Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Research and Development at CIDELEC, Sainte Gemmes, France.
J Clin Sleep Med. 2018 Mar 15;14(3):359-369. doi: 10.5664/jcsm.6978.
In obstructive sleep apnea (OSA) esophageal pressure (Pes) is the gold standard for measurement of respiratory effort, and respiratory inductance plethysmography (RIP) is considered an accepted measurement technique. However, the use of RIP could lead to limited accuracy in certain cases and therefore suprasternal pressure (SSP) monitoring might improve the reliability of OSA diagnosis. We aimed to use SSP for the visual characterization of respiratory events in adults and compared results to those obtained by RIP from polysomnography (PSG).
In patients with OSA, a 1-night SSP recording using the PneaVoX sensor (Cidelec, Sainte-Gemmes-sur-Loire, France) was done. In parallel, PSG was performed according to American Academy of Sleep Medicine criteria. A subgroup of patients agreed to have Pes measurement in addition. Characterizations of apneas as obstructive, central, and mixed as well as hypopneas as central and obstructive were done by visual evaluation of SSP, RIP, and Pes in random order by two independent scores (S1 and S2). The sensitivity and specificity of characterization by SSP compared to RIP and to Pes were calculated.
Synchronous recordings of SSP and PSG were analyzed from n = 34 patients with OSA (AHI 34.1 ± 24.2 events/h); 9 of them had synchronized Pes monitoring as well. Interscorer agreement for apnea characterization as obstructive, central, and mixed based on SSP, RIP, and Pes were found, with R values from 0.91-0.99. The sensitivity of SSP in apnea characterization with reference to RIP (S1/S2) was 91.5%/92.3% for obstructive, 82.7%/76.2% for central, and 87.4%/79.9% for mixed. The sensitivity of SSP in apnea characterization with reference to Pes was (S1/S2) 93.1%/92.1% for obstructive, 80.8%/81.6% for central, and 91.7%/90.8% for mixed. Hypopnea was only classified for the nine patients with Pes.
This study demonstrated a good agreement in the detection of respiratory effort with the SSP signal using the PneaVoX sensor compared to the RIP belts signals as well as to the Pes signal. These findings were consistently found by two independent scorers. In summary, results suggest that SSP is a reliable signal for the classification of respiratory events and could be used as an additional tool for OSA characterization in clinical practice.
在阻塞性睡眠呼吸暂停（OSA）中，食管压力（Pes）是测量呼吸努力的金标准，呼吸感应体积描记法（RIP）被认为是一种可接受的测量技术。然而，在某些情况下，RIP 的使用可能导致准确性有限，因此胸骨上压力（SSP）监测可能会提高 OSA 诊断的可靠性。我们旨在使用 SSP 对成人的呼吸事件进行视觉特征描述，并将结果与多导睡眠图（PSG）中 RIP 的结果进行比较。
对 OSA 患者进行了一夜的 PneaVoX 传感器（Cidelec，Sainte-Gemmes-sur-Loire，法国）的 SSP 记录。同时，根据美国睡眠医学学会的标准进行 PSG。一组患者同意额外进行 Pes 测量。通过 SSP、RIP 和 Pes 的视觉评估以随机顺序由两名独立评分者（S1 和 S2）对呼吸暂停进行阻塞性、中枢性和混合性以及呼吸不足进行中枢性和阻塞性特征描述。计算 SSP 与 RIP 和 Pes 特征描述的敏感性和特异性。
从 n = 34 名 OSA 患者（呼吸暂停低通气指数 34.1 ± 24.2 次/小时）中分析了 SSP 和 PSG 的同步记录；其中 9 名患者还进行了同步 Pes 监测。基于 SSP、RIP 和 Pes 对呼吸暂停特征描述的评分者间一致性发现，R 值为 0.91-0.99。SSP 在以 RIP（S1/S2）为参考的呼吸暂停特征描述中的敏感性为阻塞性 91.5%/92.3%，中枢性 82.7%/76.2%，混合性 87.4%/79.9%。以 Pes 为参考，SSP 在呼吸暂停特征描述中的敏感性为（S1/S2）阻塞性 93.1%/92.1%，中枢性 80.8%/81.6%，混合性 91.7%/90.8%。呼吸不足仅在 9 名有 Pes 的患者中进行分类。
这项研究表明，与 RIP 带信号相比，使用 PneaVoX 传感器的 SSP 信号在检测呼吸努力方面具有良好的一致性，与 Pes 信号也具有良好的一致性。这两个结果均由两名独立评分者发现。总之，结果表明 SSP 是一种可靠的信号，可用于分类呼吸事件，可作为临床实践中 OSA 特征描述的附加工具。
