Andrés-Blanco Ana M, Álvarez Daniel, Crespo Andrea, Arroyo C Ainhoa, Cerezo-Hernández Ana, Gutiérrez-Tobal Gonzalo C, Hornero Roberto, Del Campo Félix
Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.
Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.
PLoS One. 2017 Nov 27;12(11):e0188094. doi: 10.1371/journal.pone.0188094. eCollection 2017.
The coexistence of obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) leads to increased morbidity and mortality. The development of home-based screening tests is essential to expedite diagnosis. Nevertheless, there is still very limited evidence on the effectiveness of portable monitoring to diagnose OSAS in patients with pulmonary comorbidities.
To assess the influence of suffering from COPD in the performance of an oximetry-based screening test for moderate-to-severe OSAS, both in the hospital and at home.
A total of 407 patients showing moderate-to-high clinical suspicion of OSAS were involved in the study. All subjects underwent (i) supervised portable oximetry simultaneously to in-hospital polysomnography (PSG) and (ii) unsupervised portable oximetry at home. A regression-based multilayer perceptron (MLP) artificial neural network (ANN) was trained to estimate the apnea-hypopnea index (AHI) from portable oximetry recordings. Two independent validation datasets were analyzed: COPD versus non-COPD.
The portable oximetry-based MLP ANN reached similar intra-class correlation coefficient (ICC) values between the estimated AHI and the actual AHI for the non-COPD and the COPD groups either in the hospital (non-COPD: 0.937, 0.909-0.956 CI95%; COPD: 0.936, 0.899-0.960 CI95%) and at home (non-COPD: 0.731, 0.631-0.808 CI95%; COPD: 0.788, 0.678-0.864 CI95%). Regarding the area under the receiver operating characteristics curve (AUC), no statistically significant differences (p >0.01) between COPD and non-COPD groups were found in both settings, particularly for severe OSAS (AHI ≥30 events/h): 0.97 (0.92-0.99 CI95%) non-COPD vs. 0.98 (0.92-1.0 CI95%) COPD in the hospital, and 0.87 (0.79-0.92 CI95%) non-COPD vs. 0.86 (0.75-0.93 CI95%) COPD at home.
The agreement and the diagnostic performance of the estimated AHI from automated analysis of portable oximetry were similar regardless of the presence of COPD both in-lab and at-home. Particularly, portable oximetry could be used as an abbreviated screening test for moderate-to-severe OSAS in patients with COPD.
阻塞性睡眠呼吸暂停综合征（OSAS）与慢性阻塞性肺疾病（COPD）并存会导致发病率和死亡率增加。开展居家筛查测试对于加快诊断至关重要。然而，关于便携式监测在诊断合并肺部疾病患者的OSAS有效性方面的证据仍然非常有限。
评估患COPD对基于血氧饱和度测定的中重度OSAS筛查测试在医院和居家环境中表现的影响。
共有407例临床高度怀疑患有OSAS的患者参与了该研究。所有受试者均接受了以下两项测试：（i）与院内多导睡眠图（PSG）同步进行的有监督便携式血氧饱和度测定；（ii）居家无监督便携式血氧饱和度测定。训练了一个基于回归的多层感知器（MLP）人工神经网络（ANN），以根据便携式血氧饱和度测定记录估算呼吸暂停低通气指数（AHI）。分析了两个独立的验证数据集：COPD组与非COPD组。
基于便携式血氧饱和度测定的MLP ANN在估算的AHI与实际AHI之间，无论是在医院（非COPD组：0.937，95%置信区间为0.909 - 0.956；COPD组：0.936，95%置信区间为0.899 - 0.960）还是居家环境中（非COPD组：0.731，95%置信区间为0.631 - 0.808；COPD组：0.788，95%置信区间为0.678 - 0.864），非COPD组和COPD组的组内相关系数（ICC）值相似。关于受试者工作特征曲线下面积（AUC），在两种环境下COPD组与非COPD组之间均未发现统计学显著差异（p>0.01），特别是对于重度OSAS（AHI≥30次/小时）：在医院中，非COPD组为0.97（95%置信区间为0.92 - 0.99），COPD组为0.98（95%置信区间为0.92 - 1.0）；在居家环境中，非COPD组为0.87（95%置信区间为0.79 - 0.92），COPD组为0.86（95%置信区间为0.75 - 0.93）。
无论是否存在COPD，便携式血氧饱和度自动分析估算的AHI的一致性和诊断性能在实验室和居家环境中均相似。特别是，便携式血氧饱和度测定可作为COPD患者中重度OSAS的简化筛查测试。
