Stroke Program, University of Michigan, Ann Arbor, MI.
Sleep Disorders Center, University of Michigan, Ann Arbor, MI.
J Clin Sleep Med. 2014 Apr 15;10(4):371-5. doi: 10.5664/jcsm.3606.
As the importance of portable monitors for detection of sleep apnea increases, efficient and cost-minimizing methods for data interpretation are needed. We sought to compare in stroke patients, for whom portable studies often have particular advantages, results from a cardiopulmonary monitoring device with and without manual edits by a polysomnographic technologist.
Participants in an ongoing stroke surveillance study in Corpus Christi, Texas, underwent sleep apnea assessments with the ApneaLink Plus device within 45 days of stroke onset. Recordings were analyzed by the device's software unedited, and again after edits were made to the raw data by a registered polysomnographic technologist. Sensitivity and specificity were calculated, with the edited data as the reference standard. Sleep apnea was defined by 3 different apnea-hypopnea index (AHI) thresholds: ≥ 5, ≥ 10, and ≥ 15.
Among 327 subjects, 54% were male, 59% were Hispanic, and the median age was 65 years (interquartile range: 57, 77). The median AHI for the unedited data was 9 (4, 22), and for the edited data was 13 (6, 27) (p < 0.01). Specificity was above 98% for each AHI cutoff, while sensitivity was 81% to 82%. For each cutoff threshold, the edited data yielded a higher proportion of positive sleep apnea screens (p < 0.01) by approximately 10% in each group.
For stroke patients assessed with a cardiopulmonary monitoring device, manual editing by a technologist appears likely to improve sensitivity, whereas specificity of unedited data is already excellent.
随着便携式监测器在睡眠呼吸暂停检测中的重要性日益增加，需要寻找高效且能最小化成本的数据解读方法。我们旨在比较在中风患者中，便携式研究通常具有特殊优势的情况下，心肺监测设备的原始数据和经睡眠技师手动编辑后的数据结果。
在德克萨斯州科珀斯克里斯蒂市进行的一项正在进行的中风监测研究中，参与者在中风发作后 45 天内使用 ApneaLink Plus 设备进行睡眠呼吸暂停评估。原始记录未经编辑，由设备软件进行分析；之后，由注册睡眠技师对原始数据进行编辑。以编辑后的数据作为参考标准，计算敏感性和特异性。通过 3 种不同的呼吸暂停低通气指数（apnea-hypopnea index，AHI）阈值定义睡眠呼吸暂停：≥5、≥10 和≥15。
在 327 名受试者中，54%为男性，59%为西班牙裔，中位年龄为 65 岁（四分位间距：57，77）。未编辑数据的中位 AHI 为 9（4，22），编辑后数据的中位 AHI 为 13（6，27）（p<0.01）。每个 AHI 截止值的特异性均高于 98%，而敏感性为 81%至 82%。对于每个截止阈值，编辑后数据在每组中增加了约 10%的阳性睡眠呼吸暂停筛查比例（p<0.01）。
对于使用心肺监测设备评估的中风患者，由技师手动编辑似乎可以提高敏感性，而未经编辑的数据特异性已经很高。
