Smith Lindsay A, Chong Dennis W S, Vennelle Marjorie, Denvir Martin A, Newby David E, Douglas Neil J
Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Scotland, UK.
J Sleep Res. 2007 Dec;16(4):428-35. doi: 10.1111/j.1365-2869.2007.00612.x.
Sleep-disordered breathing (SDB) is common in chronic heart failure (CHF), affects disease progression and presents a potential therapeutic target. This study was designed to test the hypothesis that there would be good agreement in diagnostic outcome between home limited sleep studies and in-laboratory polysomnography (PSG) in the identification of SDB in patients with CHF. We performed synchronous in-laboratory Embletta and PSG, and home Embletta studies, prospectively in 20 consecutive patients with stable symptomatic CHF (ejection fraction 33 +/- 12%) on optimal medical therapy. Sleep efficiency was poor at 57 +/- 21%. Unlike synchronous in-laboratory Embletta (kappa coefficient 0.63, P < 0.01), home Embletta showed poor agreement with PSG (kappa coefficient 0.27, P = 0.06). Positive and negative predictive values for home Embletta in detecting SDB were 83% and 57% respectively. In this relatively small study, agreement in diagnostic outcome between home Embletta and PSG, and negative predictive value for the home Embletta, were poor. We explore possible explanations for this, both technical and situational, which should be taken into consideration when considering potential screening or diagnostic tools for SDB in patients with CHF.
睡眠呼吸紊乱（SDB）在慢性心力衰竭（CHF）中很常见，会影响疾病进展，并呈现出一个潜在的治疗靶点。本研究旨在检验以下假设：在识别CHF患者的SDB方面，家庭有限睡眠研究与实验室多导睡眠图（PSG）之间的诊断结果会有良好的一致性。我们前瞻性地对20例接受最佳药物治疗的稳定症状性CHF连续患者（射血分数33±12%）进行了同步的实验室Embletta监测和PSG监测，以及家庭Embletta监测。睡眠效率较差，为57±21%。与同步的实验室Embletta监测（kappa系数0.63，P<0.01）不同，家庭Embletta监测与PSG的一致性较差（kappa系数0.27，P = 0.06）。家庭Embletta监测检测SDB的阳性预测值和阴性预测值分别为83%和57%。在这项相对较小的研究中，家庭Embletta监测与PSG之间的诊断结果一致性以及家庭Embletta监测的阴性预测值都较差。我们探讨了对此的可能解释，包括技术和情境方面的，在考虑CHF患者SDB的潜在筛查或诊断工具时应予以考虑。
