San Pedro de Alcántara Hospital, Cáceres, Spain.
Am J Respir Crit Care Med. 2011 Oct 15;184(8):964-71. doi: 10.1164/rccm.201103-0428OC. Epub 2011 Jul 7.
Home respiratory polygraphy (HRP) is an alternative to polysomnography (PSG) for sleep apnea-hypopnea syndrome (SAHS) diagnosis. However, therapeutic decision-making is a different process than diagnosis.
This study aimed to determine the agreement between HRP and in-hospital PSG for therapeutic decision-making in a large sample.
Patients with an intermediate or high SAHS suspicion were included in a multicenter study (eight sleep centers) and assigned to home and hospital protocols in a random order. Therapeutic decisions (continuous positive airway pressure, no continuous positive airway pressure, or impossible decision) were made by an investigator in each center, based on using either HRP or PSG and a single set of auxiliary clinical variables. Patients and diagnostic methods (HRP and PSG) were assessed in random order using an electronic database. After a month the same therapeutic decision-making procedure was repeated with the same method.
Of 366 randomized patients, 348 completed the protocol. The "impossible decision" case was not observed with either PSG or HRP. Therapeutic decisions using HRP had a sensitivity of 73%, a specificity of 77%, and an agreement level (sum of true positives and negatives) of 76%. Patients with higher HRP apnea-hypopnea index (AHI) scores (≥ 30; 41% of the total sample) had a sensitivity of 94%, a specificity of 44%, and the agreement level was 91%.
The HRP-based therapeutic decision was adequate when AHI was high, but deficient in the large population of patients with mild to moderate AHI. Therefore, both selecting patients with a high suspicion and severity of SAHS and future prospective cost-effectiveness studies are necessary.
家庭呼吸描记法（HRP）是睡眠呼吸暂停低通气综合征（SAHS）诊断中替代多导睡眠图（PSG）的一种方法。然而，治疗决策是一个与诊断不同的过程。
本研究旨在确定 HRP 与住院 PSG 在大样本中治疗决策的一致性。
将具有中等或高度 SAHS 可疑的患者纳入一项多中心研究（8 个睡眠中心），并按照随机顺序分配到家庭和医院方案。每个中心的研究人员根据使用 HRP 或 PSG 以及一组单一的辅助临床变量，做出治疗决策（持续气道正压通气、不持续气道正压通气或无法决策）。患者和诊断方法（HRP 和 PSG）以电子数据库的形式随机评估。一个月后，使用相同的方法重复相同的治疗决策程序。
在随机分配的 366 名患者中，有 348 名完成了方案。无论是 PSG 还是 HRP，都没有观察到“无法决策”的情况。使用 HRP 的治疗决策的敏感性为 73%，特异性为 77%，一致性水平（真阳性和真阴性之和）为 76%。HRP 呼吸暂停低通气指数（AHI）评分较高（≥30；占总样本的 41%）的患者敏感性为 94%，特异性为 44%，一致性水平为 91%。
当 AHI 较高时，基于 HRP 的治疗决策是合适的，但在 AHI 轻度至中度的大多数患者中则不足。因此，有必要选择具有高度可疑和严重程度的 SAHS 患者，并进行未来的前瞻性成本效益研究。
