Facultad de Medicina, Universidad San Sebastián, Concepción, Chile; Departamento de Medicina Interna, Complejo Asistencial Dr. Víctor Ríos Ruiz, Los Ángeles, Chile; Evidence Based Medicine in Pulmonology (EBMIP) Working Group, Los Angeles, Chile.
Centro de Pacientes Críticos, Clínica Las Condes, Santiago, Chile; Grupo de estudio trastornos respiratorios del sueño (GETRS), Clínica Las Condes, Santiago, Chile.
Sleep Med. 2018 Jul;47:66-71. doi: 10.1016/j.sleep.2018.03.015. Epub 2018 Apr 7.
Home sleep apnea testing (HSAT) is a diagnostic measure for obstructive sleep apnea hypopnea syndrome (OSAHS) in moderate/high risk patients. Some HSAT companies contain automatic analysis (AA). However, guidelines recommend manual analysis (MA) despite the weak evidence for this recommendation.
Evaluate the concordance between AA and MA of HSAT to make either a diagnosis and severity classification.
We evaluated AA and MA of HSAT between 2015 and 2016. The study was a blind analysis reviewed by two physicians using currents recommendations. The differences between AA and MA were compared with single variable T analysis, inter-scorer agreement for diagnosis was evaluated with Cohen Kappa coefficient, correlation was examined using Tau-b Kendall, and Bland-Altman plot was constructed to analyze differences between AA and MA.
One hundred and ninety-eight patients were included. In our study, the mean age was 50 ± 15 years, 83% male, BMI 30 ± 5 and neck circumference 41 ± 4 cm. Eighty-two percent of subjects showed an apnea-hypopnea index (AHI) > 5 ev/h. Thirty-five percent of patients with OSAHS were mild (AHI: 5-15 ev/h), 34% moderate and 31% severe (>30 ev/h). The kappa coefficient between physicians was 1.0 (high), between AA and MA was 0.58 (moderate) for the diagnosis of OSAHS and 0.33 (weak) for severity with 0.70 Tau-b. The AA underestimates the IAH -8 ev/h, (95% CI -9 to -7 ev/h, p < 0.001) and delivers a misclassification of severity by 47%.
AA underestimates the rate of respiratory events and alters the classification of the severity of the disease and may modify the therapeutic approach.
家庭睡眠呼吸暂停测试（HSAT）是中/高危患者阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的诊断方法。一些 HSAT 公司包含自动分析（AA）。然而，尽管对这一建议的证据较弱，但指南仍推荐手动分析（MA）。
评估 HSAT 的 AA 与 MA 的一致性，以做出诊断和严重程度分类。
我们评估了 2015 年至 2016 年期间的 HSAT 的 AA 和 MA。该研究是一项盲法分析，由两名医生使用当前建议进行审查。使用单变量 T 分析比较 AA 和 MA 之间的差异，使用 Cohen Kappa 系数评估诊断的评分者间一致性，使用 Tau-b Kendall 检验评估相关性，并用 Bland-Altman 图分析 AA 和 MA 之间的差异。
共纳入 198 例患者。在我们的研究中，平均年龄为 50±15 岁，83%为男性，BMI 为 30±5，颈围为 41±4cm。82%的受试者出现呼吸暂停低通气指数（AHI）>5 次/小时。35%的 OSAHS 患者为轻度（AHI：5-15 次/小时），34%为中度，31%为重度（>30 次/小时）。两位医生之间的 Kappa 系数为 1.0（高），AA 与 MA 之间的 Kappa 系数为 0.58（中度），用于 OSAHS 的诊断，0.33（弱）用于严重程度，Tau-b 为 0.70。AA 低估了呼吸暂停低通气指数（IAH）-8 次/小时（95%置信区间为-9 至-7 次/小时，p<0.001），并导致严重程度的分类错误 47%。
AA 低估了呼吸事件的发生率，并改变了疾病严重程度的分类，可能会改变治疗方法。
