应用动态心电图推导呼吸曲线人工分析的方法初筛睡眠呼吸暂停低通气综合征

目的:以多导睡眠分析仪作对照,探讨应用动态心电图推导呼吸曲线(EDR),采用人工分析的方法初筛睡眠呼吸暂停低通气综合征(SAHS)的可行性。方法:2004年4月～2005年10月对120例就诊于睡眠中心的患者进行整夜(>7h)多导睡眠分析仪监测,同时同步进行动态心电图检查。双方在互相不沟通的情况下分别计算睡眠呼吸暂停低通气指数(AHI),并做出SAHS阳性与阴性的诊断,以多导睡眠分析仪结果作为金标准评价应用EDR技术初筛SAHS的可行性。结果:120例患者通过多导睡眠分析仪监测,结果88例患者SAHS阳性,32例患者SAHS阴性,应用动态心电图EDR技术人工分析方法初筛SAHS结果敏感性85.2%、特异性93.8%、阳性预测值97.4%、阴性预测值69.8%、诊断符合率87.5%。受试者工作特性曲线(ROC)下面积0.938,经相关分析两者AHI的相关系数为0.879(P=0.000),两者最长睡眠呼吸暂停时间的相关系数为0.716(P=0.000),两者最长睡眠低通气时间的相关系数为0.281(P=0.005)。结论:应用动态心电图EDR技术,采用人工分析方法对可疑SAHS患者进行初筛的符合率较高,可以作为临床上SAHS诊断的辅助工具。

Screening of Sleep Apnea-Hypopnea Syndrome by Manual Analysis of Ambulatory Electrocardiogram Derived Respiration

Objective: To evaluate the feasibility of screening sleep apnea-hypopnea syndrome (SAHS) by manual analysis of ambulatory electrocardiogram (AECG) derived respiration. Methods: The overnight sleep investigation was conducted in 120 subjects by polysomnography (PSG) and 24 hours AECG monitoring during April 2004 through October 2005.The electrocardiogram analyzers had no idea of the PSG results, So did the PSG analyzers.They were asked to give the apnea-hypopnea indexes (AHI) by electrocardiogram derived respiration (EDR) and PSG, respectively.The PSG result was considered as the gold standard to evaluate the feasibility of screening SAHS by EDR of AECG monitoring. Results:Eighty-eight of 120 subjects were diagnosed as SAHS( ) by polysomnogram (PSG), and the other thirty two were diagnosed as SAHS(-).When the analysis was performed with manual EDR technique, the sensitivity of screening SAHS with EDR was 85.2%, the specificity was 93.8%, the positive predictive value was 97.4%, the negative predictive value was 69.8%, and the diagnosis accordance rate was 87.5%.The area under the curve was 0.938.The coefficient correlation of AHI between EDR and PSG was 0.879 (P=0.000), The coefficient correlation of the longest time of apnea and hypopnea was 0.716 (P=0.000) and 0.281(P=0.005), and the correlation was statistically significant (P<0.01). Conclusion: When EDR technique was used by manual analysis to screen the suspicious SAHS, the diagnosis coincidence rate was higher.it may be a supplementary tool for diagnosis of SAHS.