Edinger J D, Hoelscher T J, Webb M D, Marsh G R, Radtke R A, Erwin C W
Veterans Administration Medical Center, Durham, NC 27705.
Sleep. 1989 Aug;12(4):315-22.
This investigation examined the diagnostic value of polysomnography (PSG) for evaluating disorders of initiating and maintaining sleep (DIMS). The sample consisted of 100 outpatients who presented to the Duke Sleep Disorders Center with a complaint of chronic insomnia. All patients were given comprehensive medical, psychiatric, behavioral, and ambulatory PSG evaluations. Sleep disorder diagnoses were assigned using the criteria of the Association of Sleep Disorders Centers. Overall, PSG yielded important diagnostic information in 65% of the sample: 34% were given a primary sleep disorder diagnosis that was heavily dependent on PSG data [periodic movements of sleep (PMS) = 25%, apnea = 3%, and subjective insomnia = 6%]; 15% were given a secondary diagnosis of one of these three disorders; and PSG ruled out suspected PMS in 9% and sleep apnea in 7% of the sample. Patients greater than 40 years of age had a significantly higher rate of positive PSG findings than younger patients. Using only the clinical exam, two experienced sleep clinicians were able to predict only 14 of 25 PMS cases and one of three cases of sleep apnea. Based on these data, we suggest using PSG routinely with older insomniacs and with younger patients who fail initial treatment.
本研究探讨了多导睡眠图（PSG）在评估入睡和维持睡眠障碍（DIMS）方面的诊断价值。样本包括100名因慢性失眠主诉就诊于杜克睡眠障碍中心的门诊患者。所有患者均接受了全面的医学、精神科、行为学及动态PSG评估。睡眠障碍诊断依据睡眠障碍中心协会的标准进行。总体而言，PSG在65%的样本中提供了重要的诊断信息：34%被诊断为原发性睡眠障碍，且诊断很大程度上依赖于PSG数据[睡眠周期性运动（PMS）=25%，呼吸暂停=3%，主观性失眠=6%]；15%被诊断为这三种障碍之一的继发性诊断；PSG排除了样本中9%的疑似PMS和7%的睡眠呼吸暂停。40岁以上患者PSG阳性结果的发生率显著高于年轻患者。仅通过临床检查，两名经验丰富的睡眠临床医生仅能预测出25例PMS病例中的14例以及3例睡眠呼吸暂停病例中的1例。基于这些数据，我们建议对老年失眠患者以及初始治疗失败的年轻患者常规使用PSG。
