Zhao Ying Y, Weng Jia, Mobley Daniel R, Wang Rui, Kwon Younghoon, Zee Phyllis C, Lutsey Pamela L, Redline Susan
Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
J Clin Sleep Med. 2017 Jan 15;13(1):121-126. doi: 10.5664/jcsm.6404.
Type 3 home sleep apnea tests may underestimate the apnea-hypopnea index (AHI) due to overestimation of total sleep time (TST). We aimed to evaluate the effect of manual editing of the total recording time (TRT) on the TST and AHI.
Thirty 15-channel in-home polysomnography studies (AHI 0 to 30 events/h) scored using American Academy of Sleep Medicine criteria were rescored by two blinded polysomnologists after data from electroencephalogram, electrooculogram, and electromyogram were masked. In method 1, periods of probable wakefulness and artifact were manually edited and removed from analysis. Method 2 identified TST as the TRT without manual editing. Paired -tests were used to compare the TST and AHI between these methods. Sensitivity and specificity of each method were calculated for gold standard AHI cutoffs of ≥ 5 and ≥ 15 events/h.
TST (mean [standard deviation, SD]) by polysomnography, method 1, and method 2 was 366.0 (70.1), 447.1 (59.0), and 542 (61.9) min, respectively. The corresponding AHI was 12.5 (8.2), 10.8 (7.0), and 9.1 (6.1) events/h, respectively. Compared to polysomnography, both alternative methods overestimated the TST (method 1: mean difference [SD] 81.1 [56.1] min, method 2: 176.0 [89.7] min; both p < 0.001) and underestimated the AHI (method 1: mean difference [SD] -1.6 [3.3], method 2: -3.3 [3.9]; both p < 0.001). The sensitivity was 100% and 70.0% for method 1, and 91.3% and 40.0% for method 2 for identifying sleep-disordered breathing using AHI cutoffs of ≥ 5 and ≥ 15 events/h, respectively.
Manual editing of TRT reduces the overestimation of TST and improves the sensitivity for identifying studies with sleep-disordered breathing.
A commentary on this article appears in this issue on page 9.
由于总睡眠时间（TST）估计过高，3型家庭睡眠呼吸暂停测试可能会低估呼吸暂停低通气指数（AHI）。我们旨在评估手动编辑总记录时间（TRT）对TST和AHI的影响。
30项使用美国睡眠医学会标准评分的15通道家庭多导睡眠图研究（AHI为0至30次事件/小时），在脑电图、眼电图和肌电图数据被屏蔽后，由两名不知情的多导睡眠图专家重新评分。在方法1中，可能的清醒期和伪迹期被手动编辑并从分析中去除。方法2将TST确定为未进行手动编辑的TRT。采用配对t检验比较这两种方法之间的TST和AHI。计算每种方法对于AHI临界值≥5次事件/小时和≥15次事件/小时的金标准的敏感性和特异性。
多导睡眠图、方法1和方法2的TST（均值[标准差，SD]）分别为366.0（70.1）、447.1（59.0）和542（61.9）分钟。相应的AHI分别为12.5（8.2）、10.8（7.0）和9.1（6.1）次事件/小时。与多导睡眠图相比，两种替代方法均高估了TST（方法1：平均差异[SD]81.1[56.1]分钟，方法2：176.0[89.7]分钟；两者p<0.001）且低估了AHI（方法1：平均差异[SD]-1.6[3.3]，方法2：-3.3[3.9]；两者p<0.001）。对于使用AHI临界值≥5次事件/小时和≥15次事件/小时来识别睡眠呼吸障碍，方法1的敏感性分别为100%和70.0%，方法2的敏感性分别为91.3%和40.0%。
手动编辑TRT可减少对TST的高估，并提高识别睡眠呼吸障碍研究的敏感性。
关于本文的一篇评论发表在本期第9页。
