动态心电图推导呼吸曲线在老年慢性阻塞性肺疾病合并睡眠呼吸暂停低通气综合征患者中筛查价值的分析

目的:分析动态心电图推导呼吸曲线(EDR)检测在慢性阻塞性肺疾病患者并发睡眠呼吸暂停低通气综合征(SAHS)中的筛查价值。方法:收集选取2017年4月至2019年4月期间,我院诊治的147例老年慢性阻塞性肺疾病患者为研究对象,以多导睡眠监测为SAHS的诊断金标准,同时行动态心电图EDR检测进行对比分析,计算动态心电图EDR检测的诊断特异度、敏感度、准确度,同时绘制受试者工作特征(ROC)曲线图,计算ROC曲线下面积(AUC)。结果:SAHS阳性和SAHS阴性组患者在年龄和性别上,差异无统计学意义(P均>0.05),而两组在BMI、糖尿病和高血压的发生上,差异有统计学意义(P均<0.05);动态心电图EDR与PSG分析结果,异无统计学意义(P>0.05);SAHS阴性和阳性患者7 h内低通气次数和AHI情况,差异有统计学意义(P<0.05);7 h内低通气次数预测SAHS的最佳截断值为30.12次(诊断敏感度为90.4%,特异度为88.3%),其ROC曲线下面积(AUC)为0.824(95%CI:0.782~0.902,P<0.008),AHI预测的最佳截断值为5.18次/h (诊断敏感度为90.3%,诊断特异度为90.1%),其AUC为0.959(95%CI:0.934~0.986,P<0.001), 7 h内低通气次数和AHI截取值的两组人群相比,差异有统计学意义(P均<0.05)。结论:动态心电图EDR检测在慢性阻塞性肺疾病患者SAHS筛查中的参考价值较高,值得在临床上进一步验证使用。

The value of dynamic electrocardiogram electrocardiogram derivational respiratory curve in screening sleep apnea hypopnea syndrome in elderly patients with chronic obstructive pulmonary disease

Objective: To analyze the value of dynamic electrocardiogram derivational respiratory curve(EDR) testing in patients with chronic obstructive pulmonary disease complicated with sleep apnea hypopnea syndrome(SAHS). Methods: A total of 147 elderly patients with chronic obstructive pulmonary disease who were diagnosed and treated in our hospital from April 2017 to April 2019 were enrolled. The polysomnography was used as the diagnostic gold standard for SAHS, and the EEG detection of dynamic electrocardiogram was used for comparative analysis. We calculated the diagnostic specificity, sensitivity, and accuracy of the dynamic electrocardiogram EDR test, and we plotted the receiver operating characteristic(ROC) curve to calculate the area under the ROC curve(AUC). Results: There were no significant differences in age and gender between the SAHS-positive and SAHS-negative groups(P>0.05), but there were significant differences in body mass index, diabetes, and hypertension between the two groups(P<0.05). There was no statistically significant difference between the EEG and PSG analysis of dynamic electrocardiogram(P>0.05). There was significant statistical difference between the number of hypoventilation and AHI in SAHS negative and positive patients within 7 h(P<0.05);for hypoventilation within 7 h, the optimal cutoff value of SAHS was 30.12(diagnostic sensitivity was 90.4%, specificity was 88.3%), and the area under the ROC curve(AUC) was 0.824(95% CI: 0.782-0.902, P<0.008). The best cutoff value predicted by AHI was 5.18 beats/h(diagnostic sensitivity was 90.3%, diagnostic specificity was 90.1%), and its AUC was 0.959(95% CI: 0.934-0.986, P<0.001). There were significant differences between the two groups of hypoventilation times and AHI cutoff values within 7 hours(both P<0.05). Conclusions: Dynamic electrocardiogram(EDG) has a great reference value in SAHS screening in patients with chronic obstructive pulmonary disease and is worthy of further clinical validation.