摘要
目的 睡眠呼吸暂停（SA）在心血管疾病患者中有较高的发生率,却常被低估.具有ApScan算法的起搏器可以利用分钟通气量传感器计算呼吸紊乱指数（RDI）.本研究旨在评估ApScan-RDI（Ap-RDI）对SA诊断的可行性.方法 入选2016年7月至2017年3月在阜外医院植入带有ApScan算法的起搏器患者,共38例.收集患者以下资料：一般情况,包括年龄、性别、体质指数、吸烟史;填写Epworth嗜睡量表;基础心脏疾病及合并症情况;临床检查结果;器械治疗适应证.所有患者在起搏器植入后,接受多导睡眠监测仪（PSG）检查,同步记录其呼吸暂停低通气指数（PSG-AHI）和Ap-RDI,评估两者相关性和一致性.与PSG-AHI相比,Ap-RDI对SA患者诊断的敏感性和特异性.结果 患者平均年龄为（65.8±9.6）岁,男25例（65.8％）.重度SA（呼吸暂停低通气指数,AHI≥30次/h）的患者8例（24.2％）,中度SA（AHI：15～30次/h）的患者3例.无一例患者在术前曾被诊断SA.Ap-RDI和PSG-AHI 有较强相关性（r=0.76,P〈0.01）,Ap-RDI与PSG-AHI一致性：95％CI为-7.2～32.4,一致性良好.Ap-RDI≥29次/min对诊断SA的敏感性为90％（95％CI 55.5％～99.7％）,特异性91.3％（95％CI 72.0％～98.9％）.结论 ApScan功能可以用于起搏器患者SA诊断.在起搏器患者中,重度SA诊断率偏低.
Objective Sleep apnea（SA） is prevalent yet under-diagnosed in patients with cardiovascular disease.The potential for automated detection of SA in patients receiving pacemakers with respiration sensors and ApScan algorithm has not been fully explored.This study tested the feasibility of automatically detecting advanced SA from a pacemaker trans-thoracic impedance sensor.Methods This study enrolled 38 patients who underwent a pacemaker with ApScan algorithm due to bradycardia.All the patients underwent overnight polysomnography（PSG）.The pacemaker trans-thoracic impedance signal was simultaneously recorded and time synchronized with the PSG.Cardiovascular health variables were abstracted from medical records.Apnea was defined as cessation of inspiratory airflow lasting 10 seconds or longer.Hypopnea was defined as a reduction of tidal volume of at least 30％ from baseline tidal volume,lasting 10 seconds or more.The respiratory disturbance index from ApScan algorithm（Ap-RDI） was developed to automatically detect SA from the pacemaker impedance sensor data.The performance of Ap-RDI was compared against PSG-AHI.Results Thirty-eight patients（aged 65.8±9.6 years,25 males） were studied.Severe SA[apnea-hypopnea index（AHI）≥30]was diagnosed in 8 patients（24.2％）.Moderate SDB（AHI 15～30）was diagnosed in 3 patients,but no patients had prior diagnosis of the disease.Ap-RDI correlated with PSG-AHI（r=0.76,P〈0.01）.An optimal cutoff value for Ap-RDI at 29 events/min was obtained by a ROC curve analysis,which yielded a sensitivity of 90％（95％CI 55.5％-99.7％）,and a specificity of 91.3％（95％ CI 72.0％-98.9％）.The Bland-Altman limits of agreement for PSG-AHI were-7.2～32.4.Conclusions It is feasible to automatically measure SA severity using a pacemaker trans-thoracic impedance sensor.SA was frequently undiagnosed in this cohort of pacemaker patients.
作者
陈若菡
陈柯萍
戴研
张澍
Chen Ruohan Chen Keping Dai Yan Zhang Shu(Center of Arrhythmia, Fuwai Hospital, Chinese Academy Medical Sciences, Peking Union Medical College , Beijing 100037, China)
出处
《中华心律失常学杂志》
2017年第4期305-309,共5页
Chinese Journal of Cardiac Arrhythmias
