San Pedro de Alcantara Hospital, Caceres, Spain.
Sleep. 2013 Feb 1;36(2):249-57. doi: 10.5665/sleep.2384.
Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals.
We performed a multicentric, randomized, blinded crossover study to determine the agreement between home respiratory polygraphy (HRP) and PSG, and between simultaneous respiratory polygraphy (respiratory polygraphy with PSG) (SimultRP) and PSG by means of 2 AHI scoring protocols with or without hyperventilation following flow reduction considered as a surrogate arousal.
We included suspected SAHS patients from 8 hospitals. They were assigned to home and hospital protocols at random. We determined the agreement between respiratory polygraphy AHI and PSG AHI scorings using Bland and Altman plots and diagnostic agreement using receiver operating characteristic (ROC) curves. The agreement in therapeutic decisions (continuous positive airway pressure treatment or not) between HRP and PSG scorings was done with likelihood ratios and post-test probability calculations.
Of 366 randomized patients, 342 completed the protocol. AHI from HRP scorings (with and without surrogate arousal) had similar agreement with PSG. AHI from SimultRP with surrogate arousal scoring had better agreement with PSG than AHI from SimultRP without surrogate arousal. HRP with surrogate arousal scoring had slightly worse ROC curves than HRP without surrogate arousal, and the opposite was true for SimultRP scorings. HRP with surrogate arousal showed slightly better agreement with PSG in therapeutic decisions than for HRP without surrogate arousal.
Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).
呼吸描记术是睡眠呼吸暂停/低通气综合征（SAHS）诊断的一种替代多导睡眠图（PSG）的方法，尽管它低估了呼吸暂停低通气指数（AHI），因为呼吸描记术无法识别觉醒。
我们进行了一项多中心、随机、双盲交叉研究，以确定家庭呼吸描记术（HRP）与 PSG 之间、同时进行的呼吸描记术（PSG 时进行呼吸描记术）（SimultRP）与 PSG 之间的一致性，方法是使用两种 AHI 评分方案，其中一种方案在流量减少后考虑使用过度通气作为替代觉醒，另一种方案不考虑过度通气。
我们纳入了来自 8 家医院的疑似 SAHS 患者。他们被随机分配到家庭和医院方案。我们使用 Bland 和 Altman 图确定呼吸描记术 AHI 与 PSG AHI 评分之间的一致性，并使用接收者操作特征（ROC）曲线确定诊断一致性。通过似然比和后测试概率计算，确定 HRP 和 PSG 评分之间在治疗决策（是否进行持续气道正压通气治疗）上的一致性。
在 366 名随机患者中，有 342 名完成了方案。带有（和不带有替代觉醒）的 HRP 评分的 AHI 与 PSG 具有相似的一致性。带有替代觉醒评分的 SimultRP 的 AHI 与 PSG 的一致性优于不带有替代觉醒评分的 SimultRP 的 AHI。带有替代觉醒评分的 HRP 的 ROC 曲线略差于不带有替代觉醒评分的 HRP，而 SimultRP 评分则相反。与不带有替代觉醒评分的 HRP 相比，带有替代觉醒评分的 HRP 在治疗决策上与 PSG 的一致性略好。
与常规程序（不带有替代觉醒的 HRP）相比，在 HRP 中纳入替代觉醒测量并不能显著提高其与 PSG 的一致性。
