摘要
目的探讨气流、脉搏血氧饱和度和胸腹运动三者结合诊断睡眠呼吸暂停低通气综合征（SAHS）的价值。方法收集70例2010年6月至2011年4月就诊于北京大学人民医院睡眠中心的疑诊SAHS的受试者，分别于不同时间在睡眠室进行整夜多导睡眠监测（PSG）及便携式睡眠监测仪（PMD）检查，对比分析PSG得出的呼吸暂停低通气指数（AHI）和PMD得到的呼吸紊乱指数（RDI）以及两种方法得出的最低血氧饱和度（LSaO2）、血氧饱和度减低指数（ODI4），判断PMD诊断SAHS的敏感度、特异度；对呈偏态分布的AHI或RDI、ODI。数据经对数变换为近似正态分布数据，以配对t检验进行差异假设检验；以Bland-Altman标绘图对比两种方法对于诊断SAHS的一致性。结果70例受试者中PSG诊断为SAHS58例。以AHI（RDI）〉5次／h为标准，PMD诊断的敏感度94．8％、特异度75．0％；两种方法得到的AHI与RDI分别为（294-27）和（274-25）次／h（经对数变换后分别为1．24±0．5和1．24±0．5，P=0．411）、ODI。分别为（214-24）和（20±25）次／h（经对数变换后分别为0．94-0．7和1．14±0．5，P=0．042），LSaO，分别为79％4-13％和79％4-12％（P=0．550），AHI与RDI之间差异无统计学意义；Bland．Ahman一致性检验结果显示两种方法得到的AHI（RDI）具有较高的一致性，并可结合图形对事件类型进行分析。结论结合呼吸气流、血氧、胸腹呼吸运动三种生理指标的睡眠呼吸生理监测对于诊断SAHS具有较高敏感度、特异度，对呼吸紊乱事件类型的判断具有一定临床参考价值。
Objective To validate the values of monitoring airflow, oxygen saturation and respiratory effort in the diagnosis of sleep apnea-hypopnea syndrome （ SAHS）. Methods A total of 70 subjects with suspected SAHS underwent the tests of polysomnography （PSG） and portable monitoring device （PMD） separately at our sleep lab. The portable monitoring device recorded nasal airflow, oxygen saturation and respiratory effort. Apnea-hypopnea index （AHI） or respiratory disturbed index （ RDI）, lowest oxygen saturation （ LSaO2 ）, oxygen desaturation index （ ODI4 ） and percentage of different types of sleep breathing events （central/obstructive/mixed hypopnea） accounting for the total numbers of sleep disordered breathing were also analyzed. The data of AHI and ODI4 showed skew distribution undergoing log transformation to approximate to normal distribution. Pair t test was used for the comparisons of different parameters. The agreement between two methods was analyzed by Bland-Altman plot. Results Fifty-eight subjects were diagnosed as SAHS with an AHI （RDI） over 5 on PSG. The sensitivity and specificity of portable monitoring device were 94. 8% and 75.0% respectively. The mean AHI derived from PSG and RDI derived from PMD were （ 27 ± 25 ） and （ 29 ±27 ） times per hour respectively and those after log transformation were （ 1.2 ±0. 5 ） and （ 1.2 ± 0. 5 ） times per hour （P = 0. 411 ）. The mean ODI4 derived from PSG and PMD were （23 ±25） and （21 ±24） and those after log transformation（0.9 ±0.7）and （1.1±0.5） times per hourrespectively （P =0. 042）. The mean values of LSaO2 were 79% ± 13% and 79% ± 12% respectively （P = 0. 550）. No significant differences existed between AHI derived from PSG and RDI derived from PMD. Bland-Altman plot also showed a high agreement between AHI derived from PSG and RDI derived from PMD. PMD could also identify major part of different events so as to aid clinical decision-making. Conclusion Portable monitoring device recording airflow, oxygen saturation and respiratory effort shows a great agreement with PSG with regards to AHI （RDI） and the identification of different types of respiratory events.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第6期415-418,共4页
National Medical Journal of China
