FHKAM(Paediatrics), Department of Paediatrics, Tuen Mun Hospital, Hong Kong.
FHKAM(Paediatrics), Department of Paediatrics, Tuen Mun Hospital, Hong Kong.
Sleep Med. 2021 May;81:457-462. doi: 10.1016/j.sleep.2021.02.048. Epub 2021 Mar 1.
Obstructive sleep apnea syndrome in children is associated with significant morbidity. Polysomnography is the main diagnostic tool but is time consuming and requires skilled manpower to supervise the patient overnight and hence long referral to diagnosis time. However, there are limitations and underestimation of the apnoea hyponea index (AHI) with alternative home sleep apnoea testing (HSAT), such as type 3 respiratory polygraphy (RP). Prior studies have demonstrated pulse transit time (PTT) to be a reliable indicator of cortical arousals. In this study, the use of PTT together with RP will be studied to determine whether the derived AHI is comparable to that of PSG.
Forty-five patients with suspected OSA met the inclusion criteria underwent PSG in the sleep laboratory for analysis. The raw data for either PSG or RP analysis were allocated separately to two different accredited sleep technicians. The primary outcome AHI derived from PTT with RP was compared to the AHI derived from PSG. Secondary outcomes compared were obstructive apnoea index (OAI), total hypopnoea index (THI) and arousal index (AI). Bland Altman analysis was used to compare the agreement of AHI derived from the 2 modalities and demonstrate whether RP is non inferior or equivalent to the gold standard for diagnosing OSAS.
The patients studied had a median age of 8.8 years (range 3-17 years). The patients were not limited to certain spectrum of severity OSA and had AHI results spread from mild to severe OSA (AHI 0.4/hr to 72.2/hr). The RP with PTT-derived AHI was strongly correlated to the PSG derived AHI as seen on the Spearman plot (r = 0.98). The Bland Altman plot showed no evidence of underestimation of the AHI due to missed arousal related hypopneas. The difference of AHI derived from RP and PSG results were clinically insignificant. The differences between the PSG and RP total hypopnoea index (THI) and arousal index (AI) were also statistically insignificant.
The study shows that RP with PTT can be considered a reliable diagnostic alternative compared with PSG. The role of PTT incorporated with RP was to minimize underestimation of AHI due to missed arousal associated hypopnea events. The results were apparent across mild to severe severity of OSA. There are advantages of RPs particularly in paediatrics. Overall this study offers promising preliminary insights that RP incorporated with PTT can be further explored as an acceptable home diagnostic tool for diagnosing OSA in children.
儿童阻塞性睡眠呼吸暂停综合征与显著发病率相关。多导睡眠图是主要的诊断工具，但耗时且需要熟练的人力来整夜监督患者，因此诊断时间较长。然而，替代家庭睡眠呼吸暂停测试（HSAT），如 3 型呼吸描记术（RP），存在对呼吸暂停低通气指数（AHI）的限制和低估。先前的研究表明脉搏传递时间（PTT）是皮质唤醒的可靠指标。在这项研究中，将使用 PTT 与 RP 一起研究，以确定衍生的 AHI 是否与 PSG 相当。
45 名疑似 OSA 的患者符合纳入标准，在睡眠实验室进行 PSG 分析。PSG 或 RP 分析的原始数据分别分配给两位不同的认证睡眠技师。主要结局指标是源自 PTT 与 RP 的 AHI 与源自 PSG 的 AHI 进行比较。比较的次要结局包括阻塞性呼吸暂停指数（OAI）、总低通气指数（THI）和唤醒指数（AI）。Bland Altman 分析用于比较两种方式衍生的 AHI 的一致性，并证明 RP 是否是非劣效或等同于诊断 OSAS 的金标准。
研究中的患者中位年龄为 8.8 岁（范围 3-17 岁）。患者不限于特定严重程度 OSA 范围，AHI 结果从轻度到重度 OSA 不等（AHI 0.4/hr 至 72.2/hr）。源自 PTT 的 RP 衍生 AHI 与源自 PSG 的 AHI 呈强相关，如 Spearman 图所示（r=0.98）。Bland Altman 图显示，由于错过与唤醒相关的低通气，AHI 没有被低估的证据。源自 RP 和 PSG 结果的 AHI 差异在临床上无意义。PSG 和 RP 总低通气指数（THI）和唤醒指数（AI）之间的差异也无统计学意义。
该研究表明，与 PSG 相比，PTT 结合 RP 可作为可靠的替代诊断方法。PTT 结合 RP 的作用是最大限度地减少由于错过与唤醒相关的低通气事件而导致的 AHI 低估。结果在轻度到重度 OSA 中均很明显。RP 的优点在于儿科特别适用。总体而言，这项研究提供了有希望的初步见解，即 PTT 结合 RP 可进一步探索作为儿童 OSA 诊断的可接受家庭诊断工具。
