Division of Pulmonary Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland; Sleep Laboratory, Department of Psychiatry, Geneva University Hospitals, 1211 Geneva 14, Switzerland.
Respir Med. 2013 Dec;107(12):2053-60. doi: 10.1016/j.rmed.2013.10.010. Epub 2013 Oct 16.
Respiratory events occurring under non-invasive ventilation (NIV) may produce sleep fragmentation. Alternatives to polysomnography (PSG) should be validated for providing simple monitoring tools for patients treated at home with NIV.
To study the value of pulse wave amplitude (PWA) reduction as a surrogate marker of cortical micro-arousals associated with respiratory events occurring during NIV.
27 PSG tracings under NIV recorded in 9 stable patients with Obesity Hypoventilation Syndrome (OHS), under 3 different ventilator modes (no back-up rate, low or high back-up rate) were analyzed. For all respiratory events (obstructive, central, or mixed event), the association with EEG-micro-arousals, PWA reduction of more than 30% and the presence of associated SpO2 desaturation ≥ 4% was recorded.
2474 respiratory events during NREM sleep were analyzed. 73.6% were associated with an EEG-MA, 91.4% with a ≥ 4% decrease in SpO2, and 74.9% with a significant PWA reduction. Sensitivity of PWA for the detection of an EEG-micro-arousal related to a respiratory event was 89.1% [95%CI: 76.7-95.3]. Positive predictive value (PPV) was 87.0% [95%CI: 75.0-94.0]. Sensitivity of PWA was highest in the S mode, compared to both other S/T modes, p = <0.001. Sensitivity of PWA was also higher for central and mixed events, compared to obstructive respiratory events, p = <0.05.
PWA reduction is a sensitive marker with a high PPV for the detection of EEG-MA associated with respiratory events during NREM sleep in stable OHS patients treated by NIV. In this situation, PWA could be used to improve scoring of hypopneas and allow an appropriate assessment of sleep fragmentation related to respiratory events.
在无创通气（NIV）下发生的呼吸事件可能导致睡眠碎片化。应该验证替代多导睡眠图（PSG）的方法，以便为在家中接受 NIV 治疗的患者提供简单的监测工具。
研究脉搏波幅度（PWA）降低作为与 NIV 期间发生的呼吸事件相关的皮质微觉醒的替代标志物的价值。
分析了 9 例稳定的肥胖低通气综合征（OHS）患者在 3 种不同通气模式（无后备频率、低后备频率或高后备频率）下 NIV 记录的 27 次 PSG 描记。对于所有呼吸事件（阻塞性、中枢性或混合性事件），记录与 EEG 微觉醒、PWA 降低超过 30%以及相关 SpO2 降低≥4%的关联。
分析了 NREM 睡眠期间的 2474 次呼吸事件。73.6%与 EEG-MA 相关，91.4%与 SpO2 降低≥4%相关，74.9%与 PWA 显著降低相关。PWA 检测与呼吸事件相关的 EEG 微觉醒的敏感性为 89.1%[95%CI：76.7-95.3]。阳性预测值（PPV）为 87.0%[95%CI：75.0-94.0]。与其他 S/T 模式相比，S 模式下 PWA 的敏感性最高，p<0.001。与阻塞性呼吸事件相比，PWA 对中枢性和混合性事件的敏感性更高，p<0.05。
在接受 NIV 治疗的稳定 OHS 患者中，PWA 降低是一种敏感的标志物，对检测与 NREM 睡眠期间呼吸事件相关的 EEG-MA 具有较高的 PPV。在这种情况下，PWA 可用于改善呼吸暂停评分，并适当评估与呼吸事件相关的睡眠碎片化。
