Nixon Gillian M, Hyde Melissa, Biggs Sarah N, Walter Lisa M, Horne Rosemary S C, Davey Margot J
The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Victoria, Australia and Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia.
J Clin Sleep Med. 2014 Nov 15;10(11):1217-21. doi: 10.5664/jcsm.4206.
In 2007 the American Academy of Sleep Medicine (AASM) published polysomnography (PSG) scoring guidelines, which were updated in 2012. A key change in terms of scoring respiratory events in children was the threshold for reduction in airflow (50% vs 30%) for the definition of hypopnea. This study aimed to determine the impact of different scoring rules on the assessment of severity of obstructive sleep apnea (OSA) in children.
Forty-two children (mean age 4.3 y, 16 F) underwent PSG. An obstructive apnea-hypopnea index (OAHI) was determined using three scoring rules: (1) ATS 1996 rules with minor modifications (modified ATS 1996); (2) AASM 2007 rules (AASM 2007); and (3) AASM 2007 rules with respiratory event related arousals included in the OAHI (AASM+RERA).
The AASM 2007 OAHI (median 0.4 events/h, range 0, 14) was lower than the modified ATS 1996 OAHI (median 0.8 range 0, 26.1, p < 0.001), underestimating severity of disease in 24% of cases. The AASM+RERA OAHI (median 0.8, range 0, 19.1) was also lower than the modified ATS 1996 OAHI (p = 0.02), but the difference was not clinically significant except at very high OAHIs.
The AASM 2007 rules lead to a lower OAHI and lesser OSA severity when compared to the previous standard. Inclusion of RERAs in the AASM 2007 OAHI leads to a comparable OAHI to the previous rules. Given that morbidity has been demonstrated even in mild OSA, these results support the inclusion of events with a reduction in airflow of less than 50% as included in the updated AASM rules in 2012.
2007年美国睡眠医学学会（AASM）发布了多导睡眠图（PSG）评分指南，并于2012年进行了更新。儿童呼吸事件评分方面的一个关键变化是低通气定义中气流减少的阈值（50%对30%）。本研究旨在确定不同评分规则对儿童阻塞性睡眠呼吸暂停（OSA）严重程度评估的影响。
42名儿童（平均年龄4.3岁，16名女性）接受了PSG检查。使用三种评分规则确定阻塞性呼吸暂停低通气指数（OAHI）：（1）经轻微修改的ATS 1996规则（改良ATS 1996）；（2）AASM 2007规则（AASM 2007）；（3）将与呼吸事件相关的觉醒纳入OAHI的AASM 2007规则（AASM+RERA）。
AASM 2007的OAHI（中位数0.4次/小时，范围0至14）低于改良ATS 1996的OAHI（中位数0.8，范围0至26.1，p<0.001），在24%的病例中低估了疾病严重程度。AASM+RERA的OAHI（中位数0.8，范围0至19.1）也低于改良ATS 1996的OAHI（p = 0.02），但除了OAHI非常高的情况外，差异无临床意义。
与先前标准相比，AASM 2007规则导致较低的OAHI和较轻的OSA严重程度。将RERAs纳入AASM 2007的OAHI会得出与先前规则相当的OAHI。鉴于即使在轻度OSA中也已证明存在发病率，这些结果支持将2012年更新的AASM规则中包括的气流减少小于50%的事件纳入其中。
