成人家庭睡眠呼吸暂停监测临床规范应用专家共识

伴随家庭睡眠呼吸暂停监测(HSAT)技术的进步以及阻塞性睡眠呼吸暂停(OSA)家庭诊疗模式临床循证数据的增加,采用不同种类生物信号采集技术的HSAT设备越来越广泛应用于成人OSA的诊断。HSAT应用于OSA的诊断需结合全面的睡眠及临床评估;HSAT可用于临床评估高风险的中重度单纯OSA患者的诊断,但不能用于排除诊断;对于合并严重心肺疾病、脑血管疾病、神经肌肉疾病等伴发疾病或疑诊合并其他类型睡眠疾病的患者首选多导睡眠监测(PSG),HSAT用于上述疾病状态下OSA诊断需考量患者病情的严重程度及伴发疾病、患者个人的倾向性、医疗保险支付方式及医疗资源的可及性等因素,在遵照基本诊疗原则的基础上,根据每个患者的不同情况,选取适宜的诊断工具;对于行动不便或病情危重需尽快启动干预治疗的OSA患者,可考虑应用HSAT;HSAT可用于合并存在心脑血管疾病等高危人群的OSA筛查;对于OSA的非气道正压通气(PAP)治疗,建议采用多通道诊断级别HSAT或PSG评估疗效;OSA患者启动PAP治疗后如果发生具有临床意义的体重波动,或依从性良好、但症状复发或持续无缓解,或新发心血管疾病或原有心血管疾病恶化,可复查HSAT或PSG;鉴于目前HSAT监测设备自动判读的准确性有限,须对原始数据进行人工回顾判读;HSAT设备类型的选择、结果的正确解读及据此制定的诊疗方案需由睡眠专业医生指导实施;鉴于尚缺乏足够的临床验证,目前不推荐消费者级别的睡眠监测设备用于成人OSA的诊断。

Expert consensus for the use of home sleep apnea test in the diagnosis of obstructive sleep apnea in adults

With the advancement of home sleep apnea test(HSAT)technology and the increase of encouraging evidence of home-based management approach for obstructive sleep apnea(OSA),HSAT devices using different types of biosignal acquisition technology are more and more widely used for the diagnosis of OSA in adults.HSAT for the diagnosis of OSA should be performed in combination with a comprehensive clinical and sleep evaluation.HSAT can be used as a diagnostic tool for uncomplicated OSA with a high pretest probability of moderate to severe OSA.A negative HSAT result cannot exclude the diagnosis of OSA for subjects with high clinical suspicion.Polysomnography(PSG)is preferred for the diagnosis of OSA in patients with significant comorbid medical conditions.The clinical application of HSAT in the diagnosis of complicated OSA needs to refer to the severity of clinical condition,comorbid disease,personal preference,local medical insurance policy and the accessibility of medical resources.HSAT may be indicated for the diagnosis of OSA in patients for whom attended PSG is not possible by virtue of immobility,safety,or critical illness.HSAT can be used for the screening of OSA in subjects with cardiocerebrovascular diseases.Follow-up HSAT or PSG is recommended to evaluate therapeutic response with non-positive airway pressure(PAP)interventions.Follow-up HSAT or PSG can be used for reassessment for patients with clinically significant weight fluctuation,persistent or recurrent symptoms under good PAP adherence,emergence or changes in cardiovascular diseases.Due to limitations of current automatic scoring algorithms that restrict the diagnostic accuracy,it is mandatory to review the raw data of type 3 devices.The selection of HSAT equipment,interpretation of monitoring results and the development of management plan should be under the guidance of physicians with sleep medicine training.Consumer-grade technologies are not appropriate for the clinical diagnosis of OSA due to lack of validation.