Department of Pneumology, CHU Mont Godinne, Université catholique de Louvain, Yvoir, Belgium.
J Sleep Res. 2013 Feb;22(1):96-103. doi: 10.1111/j.1365-2869.2012.01035.x. Epub 2012 Jul 26.
In-laboratory polysomnography is the 'gold standard' for diagnosing obstructive sleep apnea syndrome, but is time consuming and costly, with long waiting lists in many sleep laboratories. Therefore, the search for alternative methods to detect respiratory events is growing. In this prospective study, we compared attended polysomnography with two other methods, with or without mandible movement automated analysis provided by a distance-meter and added to airflow and oxygen saturation analysis for the detection of respiratory events. The mandible movement automated analysis allows for the detection of salient mandible movement, which is a surrogate for arousal. All parameters were recorded simultaneously in 570 consecutive patients (M/F: 381/189; age: 50±14 years; body mass index: 29±7 kg m(-2) ) visiting a sleep laboratory. The most frequent main diagnoses were: obstructive sleep apnea (344; 60%); insomnia/anxiety/depression (75; 13%); and upper airway resistance syndrome (25; 4%). The correlation between polysomnography and the method with mandible movement automated analysis was excellent (r: 0.95; P<0.001). Accuracy characteristics of the methods showed a statistical improvement in sensitivity and negative predictive value with the addition of mandible movement automated analysis. This was true for different diagnostic thresholds of obstructive sleep severity, with an excellent efficiency for moderate to severe index (apnea-hypopnea index ≥15h(-1) ). A Bland & Altman plot corroborated the analysis. The addition of mandible movement automated analysis significantly improves the respiratory index calculation accuracy compared with an airflow and oxygen saturation analysis. This is an attractive method for the screening of obstructive sleep apnea syndrome, increasing the ability to detect hypopnea thanks to the salient mandible movement as a marker of arousals.
实验室多导睡眠图是诊断阻塞性睡眠呼吸暂停综合征的“金标准”，但它耗时且昂贵，许多睡眠实验室都有很长的等候名单。因此，寻找替代方法来检测呼吸事件的方法越来越多。在这项前瞻性研究中，我们将 attended polysomnography 与另外两种方法进行了比较，这两种方法或有或没有下颌运动自动分析，后者由距离计提供，并添加到气流和氧饱和度分析中，以检测呼吸事件。下颌运动自动分析允许检测到明显的下颌运动，这是觉醒的替代指标。在 570 名连续就诊于睡眠实验室的患者（M/F：381/189；年龄：50±14 岁；体重指数：29±7 kg m(-2) ）中同时记录所有参数。最常见的主要诊断为：阻塞性睡眠呼吸暂停（344；60%）；失眠/焦虑/抑郁（75；13%）；和上气道阻力综合征（25；4%）。多导睡眠图和带有下颌运动自动分析的方法之间的相关性非常好（r：0.95；P<0.001）。方法的准确性特征表明，添加下颌运动自动分析可提高灵敏度和阴性预测值。对于不同的阻塞性睡眠严重程度诊断阈值，这都是如此，对于中度至重度指数（呼吸暂停低通气指数≥15h(-1) ）具有极好的效率。Bland & Altman 图证实了该分析。与仅进行气流和氧饱和度分析相比，添加下颌运动自动分析可显著提高呼吸指数计算的准确性。这是一种有吸引力的阻塞性睡眠呼吸暂停综合征筛查方法，由于明显的下颌运动作为觉醒的标志物，它提高了检测低通气的能力。
