Rouse Jessica K, Shirley Sean R, Holley Aaron B, Mysliwiec Vincent, Walter Robert J
Department of Medicine (Internal Medicine Division), 3551 Roger Brooke Drive, JBSA Ft Sam Houston, TX.
Brooke Army Medical Center, San Antonio, TX.
Mil Med. 2019 May 1;184(5-6):e137-e140. doi: 10.1093/milmed/usy317.
According to the American Academy of Sleep Medicine (AASM) guidelines, split-night polysomnography (SN-PSG) is an acceptable alternative to full-night PSG (FN-PSG) and may be considered in patients with an apnea-hypopnea index (AHI) ≥20/hr within the first 2 hours of the study. While SN-PSGs are an accurate approximation of moderate-to-severe obstructive sleep apnea (OSA), there remains the potential to misclassify the severity of sleep disordered breathing. Risks associated with the misclassification of OSA severity may be significant in high-risk professions such as active duty service members (ADSMs). The purpose of our study was to determine the accuracy of split-night polysomnography (SN-PSG) in a cohort of ADSMs.
We conducted a retrospective review of ADSMs undergoing FN-PSG with approval by our institution's Department of Clinical Investigation. FN-PSG data were processed using t-test, ANOVA, Chi-Squared, and logistical regression using JMP v12.0 to obtain partial-night data for the first 2 and 3 hours of recording. Significance was established with p-value less than 0.05. OSA severity was determined by calculating the AHI of each subject's FN-PSG and SN-PSG.
Three-hundred patients were included in the study. Overall 79% were male with a mean age of 37.6 ± 8.4 years and mean BMI of 28.5 ± 3.3 kg/m2. Of our cohort, 112 patients (37%) would have qualified for a SN-PSG, of which 94 (84%) were appropriately classified and 18 patients (16%) were misclassified.
In the relatively young, non-obese ADSM population, the majority did not qualify for a SN-PSG. The 3-hour SN-PSG accurately determined OSA severity in those with moderate-severe OSA; however, some patients with mild OSA would have been misclassified which can result in unnecessary duty limitations. A SN-PSG may not be ideal for this population.
根据美国睡眠医学学会（AASM）指南，分夜多导睡眠图（SN - PSG）是全夜多导睡眠图（FN - PSG）的一种可接受替代方法，对于研究开始后前2小时内呼吸暂停低通气指数（AHI）≥20次/小时的患者可考虑使用。虽然SN - PSG是对中度至重度阻塞性睡眠呼吸暂停（OSA）的准确近似，但仍存在对睡眠呼吸障碍严重程度进行错误分类的可能性。在现役军人（ADSM）等高风险职业中，与OSA严重程度错误分类相关的风险可能很大。我们研究的目的是确定在一组ADSM中，分夜多导睡眠图（SN - PSG）的准确性。
我们对经本机构临床研究部批准接受FN - PSG的ADSM进行了回顾性研究。使用JMP v12.0通过t检验、方差分析、卡方检验和逻辑回归处理FN - PSG数据，以获取记录的前2小时和3小时的部分夜数据。以p值小于0.05确定显著性。通过计算每个受试者的FN - PSG和SN - PSG的AHI来确定OSA严重程度。
300名患者纳入研究。总体上79%为男性，平均年龄37.6±8.4岁，平均体重指数28.5±3.3kg/m²。在我们的队列中，112名患者（37%）符合SN - PSG标准，其中94名（84%）分类正确，18名患者（16%）分类错误。
在相对年轻、非肥胖的ADSM人群中，大多数不符合SN - PSG标准。3小时的SN - PSG能准确确定中度至重度OSA患者的OSA严重程度；然而，一些轻度OSA患者会被错误分类，这可能导致不必要的职责限制。SN - PSG可能不适用于该人群。
