[活动记录仪和血氧饱和度测定法在诊断睡眠呼吸暂停低通气综合征中的价值]

Li Qinghua, Wang Biying, Dong Xiaosong, Zhang Chunfang, Li Jing, An Pei, Zhao Long, Zhang Xueli, Han Fang

Department of Respiratory and Intensive Care Unit, Peking University People's Hospital, Beijing 100044, China.

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Zhonghua Yi Xue Za Zhi. 2015 Nov 10;95(42):3411-5.

OBJECTIVE

To explore the value of actigraphy and oximetry for diagnosing sleep apnea-hypopnea syndrome (SAHS).

METHODS

Suspected SAHS subjects were enrolled from sleep center of Peking University People's Hospital between December 2013 and September 2014. Light-out and light-on were simultaneously recorded for polysomnography (PSG), actigraphy and oximetry. Actigraphy was used to correct total sleep time (TST) for oximetry. Oxygen desaturation index (ODI4), namely the times of pulse oxygen saturation (SpO2) drop≥4% per hour, was detected by oximetry. ODIA was used instead of ODI4 with TST corrected by actigraphy. Receiver operating characteristic (ROC) curve was used for evaluating the value of ODI4 and ODIA for diagnosing SAHS and cut-off value was calculated. Paired t-test or signed rank t-test was used for data acquired using actigraphy or oximetry compared with data acquired by PSG. Sensitivity and specificity were calculated using fourfold table. Disease severity of SAHS was classified by apnea-hypopnea index (AHI) detected by PSG. If AHI<5/h, SAHS was not considered. 5-<15/h was classified as mild, 15-<30/h was classified as moderate and AHI≥30/h was classified as severe.

RESULTS

Among 213 SAHS subjects, 38 of them were normal, 34 of them were mild, 51 were moderate and 90 were severe. Compared with PSG, actigraphy can correctly estimate TST in non-SAHS (P=0.408) and mild SAHS groups (P=0.949); while in moderate and severe SAHS groups, TSTs detected by actigraphy were shorter than TSTs acquired by PSG ((405±51) vs (419±40) min and (399 ± 62) vs (422 ± 60) min) (both P<0.05). Area under ROC curve (AUC) of ODI4 for diagnosing SAHS was 0.956 using a cut-off value of 5; the AUC of ODIA for diagnosing SAHS was 0.951 with a cut-off value of 5 as well. The sensitivity of ODI4 for mild, moderate and severe SAHS was 80.6%, 66.7% and 58.9% respectively, all with a specificity of 100%. After adjusting TST with actigraphy, the sensitivity of ODIA for mild, moderate and severe SAHS was 84.0%, 73.8 % and 68.9%, with specificity of 94.7%, 100% and 99.2% respectively.

CONCLUSIONS

Actigraphy can correctly estimate TST in non-SAHS and mild SAHS groups. ODI4 can be used for diagnosing SAHS. After correcting TST by actigraphy, the sensitivity of ODIA is higher.

目的

探讨活动记录仪和脉搏血氧饱和度仪在诊断睡眠呼吸暂停低通气综合征（SAHS）中的价值。

方法

选取2013年12月至2014年9月北京大学人民医院睡眠中心疑似SAHS的患者。同时记录多导睡眠图（PSG）、活动记录仪和脉搏血氧饱和度仪的熄灯和开灯时间。活动记录仪用于校正脉搏血氧饱和度仪的总睡眠时间（TST）。通过脉搏血氧饱和度仪检测氧减饱和度指数（ODI4），即每小时脉搏血氧饱和度（SpO2）下降≥4%的次数。使用活动记录仪校正后的TST，用ODIA代替ODI4。采用受试者操作特征（ROC）曲线评估ODI4和ODIA诊断SAHS的价值，并计算截断值。对活动记录仪或脉搏血氧饱和度仪获取的数据与PSG获取的数据进行配对t检验或符号秩和检验。使用四格表计算敏感性和特异性。SAHS的疾病严重程度根据PSG检测的呼吸暂停低通气指数（AHI）进行分类。若AHI<5次/小时，则不考虑为SAHS。5 - <15次/小时为轻度，15 - <30次/小时为中度，AHI≥30次/小时为重度。

结果

213例SAHS患者中，38例正常，34例轻度，51例中度，90例重度。与PSG相比，活动记录仪能正确估计非SAHS组（P = 0.408）和轻度SAHS组（P = 0.949）的TST；而在中度和重度SAHS组中，活动记录仪检测的TST短于PSG检测的TST（分别为(405±51)分钟 vs (419±40)分钟和(399 ± 62)分钟 vs (422 ± 60)分钟）（均P<0.05）。ODI4诊断SAHS的ROC曲线下面积（AUC）为0.956，截断值为5；ODIA诊断SAHS的AUC也为0.951，截断值同样为5。ODI4对轻度、中度和重度SAHS的敏感性分别为80.6%、66.7%和58.9%，特异性均为100%。用活动记录仪校正TST后，ODIA对轻度、中度和重度SAHS的敏感性分别为84.0%、73.8%和68.9%，特异性分别为94.7%、100%和99.2%。