Faculty of Medicine, University of Basel, Basel, Switzerland.
Swiss National Accident Insurance Fund (SUVA), Lucerne, Switzerland.
PLoS One. 2018 May 30;13(5):e0198315. doi: 10.1371/journal.pone.0198315. eCollection 2018.
Obstructive sleep apnea syndrome (OSAS) is common in adults. People with OSAS have a higher risk of experiencing traffic accidents and occupational injuries (OIs). We aimed to clarify the diagnostic performance of a three-channel screening device (ApneaLinkTM) compared with the gold standard of full-night attended polysomnography (PSG) among hospital outpatients not referred for sleep-related symptoms. Furthermore, we aimed to determine whether manual revision of the ApneaLinkTM autoscore enhanced diagnostic performance.
We investigated 68 patients with OI and 44 without OI recruited from the University Hospital Basel emergency room, using a cross-sectional study design. Participating patients spent one night at home with ApneaLinkTM and within 2 weeks slept for one night at the sleep laboratory. We reanalyzed all ApneaLinkTM data after manual revision.
We identified significant correlations between the ApneaLinkTM apnea-hypopnea index (AHI) autoscore and the AHI derived by PSG (r = 0.525; p <0.001) and between the ApneaLinkTM oxygen desaturation index (ODI) autoscore and that derived by PSG (r = 0.722; p <0.001). The ApneaLinkTM autoscore showed a sensitivity and specificity of 82% when comparing AHI ≥5 with the cutoff for AHI and/or ODI ≥15 from PSG. In Bland Altman plots the mean difference between ApneaLinkTM AHI autoscore and PSG was 2.75 with SD ± 8.80 (β = 0.034), and between ApneaLinkTM AHI revised score and PSG -1.50 with SD ± 9.28 (β = 0.060).
The ApneaLinkTM autoscore demonstrated good sensitivity and specificity compared with the gold standard (full-night attended PSG). However, Bland Altman plots revealed substantial fluctuations between PSG and ApneaLinkTM AHI autoscore respectively manually revised score. This spread for the AHI from a clinical perspective is large, and therefore the results have to be interpreted with caution. Furthermore, our findings suggest that there is no clinical benefit in manually revising the ApneaLinkTM autoscore.
阻塞性睡眠呼吸暂停综合征（OSAS）在成年人中很常见。患有 OSAS 的人发生交通事故和职业伤害（OIs）的风险更高。我们旨在明确三通道筛查设备（ApneaLinkTM）与全夜多导睡眠图（PSG）金标准相比在未因睡眠相关症状就诊的医院门诊患者中的诊断性能。此外，我们旨在确定手动修订 ApneaLinkTM 自动评分是否可以提高诊断性能。
我们使用横断面研究设计，从巴塞尔大学医院急诊室调查了 68 名患有 OI 和 44 名无 OI 的患者。参与的患者在家中使用 ApneaLinkTM 度过一夜，在两周内到睡眠实验室度过一夜。我们在手动修订后重新分析了所有 ApneaLinkTM 数据。
我们发现 ApneaLinkTM 呼吸暂停低通气指数（AHI）自动评分与 PSG 得出的 AHI 之间存在显著相关性（r = 0.525；p <0.001），以及 ApneaLinkTM 氧减饱和度指数（ODI）自动评分与 PSG 得出的 ODI 之间存在显著相关性（r = 0.722；p <0.001）。当将 ApneaLinkTM AHI 自动评分与 PSG 比较时，AHI ≥5 与 AHI 和/或 ODI ≥15 的 PSG 截定点进行比较时，ApneaLinkTM 自动评分的灵敏度和特异性为 82%。在 Bland Altman 图中，ApneaLinkTM AHI 自动评分与 PSG 之间的平均差异为 2.75，标准差为±8.80（β = 0.034），ApneaLinkTM AHI 修订评分与 PSG 之间的平均差异为-1.50，标准差为±9.28（β = 0.060）。
与金标准（全夜多导睡眠图）相比，ApneaLinkTM 自动评分显示出良好的灵敏度和特异性。然而，Bland Altman 图显示 PSG 和 ApneaLinkTM AHI 自动评分之间存在明显波动。从临床角度来看，AHI 的这种波动范围很大，因此结果必须谨慎解释。此外，我们的研究结果表明，手动修订 ApneaLinkTM 自动评分没有临床益处。
