Amaddeo Alessandro, Medjahdi Noria, Fernandez-Bolanos Marta, Khirani Sonia, Baffet Guillaume, Fauroux Brigitte
Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France; Paris Descartes University, Paris, France; Research Unit INSERM U 955, Team 13, Créteil, France.
Lung Function and Sleep Laboratory, AP-HP, Hôpital Armand Trousseau, Paris, France; Sleep Laboratory, AP-HP, Hôpital Robert Debré, Paris, France.
Sleep Med. 2017 Jun;34:64-70. doi: 10.1016/j.sleep.2017.02.027. Epub 2017 Mar 25.
The accuracy of respiratory polygraphy (RP) is limited because of the absence of electroencephalography (EEG). Pulse wave amplitude (PWA) reduction has been shown to be a marker of autonomic activation during arousal, and may represent a substitute for obstructive respiratory-related cortical arousal (RRCA). This study tested the hypothesis that PWA could be a surrogate for RRCA in detecting obstructive hypopnea (OH) in a pediatric population.
Two experienced readers scored 30 consecutive polysomnographies (PSG) using standard scoring rules. Automatic software detected every 20-90% reduction in PWA. A second scoring of respiratory events using PWA reduction as a surrogate for RRCA was performed (RP with PWA) for each percentage of PWA reduction. The final analysis consisted of determining the concordance between the two methods of detecting OH.
A total of 987 episodes of ≥30% flow reduction were analyzed: 330 with RRCA only, 205 with desaturation (DS) only, 134 with both, and 318 without RRCA or DS. As the percentage of reduction in PWA increased, the sensitivity of PWA as a substitute for RRCA decreased, but the specificity increased. For a decrease in PWA of 60% or 70%, the sensitivities of PWA as a substitute for RRCA were 79% and 57%, and the specificities 51% and 76%, respectively.
Pulse wave amplitude reduction lacks sensitivity and specificity to be used as a surrogate for RRCA to detect OH in children. Polysomnography remains the gold standard for the diagnosis of sleep disordered breathing in children.
由于缺乏脑电图（EEG），呼吸多导描记术（RP）的准确性受到限制。脉搏波振幅（PWA）降低已被证明是觉醒期间自主神经激活的一个标志，并且可能代表阻塞性呼吸相关皮质觉醒（RRCA）的替代指标。本研究检验了这样一个假设，即PWA在检测儿科人群的阻塞性呼吸不足（OH）方面可能是RRCA的替代指标。
两名经验丰富的阅片者使用标准评分规则对连续30份多导睡眠图（PSG）进行评分。自动软件检测PWA每降低20% - 90%的情况。针对PWA降低的每个百分比，以PWA降低作为RRCA的替代指标对呼吸事件进行第二次评分（使用PWA的RP）。最终分析包括确定两种检测OH方法之间的一致性。
总共分析了987次流量降低≥30%的发作：仅RRCA的有330次，仅去饱和（DS）的有205次，两者皆有的有134次，无RRCA或DS的有318次。随着PWA降低百分比的增加，PWA作为RRCA替代指标的敏感性降低，但特异性增加。对于PWA降低60%或70%，PWA作为RRCA替代指标的敏感性分别为79%和57%，特异性分别为51%和76%。
脉搏波振幅降低缺乏作为RRCA替代指标来检测儿童OH的敏感性和特异性。多导睡眠图仍然是儿童睡眠呼吸障碍诊断的金标准。
