Centre de référence atrophie multisystématisée, CHU de Bordeaux, Pessac, France; Service de Neurologie, CHU de Bordeaux, Pessac, France; Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
Service de Neurologie, CHU de Bordeaux, Pessac, France.
Sleep Med. 2014 Apr;15(4):476-9. doi: 10.1016/j.sleep.2013.12.013. Epub 2014 Feb 21.
To assess the diagnostic accuracy of portable polygraphy (PG) for the detection of sleep apnea (SA) in multiple system atrophy (MSA).
Thirty consecutive patients with probable MSA underwent PG (overnight recording of nasal flow, thoracic/abdominal movements and pulse oximetry), followed 4 weeks later by full polysomnography (PSG) (reference standard). The accuracy of PG was first assessed using the same threshold as for PSG (apnea-hypopnea index [AHI]≥5), then for all possible AHI thresholds using the area under the receiver operating characteristics (AUROC) curve. Inter-rater reliability of PG was assessed using the kappa coefficient.
Among 30 patients enrolled, seven were excluded for technical problems on PG or PSG and 23 were included in the main analysis. Eight out of 23 had an AHI≥5 on PSG. With the same threshold, sensitivity, specificity, positive and negative predictive values of PG for the diagnosis of SA were 87.5% (95% confidence interval: 47-99), 80% (52-96), 70% (35-93) and 92.3% (64-99), respectively. The kappa between PG raters was 0.75 (0.49-1.00) indicating good agreement. The AUROC was 0.93 (0.82-1.00). No association was found between sleep and excessive daytime sleepiness questionnaires and SA.
Portable PG seems to be valuable for ruling out SA in MSA.
评估便携式多导睡眠描记术（PG）诊断多系统萎缩（MSA）患者睡眠呼吸暂停（SA）的准确性。
连续 30 例疑诊 MSA 患者接受 PG（整夜鼻气流、胸/腹部运动和脉搏血氧饱和度监测），4 周后行全夜睡眠多导图描记术（PSG；参考标准）。首先使用与 PSG 相同的阈值（呼吸暂停低通气指数[AHI]≥5）评估 PG 的准确性，然后使用受试者工作特征（ROC）曲线下面积（AUROC）评估所有可能的 AHI 阈值的准确性。PG 的观察者间可靠性使用κ系数评估。
30 例患者中，7 例因 PG 或 PSG 技术问题被排除，23 例纳入主要分析。23 例患者中，8 例 PSG 的 AHI≥5。采用相同的阈值，PG 诊断 SA 的敏感性、特异性、阳性预测值和阴性预测值分别为 87.5%（95%置信区间：47-99）、80%（52-96）、70%（35-93）和 92.3%（64-99）。PG 观察者间的κ值为 0.75（0.49-1.00），表明一致性较好。AUROC 为 0.93（0.82-1.00）。睡眠和日间嗜睡问卷与 SA 之间无相关性。
便携式 PG 似乎可用于排除 MSA 中的 SA。
