Fernandez Alvarez Ramon, Rabec Claudio, Rubinos Cuadrado Gemma, Cascon Hernandez Juan Alejandro, Rodriguez Patricia, Georges Marjolaine, Casan Pere
Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Spain.
Respiration. 2017;93(3):162-169. doi: 10.1159/000454954. Epub 2017 Jan 14.
Polygraphy (PG) remains the standard method of assessing noninvasive ventilation (NIV) effectiveness. Built-in software (BIS) of recent NIV equipment provides estimates of some ventilator parameters, but their usefulness is unclear.
To assess the reliability of BIS compared with PG in a cohort of obesity hypoventilation syndrome (OHS) patients on NIV.
Thirty stable OHS patients on NIV were evaluated in an outpatient setting with simultaneous PG and BIS recordings. The automated apnea-hypopnea event index (EIAUT) provided by Rescan and manual scoring based on available traces obtained from the software (EIBIS) were compared with manual PG scoring (EIPG). Each manual scoring was separately performed by 2 trained operators. Agreement between the 2 operators was assessed using the kappa coefficient. Pearson correlation and Bland-Altman plots were used to evaluate agreement between EIAUT, EIBIS, and EIPG.
Twenty-six cases were valid for analysis (age ±61 years, 17 men). All patients were ventilated in the spontaneous/timed mode (mean inspiratory positive airway pressure 17 ± 3 cm H2O, mean expiratory positive airway pressure 10 ± 3 cm H2O). Cohen's kappa agreement between the operators was 0.7 for EIBIS and 0.84 for EIPG. EIBIS showed good correlation with EIPG (r2 = 0.79 p < 0.001), better than scoring provided by the automated analysis (r2 = 0.71, p < 0.006 for EIAUT vs. EIPG).
In stable OHS patients on NIV, unattended home-based monitoring using Rescan is reproducible and reliable to assess quality of ventilation when compared with PG. In addition, manual scoring of events using data obtained with this device is more consistent than software-based automated analysis.
多导睡眠图（PG）仍然是评估无创通气（NIV）有效性的标准方法。近期NIV设备的内置软件（BIS）可提供一些呼吸机参数的估计值，但其有用性尚不清楚。
在一组接受NIV治疗的肥胖低通气综合征（OHS）患者中，评估BIS与PG相比的可靠性。
在门诊环境中，对30例接受NIV治疗的稳定OHS患者进行评估，同时记录PG和BIS。将Rescan提供的自动呼吸暂停低通气事件指数（EIAUT）和基于软件获得的可用轨迹进行的手动评分（EIBIS）与手动PG评分（EIPG）进行比较。每项手动评分均由2名经过培训的操作人员分别进行。使用kappa系数评估两名操作人员之间的一致性。采用Pearson相关性分析和Bland-Altman图评估EIAUT、EIBIS和EIPG之间的一致性。
26例病例可用于分析（年龄±61岁，17例男性）。所有患者均采用自主/定时模式通气（平均吸气气道正压17±3 cm H2O，平均呼气气道正压10±3 cm H2O）。操作人员之间EIBIS的Cohen's kappa一致性为0.7，EIPG为0.84。EIBIS与EIPG显示出良好的相关性（r2 = 0.79，p < 0.001），优于自动分析提供的评分（EIAUT与EIPG相比，r2 = 0.71，p < 0.006）。
在接受NIV治疗的稳定OHS患者中，与PG相比，使用Rescan进行无人值守的家庭监测来评估通气质量是可重复且可靠的。此外，使用该设备获得的数据对事件进行手动评分比基于软件的自动分析更具一致性。
