Aurora R Nisha, Putcha Nirupama, Swartz Rachel, Punjabi Naresh M
Department of Medicine, Johns Hopkins University, Baltimore, Md.
Department of Medicine, Johns Hopkins University, Baltimore, Md; Department of Epidemiology, Johns Hopkins University, Baltimore, Md.
Am J Med. 2016 Jul;129(7):725-30. doi: 10.1016/j.amjmed.2016.02.015. Epub 2016 Mar 8.
Obstructive sleep apnea is a prevalent yet underdiagnosed condition associated with cardiovascular morbidity and mortality. Home sleep testing offers an efficient means for diagnosing obstructive sleep apnea but has been deployed primarily in clinical samples with a high pretest probability. The present study sought to assess whether obstructive sleep apnea can be diagnosed with home sleep testing in a nonreferred sample without involvement of a sleep medicine specialist.
A study of community-based adults with untreated obstructive sleep apnea was undertaken. Misclassification of disease severity according to home sleep testing with and without involvement of a sleep medicine specialist was assessed, and agreement was characterized using scatter plots, Pearson's correlation coefficient, Bland-Altman analysis, and the κ statistic. Analyses were also conducted to assess whether any observed differences varied as a function of pretest probability of obstructive sleep apnea or subjective sleepiness.
The sample consisted of 191 subjects, with more than half (56.5%) having obstructive sleep apnea. Without involvement of a sleep medicine specialist, obstructive sleep apnea was not identified in only 5.8% of the sample. Analyses comparing the categorical assessment of disease severity with and without a sleep medicine specialist showed that in total, 32 subjects (16.8%) were misclassified. Agreement in the disease severity with and without a sleep medicine specialist was not influenced by the pretest probability or daytime sleep tendency.
Obstructive sleep apnea can be reliably identified with home sleep testing in a nonreferred sample, irrespective of the pretest probability of the disease.
阻塞性睡眠呼吸暂停是一种常见但诊断不足的疾病，与心血管疾病的发病率和死亡率相关。家庭睡眠测试为诊断阻塞性睡眠呼吸暂停提供了一种有效的方法，但主要应用于具有高预测试概率的临床样本中。本研究旨在评估在没有睡眠医学专家参与的情况下，家庭睡眠测试能否在非转诊样本中诊断阻塞性睡眠呼吸暂停。
对未治疗的阻塞性睡眠呼吸暂停的社区成年人进行了一项研究。评估了在有和没有睡眠医学专家参与的情况下，根据家庭睡眠测试对疾病严重程度的错误分类，并使用散点图、Pearson相关系数、Bland-Altman分析和κ统计量来描述一致性。还进行了分析，以评估观察到的任何差异是否随阻塞性睡眠呼吸暂停的预测试概率或主观嗜睡程度而变化。
样本包括191名受试者其中一半以上（56.5%）患有阻塞性睡眠呼吸暂停。在没有睡眠医学专家参与的情况下，样本中只有5.8%未被识别出患有阻塞性睡眠呼吸暂停。比较有和没有睡眠医学专家参与的疾病严重程度分类评估的分析表明，总共有32名受试者（16.8%）被错误分类。有和没有睡眠医学专家参与的疾病严重程度的一致性不受预测试概率或白天睡眠倾向的影响。
在非转诊样本中，无论疾病的预测试概率如何，家庭睡眠测试都能可靠地识别阻塞性睡眠呼吸暂停。
