腕动仪结合血氧监测仪在诊断睡眠呼吸暂停低通气综合征中的价值  

Value of actigraphy and oximetry for diagnosing sleep apnea-hypopnea syndrome

作　　者：李清华[1] 王碧瑛[2] 董霄松[1] 张春芳[3] 李静[1] 安培[1] 赵龙[1] 张雪丽[1] 韩芳[1] 

机构地区：[1]北京大学人民医院呼吸与危重症医学科,100044 [2]福建医科大学附属第一医院呼吸内科 [3]北京大学人民医院临床流行病室,100044

出　　处：《中华医学杂志》2015年第42期3411-3415,共5页National Medical Journal of China

基　　金：国家科技计划（2014DF31500）;国家科技支撑计划（2012BAI05B02）;北京市科技计划（210700060）

摘　　要：目的 探讨腕动仪结合血氧监测仪在诊断睡眠呼吸暂停低通气综合征（SAHS）中的价值.方法 收集2013年12月至2014年9月期间至北京大学人民医院睡眠中心疑诊的SAHS受试者,同时记录多导睡眠记录仪（PSG）、腕动仪及血氧监测仪的开灯时间和关灯时间.腕动仪用于矫正血氧监测仪的总睡眠时间（TST）.血氧监测仪所得氧减指数（ODI4）为每小时Sp02下降≥4％的次数,经腕动仪矫正时间后的ODI4命名为ODIA,用受试者工作特征（ROC）曲线评定0DI4及ODIA诊断价值及判定诊断SAHS的界值.腕动仪和血氧监测仪所得指标与PSG所得指标分别使用配对t检验或符号秩和检验进行比较.四格表法计算ODI4和ODIA的敏感度和特异度.根据PSG所得的呼吸暂停低通气指数（AHI）对SAHS进行病情分级：AHI ＜5次/h为无SAHS,5～ ＜15次/h为轻度,15～＜ 30次/h为中度,≥30次/h为重度.结果 213例受试者中,无SAHS者38例,轻、中、重度SAHS各有34、51、90例.与PSG相比,腕动仪在无SAHS组（P=0.408）和轻度SAHS组（P =0.949）能够准确地估测TST;在中度和重度SAHS组,腕动仪所得TST均显著低于PSG所得TST[（405±51）比（419±40） min和（399±62）比（422±60）min]（均P＜0.05）.在诊断SAHS中ODI4的ROC曲线下面积（AUC）为0.956,界值为5;ODIA的AUC为0.951,界值也为5.ODI4诊断轻度、中度和重度SAHS的敏感度分别为80.6％、66.7％和58.9％,特异度均为100％.经腕动仪矫正TST后,ODIA诊断轻度、中度和重度SAHS敏感度分别为84.0％、73.8％和68.9％,特异度分别为94.7％、100％和99.2％.结论 腕动仪在无SAHS组和轻度SAHS组可准确估测TST.ODI4在SAHS的诊断中具有一定价值,经腕动仪矫正TST后的ODIA诊断SAHS的敏感度提高.Objective To explore the value of actigraphy and oximetry for diagnosing sleep apneahypopnea syndrome （SAHS）.Methods Suspected SAHS subjects were enrolled from sleep center of Peking University People＆#39;s Hospital between December 2013 and September 2014.Light-out and light-on were simultaneously recorded for polysomnography （PSG）,actigraphy and oximetry.Actigraphy was used to correct total sleep time （TST） for oximetry.Oxygen desaturation index （ODI4）,namely the times of pulse oxygen saturation （SpO2） drop≥4% per hour,was detected by oximetry.ODIA was used instead of ODI4 with TST corrected by actigraphy.Receiver operating characteristic （ROC） curve was used for evaluating the value of ODI4 and ODIA for diagnosing SAHS and cut-off value was calculated.Paired t-test or signed rank t-test was used for data acquired using actigraphy or oximetry compared with data acquired by PSG.Sensitivity and specificity were calculated using fourfold table.Disease severity of SAHS was classified by apneahypopnea index （AHI） detected by PSG.If AHI 〈 5/h,SAHS was not considered.5-〈 15/h was classified as mild,15-〈 30/h was classified as moderate and AHI ≥30/h was classified as severe.Results Among 213 SAHS subjects,38 of them were normal,34 of them were mild,51 were moderate and 90 were severe.Compared with PSG,actigraphy can correctly estimate TST in non-SAHS （P =0.408） and mild SAHS groups （P =0.949）;while in moderate and severe SAHS groups,TSTs detected by actigraphy were shorter than TSTs acquired by PSG （（405 ±51） vs （419 ±40） min and （399 ±62） vs （422 ±60） min） （both P 〈 0.05）.Area under ROC curve （AUC） of ODI4 for diagnosing SAHS was 0.956 using a cut-off value of 5;the AUC of ODIA for diagnosing SAHS was 0.951 with a cut-off value of 5 as well.The sensitivity of ODI4 for mild,moderate and severe SAHS was 80.6%,66.7% and 58.9% respectively,all with a specificity of 100%.After adjusting TST with actigraphy,the sensitivity of ODIA for mild,mod

关 键 词：睡眠呼吸暂停 阻塞性 低通气指数 多导睡眠记录仪 腕动仪 血氧监测仪 

分 类 号：R766[医药卫生—耳鼻咽喉科]