHI≥6.95次/h).当PSG AHI≥15次/h为诊断界值时,Watch-PAT AHI 的ROC曲线下面积为0.98,其诊断的灵敏度和特异度分别是100％和85.7％ (Watch-PAT AHI≥18.4次/h).通过Bland Altman图,可以看出PSG和Watch-PAT的诊断结果具有较好的符合度.结论 Watch-PAT通过测定外周动脉弹性来判断呼吸事件和睡眠状态的方法简单易行,结果可靠.是一种简便有效的便携式睡眠监测仪.     

脑梗死患者阻塞性睡眠呼吸紊乱与脑动脉粥样硬化风险的临床分析

目的 评估脑梗死患者合并阻塞性睡眠呼吸暂停(OSA)时脑动脉粥样硬化的风险.方法 选择经TOAST分型为大动脉粥样硬化性脑梗死患者进行头颅磁共振血管成像(MRA)及颈动脉彩色超声检查了解颅内外动脉病变的情况,并根据检查结果分为无狭窄、狭窄程度＜50％、狭窄程度≥50％组.所有患者均行多导睡眠图检查(PSG),根据睡眠呼吸暂停低通气指数(AHI)分为正常组:AHI＜5次/h;轻度OSA:5 ～ 15 次/h;中度OSA:15 ～30次/h;重度OSA:AHI≥30 次/h.比较OSA与非OSA患者脑动脉狭窄的程度、数量和狭窄分布的区别.结果 75.0％ (57/76)的患者合并OSA,其中轻度OSA为32例(56.1％),中重度OSA为25例(43.9％),颅内动脉狭窄为80.7％ (46/57),颅外动脉狭窄为54.9％ (28/51);非OSA组19例,颅内、外动脉狭窄为总发生率分别为21.1％(4/19),20.0％ (3/15).分层研究表明,随着AHI的增加,颅内外动脉狭窄的程度增加,分布更广.在轻度OSA组,颅内动脉狭窄≥50％的为28.1％(9/32),多支狭窄为28.1％(9/32),颈动脉硬化为40.7％ (11/27)而在中重度OSA组,颅内动脉狭窄≥50％的为72.0％(18/25),多支狭窄为60％ (15/25),颈动脉硬化为70.8％(17/24).轻、中重度组间差异显著(P＜0.05).前、后循环脑动脉狭窄的分布无明显差异(P=0.588).结论 OSA增加脑动脉粥样硬化风险,OSA程度越重,脑动脉硬化的程度越重,分布越广.应重视对脑梗死患者睡眠呼吸功能的评估和干预.     

颈围对阻塞性睡眠呼吸暂停低通气综合征筛查作用的研究

目的分析颈围与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的相关性,研究颈围对预测该病的价值并寻找最佳筛查值。方法以2009-06～2012-06因睡眠打鼾、高血压、糖尿病要求了解睡眠状况,在我中心行多导睡眠图(PSG)检测的≥18岁患者为对象,PSG检测前进行颈围、腰围等指标的测量。以PSG为金标准监测,分析颈围与呼吸暂停低通气指数(AHI)值之间的关系,并利用ROC曲线分析颈围对OSAHS的诊断价值,从中选择出最佳敏感度与特异度的颈围值。结果符合研究条件的受检者2167例,年龄18～89(45.0±14.34)岁,颈围21.0～58.0(38.17±3.567)cm。男性颈围大于女性颈围[(39.13±3.029)cmvs(34.07±2.683)cm,P=0.001]。轻、中、重度OSAHS患者之间颈围差异有统计学意义[(37.86±3.474)cmvs(38.24±2.935)cmvs(39.87±3.043)cm,P=0.000]。AHI与颈围呈正相关(r=0.109,P=0.000)。以PSG-AHI≥5、10、15次/h为金标准制作颈围筛查ROC曲线,显示PSG-AHI15次/h为金标准时ROC曲线下面积最大。男性颈围≥39.25cm时,敏感度为50.0%,特异度为52.5%;女性颈围≥34.75cm时,敏感度为75.5%,特异度为58.6%。结论颈围与OSAHS的AHI呈正相关,颈围在一定程度上可以作为筛查OSAHS的指标,男性颈围≥39.25cm时,女性颈围≥34.75cm时,可以预测中重度OSAHS。     

