Pordzik Johannes, Seifen Christopher, Ludwig Katharina, Ruckes Christian, Huppertz Tilman, Matthias Christoph, Gouveris Haralampos
Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, Mainz, 55131, Germany.
Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center Mainz, Mainz, 55131, Germany.
Nat Sci Sleep. 2024 Dec 5;16:1881-1889. doi: 10.2147/NSS.S482614. eCollection 2024.
The gold standard in obstructive sleep apnea (OSA) diagnostics is nocturnal full-night polysomnography (PSG). Due to high costs and high time effort portable respiratory polygraphy (PG or home sleep apnea testing-HSAT) has been developed. In contrast to PG the PSG gains relevant further information concerning sleep stages, arousals and leg movements. However, the role of PG in the diagnostic of OSA remains largely undefined. The aim of this study was to investigate the difference of PG- and PSG- related metrics in OSA, to understand if there is a difference in PG and PSG-based treatment decision and show up the time between performed PG and PSG.
99 consecutive patients with existing outpatient performed PG and followed PSG in our tertiary care otorhinolaryngology department between February 2020 and December 2023 were retrospectively assessed. All patients were treatment-naive at the time of consultation. The time between performed outpatient PG and PSG was calculated. Furthermore, clinical baseline parameter and PG as well as PSG data were evaluated. All data were then blinded presented with relevant comorbid diseases to two experts in sleep medicine in our tertiary care centre to decide whether PAP therapy was indicated or not.
Mean AHI was significantly higher in PSG (32.32 ± 22.78/h) compared to PG (22.60 ± 15.12/h) (p<0.001). Mean duration between performed PG and PSG was 194.99 ± 131.96 days (range between 37 and 842 days). Only in two patients PAP-therapy was indicated with PG results but not with PSG results. Only in one case PAP-therapy was not indicated with PG results but with PSG results.
These data suggest initiating OSA therapy based on PG results for patients with at least moderate OSA on PG, followed by a confirming PSG and a control PSG under treatment to avoid unnecessary prolongation of treatment start.
阻塞性睡眠呼吸暂停（OSA）诊断的金标准是夜间全夜多导睡眠图（PSG）。由于成本高且耗时，便携式呼吸多导仪（PG或家庭睡眠呼吸暂停测试-HSAT）应运而生。与PG相比，PSG可获取有关睡眠阶段、觉醒和腿部运动的更多相关信息。然而，PG在OSA诊断中的作用在很大程度上仍不明确。本研究的目的是调查OSA中PG和PSG相关指标的差异，了解基于PG和PSG的治疗决策是否存在差异，并显示进行PG和PSG之间的时间间隔。
对2020年2月至2023年12月期间在我们三级护理耳鼻喉科门诊进行PG检查并随后进行PSG检查的99例连续患者进行回顾性评估。所有患者在会诊时均未接受过治疗。计算门诊PG和PSG之间的时间间隔。此外，评估临床基线参数以及PG和PSG数据。然后将所有数据在不透露相关合并症疾病的情况下呈现给我们三级护理中心的两名睡眠医学专家，以决定是否需要进行持续气道正压通气（PAP）治疗。
与PG（22.60±15.12次/小时）相比，PSG的平均呼吸暂停低通气指数（AHI）显著更高（32.32±22.78次/小时）（p<0.001）。PG和PSG之间的平均持续时间为194.99±131.96天（范围为37至842天）。仅2例患者根据PG结果显示需要进行PAP治疗，但PSG结果不显示需要治疗。仅1例患者根据PG结果显示不需要进行PAP治疗，但PSG结果显示需要治疗。
这些数据表明，对于PG检查显示至少为中度OSA的患者，可根据PG结果启动OSA治疗，并随后进行确诊的PSG检查以及治疗期间的对照PSG检查，以避免不必要地延长治疗开始时间。
