Urahama Ryuma, Uesato Masaya, Aikawa Mizuho, Yamaguchi Yukiko, Hayano Koichi, Matsumura Tomoaki, Arai Makoto, Kunii Reiko, Isono Shiroh, Matsubara Hisahiro
Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan.
Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan.
World J Gastrointest Endosc. 2018 Nov 16;10(11):340-347. doi: 10.4253/wjge.v10.i11.340.
To investigate that polysomnographic monitoring can accurately evaluate respiratory disturbance incidence during sedation for gastrointestinal endoscopy compare to pulse oximetry alone.
This prospective observational study included 10 elderly patients with early gastric cancer undergoing endoscopic submucosal dissection (ESD) under propofol sedation. Apart from routine cardiorespiratory monitoring, polysomnography measurements were acquired. The primary hypothesis was tested by comparing the apnea hypopnea index (AHI), defined as the number of apnea and hypopnea instances per hour during sedation, with and without hypoxemia; hypoxemia was defined as the reduction in oxygen saturation by ≥ 3% from baseline.
Polysomnography (PSG) detected 207 respiratory disturbances in the 10 patients. PSG yielded a significantly greater AHI (10.44 ± 5.68/h) compared with pulse oximetry (1.54 ± 1.81/h, < 0.001), thus supporting our hypothesis. Obstructive AHI (9.26 ± 5.44/h) was significantly greater than central AHI (1.19 ± 0.90/h, < 0.001). Compared with pulse oximetry, PSG detected the 25 instances of respiratory disturbances with hypoxemia 107.4 s earlier on average.
Compared with pulse oximetry, PSG can better detect respiratory irregularities and thus provide superior AHI values, leading to avoidance of fatal respiratory complications during ESD under propofol-induced sedation.
研究多导睡眠图监测与单独使用脉搏血氧饱和度测定法相比，能否准确评估胃肠内镜检查镇静期间的呼吸紊乱发生率。
这项前瞻性观察性研究纳入了10例接受丙泊酚镇静下内镜黏膜下剥离术（ESD）的老年早期胃癌患者。除了常规心肺监测外，还进行了多导睡眠图测量。通过比较镇静期间每小时呼吸暂停和低通气事件数量的呼吸暂停低通气指数（AHI），对主要假设进行了检验，有无低氧血症；低氧血症定义为氧饱和度较基线降低≥3%。
多导睡眠图（PSG）在10例患者中检测到207次呼吸紊乱。与脉搏血氧饱和度测定法（1.54±1.81/h，<0.001）相比，PSG得出的AHI显著更高（10.44±5.68/h），从而支持了我们的假设。阻塞性AHI（9.26±5.44/h）显著高于中枢性AHI（1.19±0.90/h，<0.001）。与脉搏血氧饱和度测定法相比，PSG检测到的25次伴有低氧血症的呼吸紊乱平均提前107.4秒。
与脉搏血氧饱和度测定法相比，PSG能更好地检测呼吸不规则情况，从而提供更高的AHI值，有助于避免丙泊酚诱导镇静下ESD期间致命的呼吸并发症。
