便携式双通道睡眠筛查工具在心力衰竭患者睡眠呼吸暂停识别中的有效性和预测价值。
Validity and Predictive Value of a Portable Two-Channel Sleep-Screening Tool in the Identification of Sleep Apnea in Patients With Heart Failure.
作者信息
de Vries Grietje E, van der Wal Haye H, Kerstjens Huib A M, van Deursen Vincent M, Stegenga Boudewijn, van Veldhuisen Dirk J, van der Hoeven Johannes H, van der Meer Peter, Wijkstra Peter J
机构信息
Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
出版信息
J Card Fail. 2015 Oct;21(10):848-55. doi: 10.1016/j.cardfail.2015.06.009. Epub 2015 Jun 19.
BACKGROUND
Sleep apnea is an important comorbidity in heart failure (HF) and is associated with an adverse outcome. Diagnosing sleep apnea is difficult, and polysomnography, considered to be the criterion standard, is not widely available. We assessed the validity of a portable 2-channel sleep-screening tool for the identification of sleep apnea in patients with HF.
METHODS AND RESULTS
One hundred patients with stable HF had simultaneous recordings of home-based polysomnography and the screening tool (Apnealink). To compare the apnea-hypopnea index of the screening tool with polysomnography, intraclass correlation (ICC), sensitivity, and specificity were calculated, and a Bland-Altman plot and receiver operating characteristic (ROC) curves were constructed. Ninety valid measurements with the screening tool were obtained (mean age 65.5 ± 11.0 y, 72% male, mean left ventricular ejection fraction 34.6 ± 11.0%). Agreement between the screening tool and polysomnography was high (ICC 0.85). The optimal cutoff value was apnea-hypopnea index ≥15/h (area under the ROC curve 0.94). Sensitivity and specificity were 92.9% and 91.9%, respectively.
CONCLUSIONS
The screening tool is useful in excluding the presence of sleep apnea in HF patients to refer only high-risk patients for more extensive polysomnography. This method may potentially reduce the need for the more expensive polysomnography.
背景
睡眠呼吸暂停是心力衰竭（HF）的一种重要合并症，与不良预后相关。睡眠呼吸暂停的诊断较为困难，而被视为标准的多导睡眠图检查并不能广泛应用。我们评估了一种便携式双通道睡眠筛查工具在识别HF患者睡眠呼吸暂停方面的有效性。
方法与结果
100例稳定HF患者同时进行了家庭多导睡眠图检查和筛查工具（Apnealink）记录。为比较筛查工具与多导睡眠图的呼吸暂停低通气指数，计算了组内相关系数（ICC）、敏感性和特异性，并绘制了Bland-Altman图和受试者工作特征（ROC）曲线。获得了90次使用筛查工具的有效测量结果（平均年龄65.5±11.0岁，72%为男性，平均左心室射血分数34.6±11.0%）。筛查工具与多导睡眠图之间的一致性较高（ICC 0.85）。最佳截断值为呼吸暂停低通气指数≥15次/小时（ROC曲线下面积0.94）。敏感性和特异性分别为92.9%和91.9%。
结论
该筛查工具有助于排除HF患者存在睡眠呼吸暂停的情况，仅将高危患者转诊进行更全面的多导睡眠图检查。这种方法可能会减少对更昂贵的多导睡眠图检查的需求。
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