便携式脉搏血氧仪在成人阻塞性睡眠呼吸暂停患者中的应用价值  

Study on the application value of portable pulse oximeter in adult patients with obstructive sleep apnea

作　　者：陈媛媛 彭茂桓 董霄松[2] 赵瑞 孙铭泽 顾家慧 张雪丽 赵龙[2] 周兵[2] 伍斓博 王韦涵 韩芳[2] Chen Yuanyuan;Peng Maohuan;Dong Xiaosong;Zhao Rui;Sun Mingze;Gu Jiahui;Zhang Xueli;Zhao Long;Zhou Bing;Wu Lanbo;Wang Weihan;Han Fang(Institute of Medical Technology,Peking University Health Science Center,Beijing 100083,China;Department of Respiratory and Sleep Medicine,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学医学部医学技术研究院,北京100083 [2]北京大学人民医院呼吸睡眠医学科,北京100044

出　　处：《中华结核和呼吸杂志》2024年第6期529-534,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：北京大学人民医院研究与发展基金(RDL2022-02)。

摘　　要：目的评价便携式脉搏血氧仪(CS-WOxi)在成人阻塞性睡眠呼吸暂停(OSA)中的应用价值。方法本研究前瞻性纳入2022年7月至2023年7月因打鼾就诊于北京大学人民医院呼吸睡眠医学科进行多导睡眠监测(PSG)的成人患者,在PSG监测时同步使用CS-WOxi持续监测经皮动脉血氧饱和度(SpO_(2))。利用差异性检验、Pearson相关系数及Bland-Altman法评估CS-WOxi测得的3%氧减指数(CS-ODI_(3))与PSG测得的3%氧减指数(PSG-ODI_(3))之间的一致性,并以受试者工作特征(ROC)曲线确定其诊断OSA的最佳界值。结果共纳入184例受试者,其中男性121例(65.8%),女性63例(34.2%),年龄为46.0(34.3,59.0)岁,体重指数(BMI)为26.0(23.3,29.6)kg/m^(2),呼吸暂停低通气指数(AHI)为18.2(5.8,40.8)次/h。CS-ODI_(3)与PSG-ODI_(3)之间差异有统计学意义[17.1(6.2,42.7)次/h比14.0(2.9,32.6)次/h,P<0.001],两者相关系数为0.93(P<0.001)。CS-ODI_(3)与PSG测得的AHI(PSG-AHI)之间相关性较好(r=0.92,P<0.001),Bland-Altman一致性检验显示两者平均差值为0.7次/h,95%一致性界限为(-17.9,19.3次/h)。当使用CS-ODI_(3)≥5次/h来识别OSA时,敏感度为94.4%,特异度为80.0%,准确率为91.3%。以PSG作为金标准时,CS-ODI_(3)诊断OSA(PSG-AHI≥5次/h)的ROC曲线下面积(AUC)为0.933。结论便携式脉搏血氧仪对于OSA高风险患者SpO_(2)指标监测较准确,识别OSA有较好的敏感度和特异度,是可用于筛查的可靠工具。Objective To evaluate the application value of portable pulse oximeter in adult obstructive sleep apnea(OSA).Methods This study prospectively enrolled adult patients who underwent polysomnography(PSG)due to snoring at the Respiratory and Sleep Medicine Department of Peking University People′s Hospital from July 2022 to July 2023.During PSG monitoring,CS-WOxi was continuously used to monitor blood oxygen levels.The consistency between 3%oxygen desaturation index(ODI_(3))measured by portable pulse oximeter and ODI_(3) of polysomnography was evaluated using difference test,Pearson′s correlation coefficient,and Bland-altman method.Receiver operating characteristic curve was used to determine the optimal threshold for diagnosing OSA.Results A total of 184 subjects were included,including 121 males(65.8%)and 63 females(34.2%).The mean age was 46.0(34.3,59.0)years,body mass index was 26.0(23.3,29.6)kg/m^(2),and the apnea-hypopnea index was 18.2(5.8,40.8)events/h.There was a significant difference between CS-ODI_(3) and PSG-ODI_(3)[17.1(6.2,42.7)vs.14.0(2.9,32.6),P<0.001],and the Pearson correlation coefficient was 0.93(P<0.001).There was a good correlation between CS-ODI_(3) and PSG-AHI(r=0.92,P<0.001).Bland-Altman consistency test showed that the average difference between the two was 0.7 events/h,and the 95%consistency limit was(-17.9,19.3 events/h).When the CS-ODI_(3)≥5 events/h was used to identify OSA,the sensitivity was 94.4%,the specificity was 80.0%,and the accuracy was 91.3%.When PSG-AHI≥5 events/h was used as the diagnostic criteria,the area under the receiver operating characteristic curve was 0.933.Conclusion Portable pulse oximeter can monitor pulse oxygen saturation accurately and has good sensitivity and specificity for OSA high-risk patients,and is a reliable tool for OSA screening.

关 键 词：睡眠呼吸暂停 阻塞性 血氧测定法 多导睡眠监测 氧减指数 

分 类 号：R766[医药卫生—耳鼻咽喉科]