Clinical and Academic Department of Sleep and Breathing, National Heart and Lung Institute, Royal Brompton Hospital and Imperial College, London, United Kingdom.
Sleep. 2013 Sep 1;36(9):1341-8. doi: 10.5665/sleep.2960.
To evaluate the effect of respiratory scoring criteria on diagnosis and classification of sleep disordered breathing (SDB) in chronic heart failure (CHF).
Cross-sectional observational study.
Heart failure and general cardiology clinics at two London hospitals.
One hundred eighty stable patients with CHF and a median age of 69.6 y, 86% male.
SDB was diagnosed by polysomnography. The apnea-hypopnea index (AHI) was initially scored using a conservative hypopnea definition of a ≥ 50% decrease in nasal airflow with a ≥ 4% oxygen desaturation. The AHI was rescored with hypopnea defined according to the American Academy of Sleep Medicine (AASM) alternative scoring rule, requiring an associated ≥ 3% oxygen desaturation or arousal. SDB was defined as AHI ≥ 15/h. Diagnosis and classification of SDB as obstructive sleep apnea (OSA) or central sleep apnea (CSA) with each rule were compared. The effect of mixed apneas on classification of SDB as CSA or OSA was also investigated.
Median AHI increased from 9.3/h to 13.8/h (median difference 4.6/h) when the AASM alternative rule was used to score hypopneas. SDB prevalence increased from 29% to 46% with the alternative scoring rule (P < 0.001). Classification of SDB as OSA or CSA was not significantly altered by hypopnea scoring rules or the categorization of mixed apneas.
Hypopnea scoring rules can significantly influence the apnea-hypopnea index and diagnosis of sleep disordered breathing in chronic heart failure but do not alter the classification as obstructive sleep apnea or central sleep apnea. Standardization of hypopnea scoring rules is important to ensure consistency in diagnosis of sleep disordered breathing in chronic heart failure patients.
评估呼吸评分标准对慢性心力衰竭（CHF）睡眠呼吸障碍（SDB）的诊断和分类的影响。
横断面观察性研究。
伦敦两家医院的心力衰竭和普通心脏病学诊所。
180 名稳定的 CHF 患者，年龄中位数为 69.6 岁，86%为男性。
通过多导睡眠图诊断 SDB。最初，使用呼吸暂停-低通气指数（AHI）的保守性低通气定义（即鼻气流减少≥50%，同时伴有≥4%的氧减饱和度）对其进行评分。随后，根据美国睡眠医学学会（AASM）替代评分规则重新定义低通气，要求相关的≥3%的氧减饱和度或觉醒。将 SDB定义为 AHI≥15/h。比较了每种规则下的 AHI≥15/h 的 SDB 诊断和分类为阻塞性睡眠呼吸暂停（OSA）或中枢性睡眠呼吸暂停（CSA）的情况。还研究了混合性呼吸暂停对 CSA 或 OSA 分类的影响。
当使用 AASM 替代规则对低通气进行评分时，AHI 中位数从 9.3/h 增加到 13.8/h（中位数差异为 4.6/h）。使用替代评分规则时，SDB 的患病率从 29%增加到 46%（P<0.001）。低通气评分规则或混合性呼吸暂停的分类并未显著改变 SDB 的分类为 OSA 或 CSA。
低通气评分规则可显著影响慢性心力衰竭患者的呼吸暂停-低通气指数和睡眠呼吸障碍的诊断，但不会改变其作为阻塞性睡眠呼吸暂停或中枢性睡眠呼吸暂停的分类。低通气评分规则的标准化对于确保慢性心力衰竭患者睡眠呼吸障碍的诊断一致性非常重要。
