远程睡眠监测在阻塞性睡眠呼吸暂停低通气综合征诊断中的应用  

Evaluation of remote sleep monitoring in the detection of obstructive sleep apnea hypopnea syndrome

作　　者：吴喜昊 王镇山[2] 薛欣[2] WU Xihao;WANG Zhenshan;XUE Xin(Department of Respiratory Medicine,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang 441021,China;Department of Respiratory Medicine,the Second Affiliated Hospital of Dalian Medical University,Dalian 116027,China)

机构地区：[1]襄阳市中心医院湖北文理学院附属医院呼吸内科,湖北襄阳441021 [2]大连医科大学附属第二医院呼吸内科,辽宁大连116027

出　　处：《大连医科大学学报》2018年第2期129-132,137,共5页Journal of Dalian Medical University

摘　　要：目的评价远程睡眠监测对于阻塞性睡眠呼吸暂停低通气综合征的(obstructive sleep apnea hypopnea syndrome,OSAHS)诊断价值。方法收集2016年10月至2017年2月于大连医科大学附属第二医院呼吸内科睡眠中心就诊,疑诊为OSAHS者31例,平均年龄(55.12±12.66)岁,体重指数(29.15±5.85)kg/m^2。分别使用飞利浦伟康睡眠诊断Alice LE及RS01睡眠呼吸初筛仪对其行不少于7 h的整夜睡眠监测。多导睡眠监测在睡眠中心进行,远程睡眠监测在睡眠中心、病房或家中进行。监测并比较两种方法测得的患者的睡眠呼吸暂停低通气指数(Apnea-hypopnea index,AHI)、最低血氧饱和度(Nadir SpO_2)和平均血氧饱和度(Mean SpO_2)。结果 31例多导睡眠监测结果示非OSAHS 12例,OSAHS 19例,其中轻度7例,中度4例,重度8例。远程睡眠监测示非OSAHS 17例,OSAHS 14例,其中轻度4例,中度3例,重度7例。两种监测系统间AHI、Mean SpO_2差异有统计学意义(P<0.05),Nadir SpO_2差异无统计学意义(P>0.05)。两种监测系统间AHI、Mean SpO_2和Nadir SpO_2相关系数分别为0.879、0.705和0.595(P<0.05)。对不符合OSAHS、轻度OSAHS、中度OSAHS、重度OSAHS,4种分级的AHI进行一致性检验,Kappa=0.531,P=0.000。远程睡眠监测的诊断符合率为77.42%,敏感性为68.42%,特异性为91.67%,阳性预计值为73.68%,阴性预计值为64.71%。ROC曲线分析远程睡眠监测所得AHI对OSAHS的诊断价值,曲线下面积为0.851,P=0.001。结论远程睡眠监测是一种便捷、可靠的OSAHS筛查工具,尤其适用于社区及基层医院重度OSAHS患者。Objective To assess the accuracy of remote sleep monitoring in the diagnosis of obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Clinical data of 31 patients suspected for OSAHS were collected from October 2016 to February 2017 in respiratory medicine sleep center of the Second Hospital of Dalian Medical University.The mean age of the 31 participants was(55.12±12.66)years and the mean body mass index was(29.15±5.85)kg/m 2.Philips sleep diagnostic instrument Alice LE and sleep breathing initial screening instrument RS01 were used to monitor at least seven hours of sleep all night.Polysomnography monitor was carried out in the sleep center.Remote sleep monitoring can be carried out at home,in sickroom or in the sleep center.After the test,we collected apnea hypopnea index(AHI),nadir oxygen saturation(Nadir SpO 2)and mean oxygen saturation(Mean SpO 2)and analyzed the data by manual analysis.Results Among the 31 patients,PSG showed 12 non-OSAHS cases and 19 OSAHS cases including 7 mild cases,4 moderate cases and 8 severe cases.Remote sleep monitoring showed 17 non-OSAHS patients and 14 OSAHS patients including 4 mild cases,3 moderate cases and 7 severe cases.Matching rank and inspection was adopted to test the data(AHI,Nadir SpO 2,and Mean SpO 2)collected by the tow monitoring systems.The difference between AHI and Mean SpO 2 was statistically significant(P<0.01).No statistically significant difference was seen between the Nadir SpO 2(P>0.05).There was a good correlation between AHI,Nadir SpO 2 and Mean SpO 2(r=0.879,0.705 and 0.595,P<0.01).Kappa identity test was adopted to test the AHI of 4 levels(non-OSAHS,mild OSAHS,moderate OSAHS,and severe OSAHS).The result showed a good consistency(Kappa=0.531,P=0.000).The remote sleep monitoring diagnosing rate was 77.42%.The sensitivity and specificity were 68.42%and 91.67%,respectively.The misdiagnosis rate and missed diagnosis rate were 8.33%and 31.58%,respectively.The positive expectation and negative expectation were 73.68%and 64.71%,respectively.The ROC curve

关 键 词：远程睡眠监测 阻塞性睡眠呼吸暂停低通气综合征 相关性 一致性 符合率 

分 类 号：R56[医药卫生—呼吸系统]