O'Mahony Anne M, Garvey John F, McNicholas Walter T
School of Medicine, University College Dublin, Dublin, Ireland.
First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Thorac Dis. 2020 Sep;12(9):5020-5038. doi: 10.21037/jtd-sleep-2020-003.
Obstructive sleep apnoea (OSA) is a growing and serious worldwide health problem with significant health and socioeconomic consequences. Current diagnostic testing strategies are limited by cost, access to resources and over reliance on one measure, namely the apnoea-hypopnoea frequency per hour (AHI). Recent evidence supports moving away from the AHI as the principle measure of OSA severity towards a more personalised approach to OSA diagnosis and treatment that includes phenotypic and biological traits. Novel advances in technology include the use of signals such as heart rate variability (HRV), oximetry and peripheral arterial tonometry (PAT) as alternative or additional measures. Ubiquitous use of smartphones and developments in wearable technology have also led to increased availability of applications and devices to facilitate home screening of at-risk populations, although current evidence indicates relatively poor accuracy in comparison with the traditional gold standard polysomnography (PSG). In this review, we evaluate the current strategies for diagnosing OSA in the context of their limitations, potential physiological targets as alternatives to AHI and the role of novel technology in OSA. We also evaluate the current evidence for using newer technologies in OSA diagnosis, the physiological targets such as smartphone applications and wearable technology. Future developments in OSA diagnosis and assessment will likely focus increasingly on systemic effects of sleep disordered breathing (SDB) such as changes in nocturnal oxygen and blood pressure (BP); and may also include other factors such as circulating biomarkers. These developments will likely require a re-evaluation of the diagnostic and grading criteria for clinically significant OSA.
阻塞性睡眠呼吸暂停（OSA）是一个日益严重的全球性健康问题，会产生重大的健康和社会经济后果。当前的诊断测试策略受到成本、资源获取以及过度依赖单一指标（即每小时呼吸暂停低通气频率（AHI））的限制。最近的证据支持从将AHI作为OSA严重程度的主要指标，转向采用更个性化的OSA诊断和治疗方法，该方法包括表型和生物学特征。技术上的新进展包括使用诸如心率变异性（HRV）、血氧饱和度测定和外周动脉张力测定（PAT）等信号作为替代或补充指标。智能手机的广泛使用和可穿戴技术的发展，也使得用于促进对高危人群进行家庭筛查的应用程序和设备越来越多，尽管目前的证据表明，与传统的金标准多导睡眠图（PSG）相比，其准确性相对较差。在本综述中，我们评估了当前诊断OSA的策略及其局限性、作为AHI替代指标的潜在生理靶点，以及新技术在OSA中的作用。我们还评估了在OSA诊断中使用新技术、智能手机应用程序和可穿戴技术等生理靶点的现有证据。OSA诊断和评估的未来发展可能会越来越关注睡眠呼吸障碍（SDB）的全身影响，如夜间氧气和血压（BP）的变化；也可能包括其他因素，如循环生物标志物。这些发展可能需要重新评估具有临床意义的OSA的诊断和分级标准。
