腕式脉搏血氧仪对OSAHS的诊断价值及持续气道正压通气的疗效评估  

Value of pulse oximetry for diagnosing obstructive sleep apnea-hypopnea syndrome and evaluation of the effect of the continuous positive airway pressure therapy

作　　者：王碧瑛[1] 韩芳[2] 李清华[2] 陈晓[1] 李静[2] 安培[2] 赵龙[2] 张雪丽[2] 陈公平[1] 

机构地区：[1]福建医科大学附属第一医院呼吸与危重症医学科 福建省睡眠呼吸疾病诊治中心 福建医科大学呼吸病学研究室,福州350005 [2]北京大学人民医院呼吸与危重症医学科

出　　处：《中华医学杂志》2015年第40期3273-3276,共4页National Medical Journal of China

基　　金：国家科技支撑计划项目（2012BAl05802）;国家国际科技合作与交流专项（2014DFA31500）

摘　　要：目的 探讨腕式脉搏血氧仪对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的诊断价值,评估持续气道正压通气（CPAP）对患者的疗效.方法 连续纳入2013年1月至2014年3月在福建医科大学附属第一医院呼吸与危重症医学科及北京大学人民医院呼吸与危重症医学科睡眠中心就诊并确诊为OSAHS的244例患者,根据呼吸暂停低通气指数（AHI）分为轻、中、重度组.对比3组患者在CPAP治疗前后的夜间脉搏升高指数（NPEI,即每小时睡眠中心率波动〉6次/min的次数）、平均心率、标准差心率;同时对心率相关指标与AHI进行Spearman相关性分析,寻找反映心率相关的最佳指标,并与AHI进行比较,计算其敏感度、特异度,绘制受试者工作特征（ROC）曲线.结果 轻、中、重度组患者CPAP治疗后的NPEI均显著低于治疗前（15.4 ±12.4比19.4 ±13.3、15.4 ±9.1比24.1 ±11.9、21.9 ±14.8比48.8 ±20.3,均P〈0.05）;患者的平均心率、心率标准差、NPEI与AHI呈显著相关（r=0.334、0.337、0.660,均P〈0.05）;ROC曲线显示以NPEI≥30次/h为诊断指标时,其诊断OSAHS的敏感度、特异度分别为68.0%、73.0%.结论 腕式脉搏血氧仪可作为OSAHS有效的初筛手段,而且能从监测NPEI变化来评价CPAP治疗效果.Objective To explore the value of pulse oximetry for diagnosing obstructive sleep apnea hypopnea syndrome （OSAHS） and evaluation of the effect of the continuous positive airway pressure （CPAP） therapy.Methods From January 2013 to March 2014, 244 OSAHS patients admitted to department of respiratory and critical care medicine of the first affiliated hospital of Fujian Medical University and department of respiratory and critical care medicine of People＇s Hospital of Peking University were recruited.According to apnea-hypopnea index （AHI） , all patients were divided into mild , moderate and severe groups.The differences in pulse-associated indicators [ nocturnal pulse elevation index （NPEI） , namely counts of heart rate （HR） variation 〉6 bpm/h, average HR and standard deviation of HR ] were compared among three groups before and after CPAP therapy.Spearman correlation analysis between pulse-associated indicators and AHI was performed to explore the optimal indicator.Receiver operating characteristic （ROC） curve were conducted and sensitivity and specificity were obtained.Results NPEI after CPAP treatment were significantly lower than before among all the three groups （mild group 15.4 ± 12.4 vs 19.4 ±13.3, moderate group 15.4 ±9.1 vs 24.1 ±11.9, severe group 21.9 ±14.8 vs 48.8 ± 20.3, all P〈0.05）;there were significant correlations of AHI with average HR , standard deviation of HR and NPEI （r=0.334, 0.337 and 0.660, respectively） （all P 〈0.05）; ROC curve showed a NPEI of 30beat per hour had a sensitivity of 68.0%and a specificity of 73.0%in diagnosing OSAHS.Conclusion Nocturnal oximetry could be a useful tool for screening OSAHS in clinical practice , and the NPEI can evaluate the efficacy of the CPAP therapy.

关 键 词：睡眠呼吸暂停 阻塞性 血氧测定法 诊断 连续气道正压通气 

分 类 号：R766[医药卫生—耳鼻咽喉科]