夜间血氧饱和度下降指数：一种用于检测外科手术患者睡眠呼吸障碍的敏感且特异的工具。

Oxygen desaturation index from nocturnal oximetry: a sensitive and specific tool to detect sleep-disordered breathing in surgical patients.

机构信息

Department of Anesthesia, University Health Network, University of Toronto, 399, Bathurst Street, Toronto, ON, Canada M5T 2S8.

出版信息

Anesth Analg. 2012 May;114(5):993-1000. doi: 10.1213/ANE.0b013e318248f4f5. Epub 2012 Feb 24.

DOI:10.1213/ANE.0b013e318248f4f5

PMID:22366847

Abstract

INTRODUCTION

It is impractical to perform polysomnography (PSG) in all surgical patients suspected of having sleep disordered breathing (SDB). We investigated the role of nocturnal oximetry in diagnosing SDB in surgical patients.

METHOD

All patients 18 years and older who visited the preoperative clinics for scheduled inpatient surgery were approached for study participation. Patients expected to have abnormal electroencephalographic findings were excluded. All patients underwent an overnight PSG at home with a portable device and a pulse oximeter. The PSG recordings were scored by a certified sleep technologist. The oximetry recordings were processed electronically.

RESULT

Four hundred seventy-five patients completed the study: 217 males and 258 females, aged 60 ± 11 years, and body mass index 31 ± 7 kg/m(2). The apnea-hypopnea index (AHI), the average number of episodes of apnea and hypopnea per hour of sleep, was 9.1 (2.8 to 21.4) [median (interquartile range)] and 64% patients had AHI >5. There was a significant correlation between oxygen desaturation index (ODI, hourly average number of desaturation episodes) and cumulative time percentage with SpO(2) <90% (CT90) from nocturnal oximetry, with the parameters measuring sleep breathing disorders from PSG. Compared to CT90, ODI had a stronger correlation and was a better predictor for AHI. The area under receiver operator characteristics curve for ODI to predict AHI >5, AHI >15, and AHI >30 was 0.908 (CI: 0.880 to 0.936), 0.931 (CI: 0.090 to 0.952), and 0.958 (CI: 0.937 to 0.979), respectively. The cutoff value based on the maximal accuracy for ODI to predict AHI >5, AHI >15, and AHI >30 was ODI >5, ODI >15, and ODI >30. The accuracy was 86% (CI: 83%-88%), 86% (CI: 83%-89%), and 94% (CI: 92%-96%), respectively. The ODI >10 demonstrated a sensitivity of 93% and a specificity of 75% to detect moderate and severe SDB.

CONCLUSIONS

ODI from a high-resolution nocturnal oximeter is a sensitive and specific tool to detect undiagnosed SDB in surgical patients.

摘要

简介

对所有疑似睡眠呼吸障碍（SDB）的手术患者进行多导睡眠图（PSG）检查是不切实际的。我们研究了夜间血氧仪在诊断手术患者 SDB 中的作用。

方法

所有年龄在 18 岁及以上、因计划住院手术而就诊术前门诊的患者均被纳入研究。排除预计脑电图异常的患者。所有患者均在家中使用便携式设备和脉搏血氧仪进行整夜 PSG。PSG 记录由经过认证的睡眠技师进行评分。血氧仪记录经电子处理。

结果

475 名患者完成了研究：217 名男性和 258 名女性，年龄 60 ± 11 岁，体重指数 31 ± 7kg/m²。呼吸暂停低通气指数（AHI，每小时睡眠中呼吸暂停和低通气的平均次数）为 9.1（2.8 至 21.4）[中位数（四分位间距）]，64%的患者 AHI>5。夜间血氧仪的氧减指数（ODI，每小时脱氧事件的平均次数）与累积时间百分比与 SpO2<90%（CT90）之间存在显著相关性，与 PSG 测量的睡眠呼吸障碍参数相关。与 CT90 相比，ODI 相关性更强，是 AHI>5、AHI>15 和 AHI>30 的更好预测指标。ODI 预测 AHI>5、AHI>15 和 AHI>30 的受试者工作特征曲线下面积分别为 0.908（CI：0.880 至 0.936）、0.931（CI：0.090 至 0.952）和 0.958（CI：0.937 至 0.979）。基于最大准确性的 ODI 预测 AHI>5、AHI>15 和 AHI>30 的截断值为 ODI>5、ODI>15 和 ODI>30。准确率分别为 86%（CI：83%-88%）、86%（CI：83%-89%）和 94%（CI：92%-96%）。ODI>10 对检测中重度 SDB 的敏感性为 93%，特异性为 75%。