Lindemann J, Augenstein B, Stupp F, Saul B, Reichert M, Riepl R, Sommer F, Grossi A-S
Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland.
HNO. 2017 Feb;65(2):134-140. doi: 10.1007/s00106-016-0308-6.
Cardiorespiratory polysomnography (PSG) is considered the reference method for diagnosis of obstructive sleep apnea (OSA). Due to waiting times and high costs, payers increasingly request outpatient polygraphy (PG) as an alternative to inpatient PSG. The aim of the present study was to evaluate the diagnostic accuracy of different outpatient PG devices compared to stationary PSG in clinical practice.
Externally collected outpatient PG findings of 406 patients were retrospectively compared with the corresponding PSG findings.
Among the 406 patients were 343 men (85%) and 63 women (15%), with mean age 50 years. Mean body mass index (BMI) was 30 kg/m. The rank correlation coefficient for PG- and PSG- derived apnea-hypopnea index (AHI) values was r = 0.574. On average, PG underestimated the AHI by 6.4 (±20.5) events/h. OSAS severity was determined correctly by PG in only 43% of cases. Sensitivity (90.7%) and specificity (45.2%) of ambulatory PG was calculated for the threshold value AHI ≥ 5/h. Based on the results of PG, an indicated therapy would have been omitted in 35 cases (9%) and unnecessary treatment initiated in 17 cases (4%). The PG devices used showed a comparable diagnostic accuracy (r = 0.513-0.657), with a sensitivity of 81.3-96.9% and a specificity of 33.3-50.0%.
Outpatient PG cannot reliably assess OSA severity in clinical routine. Confirmation by PSG in a sleep lab in symptomatic patients is obligatory. Outpatient PG devices should only be used as an upstream screening method. The automatic evaluation of the PG should always be proofed.
心肺多导睡眠图（PSG）被认为是诊断阻塞性睡眠呼吸暂停（OSA）的参考方法。由于等待时间长和成本高，医保机构越来越多地要求采用门诊多导睡眠监测（PG）作为住院PSG的替代方法。本研究的目的是在临床实践中评估不同门诊PG设备与固定式PSG相比的诊断准确性。
回顾性比较了406例患者外部收集的门诊PG检查结果与相应的PSG检查结果。
406例患者中，男性343例（85%），女性63例（15%），平均年龄50岁。平均体重指数（BMI）为30kg/m²。PG和PSG得出的呼吸暂停低通气指数（AHI）值的等级相关系数为r = 0.574。PG平均低估AHI 6.4（±20.5）次/小时。PG仅在43%的病例中正确确定了OSAS的严重程度。对于AHI≥5次/小时的阈值，计算了动态PG的敏感性（90.7%）和特异性（45.2%）。根据PG结果，35例（9%）患者会被遗漏必要的治疗，17例（4%）患者会开始不必要的治疗。所使用的PG设备显示出相当的诊断准确性（r = 0.513 - 0.657），敏感性为81.3 - 96.9%，特异性为33.3 - 50.0%。
门诊PG在临床常规中不能可靠地评估OSA的严重程度。有症状的患者必须在睡眠实验室通过PSG进行确诊。门诊PG设备仅应用作初步筛查方法。PG的自动评估应始终进行验证。
