Savage Henry Oluwasefunmi, Khushaba Rami N, Zaffaroni Alberto, Colefax Michael, Farrugia Steven, Schindhelm Klaus, Teschler Helmut, Weinreich Gerhard, Grueger Hartmut, Neddermann Martina, Heneghan Conor, Simonds Anita, Cowie Martin R
National Institute for Health Research Cardiovascular and Respiratory Biomedical Research Units, Royal Brompton Hospital, London, UK.
Imperial College London, London, UK.
ESC Heart Fail. 2016 Sep;3(3):212-219. doi: 10.1002/ehf2.12086. Epub 2016 Mar 1.
At least 50% of patients with heart failure (HF) may have sleep-disordered breathing (SDB). Overnight in-hospital polysomnography (PSG) is considered the gold standard for diagnosis, but a lack of access to such testing contributes to under-diagnosis of SDB. Therefore, there is a need for simple and reliable validated methods to aid diagnosis in patients with HF. The aim of this study was to investigate the accuracy of a non-contact type IV screening device, SleepMinder (SM), compared with in-hospital PSG for detecting SDB in patients with HF.
The study included 75 adult patients with systolic HF and suspected SDB who underwent simultaneous PSG and SM recordings. An algorithm was developed from the SM signals, using digital signal processing and pattern recognition techniques to calculate the SM apnoea-hypopnoea index (AHI). This was then compared with expert-scored PSG . The SM algorithm had 70% sensitivity and 89% specificity for identifying patients with clinically significant SDB (AHI ≥ 15/h). At this threshold, it had a positive likelihood ratio of 6.3 and a negative likelihood ratio of 0.16. The overall accuracy of the SM algorithm was 85.8% as shown by the area under a receiver operator characteristic curve. The mean AHI with SM was 3.8/h (95% confidence interval 0.5-7.1) lower than that with PSG.
The accuracy of the non-contact type IV screening device SM is good for clinically significant SDB in patients with systolic HF and could be considered as a simple first step in the diagnostic pathway.
至少50%的心力衰竭（HF）患者可能存在睡眠呼吸紊乱（SDB）。夜间住院多导睡眠图（PSG）被认为是诊断的金标准，但缺乏进行此类检测的条件导致SDB诊断不足。因此，需要简单可靠的经过验证的方法来辅助HF患者的诊断。本研究的目的是调查一种非接触式IV型筛查设备SleepMinder（SM）与住院PSG相比，用于检测HF患者SDB的准确性。
该研究纳入了75名患有收缩性HF且疑似SDB的成年患者，他们同时接受了PSG和SM记录。利用数字信号处理和模式识别技术从SM信号中开发了一种算法，以计算SM呼吸暂停低通气指数（AHI）。然后将其与专家评分的PSG进行比较。SM算法识别具有临床显著意义的SDB（AHI≥15次/小时）患者的灵敏度为70%，特异度为89%。在此阈值下，其阳性似然比为6.3，阴性似然比为0.16。如受试者工作特征曲线下面积所示，SM算法的总体准确率为85.8%。SM测得的平均AHI比PSG低3.8次/小时（95%置信区间0.5 - 7.1）。
非接触式IV型筛查设备SM对于收缩性HF患者具有临床显著意义的SDB诊断准确性良好，可被视为诊断途径中的简单第一步。