儿童和青少年肥胖与阻塞性睡眠呼吸暂停的关系

目的 成人肥胖与阻塞性呼吸暂停(OSA)的严重程度存在明显的正相关,但儿童肥胖与OSA的严重程度是否也存在正相关,目前结果并不一致.我们探讨儿童肥胖与OSA严重程度的关系以及分析不同体质量组儿童和青少年的多导睡眠图(PSG)的特点.方法 对235例疑为睡眠呼吸暂停面前来睡眠中心进行PSG检查的儿童和青少年(7～18岁)进行回顾性分析,根据体质量分为正常、超重和肥胖三组,比较不同组别之间的PSG结果以及肥胖与睡眠呼吸暂停低通气指数(AHI)和最低血氧饱和度相关性分析.结果 ①191例诊断为OSA,其中肥胖组有36例(18.8％),超重组有37例(19.4％),正常组有118例(61.8％);②肥胖组的平均AHI[(19.10±24.60)次/h]明显大于超重组[(8.90±13.00)次/h]和正常组[(8.50±15.50)次/h],差异有统计学意义(P值均＜0.05);③肥胖与AHI呈正相关(r =0.202),与低氧血症呈负相关(r=-0.219),P值均＜0.05.结论 儿童及青少年OSA发病与自身的肥胖存在密切相关.     

Modified STOP-BANG questionnaire to predict obesity hypoventilation syndrome in obese subjects with obstructive sleep apnea

Purpose

The STOP-BANG questionnaire (SBQ) has never been studied in the context of its ability to predict obesity hypoventilation syndrome (OHS). Our aim was to evaluate the predictive performance of the original and modified SBQs for OHS in obese subjects with obstructive sleep apnea (OSA).

Methods

Demographics, polysomnographic data, body mass index (BMI), Epworth Sleepiness Scale (ESS) scores, arterial blood gases, spirometric measurements, and SBQ scores were recorded. The modified SBQ was created by dividing BMI into ranges and adding the serum bicarbonate ranges.

Results

The study included 196 obese subjects, of whom 17 had normal polysomnography. Of the remaining subjects, 105 had pure OSA and 74 had OHS with OSA. Both the original and modified SBQs scores were higher for the OHS subjects than for those with pure OSA (p?<?0.001). An original SBQ score of ≥6 gave a satisfactory discrimination for OHS diagnosis (sensitivity 71.6 %, specificity 59.1 %, positive predictive value (PPV) 55.2 %, and negative predictive value (NPV) 74.7 %). The diagnostic OR for an original SBQ score of ≥6 for predicting OHS was 3.7. The sensitivity and NPV were increased for the modified SBQ (sensitivity 89.2 %, specificity 47.6 %, PPV 54.6 %, NPV 86.2 %), and the OR was 7.5. Both the original and modified SBQ scores were moderately correlated with ESS, AHI, ODI, lowest SpO₂, and sleep time spent with SpO₂ <90 %.

Conclusions

The modified SBQ can be used to screen for OHS in obese subjects.

     

Evaluation and validation of four translated Chinese questionnaires for obstructive sleep apnea patients in Hong Kong

Background

The present study validates and evaluates the sensitivity and specificity of four internationally popular questionnaires, translated into Chinese, for assessing suspected obstructive sleep apnea (OSA) patients, namely, the Berlin questionnaire, the ASA checklist, the STOP questionnaire and the STOP–BANG questionnaire. Their predictive values in OSA risks in patients presenting with OSA symptoms are examined. Questionnaires may be helpful in prioritizing polysomnography (PSG) and in treatment for the more severe cases.

Methods

All patients attending our sleep laboratory for overnight PSG were recruited. They were asked to complete three questionnaires (Berlin, ASA checklist and STOP) 2 weeks before and on the same night as the PSG. STOP–BANG questionnaire, an extended STOP with demographic data, ‘B’-body mass index (BMI), ‘A’-age, ‘N’-neck circumference and ‘G’-gender was completed by our technologists using the patient’s completed STOP.

Results

A number of 141 patients were recruited. The sensitivities and specificities for STOP–BANG with cutoffs at PSG’s RDI?=?5, RDI?=?15 and RDI?=?30 were 81 % to 86 % and 34 % to 57 %, respectively. The high-risk group patients identified by STOP–BANG had significantly higher respiratory disturbance index and lower minimum oxygen saturation than the low-risk group patients.

