Mayer Pierre, Herrero Babiloni Alberto, Aubé Jean-Louis, Kaddaha Zeina, Marshansky Serguei, Rompré Pierre H, Jobin Vincent, Lavigne Gilles J
Centre Hospitalier de l'Universite de Montreal (CHUM), Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
Research Center, Sacre-Coeur Hospital, Montreal University, Montreal, QC, Canada.
Nat Sci Sleep. 2019 Dec 19;11:423-431. doi: 10.2147/NSS.S234703. eCollection 2019.
Portable monitoring (PM) is an alternative to laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA). However, PM tends to underestimate the apnea-hypopnea index (AHI), as it does not identify non-desaturating events associated with electroencephalographic (EEG) arousal. The objectives were to explore heart rate acceleration (HRa) and decrease in pulse transit time (PTT) as surrogates to EEG arousal for non-desaturating hypopnea and respiratory effort-related arousal (RERA), and to estimate cut-off values for their use with both total sleep time (TST), the standard method for PSG, and total recording time (TRT), the usual method for PM.
Twenty-four consecutive individuals with suspected OSA were studied with PSG. Calculated outcomes were: AHI, respiratory disturbance index with EEG arousal (RDIe) and autonomic arousal by HRa (RDI-HRa) and PTT decreases (RDI-PTT) at different time cut-offs. Using RDIe as reference, Bland Altman and intraclass coefficient of correlation (ICC) were used to calculate agreement between indexes, and receiver operating curves (ROC) for sensitivity/specificity of the different cut-offs.
Autonomic arousals, limited to respiratory events, were present in 36% of non-desaturating hypopneas and 29% of RERAs. Using TST, RDI-HRa of 10 bpm (ICC= 0.89) and RDI-PTT with a decrease of -15 msec (ICC=0.90) agreed better with RDIe. With TRT, the RDI-HRa of 5 bpm agreed better with the RDIe (ICC=0.89). Bland-Altman plots showed mean differences of 1.53 between RDI-HRa10-TST and RDIe and 0.89 between RDI-HRa5-TRT and RDIe.
Autonomic arousals (HRa and PTT) may be a suitable proxy of EEG arousals associated with respiratory events, using both TST and TRT. Therefore, they could potentially help to capture borderline symptomatic patients and to monitor treatment outcomes.
便携式监测（PM）是诊断阻塞性睡眠呼吸暂停（OSA）的实验室多导睡眠图（PSG）的替代方法。然而，PM往往会低估呼吸暂停低通气指数（AHI），因为它无法识别与脑电图（EEG）觉醒相关的非低氧血症事件。目的是探索心率加速（HRa）和脉搏传输时间（PTT）的降低作为非低氧血症低通气和呼吸努力相关觉醒（RERA）的EEG觉醒替代指标，并估计它们与总睡眠时间（TST，PSG的标准方法）和总记录时间（TRT，PM的常用方法）一起使用时的临界值。
对24名连续的疑似OSA个体进行PSG研究。计算的结果包括：AHI、伴有EEG觉醒的呼吸紊乱指数（RDIe）以及在不同时间临界值下通过HRa（RDI-HRa）和PTT降低（RDI-PTT）的自主神经觉醒。以RDIe为参考，使用布兰德-奥特曼分析和组内相关系数（ICC）计算各指标之间的一致性，并绘制不同临界值的受试者工作特征曲线（ROC）以评估敏感性/特异性。
自主神经觉醒仅限于呼吸事件，在36%的非低氧血症低通气和29%的RERA中出现。使用TST时，HRa为10次/分钟的RDI-HRa（ICC = 0.89）和PTT降低-15毫秒的RDI-PTT（ICC = 0.90）与RDIe的一致性更好。使用TRT时，HRa为5次/分钟的RDI-HRa与RDIe的一致性更好（ICC = 0.89）。布兰德-奥特曼图显示，HRa为10次/分钟-TST的RDI-HRa与RDIe之间的平均差异为1.53，HRa为5次/分钟-TRT的RDI-HRa与RDIe之间的平均差异为0.89。
自主神经觉醒（HRa和PTT）可能是与呼吸事件相关的EEG觉醒的合适替代指标，可同时使用TST和TRT。因此，它们可能有助于识别临界症状患者并监测治疗结果。
