Szyszko Ariel, Franceschini Carlos, Gonzalez-Zuelgaray Jorge
Service of Arrhythmias and Electrophysiology, Instituto Argentino de Diagnostico y Tratamiento, Marcelo T. de Alvear 2346, 1122 Buenos Aires, Argentina.
Europace. 2009 Jan;11(1):94-9. doi: 10.1093/europace/eun285. Epub 2008 Oct 29.
Sleep apnoea has significant medical implications. A reliable non-invasive method (as a regular Holter system with a specific software) would be valuable for the screening of this condition in ambulatory patients.
A total of 40 patients were divided into two groups: Group I, 20 patients with clinical suspicion of obstructive sleep apnoea (OSA) and Epworth sleepiness score >or= 10 and Group II, 20 controls. In Group I, polysomnography was performed simultaneously with Holter (specific software to detect sleep apnoea). In Group II, Holter-based detection was utilized. A cutoff value of 10 for the apnoea-hypopnoea index (for polysomnography) or for the respiratory disturbance index (RDI) (for Holter) was considered abnormal. Sleep apnoea was confirmed by polysomnography in 14 patients (70%) in Group I. Holter recordings correctly identified OSA in 11 patients (r = 0.74 with polysomnography; P = 0.0002). Holter showed 78.5% sensitivity, 83.3% specificity, 91.6% positive predictive value, and 62.5% negative predictive value (with polysomnography as the gold standard). The RDI measured by Holter was 19.5 +/- 20 in Group I and 3.9 +/- 4.4 in controls (P < 0.005). The measurement between Holter and polysomnography (Bland and Altman method) showed good correlation (mean 4.7 with 39.4 and -30.1 SD) and a Pearson correlation coefficient (r) of 0.74 (P = 0.0002, 95% CI: 0.44-0.89).
Holter-based software may constitute an accessible tool on initial suspicion of OSA.
睡眠呼吸暂停具有重要的医学意义。一种可靠的非侵入性方法（如配备特定软件的常规动态心电图系统）对于在门诊患者中筛查这种疾病将很有价值。
共40例患者分为两组：第一组，20例临床怀疑为阻塞性睡眠呼吸暂停（OSA）且爱泼沃斯嗜睡量表评分≥10分的患者；第二组，20例对照者。第一组中，多导睡眠图与动态心电图（用于检测睡眠呼吸暂停的特定软件）同时进行。第二组采用基于动态心电图的检测方法。呼吸暂停低通气指数（多导睡眠图）或呼吸紊乱指数（RDI，动态心电图）≥10被视为异常。多导睡眠图证实第一组中有14例患者（70%）存在睡眠呼吸暂停。动态心电图记录正确识别出11例OSA患者（与多导睡眠图的r = 0.74；P = 0.0002）。动态心电图显示敏感性为78.5%，特异性为83.3%，阳性预测值为91.6%，阴性预测值为62.5%（以多导睡眠图作为金标准）。第一组中动态心电图测得的RDI为19.5±20，对照组为3.9±4.4（P < 0.005）。动态心电图与多导睡眠图之间的测量（Bland和Altman方法）显示出良好的相关性（均值为4.7，标准差为39.4和 - 30.1），Pearson相关系数（r）为0.74（P = 0.0002，95%可信区间：0.44 - 0.89）。
基于动态心电图的软件可能是初步怀疑OSA时可采用的一种工具。