Conclusion

Among the four questionnaires studied, STOP–BANG, with only eight questions and the highest sensitivity, is the best questionnaire of the four for OSA screening. This can potentially assist in prioritizing PSG and can be helpful in clinical or self-evaluation by the general public.     

Home-based diagnosis of obstructive sleep apnea by polysomnography type 2: accuracy,reliability, and feasibility

Purpose

Despite being used in large cohort studies, role of polysomnography (PSG) type 2 is still controversy. This study was aimed to determine its accuracy, reliability, and feasibility in diagnosis of obstructive sleep apnea (OSA) compared to gold standard.

Methods

Adult patients with stable medical conditions who complained of snoring or excessive sleepiness and lived around Bangkok were recruited from a sleep clinic. All were asked to fill questionnaires and have PSG done in laboratory (in-Lab PSG) and at home (Home PSG) on separate nights within 2–4 weeks interval.

Results

Eighty-six patients, 48 males and 38 females, were included. Mean of total sleep time, sleep efficiency, and stage R were significantly greater in Home PSG than in-Lab PSG (p?p?=?0.04), but with excellent reliability, intra-class correlation coefficients of 0.96 (95 % CI; 0.93–0.97), and good agreements (κ?=?0.59–0.70) between both tests. The sensitivity, specificity, and accuracy of Home PSG at cut-off point of AHI ≥5, were 0.97, 0.56, and 0.85, respectively, and at AHI ≥15 were 0.95, 0.76, and 0.85, respectively. Sixty-four patients (74.4 %) preferred home-PSG but four patients (4.7 %) needed repeated tests due to significant data loss.

Conclusions

This is the first report in Asia demonstrating that home-based diagnosis of OSA by PSG type 2 was feasible performing with good reliability, high accuracy, and a low failure rate. However, further studies focusing on its cost-effectiveness are required.     

Validation of Bahasa Malaysia STOP-BANG questionnaire for identification of obstructive sleep apnea

Sleep and Breathing - The diagnosis of obstructive sleep apnea (OSA) by polysomnography (PSG) is time-consuming and expensive. The STOP-BANG questionnaire (SBQ) is an adequate screening tool and...     

A fatty meal aggravates apnea and increases sleep in patients with obstructive sleep apnea

Purpose

The purpose of this study was to investigate the role of a fatty meal before bedtime, on sleep characteristics and blood pressure in patients with obstructive sleep apnea (OSA).

Methods

Recently diagnosed, by full polysomnography (PSG), patients with OSA (n?=?19) were included. These underwent PSG for additional two consecutive nights. Two hours before the PSG examination, a ham and cheese sandwich of 360 kcal was served to all patients, at first night, while a fatty meal of 1,800 kcal was served before the second PSG examination. Comparisons were performed between the last two examinations in terms of PSG data and morning and night blood pressure measurements.

Results

After the fatty meal, a significant increase was observed in total sleep time (p?=?0.026) in the Apnea–Hypopnea Index (AHI) (p?=?0.015), as well as in the absolute number of obstructive and central apneas (p?=?0.032 and p?=?0.042, respectively) compared to the previous night. Conversely, distribution of sleep stages and indices of nocturnal hypoxia (average and minimum SpO₂ and sleep time with SpO₂?<?90 %) did not change significantly. Likewise, no significant change was observed in blood pressure measurements.

Conclusions

Fatty meal intake before sleep can increase AHI in OSA patients, although it does not affect sleep architecture or indices of hypoxia.     

