Westenberg Jean N, Petrof Basil J, Noel Francine, Zielinski David, Constantin Evelyn, Oskoui Maryam, Kaminska Marta
Respiratory and Epidemiology and Clinical Research Unit, Translational Research in Respiratory Diseases Program, McGill University Health Centre, Montreal, Quebec, Canada.
Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.
J Clin Sleep Med. 2021 Aug 1;17(8):1579-1590. doi: 10.5664/jcsm.9254.
Sleep-disordered breathing (SDB) is common in patients with neuromuscular disorders (NMD), developing before chronic hypercapnia appears. Polysomnography (PSG) is the diagnostic gold standard but is often impractical and poorly accessible for individuals with NMD. We sought to determine the diagnostic accuracy, feasibility, and patient preference of home sleep apnea testing (HSAT) compared with PSG for the detection of SDB in NMD.
Participants with NMD at risk for SDB aged ≥ 13 years underwent HSAT followed by overnight PSG with concomitant laboratory sleep apnea testing (same device as HSAT). Sensitivity and specificity were calculated for standard apnea-hypopnea index cutoffs for mild (≥ 5 events/h), moderate (≥ 15 events/h), and severe SDB (≥ 30 events/h) and for an oxygen desaturation index ≥ 5 events/h. Receiver operating characteristic curves were built. A questionnaire assessed patient preference.
Of 38 participants, 73% had moderate to severe SDB and 79% had technically acceptable HSAT. For an apnea-hypopnea index ≥ 15 events/h, HSAT sensitivity and specificity were 50% and 88%, respectively. For an oxygen desaturation index ≥ 5 events/h, HSAT sensitivity and specificity were 95% and 78%, respectively. The area under the receiver operating characteristic curve for an apnea-hypopnea index ≥ 15 events/h was 0.88 (95% confidence interval, 0.69-1.00) for HSAT. The HSAT underestimated the apnea-hypopnea index from PSG (bias, -10.7 ± 15.9 events/h). HSAT was preferred to PSG by 61% of participants.
HSAT is feasible, preferred by patients, and reliable for detecting SDB in most patients, although it cannot definitively rule out SDB. Therefore, HSAT is a viable diagnostic approach for SDB in NMD when PSG is not feasible, recognizing that it does not accurately distinguish between upper-airway obstruction and hypoventilation. Additional work is needed to further optimize home sleep testing in NMD.
Westenberg JN, Petrof BJ, Noel F, et al. Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders. 2021;17(8):1579-1590.
睡眠呼吸障碍（SDB）在神经肌肉疾病（NMD）患者中很常见，在慢性高碳酸血症出现之前就已发生。多导睡眠图（PSG）是诊断的金标准，但对于NMD患者来说往往不切实际且难以获得。我们试图确定家庭睡眠呼吸暂停测试（HSAT）与PSG相比，在检测NMD患者的SDB方面的诊断准确性、可行性和患者偏好。
年龄≥13岁、有SDB风险的NMD参与者先进行HSAT，然后进行夜间PSG以及同步的实验室睡眠呼吸暂停测试（与HSAT使用相同设备）。计算轻度（≥5次事件/小时）、中度（≥15次事件/小时）和重度SDB（≥30次事件/小时）的标准呼吸暂停低通气指数临界值以及氧饱和度下降指数≥5次事件/小时时的敏感性和特异性。绘制受试者工作特征曲线。通过问卷调查评估患者偏好。
38名参与者中，73%有中度至重度SDB，79%的HSAT在技术上可接受。对于呼吸暂停低通气指数≥15次事件/小时，HSAT的敏感性和特异性分别为50%和88%。对于氧饱和度下降指数≥5次事件/小时，HSAT的敏感性和特异性分别为95%和78%。对于呼吸暂停低通气指数≥15次事件/小时，HSAT的受试者工作特征曲线下面积为0.88（95%置信区间，0.69 - 1.00）。HSAT低估了PSG的呼吸暂停低通气指数（偏差，-10.7±15.9次事件/小时）。61%的参与者更喜欢HSAT而不是PSG。
HSAT是可行的，受患者青睐，并且对大多数患者检测SDB是可靠的，尽管它不能明确排除SDB。因此，当PSG不可行时，HSAT是NMD患者SDB的一种可行诊断方法，但要认识到它不能准确区分上气道阻塞和通气不足。需要进一步开展工作以进一步优化NMD患者的家庭睡眠测试。
Westenberg JN, Petrof BJ, Noel F,等。家庭便携式监测在青少年和成人神经肌肉疾病患者睡眠呼吸障碍诊断中的验证。2021；17(8):1579 - 1590。
