To Kin-Wang, Chan Wing-Chi, Chan Tat-On, Tung Alvin, Ngai Jenny, Ng Susanna, Choo Kah-Lin, Hui David S
Respiratory Medicine Division, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Respirology. 2009 Mar;14(2):270-5. doi: 10.1111/j.1440-1843.2008.01439.x. Epub 2008 Dec 11.
Obstructive sleep apnoea syndrome (OSAS) is a common disorder associated with early atherosclerosis, diabetes mellitus, ischaemic heart disease and cerebrovascular disease. The gold standard for confirming OSAS is based on an attended overnight polysomnography (PSG) in a sleep laboratory; however lack of health-care resources creates long waiting times for patient access to this diagnostic test. This study evaluated the ability of a portable sleep-monitoring device to identify patients in Hong Kong with suspected OSAS.
Patients with symptoms of OSAS were invited to use the ARES (apnoea risk evaluation system) concurrently with an attended inpatient PSG. Several sets of AHI were generated by the ARES provider based on different oxygen desaturation criteria and surrogate parameters of arousal. The results were compared against PSG to determine the optimal sensitivity and specificity.
There were 141 patients who completed the study successfully. Results of AHI from the ARES study were presented in the order of different scoring criteria--4% oxygen desaturation alone, obstructive events with 3% oxygen desaturation and obstructive events with 1% desaturation plus surrogate arousal criteria. The sensitivity was 0.84 (95% confidence interval (CI): 0.77-0.90), 0.89 (95% CI: 0.89-0.94) and 0.97 (95% CI: 0.94-0.99), respectively. The specificity was 1, 1 and 0.63 (95% CI: 0.55-0.71), respectively. The receiver operating curve had an area of 0.96, 0.97 and 0.98, respectively. The kappa coefficient varied from 0.24 to 0.55 for agreement of severity between PSG and ARES. The likelihood ratio positive and the likelihood ratio negative were 2.61, infinity, infinity and 0.16, 0.11, 0.05, respectively, in the order of oxygen desaturation described earlier.
The ARES device has reasonable sensitivity and specificity for diagnosing severe OSAS in symptomatic Chinese patients. There is moderate agreement between ARES and PSG in the diagnosis of severe disease, but less agreement in patients with mild/moderate disease.
阻塞性睡眠呼吸暂停综合征（OSAS）是一种常见疾病，与早期动脉粥样硬化、糖尿病、缺血性心脏病和脑血管疾病相关。确诊OSAS的金标准是在睡眠实验室进行的有医护人员在场的夜间多导睡眠图（PSG）检查；然而，医疗资源的匮乏导致患者等待进行这项诊断检查的时间过长。本研究评估了一种便携式睡眠监测设备识别香港疑似OSAS患者的能力。
邀请有OSAS症状的患者同时使用ARES（呼吸暂停风险评估系统）和有医护人员在场的住院PSG检查。ARES供应商根据不同的氧饱和度降低标准和觉醒替代参数生成了几组呼吸暂停低通气指数（AHI）。将结果与PSG检查结果进行比较，以确定最佳的敏感性和特异性。
共有141名患者成功完成了研究。ARES研究的AHI结果按照不同的评分标准呈现——仅4%氧饱和度降低、3%氧饱和度降低的阻塞性事件以及1%氧饱和度降低加替代觉醒标准的阻塞性事件。敏感性分别为0.84（95%置信区间（CI）：0.77 - 0.90）、0.89（95%CI：0.89 - 0.94）和0.97（95%CI：0.94 - 0.99）。特异性分别为1、1和0.63（95%CI：0.55 - 0.71）。受试者工作特征曲线的面积分别为0.96、0.97和0.98。PSG和ARES之间严重程度一致性的kappa系数在0.24至0.55之间。按照上述氧饱和度降低顺序，阳性似然比和阴性似然比分别为2.61、无穷大、无穷大以及0.16、0.11、0.05。
ARES设备对有症状的中国患者诊断重度OSAS具有合理的敏感性和特异性。在重度疾病的诊断中，ARES和PSG之间有中度一致性，但在轻/中度疾病患者中一致性较差。