The minimum period of polysomnography required to confirm a diagnosis of severe obstructive sleep apnoea

Background and objective: To combine the diagnosis of OSA with titration of positive airway pressure (PAP), current guidelines recommend that split‐night polysomnography (PSG) be performed if an AHI of ≥40/h is recorded over 2 h. However, the diagnostic validity of partial‐night PSG is uncertain. This study aimed to test the validity of partial‐night PSG and to determine the optimum AHI cut‐off points. Methods: Patients who visited the sleep centre at a tertiary medical centre between January and December 2008, for symptoms related to sleep disorders (sleepiness, snoring, sleep disturbance), and who completed full‐night PSG, were evaluated for this study. Full‐night PSG data were processed to obtain partial‐night PSG data, from which AHI were computed as a reference for diagnosing severe OSA. Full‐night and partial‐night PSG data obtained over different recording times (expressed as x‐h PSG, where x = 1–6) were compared using receiver operating characteristic (ROC) curve analysis. The diagnostic validity of 2‐h PSG with different AHI cut‐off points (25/h to 45/h) was also calculated. Results: Data from 198 PSG recordings was processed. For 2‐h PSG, an AHI cut‐off point of 30/h gave the highest accuracy of 90.9%. Comparing areas under the ROC curves (AUC), 2‐h PSG (AUC = 0.97) was as good as 2.5‐h PSG (AUC = 0.977, P = 0.057) and 3‐h PSG (AUC = 0.978, P = 0.125), but was better than 1.5‐h PSG (AUC = 0.955, P = 0.016). Conclusions: Partial‐night PSG is effective for diagnosing severe OSA. If there is an unabridged PSG recording indicating an AHI of ≥30/h for 2 h, severe OSA can be diagnosed and PAP titration initiated.     

Validation of ApneaLink Ox™ for the diagnosis of obstructive sleep apnea

Objective

The aim of the study was to validate the automatic and manual analysis of ApneaLink Ox? (ALOX) in patients with suspected obstructive sleep apnea (OSA).

Methods

All patients with suspected OSA had a polysomnography (PSG) and an ALOX performed in the sleep laboratory. For automatic analysis, hypopnea was defined as a decrease in airflow ≥30 % of baseline for at least 10 s plus oxygen desaturation ≥3 or 4 %. While for the manual analysis, hypopnoea was considered when a reduction of airflow ≥30 % of ≥10 s plus oxygen desaturation ≥3 % or increase in cardiac rate ≥5 beats/min were identified or, when only a reduction of airflow ≥50 % was observed. OSA was defined as a respiratory disturbance index (RDI) ≥5. The apnea/hypopnea automatic index (AHI3-a, AHI4-a) and manual index were estimated. Receiver operating characteristics (ROC) analysis and the agreement between ALOX and PSG were performed.

Results

Fifty-five patients were included (38 men; mean age, 48.2; median, RDI 15.1; median BMI, 30 Kg/m²). The automatic analysis of ALOX under-estimated the RDI from PSG, mainly for the criterion of oxygen desaturation ≥4 % (AHI3-a–RDI, ?3.6?±?10.1; AHI4-a–RDI, ?6.5?±?10.9, p?<?0.05). The autoscoring from ALOX device showed a better performance when it was set up to identify hypopneas with an oxygen desaturation criterion of ≥3 % than when it was configured with an oxygen desaturation criterion of ≥4 % (area under the receiver operator curves, 0.87 vs. 0.84). Also, the manual analysis was found to be better than the autoscoring set up with an oxygen desaturation of ≥3 % (0.923 vs. 0.87). The manual analysis showed a good interobserver agreement for the classification of patients with or without OSA (k?=?0.81).

Conclusion

The AHI obtained automatically from the ApneaLink Ox? using oxygen desaturation ≥3 % as a criterion of hypopnea had a good performance to diagnose OSA. The manual scoring from ApneaLink Ox? was better than the automatic scoring to discriminate patients with OSA.     

心电图对急性下壁心肌梗死患者梗死相关血管及闭塞部位的预测价值

目的:探讨急性下壁心肌梗死患者的体表心电图对梗死相关血管及闭塞部位的预测价值。方法:对62例急性下壁心肌梗死患者的体表心电图和冠状动脉造影资料进行回顾性对比分析。结果:梗死相关血管为右冠状动脉者50例(80.65%),左回旋支者12例(19.35%)。单纯急性下壁心肌梗死多发生在右冠状动脉中远段(62.07%);并发右室梗死者均发生在右冠状动脉,且多发生在右冠状动脉近段(70.00%)。STⅢ抬高/STⅡ抬高>1、STaVL压低≥0.5mm、STV1抬高≥0.5mm、STV3压低/STⅢ抬高≤1.2提示梗死相关血管为右冠状动脉的灵敏度分别为88.00%、90.00%、66.00%、72.00%,特异度分别为58.33%、75.00%、83.33%、66.67%。STⅢ抬高/STⅡ抬高≤1、STaVL呈等电位线或抬高、STV1压低≥0.5mm、STV3压低/STⅢ抬高>1.2提示梗死相关血管为左回旋支的灵敏度分别为58.33%、75.00%、66.67%、66.67%,特异度分别为88.00%、90.00%、80.00%、72.00%。结论:急性下壁心肌梗死时,体表心电图对梗死相关血管及闭塞部位有重要的预测价值。     

