Stöberl Anna S, Schwarz Esther I, Haile Sarah R, Turnbull Christopher D, Rossi Valentina A, Stradling John R, Kohler Malcolm
Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
J Sleep Res. 2017 Dec;26(6):782-788. doi: 10.1111/jsr.12558. Epub 2017 May 26.
One night of a sleep study is the standard for diagnosis and exclusion of obstructive sleep apnea. Single testing requires high sensitivity of the test method and a stable disease of interest to warrant a low rate of false-negative tests. Obstructive sleep apnea is diagnosed and graded by conventional thresholds of apneas and hypopneas per hour of sleep, and treatment is usually initiated in the presence of symptoms. The aim of this study was to assess night-to-night variability of obstructive sleep apnea to reassess the current practice. Seventy-seven patients previously diagnosed with obstructive sleep apnea, randomised to continuous positive airway pressure withdrawal within four trials, performed nightly pulse-oximetry over 2 weeks while off continuous positive airway pressure. The main outcome of interest was the coefficient of variation of the oxygen desaturation index marking night-to-night variability in obstructive sleep apnea. Obstructive sleep apnea was categorised according to conventional thresholds using oxygen desaturation index (no obstructive sleep apnea: <5 per h; mild: 5-15 per h; moderate: 15-30 per h; and severe: >30 per h). High night-to-night variability of obstructive sleep apnea was evidenced by a coefficient of variation of oxygen desaturation index of 31.1% (SD 16.5). Differences in oxygen desaturation index of >10 per h between nights were found in 84.4% and shifts in obstructive sleep apnea severity category in 77.9% of patients. The probability of missing moderate obstructive sleep apnea was up to 60%. Variability was higher in less severe obstructive sleep apnea. Obstructive sleep apnea shows a considerable night-to-night variability. Single-night diagnostic sleep studies are prone to miscategorise obstructive sleep apnea if arbitrary thresholds are used. Thus, treatment decisions should be based less on the conventional derivatives from sleep studies, especially in patients with less severe obstructive sleep apnea.
www.controlled-trials.com (ISRCTN 93153804, ISRCTN 73047833) and www.clinicaltrials.gov (NCT01332175 & NCT02050425).
一晚的睡眠监测是诊断和排除阻塞性睡眠呼吸暂停的标准。单次检测要求检测方法具有高灵敏度且所关注的疾病稳定，以保证假阴性检测率较低。阻塞性睡眠呼吸暂停通过每小时睡眠中呼吸暂停和低通气的传统阈值进行诊断和分级，通常在出现症状时开始治疗。本研究的目的是评估阻塞性睡眠呼吸暂停的夜间变异性，以重新评估当前的做法。77例先前诊断为阻塞性睡眠呼吸暂停的患者，在四项试验中随机接受持续气道正压通气撤机，在停止持续气道正压通气的情况下，进行了为期2周的夜间脉搏血氧饱和度监测。主要关注的结果是氧饱和度下降指数的变异系数，该系数标志着阻塞性睡眠呼吸暂停的夜间变异性。根据氧饱和度下降指数的传统阈值对阻塞性睡眠呼吸暂停进行分类（无阻塞性睡眠呼吸暂停：每小时<5次；轻度：每小时5 - 15次；中度：每小时15 - 30次；重度：每小时>30次）。氧饱和度下降指数的变异系数为31.1%（标准差16.5），证明了阻塞性睡眠呼吸暂停存在较高的夜间变异性。84.4%的患者夜间氧饱和度下降指数差异每小时>10次，77.9%的患者阻塞性睡眠呼吸暂停严重程度类别发生变化。漏诊中度阻塞性睡眠呼吸暂停的概率高达60%。在不太严重的阻塞性睡眠呼吸暂停中变异性更高。阻塞性睡眠呼吸暂停表现出相当大的夜间变异性。如果使用任意阈值，单夜诊断性睡眠研究容易对阻塞性睡眠呼吸暂停进行错误分类。因此，治疗决策应减少基于睡眠研究的传统指标，尤其是在阻塞性睡眠呼吸暂停不太严重的患者中。
www.controlled-trials.com（ISRCTN 93153804，ISRCTN 73047833）和www.clinicaltrials.gov（NCT01332175 & NCT02050425）。