A pilot validation study for the NOX T3TM portable monitor for the detection of OSA

Purpose

The aim of the current pilot study is to compare the diagnostic accuracy of the NOX T3^TM (T3) portable sleep monitor (PM) to that of simultaneously recorded in-lab polysomnogram (PSG).

Methods

A total of 40 participants were recruited following face-to-face evaluation at a sleep disorders clinic. Each participant wore both PSG and PM equipment simultaneously during their in-lab PSG. PSG records were manually scored using the American Academy of Sleep Medicine (AASM) criteria, and PM records were double-scored using the device’s autoscore algorithm as well as manual scoring.

Results

The final sample consisted of 32 participants (56 % male, 50 % black) with a mean ESS, BMI, and apnea–hypopnea index (AHI) of 10.4, 32.8, and 16.3, respectively. Three participants (7.5 %) were excluded for poor PM signal quality. Mean AHI derived from the T3’s autoscore algorithm was similar to that from manual scoring (19.6 ± 18.9 vs. 18.6 ± 19.1, respectively). Autoscore-derived T3 AHI and PSG-derived AHI were strongly related (r = .93). The T3 (autoscored AHI) demonstrated a high degree of sensitivity for the presence of obstructive sleep apnea syndrome (OSA; 100 %) and acceptable specificity for the exclusion of OSA using an AHI cutoff of ≥5 events/h (70 %). The unit (autoscored) had a high degree of both sensitivity (92 %) and specificity (85 %) when the presence of OSA was defined more conservatively (AHI > 15 events/h). For OSA defined as an AHI of ≥5, the T3 (autoscored) correctly identified 88 % of positive cases and 100 % of negative cases.

Conclusions

In this small, clinic-based sample, the T3 demonstrated very good measurement agreement compared to PSG and a high degree of sensitivity for detecting even mild OSA. False positives appeared to be due to respiratory effort-related arousals (RERAs) being autoscored as obstructive apneas and may be due to inherent discrepancy in flow measurement sensitivity between PSG and portable monitors.     

Diagnosis of sleep-disordered breathing by half-night polysomnography.

We hypothesized that sleep-disordered breathing (SDB), defined by the apnea index (AI), the apnea + hypopnea index (A + H/I), or the desaturation event frequency (number of desaturations greater than 5%/h slept) (DEF), could be diagnosed after less than full-night polysomnography (PSG). Forty-eight consecutive full-night PSG sessions were evaluated by separately analyzing the first half (PSG-1/2) and the total (PSG-T) sleep time: 134.42 +/- 35.7 and 277.15 +/- 56.5 min (mean +/- SD), respectively. PSG-1/2 and PSG-T were not different with respect to AI. The DEF was statistically but not clinically higher during PSG-1/2 (41.72 +/- 41 versus 37.95 +/- 35.8, p = 0.04). Sensitivities, specificities, and predictive values of each PSG-1/2 parameter were determined by comparing the values with those measured during PSG-T, using cutoff frequencies of both 5 and 10 events/h slept to define SDB. At a cutoff frequency of 10, sensitivities and positive predictive values were high for all PSG-1/2 parameters (range, 94.6 to 96.9%). The specificities of the DEF and AI during PSG-1/2 were also high (93.75 and 95%, respectively), but the negative predictive value of the DEF was substantially better (93.75 versus 83.3%). With SDB defined by 5 events/h slept, there also were high sensitivities (87.9 to 93%), positive predictive values (93.6 to 100%), and specificities (86.7 to 100%) for all parameters. Negative predictive values, however, were substantially reduced (62.5 to 76.5%). We conclude that PSG during 2 h of sleep is an appropriate method for evaluating SDB.(ABSTRACT TRUNCATED AT 250 WORDS)